Thursday, October 27, 2005

Worrying About the Wrong Things Again.

Now I should preface this by saying that my feelings on H5N1 are complex. Not that I am not completely against it. I should make that clear; I am not some nut that thinks that a good pandemic is just what the world needs these days. Rather the complexity is in regards to whether the amount of fear being generated is to much, too little or just right.

From a public health point of view I am pretty optimistic. There are several lines of research being pursued in regards to anti-virals, vaccines, even RNA interference technologies coming down the pipe (though iRNA technologies are less still some way off). Even if an infectious pandemic began yesterday, it takes some time to spread both geographically and within local populations.

There is also the possibility that the mutation(s) needed to allow the virus to pass easily between humans could reduces the mortality rate of the virus. From what I understand it is currently attacking deep in the lungs which makes it more damaging but less infectious. If it is to adapt to the higher respiratory tract it could mean that the body gets a chance to start fighting the disease before it spreads to the lungs giving the immune system a valuable head start. This is just speculative on my part but it sounds plausible. It turns out that in the past the greatest number of deaths during these new human flu pandemics were caused by dehydration and secondary infections, both of which we now have much better treatments for these days.

But when a minority of doctors come on TV and radio and tell people that they are being foolish for being concerned about the possibility I am not so sure I agree. The actual epidemiologists have been warning about this virus for years and politicians have been rather unimpressed. It is only now that the exact predictions they made about the H5N1 virus began coming true (first you would see isolated cases, then clusters from the same farm exposure, then being passed by close family members who are caring for sick people, then small clusters in small communities would pop up and disappear) that the public got scared and only after the public got scared that we suddenly realized how poorly prepared we are for an infectious pandemic. The merely contagious pandemic of AIDS was a slow motion debacle that is still playing itself out via political interference and insufficient levels of funding. Here are some quick questions:

In the event of a pandemic, who gets to make the decisions of where medical supplies like masks and gloves and drugs and I.V. bags go?

Can doctors be reassigned against their will to areas which the states thinks are high priority but the feds think are low?

Are quarantine laws well crafted?

Who can lawfully decide to suspend transportation links?
These questions and many others need to be answered by people who are afraid of the consequences of getting them wrong.

Even if the right level of concern is being expressed, is it being directed properly? When people hear about wild birds with H5N1 being discovered in Europe they ask questions like "Will it lead to mass culls of Europe's poultry?" or "Will it spread to North American birds?" What should really be disturbing people is that European birds migrate to Africa. I suspect that Africa has a wide range of poultry practices from industrial type farms (with some having good health practices and others having less so) to subsistence level rural farming with chickens, pigs and wild birds mixing in one small plot just as they do in some affected areas of Asia. There are also populations of people there with malnutrition, HIV stricken immune systems and variable levels of health care and monitoring systems. Does anyone think that Robert Mugabe is competent to handle something like an outbreak of H5N1?

In short, support the medical and biochemical research and overthrow dictators. And while you are saving the world try picking up after your dog when you walk him or her. You know who you are.

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