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Fowl play
Published in Al-Ahram Weekly on 20 - 10 - 2005


By Lubna Abdel-Aziz
With colder days fast approaching, our thoughts turn to the seasonal joys ahead, warm, furry comforts, simmering, steaming, soups, "chestnuts roasting on an open fire" on long cozy winter nights. A black cloud however, hangs over all the season's delights because of the impending arrival of that killjoy virus, known as the "flu". The dread of another flu epidemic chills the hearts of all healthcare providers around the world. It has been so every winter since the outbreak of the "Spanish Flu" or "La Grippe", which devastated the world population in 1918-19 at the heels of WW I, the Great War. Unstoppable in its savage fury, it destroyed as many as 50 million people worldwide, wiping out 25 per cent of the population of Europe alone. This was not the first influenza outbreak known to man. Its history can be traced with some accuracy for at least 300 years, and even before, yet it was only in 1932 that the virus was first isolated. Prior to that it was identified only by known signs and symptoms and the explosive manifestations of its outbreaks.
What is the nature of this regular visitor which we all have unwillingly received dozens of times during our lifetime? We know only too well of its throbbing aches and smarting pains, but few of us fully comprehend this potentially deadly virus.
Influenza is a respiratory disease causing chills, fever, headaches, and is often confused with the common cold or similar illnesses. The influenza virus is inhaled and comes in contact with the upper air passages, penetrating the cells that line those passages. It reproduces swiftly, infecting other cells along the respiratory tract. The virus may spread deep within the lung tissue and other parts of the body. Once carried away in exhaled air, it infects all those who come in contact with it. Our immune system comes to the rescue. It develops antibodies against the virus, so that if we are exposed again, the antibodies kill the virus before it has a chance to establish itself in our bodies. But the virus frequently changes its structure, so that our antibodies are helpless in combating the new variety. Each influenza outbreak is therefore caused by the same virus that has slightly modified its molecular structure from the earlier virus (mutation), in order to escape detection by our bodies. Scientists identify the different strains of the virus by giving them new names, such as "Asian Flu".
"Epidemics of influenza occur in most countries some years, and in some countries most years." Their annual arrival is imminent in either epidemic or pandemic proportions. Epidemics occur suddenly, spreading in an area or population at the same time, while pandemics, cross international boundaries, circling the globe. In short a pandemic is an epidemic of global proportions. Evidence of pandemics since 1590, include 10 probable and five possible, with earlier pandemics suggested throughout history. Researchers have for decades focussed on the study of the influenza virus over all other virus diseases, until the advent of the HIV virus two decades ago. Despite this, little has been achieved in changing the pattern of influenza infections, because of their ability to change their genetic make-up.
These little creatures keep coming, in different shapes, patterns, forms, and sizes, using numerous camouflages, multiple attires, totally mastering the art of disguise. They, as all other living things, must survive! Their favourite season is winter, with its cold weather, high humidity, and crowds of people hovering together for warmth and merriment. Nothing in the last 100 years has been discovered to affect the recurrent pattern of epidemics and pandemics of influenza infections. Our future therefore, is defined by our past.
The interval between pandemics varies from 10 to 50 years. Despite increased travel and more congested populations, there has been no significant difference. Health experts have predicted the next pandemic as occurring around 2008, originating in China/Russia/ Asia, where all past pandemics have originated in the last 300 years. The most plausible theory is that it will be a hodgepodge of human and avian strains. The dreaded prophecy of Avian, or Bird Flu is at our doors. Where it goes from there depends greatly on how well scientists are able to abort its spread in the different geographic regions.
The current virus was first discovered in Hong Kong in 1997, followed by a brief stop in Vietnam in 2004. It reappeared on China's Lake Quinghai in May of 2003, and was identified as the same deadly avian flu, H5N1 virus. Since then it has ravaged southeast Asia's poultry flocks, with over 140 million birds slaughtered. Appearing in Russia in August 2005, carried by flocks of migrant geese and ducks, then in Indonesia, Vietnam, Thailand, Laos, Turkey, Romania, and now Greece. It has already circled Asia, with Europe as its next target on its frenzied worldwide journey infecting 116 humans, and killing 60 to date. The European Commission has already banned the import of live birds from Turkey and Romania.
Fears of a global pandemic have scientists, epidemiologists, researchers, pharmacists, physicians, officials, scrambling for an answer, a cure, a vaccine, anything to avert a deadly catastrophe. If the virus adapts, and jumps from birds to humans, to be transmitted from human to human, experts fear that a global human pandemic will occur, the likes of which the world has never seen before. History confirms that the 1918 virus jumped from birds to humans, and history has a way of repeating itself. Should the avian H5N1 virus develop this ability, its effect will rival the 1918 pandemic.
With the Spanish Flu virus as a guide, "the efforts to understand what happened in 1918 has taken a new urgency" said Jeffrey Taubenburger of the renowned US Armed Forces Institute of Pathology, "we need to understand why the virus was so pathogenic." The patient's lungs fill with fluid, causing him to practically drown within less than a week. If the pandemic occurred today, it will likely kill from five to 150 million people, warn UN experts. Governments are advised to take immediate and coordinated steps in addressing the bird flu threat.
There were three pandemics in the 20th century. The Spanish Flu (1918-19), The Asian Flu (1957-58), and the Hong Kong Flu (1968-69). All of them had spread worldwide within a year of their detection.
Governments around the world are stockpiling anti-viral drugs which are in limited supply, and fall short of even covering a percentage of their populations. In any case, experts are sceptical about the efficacy of any drugs or vaccines. Infectious disease expert, Michael Osterholm, fears that if the H5N1 bird flu virus infects humans, it will move too quickly for drugs or vaccines to be of any use. Says Jeffrey Staples, a senior medical at International SOS: "If the virus mutates into a full pandemic form, it will probably spread beyond our capabilities to contain it with medication."
If not drugs or vaccines, then what are our alternatives? So far, there are no answers.
What are we to expect? The symptoms in humans range from typical influenza-like symptoms, with fever, cough, sore-throat, and muscle aches, to eye infections, pneumonia, acute respiratory distress, viral pneumonia, and other severe life-threatening complications. Humans have little or no immune protection against avian influenza. When it comes crushing down on us, we only hope that our governments and health officials have taken the necessary precautions to preserve and protect lives from this deadly little devil -- the avian flu virus.
Arming ourselves with information is our most powerful weapon, perhaps our best protection. With a threat of this magnitude, how small everything else seems. Even wars will be dwarfed in proportion to such a global catastrophe, as was the Great War and the 1918 pandemic.
Sometimes only prayers are left for mankind to resort to!
I had a little bird, its name was Enza
I opened the window, and in-flu-enza!
Children's song, 1918
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