Bird Flu Update

Since I wrote that last part (and thanks for all the kind comments), there have been some significant developments.

The H5N1 virus has spread to Europe and Africa following migratory bird flight pathways, and H5N1 has been confirmed in Germany, Nigeria and Iraq. Human deaths have increased to about 100 worldwide, with most still in Asia where the virus apparently originated. There has been a recent report of dead birds in the Bahamas, and it is feared that they may have died from H5N1. This is not confirmed as H5N1 as far I can tell, but it's an inevitability that H5N1 will get to North and South America, so when it arrives is basically irrelevant. This year or next year does not really matter in the great scheme of things.

This article demonstrates why this bug is so nasty, apparently avian viruses have an attachment protein that allow it to adhere to cellular organelles in many different cell types in humans, including brain and other cells. The 1918 pandemic most frequently presented as pneumonia, but others had cholera-like diarrhea and a few had encephalitis as their presentation. This rather sad paper, based on virology samples and autopsy of a six year-old H5N1 victim, showed viral replication in the lungs and intestine, which makes sense as H5N1 is primarily an intestinal infection in birds.

Viruses are less a carefully plotting life form and more an adaptive program running at the biochemical level. Right now, H5N1 is compiled to run on the 'AvianOS' and only runs on 'ManOS' by accident. At a biochemical level, the situation is suboptimal for human infection -- the average bird body temperature is 106 F, for example. Chemical processes that run best at that temperature may not do so at 98.6 F. Our outer cell proteins that H5N1 depends on to attach to our cells and become absorbed are not quite the same as bird proteins, making efficient infection a problem. That being the case, lack of efficiency can be overcome by sheer numbers, and if you handle a bird that is dead or dying from H5N1, or hang out with a lot of bird poop, the Law of Large Numbers is that you'll get infected. Being that one virion that makes it into a cell and sets up shop will crank out 100,000 or so copies of itself, it doesn't take a large number of infected cells to get you into trouble.

The sloppy replication process of the virus also aids in its perpetuation, and is our main concern. Rather than high-fidelity replication that we as humans enjoy, viral replication is more like a big game of 'telephone'. The message is a little corrupted every time it replicates, and you can never tell when the message will be corrupted into 'The combination to infection of human cells is 7-32-78...", and they'll get it right. The theory now of how the 1918 pandemic started is that precisely this process occurred -- random mutation into a virus will all the nastiness of bird influenza, with the capability to infect humans.

The other risk of H5N1 is that another animal that is susceptable to human AND avian viruses will get both at the same time, and the genes for both reassorted into a version that "steals" the human combination and maintains the pathogenicity (ability to cause disease) of the bird flu. Pigs are the main suspect here, which explains why they end up on the chopping block with birds. The upside of this is that not all of the badness of the bird version may make it into the final combined product, but it's still a concern.

There endeth the virology lesson for today.

Preparation and Reaction

As far as what to do when the pandemic hits, the best advice I have seen is to stay put. Trying to go somewhere else in the middle of a pandemic isn't going to help you, wherever you go they'll a) be having problems, too, and b) won't welcome you warmly given that you'll be considered infectious until proven otherwise. People can spread influenza for something like 48 hours before they get symptomatic, so if you do go somewhere and they quarantine you, you'll spend 48 hours with other people, some of whom may be sick. Not ideal.

If you or yours do get sick, the biggest problem in 1918 was a lack of nursing care. Dehydration, especially in kids, is a killer. Get your respiratory rate up to 30 a minute, run a 104 F fever and have a sore throat that makes swallowing feel like gargling glass shards is a recipie for rapid dehydration. The 'drink liquids' thing is not a suggestion, it's a rule. People who get sick on their own are often so ill they can't do for themselves, and in some remote areas like Inuit villages the flu killed everyone in 1918 because nobody was healthy enough to tend to the others. One big advantage of being obese Americans is that we have the reserves to go a week without eating. Not drinking is another matter.

Getting a fever down is a lot easier today when you can go to Wal-Mart and buy 500 ibuprofen for $10. Tylenol, ibuprofen and naproxen sodium are all effective fever reducers, and alternating tylenol and ibuprofen is a trick we use in pedi patients with really resistant fevers -- tyenol every 4 hours (or six, depending on the bottle), and ibuprofen every six hours. The added advantage of NSAIDs is that they help with the muscle aches, keeping hydrated will do that as well. Aspirin works for this, too, but kids especially shouldn't get aspirin because of a rare side-effect called Reye's Syndrome, and adding gastric bleeding problems to a raging influenza is not a recipie for success. Buy one of those oil cans of your NSAID of choice NOW, before you get sick. It'll keep for a couple of years, and you'll probably use them in the meantime.

It's time to go to the hospital when you can't get fluids into someone and have them stay down for more than 24 hours or when people start getting blue around the lips. Your hospital will be overwhelmed, but unless you have the Noah Wyle (TM) Home Intubation And Ventilation Kit, it's the only place you'll be able to find respiratory support or IV fluids. Most hospitals will not be prepared for this, and those that think they're prepared won't be. The US healthcare system is about the best for acute care, but not everywhere all at once, there is limited surge capacity and when your hospital's vent beds are full, that's it -- no vent for you. As previously stated, going somewhere else won't help.

There is some chance for societal breakdown in this, and if that happens, there's little that is a better persuader than a 12-gauge shotgun. I have the Benelli Nova Tactical on order, it's intimidation defined but with BB shot loads it won't go through your neighbor's house. I'm all for being neighborly and helping out others, but when your neighbors start to help themselves, a firearm is a good way to start a conversation about community responsibilities and consequences in Adult Mode. Two-handed firearms are easier to handle and use, so the 12 pump is my choice.

There is a veterinary vaccine that may protect domestic flocks from H5N1, but we'll have to see about that. Living as I do a couple of dozen miles south of a large poultry-producing region, a coming bird flu outbreak is not a welcome event, but I'd be surprised if we don't see it here in bird populations within 12 months. Let me emphasize that you NOT HANDLE DEAD OR DYING/FUNNY ACTING BIRDS. Emphasize this to your kids, now -- being curious they'll be excited to get close to the duck that normally flies away, not understanding the risk.

Meanwhile, pray if it's your orientation for wisdom for the researchers and public health people, stock up a little on basics (food, medicines you need), keep yourself mindful of the news on this issue and GET THE FLU SHOT when it comes out and if you care for adults over 65 get their docs to give them Pneumovax. The 1977 Swine Flu vaccination was a freak, nobody since then has gotten sick from the flu vaccine. Remember, if you get sick you might feel like dying but you probably won't.