Recently I initiated a discussion on pandemic influenza with particular emphasis on bird flu. Today’s discussion will focus on what a new pandemic might look like. To answer this question, it may be helpful to examine lessons from past pandemics, courtesy of the United Kingdom Department of Health. For example, pandemics do not always develop predictably and do not always occur in the winter months. There is a rapid surge in number of cases over a brief period of time, often measured in weeks. Moreover, the mortality and the severity and patterns of illness, including the age of those most severely affected, may vary. Finally, pandemics tend to occur in waves with subsequent waves being either more or less severe. It also goes without saying that a sizeable proportion of the population would need medical care. But since the need for disaster planning, health care personnel, isolation units, public health involvement, hospital beds, and equipment will far exceed supply, some difficult choices, based primarily on availability of resources, will have to be made as to who gets what and when.
Influenza pandemics have been recorded throughout history, and it is only a matter of time before another one occurs and this includes the avian flu virus (H5N1). Most virologists fully recognize that the H5N1 virus is missing one essential characteristic that it needs to produce sustained and rapid person-to-person transmission, i.e., the ability to become pandemic in scope. This missing characteristic is just one genetic mutation away and when this event may occur is, at this writing, not known. However, it does mean that it is imperative for scientists to continue their surveillance of H5N1 as well as other potential influenza viruses that could become a transmissible agent(s) in a future pandemic ( Louisa Chapman, Centers for Disease Control & Prevention).
Based on observations extracted from data obtained from the most recent pandemic in 1968, indications are that the death toll worldwide could exceed 7.4 million (World Health Organization, 2005). In the U.S., assuming no adequate interventions, we could see from 89,000 to 207,000 excess deaths with an economic cost as high as $166.5 billion ( Meltzer, Cox, Fukuda, 1999 Emerg Inf Dis 5:659-671). There is no question that everyday events that we take for granted will be severely impacted. All public gathering places could be either closed or severely curtailed, and this could include churches, schools, many work environments, modes of transportation, restaurants, theaters, etc. People might be unable to buy their day-to-day items, such as food, prescription drugs, gas, or oil, because stores might be unable to open because their employees are unable to report to work because of illness. So in a real sense, during such an emergency, our homes would become our sanctuary of relative safety.
Are we ready for this eventuality should it occur?
The next installment will discuss what can be done to control a bird flu-like pandemic providing we act now!