Bird flu draws crowd to KRMC talk

If they weren't losing sleep before, medical professionals left a recent bird-flu presentation with at least a wake-up call to the urgency of pandemic planning.

Peter Smith, a pathologist at Kalispell Regional Medical Center, said his goal was not to dramatize the pandemic potential. He drew his facts and predictions from the Centers for Disease Control and the World Health Organization.

"Influenza pandemics are inevitable," he said.

He said that major or minor influenza pandemics erupt about every 30 years. With the last recorded as the Hong Kong Flu in 1968, a pandemic creeps closer with every tick of the biologic clock.

Smith defined a pandemic as an epidemic disease outbreak that manifests on a worldwide level.

"History shows that Mother Nature uses infectious pandemics to reduce the population," he said.

Smith said the virus kills by causing a person's immune system to go into panic mode.

Because the body has no experience with this virus called H5N1, the immune system launches a virtual barrage of a material called cytokine. This massive attack damages the lungs, leading to acute respiratory distress syndrome.

"It's like a person is attacked by his own body," Smith said. "A person basically drowns in his own secretions."

If a patient survives, the damaged lungs remain extremely vulnerable to secondary infections of bacterial pneumonia.

According to Smith, youth or good health don't provide an ace-in-the-hole against a new virus like H5N1. Consider the experience of the Spanish Flu of 1918-19 that took 50 million lives.

"It had a predilection for the young and healthy," he said.

Smith drew on the recent experience with severe acute respiratory syndrome to predict how quickly a pandemic might spread. As a never before seen coronavirus (common cold), the disease caused death in Asia as well as Canada.

"With SARS, in 24 hours it reached three countries," he said. "In three months, it reached six continents."

Even before jet travel, the Spanish Flu caused illness in 40 percent of the people inhabiting planet Earth. Of those, 5 percent died of the influenza or secondary infections.

"The 1918 flu was a completely novel virus from the wild bird reservoir," Smith said. "It spread to poultry."

He said smaller pandemics, including the 1957 Asian flu and 1968 Hong Kong flu, had circulated before in slightly different forms. Like the virulent Spanish Flu, H5N1 has never circulated among humans before.

"This has a mortality rate of 60 per cent," he said.

Smith cautioned that this number was based on just a little over 200 human cases of H5N1 and not on randomized studies.

Montana's draft "Pandemic Influenza Response" plan, prepared by the Department of Public Health and Human Services, provides a more optimistic outlook. It estimates that 330,000 Montanans would get ill with 3,600 needing hospital care and 850 dying of bird flu or its complications.

National projections suggest H5N1 has the potential for 180 to 360 million deaths worldwide.

Currently, there has been no sustained human-to-human transmission of H5N1 since it first was detected when a 3-year-old boy fell ill in 1997 in Hong Kong. Of 17 more who became infected, five died.

The virus was stopped when public health eradicated every chicken in the area. It came back in 2001 but stopped again by killing all the chickens.

But in 2002, a new strain in chickens escaped, spreading to Japan, South Korea and beyond via poultry shipments. Because poor countries don't compensate farmers for their killed chickens, the incentive remains high to cover up bird-flu outbreaks.

According to Smith, the dense populations of southeast Asia combined with poultry-farming practices add up to a volatile environment for virus marriages.

"In this country there are very stringent separations of wild fowl and domestic poultry," he said.

For that reason, Smith said he worries little about recent reports of wild birds with the avian flu. He watches for human-to-human spread as the hallmark of pandemic in the making.

In the continuing history of H5N1, 2005 saw human deaths increasing in Vietnam, Thailand, Cambodia and in Indonesia. Experts fear small clusters of cases may mean the virus has come close to sustained human-to-human transmission.

For the first six months of a pandemic, Smith said a vaccine won't figure into the survival equation. Antiviral medications offer the best hope in that period.

"Tamiflu has shown some effect," he said.

If taken within 24 hours of exposure, Tamiflu may prevent a person from becoming ill. However, Smith said the federal government has only ordered enough stockpile for about 25 percent of the population.

He speculated, based on facts and history, that the pandemic will start in southeast Asia and progress to worldwide exposure in 180 days. With massive job absenteeism, Smith predicts the global economy will slow to a standstill.

"This really, truly is an international issue," he said.

Smith urged medical staff to consider forming a committee concerned just with bird flu. Smith said the pandemic will pose a lot of difficult questions, putting society in a position it hasn't faced before.

As a result, national, state and local officials continue to make plans for backup hospital beds, mass vaccine distribution plans as well as backup morgue space.

Kalispell Regional Medical Center now has a disaster committee that has looked at planning for a pandemic as well as responses to other emergencies and hazards. Work on bird flu began seven to eight months ago in coordination with public health and other members of this area's incident-command system.

The committee's work has including planning for surge capacity at the hospital and taking inventory of supplies in the event of a pandemic, safety director Bill Boyd said.

Boyd said medical-center staff will participate in a joint exercise Sept. 18 and 19 focused mainly on influenza planning.

Smith suggested the following Web sites: who.int; bbc.co.uk; and cdc.gov

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.Preparation key for pandemic

Like other disasters, a pandemic requires that citizens plan to lessen the impact. To prepare for the interruption of goods and services, experts recommend that households stockpile:

. Potable water - A supply of clean water should be stored in approved plastic or glass containers. Plan on at least one gallon per person per day. A water filter is recommended for extended periods.

Food - Stock enough food to provide 1,000 to 2,000 calories per day per person. Buy food which requires no refrigeration such as canned meats, fruits, vegetables and soups, packaged cereal, pasta, crackers and cookies, rice and beans, peanut butter, honey and sugar, salt, condiments and spices, cooking oil, jerky, dehydrated or freeze-dried foods. Stock vitamins, especially C, powdered milk, tea, coffee and lemonade/Kool-aid mix, baby food/formula and pet food.

Medicines and medical supplies - Several months' supply of all prescription medicines is essential. Consider medicines such as pain medications, antibiotics, Tamiflu (antiviral), steroid and antibiotic ointments, Benadryl, cortisone, antacids, Immodium, topical dental anesthetics. Other supplies include bandages, splints, iodine, alcohol, suture kits, syringes, needles, local anesthetic, sterile gloves, dental kit, masks.

. Toiletries - Recommended items include toothpaste and brushes, toilet paper, sanitizer, baby wipes, diapers, soap, alcohol handwash.

Miscellaneous - Other useful items include flashlights, batteries, hand-generating lights and radios, candles, matches, lighters, heat and light source (propane, kerosene or woodstove, generator and fuel, garbage bags, extra blankets, camping gear.

Useful Web sites include nitro-pak.com, beprepared.com, sportsmanguide.com, pandemicflu.gov, avianflu.gov