The Monster at Our Door: The Global Threat of Avian Flu [Anglais] [Relié]

Another great 'Doom, Doom, the End is Near' book. It may even be true.

But somehow after the prospect of nuclear war, then nuclear winter, Hong Kong flu, then Global Warming, AIDS, Ebola and so on you get just a bit jaded.

First the bad news. Avian Flu is a killer. The 1918 flu pandemic killed about 2.5% of the people it infected. This new one seems to kill about 50% (this book says two out of every three) of the people that get infected. It is rapidly spreading. This week there were cases reported in Turkey, right on the threshold of Europe (Birds do fly around a lot).

Second, the good news. In order for the virus to really be deadly to large numbers of people it has to mutate to make it capable of being transmitted from human to human instead of just bird to human as it is now. When it mutates it isn't as likely to be as deadly as it is now. A virus only has so much ability to carry things around. If it develops a 'skin' tough enough to travel by air, it will likely lose some of its deadlyness. Why? Because of all the flu's around this is about the worst. When it mutates, the skin is going to take more virus stuff, and some of that comes from the deadly stuff. Ebola has a higher mortality than Avian flu, the virus can't live outside of body fluids. Still at 50% mortality for Avian Flu, even if it goes to 5%, that's still worse than the 1918 variety. Another good point is that all of the governments around the world from Viet Nam to the UN are concentrating on the problem It's going to be tracked very carefully. As soon as an airborne variety mutates, a vaccine will be developed on an emergency basis.

Is there a risk -- absolutely. It it an emergency -- not yet. Is the book worth reading, absolutely, even if for no other reason than to see how our Government operates when faced with problems like this.

"The Monster at Our Door" provides an excellent summary of key flu characteristics, assessment of the current serious avian flu threat, and the shocking failure of our government to take appropriate action.

Davis reports that RNA viruses evolve up to millions-fold faster than their our antibody sources. One key point is that the co-infection of a host by two different subtypes can result in reassortment of constituent genes, and a new, more virulent strain.

A second key point is that starvation, malaria, and coo-infections act as flu impact multipliers - thus, Asia, Africa, and Latin America are particularly vulnerable.

Davis also summarizes the failure of recent "market-solutions" to the flu problem. Vaccine producers waited until demand strengthened in '57, resulting in availability that was generally too late and a total of about 80,000 U.S. deaths. This happened again in '68, and about 34,000 deaths followed. Another serious problem with past market-based solutions is that they failed to focus on those most vulnerable - elderly, asthmatics, and pregnant women - often corporations bought up the supply to give to their relatively healthy workers.

Still another key point brought out by Davis is the likely success of isolation and quarantine in a slow-moving virus (eg. SARS), vs. H5N1 flu. SARS has a five-day incubation period and only becomes contagious well after the onset of obvious fever and dry coughing. Infectiousness and sickness with other viruses (eg. HIV), however, do not coincide - HIV can be contagious for years without symptoms being present. Further, pandemic flu spreads much more easily than SARS. Thus, while SARS was controlled largely by authoritarian China's ability to quickly isolate and quarantine, this would not be possible with a faster-moving flu - especially in a democratic nation with advanced travel systems such as the U.S.

Another problem with the new flu is that it benefits through traveling and mutating via swine and poultry. These food sources represent 76% of the developing world's increased meat consumption; further the problem is acerbated by the increased tendency for their being concentrated in large-scale production centered around processing facilities. Destroying the affected livestock has proven effective, but this is increasingly difficult in areas with limited diagnoses capability and where the local population relies so heavily on the affected sources.

H5N1 has broken out in a number of Asian countries, and recently has been found in Russia, Africa, and Eastern Europe. Experts increasingly are concerned that eventually it will mutate into a form that is easily transmitted between humans. At that point, it's anyone's guess how strong the flu will be (the mutation may make it weaker, or it may retain its current strength; further, mutations may or may not render current vaccines and treatments being developed inpotent) - thus, estimates of world-wide fatalities range up to ONE BILLION!

As for defenses, in '76 the U.S. had 37 vaccine producers - now there are only two, and production for one of them is located in England and was shut down last year for quality problems. Japan has acquired enough Tamiflu medication for 20% of its population, while as of '04 the Bush Administration had only arranged for less than 1% of U.S. coverage. Davis also points out that in '04 the U.S. spent more on abstinance education than avian flu vaccine, and until very recently there has been greater focus on bio-terror defense (anthrax, smallpox, etc.) than influenza.

"The Monster at Our Door" is a great educational and wake-up contribution; I recommend it to EVERYONE!

This book is a comprehensive look at just what bird (or avian) flu is all about, and what the world is, or is not, doing about it.

Influenzas are divided into three major categories. Types B & C are relatively mild, leading to the common cold, or, at worst, the winter flu. But Type A is the unpredictable, and lethal, strain that is fully entrenched among the bird population of East Asia. It is very easy for the disease to jump from migratory birds, to ducks, to chickens, to swans and egrets, and back again, mutating along the way. Until now, the human deaths have come from direct contact with infected birds. But the time is coming when that last mutation will click into place, causing it to jump from person to person. A worldwide flu pandemic, with a death toll in the hundreds of millions, is, as one researcher put it, "late."

What is America doing to prepare for the coming pandemic? Not much. Industrial chicken farms, with millions of chickens crowded into one building, are a wonderful breeding ground for diseases of all sorts, not just bird flu. Remember SARS from a couple of years ago? Among the reasons why it was contained is that the cities where it happened, Toronto and Hong Kong, are modern cities with modern health care systems. Imagine if SARS had shown up somewhere in Africa, with a much less modern health care system.

The major drug companies have opposed moves to allow other countries to make cheap copies of flu vaccines, even though there are nowhere near enough doses of vaccines even for first responders, out of concern for their corporate bottom line. The Bush Administration is more interested in spending money preparing for a smallpox or anthrax outbreak, something which has much less chance of ever happening, than in spending it on bird flu, which is coming in the near future.

This is a very spooky book, which I guess is the idea. It is written for the layman, and does a fine job at showing how unprepared America is for the next flu pandemic. It is very highly recommended.