[Pepper]

World News

December 06, 2004

Chinese on high alert as experts predict bird flu disaster
By Oliver August
Warning from World Health Organisation talks of imminent danger and up to 100 million cases
BEIJING has drawn up a far-reaching plan to combat a bird flu epidemic that could kill tens of millions of people, The Times has learnt.

The plan, which has not been published, involves curtailing travel to prevent the virus being carried around the country and envisages emergency measures to ensure supplies of food, energy and other essential services.

Last week the World Health Organisation (WHO) gave warning of an unprecedented bird flu epidemic. “We are talking at least 2 to 7 million, maybe more — 20 million or 50 million, or in the worst case 100 million people,” Shigeru Omi, WHO’s regional director for Asia, said. A viral jump from fowl to human beings is thought imminent.

“China is taking the threat of a pandemic very seriously,” said Julie Hall, a WHO adviser in Beijing, who has seen the broad outlines of the country’s contingency plan.

“We attach great importance to fighting bird flu. We haven’t closed our eyes for a single day,” a spokeswoman for the Chinese Centre for Disease Control, a central government body, said.

Qi Lei scares the Chinese Government more than any foreign enemy — and he does not even know it. The skinny 38-year-old coalman cycles into central Beijing every morning from his shed in the countryside to deliver coal bricks stacked on the back of his rusting tricycle. “I ride around with no fixed destination, just wherever people need coal to heat their homes,” he said.

What really frightens Beijing is what else Mr Qi might bring with him from the farm villages of Hebei province, a prime breeding ground for the bird flu virus. Unregulated traffic from rural to urban areas as practised by Mr Qi is the most likely transmission route, as it was with the spread of the Sars virus, and one of the first things the Government would want to do is curtail movement from rural to urban areas.

Private delivery men such as Mr Qi would be prevented from entering Beijing, even if that means residents freezing during the winter months.

“I won’t be able to take care of them and they will have to survive on their own,” he said. Maps have apparently been drawn up with separate marks pencilled in for vehicle and pedestrian roadblocks.

Initial measures would include the stockpiling of vaccines and the mobilisation of trained personnel in affected areas. But given China’s size, experts expect that vaccines — as far as they even exist — will run out quickly.

When regional outbreaks start to form a pandemic, more drastic action will be needed.

Essential services such as burials would be carried out by special government squads, possibly involving the army. “If 10,000 people died in one day, I wouldn’t know what to do,” Peng Zong, a director of a private undertakers, said.

Sites for mass graves have been identified and quietly cordoned off to avoid the spread of other diseases, one official said.

Another big concern is the supply of food, and Beijing has drawn up lists of emergency food depots. Citizens waiting out the pandemic in their homes would be informed by vehicle-mounted loudspeakers how to access food supplies. It is assumed that access to media would be curtailed either for lack of electricity or because of the closure of all public buildings, including the state television studios. During the Sars crisis last year, Beijing was criticised for acting belatedly and sloppily, and the WHO has repeatedly pressed China and other Asian countries to step up their anti-disease campaigns.

“The level of transmission at the moment is unprecedented historically,” Dr Omi said. “History has told us that on average every 30 years, at least, a pandemic will occur. The next one is due — some would say it is overdue.”

The speed of the spread of bird flu virus and its adaptation to a form that can be carried by pigs and cats had shown that conditions were ripe for a devastating pandemic.

“It will come,” he said. “Before it would have taken a year to spread around the world but, thanks to globalisation, it will take just weeks.”

HEALTH HAZARD FOR 100 YEARS
# Avian influenza, better known as bird flu, is a highly contagious viral disease that was first identified more than 100 years ago. It affects turkeys, ducks, quail, chickens and other birds

# There are about 20 strains of bird flu but the recent outbreaks in Asia have been caused mainly by a highly contagious strain known as H5N1

# The three flu pandemics of the 20th century — the 1918-19 Spanish flu, 1957-58 Asian flu and 1968-69 Hong Kong flu — started when genetic material from bird flu passed into human flu, making a far more dangerous virus

# The more often humans come into contact with infected poultry, the more likely it is that H5N1 will join with human flu and mutate into a more virulent disease

# Recent bird flu outbreaks have been resistant to the oldest and cheapest flu drugs, rimantadine and amantadine. Newer drugs, zanamivir and oseltamivir, are effective but expensive. Vaccines are difficult to develop because bird flu viruses mutate frequently

# According to the World Health Organisation, bird flu has killed 23 people this year. Eight cases were in Thailand and 15 in Vietnam

# Severe acute respiratory syndrome (Sars) is confused with bird flu as both are respiratory diseases that have caused epidemics in Asia. Sars is caused by a previously unknown type of coronavirus, of the common cold virus family


http://www.timesonline.co.uk/article/0,,3-1390265,00.html

[CanadaSue]

My focus today was derailed. I'll have some comments to make about this tomorrow.

Too tired to think straight right now - just quickly scanning stuff before bed.

[Arubi]

Health checks ahead at airports
Natasha Bita
06dec04

TRAVELLERS face tougher health checks under a World Health Organisation plan to stop the global spread of SARS-style diseases.

Under the proposed new rules, sick tourists might be quizzed at airport check-in counters and quarantined or vaccinated during international health emergencies. Aircraft captains would have to warn airport medical staff of any passengers with symptoms of a contagious disease such as a fever, rash or unusual bleeding.
Australia and Papua New Guinea are the only countries that have refused to sign WHO's existing 53-year-old international health regulations, claiming they are too lax. But Australia is planning to adopt the stricter set of rules being drafted in Geneva to deal with alarming new diseases such as SARS, avian influenza and the ebola virus.

"This time around, we're active participants in the revision, with a view to signing up," a senior federal Health Department official involved in the WHO negotiations told The Australian yesterday.

"It's to our advantage. Being in the region most affected by SARS and avian influenza, we certainly want to see the (WHO) framework in place."

Under the tougher regulations, WHO could intervene to help stop the international spread of diseases such as SARS and ebola, as well as illness caused by chemical spills or radioactive contamination.

"The current regulations only deal with cholera, plague and yellow fever, so there are many emergency situations which they wouldn't cover," the WHO official in charge of the review, Max Hardiman, told The Australian from Geneva. "In recent years, WHO has put out messages and made recommendations (to deal with outbreaks of SARS and avian flu), but we haven't had those recognised by an agreement between our member states."

The new regulations - to be finalised by WHO member nations next May - would set out procedures for countries to prevent a serious disease spreading beyond their borders. Travellers could face extra controls during health emergencies.

The Australian Health Department official said the economic and trade impact of SARS had cost the Southeast Asian region $85billion.

"The SARS and avian influenza experience, if they did anything, heightened the case for the world to get its act together to fix any weak links in current global surveillance mechanisms," he said.


http://www.theaustralian.news.com.au/common/story_page/0,5744,11597908%5E2702,00.html

[Arubi]

Smuggled birds could bring avian flu
An illegal trade in wildlife could turn a Southeast Asian virus into a worldwide threat.

By M.A.J. McKENNA
The Atlanta Journal-Constitution
Published on: 12/05/04


The small suitcase being carried through the Brussels airport by the traveler from Thailand looked unremarkable. But when customs officials opened it Oct. 18, they found a surprise: two rare small eagles, weak but healthy-looking, taped inside lengths of PVC pipe.

Their surprise turned to horror when tests on the eagles came back four days later: The smuggled birds were infected with avian influenza H5N1, the Southeast Asian virus that health authorities fear could blow up into a pandemic and kill millions.

The finding launched a frantic hunt for the man who carried the eagles, the officials who inspected them and the 135 passengers who shared the man's two flights. Twenty-three people were tested; 652 birds that had been in the airport, including the eagles, were destroyed.

The episode did not spark an outbreak, but it shook international health authorities. It demonstrated that the multibillion-dollar trade in smuggled wildlife could become an inadvertent and efficient ally in moving a lethal disease out of its home region, across oceans and around the world.

Underscoring that fear, three weeks later, customs officials in Taipei found 28 parrots packed into PVC pipe in a piece of hand luggage. The bag had been carried from Indonesia, another country grappling with H5N1 flu.

"Those are the ones that were caught. There are almost certainly others that have not been caught," said Dr. Peter Daszak, the executive director of the Consortium for Conservation Medicine in New York. "The global trade in wildlife is potentially a major source of imported disease."

So far this year, avian influenza H5N1 has sickened 44 humans in Thailand and Vietnam, killing 32 of them, as well as causing the slaughter or death from illness of more than 100 million birds — but it has not moved beyond eight countries in Southeast Asia.

Its potential for causing a pandemic, a devastating worldwide epidemic, will be discussed in Atlanta this morning by the American Medical Association's visiting House of Delegates. Speakers will include Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, and Dr. David Johnson of Aventis Pasteur, which became the United States' sole supplier of injectable flu vaccine for this winter after rival Chiron Corp.'s contaminated vaccine was impounded.

The AMA meeting takes place amid sharply elevated concern over H5N1 flu. Last Monday, a World Health Organization official warned that if avian flu gains the genetic ability to move easily from person to person — something that no scientist knows how to stop — it could cause up to 100 million deaths around the world.

Dangerous gaps

Last month, the WHO summoned vaccine manufacturers to its Geneva headquarters for an emergency summit, warning that the world's capacity for making pandemic flu vaccine stands at only 330 million doses and that vaccine production will take at lease six months.

Against that backdrop, the United States' vulnerability to imported avian flu is assuming heightened importance. Federal authorities who deal with the illegal wildlife trade and its potential consequences for human health agree there are gaps through which a smuggled ill bird — or a human infected by it — might slip without being caught.

The ability of smuggled wildlife to cause wildlife disease has long been recognized: In 1971, a batch of parrots infected with a strain of Newcastle disease and brought illegally from Mexico, killed millions of poultry in California, causing $65 million in damage. But the need to block animal diseases because they threaten humans is a new problem, spurred by the 1999 U.S. arrival of West Nile virus — primarily a disease of birds and horses — and reinforced by last year's outbreak of monkeypox, transmitted by Gambian giant rats.

But the U.S. Fish and Wildlife Service, the primary federal entity charged with intercepting smuggled wildlife, has only 100 inspectors spread among U.S. ports, airports and border crossings.

"The resources that are put into trying to police the illegal trade are minuscule," said Peter Knights of the anti-smuggling organization WildAid. "We seem to be extremely worried about anthrax and bioterrorism, but there is a risk here that we are not taking seriously enough."

Fish and Wildlife concentrates on commercial and cargo shipments, said Sheila Einsweiler, its senior wildlife inspector. "We are not down in the passenger terminals X-raying luggage," she said. "Wildlife that comes through passenger terminals comes through other agencies first and is then passed on to us."

The responsibility for spotting smuggled wildlife in carry-on luggage or clothing is shared between the Department of Homeland Security, which now operates the Customs Service, and the Department of Agriculture, which quarantines animals that are found and seized.

Neither agency focuses first on human health threats. "Our primary authority is diseases that threaten the livestock and commercial-poultry industries," said Dr. Edgardo Arza, the Georgia-area veterinarian-in-charge for the USDA's Animal and Plant Health Inspection Service.

Relying on others

Human health is the CDC's responsibility — but in most parts of the country, the agency must rely on an alert federal colleague. CDC has quarantine stations at only 11 airports, including Atlanta's Hartsfield-Jackson International Airport. And despite expansions of its powers during the 2003 SARS epidemic, it does not have the authority to detain someone who might be infected with avian flu H5N1.

"That is in the works," said Dr. Martin Cetron, chief of the CDC's Division of Global Migration and Quarantine. "But it is not now a human quarantinable disease."

Smuggled birds until recently seemed an insignificant threat compared with the main means by which flu viruses were believed to move: the millions of migratory waterfowl that circle the globe each year.

New research, though, has knocked down that theory. "There is no evidence to show that migratory birds have moved this virus outside the infected zones in Southeast Asia," said Dr. David Swayne, lab director at USDA's Southeast Poultry Research Laboratory in Athens, which participates in international collaborations tracking bird viruses. Asked about the possibility of smuggled birds transporting avian influenza H5N1, Swayne said: "We should be more worried than we are."

In areas that have extensive trade with Asia, officials are worried. "We think about it all the time," said Dr. Laurene Mascola, chief of acute communicable diseases at the Los Angeles County Health Department.

Seattle is so concerned that it uses pandemic flu, rather than bioterror attacks, as its model for practicing emergency response. "We have concentrated most on trying to detect the arrival of H5N1 in an infected human," said Dr. Jeffrey Duchin, chief of communicable disease control for Seattle & King County Public Health.

"Many of us in public health have come to realize the importance of surveillance" for animal diseases that could threaten humans, he said.

http://www.ajc.com/news/content/health/1204/06birdflu.html

[CanadaSue]

If it wasn't for the fact that China is far too large to be called a microcosm, I'd describe it as a microcosm of the problems any nation that's not first world is going to face. First world nations will face a lot of these anyway.

For ANY nation, the curtailment of travel is going to be a major issue. China can order it & most will obey, at least overtly. I'm not so sure that would be the case here. Qi Lei is one of 2 travel concerns. The first involves those wealthier than he who CAN take trains, the bus, perhaps even ana air flight to another part of the country of the nation. They'll help flu 'hop' from one region to another. Once it gets there the Qi Lei's will spread it thoroughly within a smaller area.

Qi Lei is far from their only category of daily traveler, the itinerant salesman. What of their huge pool or migrant labour who follows agricultural & other work? They're extremely poor, many have no education & if they don't travel & work, they don't eat.

Now speaking from a public health point of view, I understand WHY Chinese authorities want to curtail the movement of Qi Lei & others who move in & out of rural areas. It MAY very well slow the spread of disease if if begins with a large outbreak in poultry. Yes, rural people would most likely catch it first, then transmit it into town, perhaps one step at a time or in bigger hops.

But...

Many Chinese are becoming increasingly urbanized. The Peoples Daily - something I read several times a week describes overtly & if you read between the lines, a fascinating glimpse of an enormous nation in transition from rual poverty to urban affluence - comparative affluence, true but with the same concerns we see here. Lives are changing, priorities & focus as well & the young marrieds increasingly head to the city for better prosperity. They still rely on the countryside for their food & the rural folk often rely on people such as Qi for coal, rare items, (to them) & their absence will cause disaster in its own right.

China faces some excruciating choices. Attempting to limit travel by the likes of Qi Lei & migrant workers slows the death rate from flu but increases it dramatically from starvation, freezing, etc. Consider pandemic beginning during a cold, early winter, We know China is currently facing an energy shortage. To be blunt - as it stands, people WILL freeze to death this winter. Throw in pandemic flu &... ouch.

Stockpiling of vaccine - what vaccine? China makes some available every year but doses are numbered in the tens of millions as best as I can determine. This for a nation which last time I checked, numbered 1.3 billion people. Many of those live in isolated, very rural, very poor areas. They will not see vaccine. They will not see health care other than what may already be there & that would be slim indeed. I'll be looking to see if China speaks to the issue of vaccine - how much CAN they produce, how much COULD the produce. I'm going to go out on a trunk & guess not much.

Their army will come in handy - burials will become nightmarish & are best handled 'in bulk'. Food supply - I don't even want to go there. Rural citizens might fare better there, unless their food supplies are taken for 'redistribution'. And just how DOES your average Chinese citizen access centralized food rations - without exposing themsleves to illness? How, for that matter, does the government plan to protect its army from flu?

This one just kills me:

***It is assumed that access to media would be curtailed either for lack of electricity or because of the closure of all public buildings, including the state television studios.**

That assumption, imho is bang on, but not for those reasons. China doesn't like dealing in public but after a time, the press will be tripping over stories everywhere anyway. Still, the total loss in China could be astronomical & we'll never know how many die. We'll never know the degree of hardship faced there or b how many.


Now for airport health checks - double edged sword here...

As I expected, much of the planned actions make sense but the potential for abuse is unbelievable. As a passenger on a flight, I would darned well hope my captain informs the recieving airport of any unusually ill person - bleeding, rashes, fevers, rate right up their on my personal paranoia list. While me being quarantined coming off such a flight is horrible to contemplate, NOT being quarantined until the nature of the illness is determined is even more horrifying. I've been on the plane, perhaps sitting within a few rows of the sick passenger, I want to know what they had & what my risk is.

But how does one effectively train customs workers & other airport staff in what to look for, when it's appropriate to at least temporarily detain passengers & when it is not? My 'fever' may be due to pelting down the length of a terminal to catch a connecting flight. Will they wait 10 minutes & retake my temperature? And qurantine where? Quarantine in Canada, the US & Europe okay, but quarantine in Thailand doesn't comfort me in the slightest.

Vaccination during interantional health emergencies is another dog's breakfast - tough to implement properly without casualties but tougher to NOT contemplate. There are gaps in world wide surveillence large enough to drive an alien invasion fleet through & frankly I don't really expect that to change. The WHO & other international agencies can only spread themselves so thinly. Traditonally as well, more wealthy nations are only willing to throw so much money at international surveillence unless the disease being surveilled for has the capability of knocking at their front door - understandable.

Flu however, doesn't care who you are or how many channels your TV gets or even if you have a TV. SARS doesn't either & many transmissible diseases don't depend on poverty for spread. Ebols does - frankly, I'm not the least bit concerned about large scale outbreaks of Ebola in the developed world. There would be some isolated & undortunate secondary cases but they would qickly halt any chains of transmission. Such is not the case with flu.

[Deb Mc]

Nice catches, all! :eek:

Do you all think it'll be possible to curtail the travel in Asia, for quarantine? Imo, I doubt that they'll be successful, especially with the amount of smuggling that goes on over there. If there's any sort of outbreak, the most probable way to break it would be to isolate your own country. Trying to isolate China by itself would be neigh unto impossible, imo.

Fwiw...

[CanadaSue]

Not even close. They can't stop illegal border corossing now. Where do they get the manpower to curtail movement of people & deal with the dozens of equally high priority tasks?

Put it this way. You stay home, you, hubby & kids starve to death. If you can get 5 miles to the next village, you can return with food for a week. Multiply that by hundreds, thousands of poor rural billages across Asia...

For that matter - how are we realistically expecting to effect quarantines on a large scale here?

[driveshesaid]

Okay, you guys! You just don't want me to sleep, right? :eek:


drive