Bird Flu: Why Modern Medicine Won't Save Us
Very often when people begin to learn about bird flu, they jump
to the conclusion that because medicine has advanced by quantum
leaps since the 1918-19 influenza pandemic (global epidemic),
there is nothing to worry about. They are certainly right about
the advance of medicine, which has been extraordinary by any
measure. Unfortunately, when it comes to dealing with a bird-flu
pandemic, these advances fall short in many areas. To name the
most significant: 1. Bird flu is caused by an influenza virus,
for which there are only four approved antiviral agents in the
U.S. The virus has extensive resistance to two of these
medicines already, and resistance might develop in the remaining
two once they are used more widely in a pandemic. The two
remaining medicines, Tamiflu (oseltamivir) and Relenza
(zanamivir), are in extremely short supply and, even with
planned increases in their manufacture, will remain in short
supply for many years to come. These medicines must be given
within 48 hours of the onset of symptoms, which can be difficult
to accomplish for a variety of reasons. Even when they are
available and given on time, their effectiveness is less than
100 percent. And because bird flu is very different than the
usual influenza we are used to, higher doses given for longer
periods of time may be necessary for optimal effect. 2. While we
have many wonderful antibiotic medicines, these are not
effective against bird flu, because antibiotics treat only
bacterial infections, not viral infections. Antibiotics can be
used to treat bacterial infections that develop after viral
infections have damaged the body, allowing bacterial infections
to "take over." This can happen, for example, when viral
pneumonia turns into bacterial pneumonia. However, this did not
happen in the 1918-19 Spanish flu to any extent, nor in the 2003
SARS pandemic, and it doesn't appear to be a significant factor
in the deaths that have occurred so far from bird flu. Hence all
our sophisticated antibiotics will not be of much help with bird
flu. 3. The most common cause of death from the 1918-19
influenza pandemic, the SARS pandemic, and from bird flu is
acute respiratory distress syndrome (ARDS). The viruses from
these diseases cause severe damage to lungs, which results in
ARDS. Numerous treatments have been tried but generally have
failed. Patients with ARDS require mechanical ventilatory
support, meaning they need to be on a mechanical respirator.
These are expensive machines, and the supply in the United
States is only slightly above demand during the normal flu
season. Simply put, when the bird-flu pandemic strikes, there
won't be enough of these machines, and so people who develop
ARDS will not have access to this potentially life-saving
treatment. 4. There won't be enough isolation rooms to place the
large numbers of patients with bird flu in, which will result in
more people becoming ill through exposure to people with bird
flu. Likewise, there won't be enough of some medical equipment,
because of increased demand for some items coupled with
decreased supply--because of our reliance on a global supply
chain, foreign manufacture, and just-in-time delivery. There
won't be enough personal protective equipment (such as
disposable gloves, N95 face masks, gowns, face shields or
goggles, head caps, and shoe covers), which will increase
exposure and infection. 5. During the coming pandemic, there
won't be enough beds in hospitals for all the sick people with
bird flu. Makeshift "hospitals" will have to be established
outside of existing hospitals to care for all the ill patients.
6. An effective vaccine has yet to be developed, and the chances
that one will be developed before a pandemic emerges are
practically nonexistent. Once a vaccine is developed, it will be
months into the pandemic, and many people will already have
become ill. Because we have no natural immunity to this new
virus, we might need two immunization shots to develop
sufficient immunity. This makes implementing an immunization
program more difficult, and decreases the amount of vaccine
available for everyone. Vaccines, like antiviral medicines, are
not 100 percent effective in either preventing infection or
minimizing symptoms once infected. A startling new report (a)
found only limited benefit from influenza vaccines: "In people
over 65, the vaccines 'are apparently ineffective' in the
prevention of influenza, pneumonia and hospital admissions,
although they did reduce deaths from pneumonia a bit, by up to
30 percent." According to the Influenza Vaccine Supply (IVS)
International Task Force, "Whatever scenario, even the most
optimistic, the worldwide [vaccine] production capacity will be
clearly insufficient in case of pandemic." 7. Shortages of
nurses and other healthcare personnel will be significant,
because of overexposure to people with bird flu--and thus a
higher illness and death rate among healthcare workers, and
because a high proportion will simply decide not to come to
work. A similar situation occurred in New Orleans during
Hurricane Katrina when 250 members of the police department
(one-sixth of the force) abandoned their jobs during the
hurricane and flooding. It also happened in Toronto during the
SARS outbreak, when some nurses and other healthcare workers
submitted their resignations (although many were persuaded to
stay). The shortage of nurses, which is already a big problem in
the United States, was highlighted recently by Keji Fukuda of
the influenza branch of the Centers for Disease Control and
Prevention (CDC). According to Fukuda, scientists are racing to
prevent what could be millions of deaths from a flu pandemic,
but what could trip them up is the simple lack of nurses and
hospital beds. He said, "No matter how good medical technology
is, if we don't have healthcare workers to care for sick people
and hospital beds to put them in, it's not a good situation."
And it's not only the limited numbers of nurses--it's also a
question of whether or not healthcare workers would come to work
during a bird-flu pandemic. A recent article (b) reported the
disturbing findings of a survey of 6,000 healthcare works in and
around New York City:
"One assumption blown away by Hurricane Katrina is that if
government does nothing else, at least it protects people's
health and safety.
The Mailman School of Public Health at Columbia University in
New York City set out to look at how many healthcare workers
said they would show up for work, depending on the type of
emergency. There was some good news: 87 percent of 6,000 workers
surveyed in 47 facilities in and around New York said they would
be able to go to work in the event of a mass casualty incident,
and 81 percent for an environmental disaster. Only 61 percent,
however, would show up for a smallpox epidemic, just 48 percent
during a SARS epidemic and 57 percent during a 'radiological
event.' That's a problem, isn't it? Less than half of healthcare
workers expect to work during a SARS [or bird-flu] epidemic, and
less than two-thirds if terrorists set off a so-called dirty
bomb in the financial district. 'Although we might assume that
healthcare employees have an obligation to respond to these
high-impact events, our findings indicate that personal
obligations, as well as concerns for their own safety, play a
pivotal role in workers' willingness to report to work,' said
Kristine Qureshi, a researcher in the epidemiology department at
Columbia." And so "modern medicine," no matter how advanced,
will clearly have difficulty dealing with a bird-flu pandemic.
In a sense, the next pandemic could very well be analogous to
the Hurricane Katrina situation, with mass confusion, lack of
resources, visible dead bodies, acts of cowardice and acts of
heroism, financial disaster, panic, and every emotion
possible--nothing like we are used to witnessing in America;
shocking. Partly because of the limitations of both government
and healthcare capabilities, individuals need to prepare for the
coming bird-flu pandemic themselves. There are four specific
areas that must be addressed, as I have written in an earlier
article (which can be accessed on our Web site.) (a) Rosenthal
E: 2 Studies Find Flu Treatments Fall Far Short. International
Herald Tribune. September 22, 2005. Available at:
http://www.nytimes.com/2005/09/22/health/22flu.html?th&emc=th.
Accessed on September 23, 2005 (b) Olmsted D: Health wrap: of
disasters and diseases. Monsters and Critics News, September 9,
2005. Available at:
http://news.monstersandcritics.com/health/article_1047166.php/Hea
lth_Wrap_Of_disasters_and_diseases. Accessed on September 15,
2005
Bradford Frank, M.D., M.P.H., M.B.A. The Frank Group P.O. Box
138 Lakewood, NY 14750 http://www.AvoidBirdFlu.com