Bird flu nightmare needs wake-up call

YEARS ago when I first started studying the avian influenza virus H5N1, it seemed highly unlikely that it would ever develop into pandemic status. I believed it might eventually trigger a conventional bout of flu, but certainly nothing to the degree of its H1N1 ancestor, the 1918 Spanish Flu that killed 50 to 100 million people.

I have followed this virus in its inexorable march towards a pandemic, seen how it kept surprising the experts by picking up more and more human-infectious traits, until now there is virtually no doubt that there will be a worldwide avian flu pandemic and that H5N1 will be responsible for it.

We have all heard the projections from avian influenza experts like Dr Michael Osterholm that in a single flu season as many as 360 million people could die. That figure is unimaginable. It's the total number of dead from the Boxing Day Tsunami every two hours, or a fully loaded 747 crashing every 13 seconds, around the clock for months on end. Three million dead in the UK alone or the equivalent of six Edinburghs.

The global integrated economy cannot survive a pandemic of this magnitude. Absenteeism rates of upwards of 75 per cent caused by illness and panic would cripple food distribution, utility access and virtually all other commerce. The bleak vision of surviving on canned food and bottled water in cold, dark homes, fearful of stepping outdoors for months on end, could happen right here in Scotland and around the world.

Do not make the error of assuming this cannot happen here. Migratory birds from Western China brought H5N1 to Turkey in early October where it lay undetected until people started dying a couple of weeks ago. Those migratory patterns continue into North Africa and Western Europe. When will H5N1 arrive in Scotland? Judging by the Turkish model, it may already be here. Let's not even consider what can happen when an infected individual arrives at Edinburgh Airport.

The 1918 pandemic started in an Army barracks in Kansas. Within one week the virus was present in all 48 contiguous United States in an era where the only modes of transport were trains and horses. The spread of this virus in the jet age is unimaginable. There likely would not be a corner of the Earth where this modern plague would not be present within weeks, maybe days.

The virus needs to pick up another trait or two to become as easily transmitted between humans as a common cold. That could happen at any time or it may already have begun.

Developing a vaccine against H5N1 is like targeting a clay pigeon. You have to shoot ahead of the target to allow the bullet and clay to intersect. Unfortunately H5N1 is a pigeon that does random, sudden 90 degree turns. It is the ultimate moving target. The time to develop and manufacture a global vaccine is six to eight months. By that time, the avian flu virus will likely have mutated into a form that is immune to the vaccine.

Current flu vaccines have no effect on H5N1, and although it is recommended that everyone be vaccinated, we should be clear in the knowledge that should a pandemic start, there is no protection from current vaccines or certainly from antiviral drugs. The antivirals of choice right now are Roche's Tamiflu and Glaxo's Relenza. The UK has ordered more than 200 million of Tamiflu, believing that it could help fend off the pandemic. Unfortunately, Tamiflu is fairly useless as an avian flu pandemic fighter.

In a recent Asian study Tamiflu was proven as ineffective as sugar pills against some H5N1 strains. The best use for these drugs is as a preventative, taking at least two doses per day from the moment the first virus arrives in your area and throughout all the months of the flu wave.

To provide everyone in the world with this albeit minor preventative measure would require, in a conservative calculation, 650 billion pills or the equivalent to the total weight of the Queen Elizabeth II fully loaded with passengers and cargo just in pure Tamiflu! All we have to do is write a cheque to Roche for one trillion pounds. And it still wouldn't stop the pandemic.

Thorough hygiene and other common-sense precautions are the only ways to blunt the impact of this pandemic. Raw poultry must be considered as a biohazard. Surfaces and clothing must be disinfected with bleach. It's time to rediscover the "disinfect everything" policy of the NHS matrons of the 1950s.

H5N1 could surprise us all and evolve into a squirrel or koala virus, sparing humanity. However, the chances of that occurring are next to zero. The world is fully unprepared. The onus must shift from wasting billions on "magic bullet" drugs that don't work to preparation and survivability.

Al Avlicino is the author of Beat the Flu: How to Stay Healthy Through the Coming Bird Flu Pandemic, published by Fusion Press, priced 9.99