It is an eerily familiar scenario full of dire possibilities and fatal outcomes. Like a tropical storm developing into a hurricane in the Atlantic Ocean, the current avian flu strain, H1N5, could transform into a deadly human virus capable of killing millions. The similarities don't end there. The path of a flu virus is difficult to predict, and defenses have to be in place at any time in case a viral storm attacks. The only certainty is that a killer virus will eventually appear, says Dr. Joseph Dalavisio, head of the Infectious Diseases Section at Ochsner Clinic Foundation.
"I'm sure there will be more flu pandemics," he says. "Whether it happens now or later -- it's like forecasting a hurricane."
Part of this unpredictability stems from the mutating nature of flu viruses. Christine Pearson, a spokesperson for the Centers for Disease Control (CDC), says that wild birds typically carry avian flu viruses but are immune to them. Sometimes, as in the case of H1N5, the virus "jumps" from wild birds to domestic ones, such as chickens and other poultry, that can become ill and die from the virus. If people are in close proximity to the infected birds, reports Pearson, the virus can mutate and infect humans.
So far, the avian virus has infected more than 120 people in Asia and half of them have died. Almost all were in close contact with sick chickens; there has been only one confirmed case of a person infecting another human. More than 150 million chickens and ducks have either died from the virus or have been slaughtered to stop the disease's spread.
In its current form, the virus is not easily transmitted from person to person. For that to take place, the virus would have to either mutate on its own or recombine with a human flu virus to form a new virus strain. This potential recombination worries experts, but as Dalavisio points out, a new virus' efficacy is questionable.
"What people don't know is if it recombines with a normal flu virus, then will it retain its deadliness?" asks Dalavisio. "Even if the virus' virulence is lower but is efficiently transmitted, it would still be a scary scenario."
History demonstrates just how terrifying the reality can be. In 1918, the world suffered through its worst pandemic ever, and a flu virus, Spanish flu, caused it. It is estimated that anywhere between 20 million and 50 million people died in that outbreak worldwide. In the United States, according to John Barry's book, The Great Influenza, 675,000 people perished, most within a 12-week period. Unlike most influenza epidemics, which normally cause high morbidity and mortality rates among the elderly and very young, the Spanish flu killed young adults as well. The memory of this great scourge recently resurfaced thanks to books like Barry's, which was part of President George Bush's summer reading list.
It must have been a powerful read. The Bush Administration has proposed a $7.1 billion plan to fight flu pandemics. Perhaps prompted by the slow response to Hurricane Katrina, Bush unveiled his flu-fighting strategy on Nov. 1, saying, "If a pandemic strikes, our country must have the surge capacity in place that will allow us to bring a new vaccine online quickly and manufacture enough to immunize every American against the pandemic strain."
The proposal, which depends on Congress' approval, would include the following:
• $1.2 billion to purchase enough doses of a vaccine against H1N5. Pharmaceutical company Sanofi-Pasteur currently is producing a vaccine, and the National Institute of Allergy and Infectious Diseases (NIAD) is overseeing human trials on the vaccine, although results have yet to be announced. The amount of vaccine needed for each dose will determine the number of doses produced; front-line health-care personnel and at-risk populations would be the first to receive the vaccine.
• $1 billion to stockpile anti-viral drugs such as Tamiflu and Relenza. These drugs do not prevent the virus, but under laboratory conditions, they have demonstrated an ability to inhibit the virus from reproducing, which lessens the disease's severity.
• $2.8 billion to change the manufacturing of flu vaccines from the current practice of using chicken eggs to the much faster method of using cell cultures.
• $251 million for international flu surveillance and for building new laboratories in countries affected by the avian flu.
• $583 million for state and local governments to prepare emergency pandemic plans. Thirty-one states already have plans; Louisiana's plan is outdated and needs to be revised. Dr. Raoult Ratard, Louisiana State Epidemiologist says the revision will take place in January.
Critics of the Bush plan complain it is coming too late, and that it places a financial strain on state governments. On Nov. 2, Health and Human Services Secretary Michael Leavitt went before the Senate Appropriations Committee's Labor, Health and Human Services subcommittee to discuss the plan. Senator Tom Harkin, a Democrat from Iowa, expressed dismay regarding the part of the plan that asks states to pay 75 percent of the cost for some of the anti-viral stockpile. Harkin believes this is unfair and will jeopardize poorer states.
"It almost seems then that they will be allocated based upon a state's ability to pay," Harkin says. "How are you going to ask Louisiana right now to come up with the money for that? Take Mississippi. They've been hit hard."
The Louisiana Legislature drastically reduced the state's Medicaid budget during the extraordinary session. Dr. Ratard says there is little money for stockpiling anti-viral medication.
"Maybe 25 cents. We don't have the money yet, and we're not sure who -- the federal government or the state -- will pay for it."
Like the state, New Orleans doesn't currently have a pandemic flu plan, although Dr. Kevin Stephens, director of the city's Health Department, says he is working with the CDC to develop one. Considering that there are other more immediate health-care concerns for the department staff, which has been reduced from a Pre-Katrina total of 300 employees to a current level of 77 employees, Stephens isn't giving the bird flu top priority.
"Our anxiety behind it isn't zero, but intelligence tells us that we don't have to put it on the front burner," explains Stephens. "Shoring up the health-care infrastructure -- making hospital beds available and reopening clinics -- is a higher priority. We need to get ready for the regular flu season."
The best way the public can prepare for flu season is to get a flu shot or a nasal spray vaccine. Each vaccine contains three influenza viruses, which change every year based on international surveillance and scientists' estimates about what types and strains of viruses will circulate in a given year. Stephens has been making it easier for New Orleanians to get vaccinated, especially those who have been displaced by Hurricanes Katrina and Rita.
Stephens approached Dr. Gerbeding, director of the CDC, and asked her if they would provide vaccines for evacuees. Gerbeding agreed to the request, and Stephens then made it his goal to make sure everyone in shelters and camps were immunized.
"Overcrowding and stress can lower an individual's immune system and make them more vulnerable to the flu," Stephens reports. "Our strategy was to get them immunized and it has gone really well. I'm only the health director for the city of New Orleans, so I've had to rely on my colleagues at the state's Office of Public Health (OPH) to get these people immunized."
Stephens believes nearly all of those in the camps and shelters received the vaccine. Unlike last year, which saw a shortage of flu vaccine, there should be an adequate supply for this season. Part of the problem last year was that there were only two manufacturers producing a vaccine. Now there are four. Lola Russell, another spokesperson with the CDC, believes demand can also lead to more doses being available.
"Increased demand is a good thing, because flu vaccine manufacturers sell their product mostly to the private sector," explains Russell. "Orders are placed in the summer, so the more orders, the more produced."
By the end of November, Russell reports, there should be a total of 80 to 83 million doses of vaccine made so far. There were only 61 million doses created in 2004. With a sufficient supply available, it would make sense that most people would take advantage of the situation and get a flu shot, but that's not always the case, says Rueben Tapia, director of the Immunization Program for OPH.
"We have not gotten to the point where the vaccine is considered a must," says Tapia. "Some of this stems from the myth that the vaccine actually causes the flu."
Tapia's office oversees the free flu immunization program, which is available throughout the state by the OPH parish health units. Vaccine doses are provided for nursing home residents, the elderly, young children and other at-risk groups such as those with chronic respiratory illnesses and pregnant women. This year has been a little different than usual.
"Early in the season we allocated shots to those displaced in shelters," Tapia says. "Our traditional target groups had to wait, but we're back now. We've been providing the free shots to those groups at our parish health units."
Pearson says it is still too early to tell what this year's flu season will be like. There has been very little flu activity so far, with only 21 states reporting sporadic activity. Last year it started slow as well. Ratard reports there have been very few instances of flu in Louisiana.
There is still time to get a flu vaccination. After getting the shot, it takes about two weeks for the body to be immunized against the current strain of flu virus. For those who are not eligible for a free shot, there are mobile clinics in the city where shots can be purchased, or you can contact your doctor. Tapia says his office is scheduled to receive a flu vaccine donation in December. These shots will be available on a first-come-first-served basis to everyone.
The current flu vaccine does not protect against avian flu. Even so, Dalavisio says he is concerned but not panicked. A huge flu epidemic among domestic birds does not necessarily translate into a human pandemic. "There have been three or four years where there have been avian flu viruses that have killed many chickens. But it didn't produce a human virus."