[AI] Avian Flu Daily Thread 03.12.05

[LMonty911]

Members, please add any interesting Avian Flu articles/info you find to teh daily thread, or link to them here. Thanks!

Yesterdays thread is here:

http://www.timebomb2000.com/vb/showthread.php?t=142536

 

[LMonty911]

http://www.thestandard.com.hk/stdn/std/Weekend/GC12Jp01.html

Apocalypse next

Mike Chueng

Weekend: March 12-13, 2005

REUTERS

Picture this:



Hong Kong has virtually shut down as hospitals are inundated with thousands of suspected bird flu cases.

After months of warnings from health officials, an avian influenza virus capable of rapid human-to-human transmission is a reality. The virus has mutated quickly from an earlier form passed from poultry to people.

The announcement by the World Health Organization (WHO) that the virus is now a pandemic, affecting numerous countries including Hong Kong, has prompted the Secretary of Health, Welfare and Food to elevate the city's response level to Emergency, effectively mobilizing the city's stockpile of anti-viral medication in an attempt to slow the virus' progress.

Despite drafting a plan conceived precisely for such a scenario, the government is overwhelmed on all fronts, with more than a quarter of the city infected.

Because the virus causes few initial symptoms, it is proving far more infectious than SARS.

Seventy percent of those infected could die without anti-viral medication, and even with medication, the prognosis for recovery is grim.

With practically everyone in the city a potential carrier, the government is unable to implement the quarantine measures that proved so useful in containing SARS. Its call for the closure of all schools and a ban on all non-essential public gatherings will do little to improve the situation in the city as most people, including carriers who have yet to display symptoms, are already staying home of their own accord for fear of infection.



The Department of Health has commandeered large amounts of television and radio broadcast time to educate the public in self-management of influenza-like illnesses, including advice about how and when to get treatment.

Over the next few days, increasing numbers of people are likely to feel the effects of the virus and seek medical attention.

The health care system, already seriously strained by the crisis, could buckle under the pressure.

Health officials have long since abandoned confirmation testing on suspected carriers, realizing that the sheer number of people with flu-like symptoms makes the procedure too burdensome and unnecessary at such a late stage.

The government is struggling to keep the city running with a skeleton crew of health, transport, tele-communications, law enforcement, and utilities workers while it buys time and waits for the virus to run its course.

Despite the efforts of scientists worldwide, a vaccine is at least six months away.

Even then, the vaccine may not be entirely effective against this terrifying new strain of human bird flu.

Meanwhile, with many top government officials themselves infected, many of the city's services are running on autopilot with little supervision.

Could this nightmare scenario occur?

Officials at the World Health Organization take it very seriously. If the present H5N1 avian influenza strain were to mutate into a virus capable of rapid person-to-person transmission, the picture painted above is likely, according to WHO spokesman Peter Cordingley. So likely that an emergency plan aimed at dealing with broad territory-wide paralysis and significant deaths from pandemic influenza has already been drawn for governments worldwide to adopt.

Cordingley says governments should prepare for scenarios where ``one third of the workforce is sick or too frightened to leave home'' and come up with contingency plans to keep such basic services as transport and telecommunications running while the virus is still active.

Hong Kong, where the first instance of direct bird-to-human transmission of the virus was documented during an outbreak of avian influenza among poultry in 1997, has taken the lead in creating an emergency plan of its own.

Designed to match the guidelines suggested in the WHO's emergency plan, Hong Kong's ``Preparedness Plan for Influenza Pandemic'' is broken down into three response levels - Alert, Serious and Emergency. The Emergency response level will be declared if the existence of an easily transmitted human-to-human strain is confirmed, or an influenza pandemic is already under way.

According to Department of Health spokesman Edmond Chow, Hong Kong has a stockpile of 3.7 million doses of the anti-viral drug Tamiflu for emergency use in the event of a pandemic - enough for more than half the city. It wants to boost the stockpile to 20 million doses within the next 12 months.

Cordingley believes Hong Kong is doing everything it is supposed to do to prepare for the worst. He has nothing but praise for its resolve to deal with the influenza threat.

``Hong Kong is among the best in the world at this business,'' he says.

The city is also doing its part to help other Asian countries that lack resources or expertise in the area. ``Hong Kong is well placed and is already helping its neighbors,'' he adds.

In the area of preventative measures, the city has taken dramatic steps to ensure that new strains of bird flu don't come from its own poultry. New influenza strains capable of spreading through a human population will likely emerge overseas before emerging from inside Hong Kong.

Professor Leo Poon Lit-man, an expert in influenza viruses at the University of Hong Kong, says the government has done ``a fantastic job'' reducing the risk of infection from poultry with a host of effective screening and transportation measures.

But is it all enough? Would we be able to stop bird flu if it hits Hong Kong?

Despite the preparedness plan, stockpiles of anti-viral medications and aggressive prevention measures, there is little that could be done if a pandemic reaches Hong Kong. A rapidly mutating virus moving at will through the world would be almost impossible to stop at the city borders.

``There will be nothing that can stop it,'' Cordingley says.

Adds Poon: ``If [the virus] adapts in humans, I don't think we'll be able to control it. It will be out of hand.''

In the event of an influenza pandemic, the plan should be effective in at least keeping the city running rather than lowering the infection rate.

Says Cordingley, the quarantine measures that proved effective in controlling SARS would be ineffective in an influenza pandemic. The bird flu virus' short incubation period of two to three days means significant parts of the population would be infected quickly and show few visible symptoms, frustrating efforts to isolate high-risk groups and prevent further infection.

It is unlikely that any isolation ward could contain the infection. Nor is it likely there would be an epicentre of the disease, as the Amoy Gardens housing estate was in the SARS epidemic. Facemasks, however, would be of help.

``You can [implement quarantines] with SARS, but you can't do it with influenza,'' Cordingley says.

``How are you going to quarantine people if you don't even know who has it?''

Surveillance activities such as identifying potentially infected inbound travelers at airports would be irrelevant should the virus reach Hong Kong.

Equally bleak is Cordingley's belief that government plans to provide anti-viral medication to the infected would have limited impact since the medications currently available can only ease the symptoms of infection. A more effective vaccine would take months to create.

``Work [on the vaccine] would not start until the pandemic happens,'' after countless people had already been infected, he adds.



And the chances of a doomsday virus with rapid person-to-person capability emerging?

Cordingley says we are two quick mutations away from such a virus. The current H5N1 virus, which has shown only moderate ability to transmit from birds to humans, must first mutate into a strain that passes easily from poultry to the public, then mutate into a strain that can transmit as easily between people as common flu does now.

``We just don't know,'' says Poon, referring to if or when those mutations will happen.



``We really don't know what's going to happen in the future.''

 

[LMonty911]

Vietnam avian flu cases spark concern as WHO gives numbers
Mar 11, 2005 (CIDRAP News) – The recent series of cases of avian influenza in a single province in Vietnam has increased concern about whether the nature of the illness is changing.

At least eight people from the northern province of Thai Binh have tested positive for H5N1 flu since this outbreak began in December 2004, according to Agence France-Presse (AFP), and two have died. Overall, 25 laboratory-confirmed cases, 14 of them fatal, have occurred in Vietnam and Cambodia since mid-December 2004, the World Health Organization (WHO) said today in an update on the case count.

The Thai Binh cases include two people who tested positive for avian flu despite having no symptoms. Both have family members who contracted avian flu.

"It's too early to say whether these cases are any different from previous cases or not," said Dr. Peter Horby, a WHO epidemiologist in Hanoi, in an Associated Press (AP) story yesterday. Referring to the asymptomatic cases, he added: "The two people with atypical infections could be related to improved testing, or it could relate to some difference in the virus. We won't know till we isolate the virus. It's too early to be raising alarms."

A local health official told AFP that people in Thai Binh need more information.

"What worries us most is that people don't have enough information on bird flu transmission and on poultry-raising," Dang Duc Rieu, director of the provincial animal health department, said in an AFP report on Mar 9.

He said local people, including local authorities, are very worried because more human cases of avian flu have occurred this year even as the toll on poultry has been lower than last year. "We are closely monitoring the infected people and places where the poultry outbreaks were reported," he said.

In the Thai Binh village of Thuy Luong, Le Thi Nhuan told AFP that people are avoiding her and her family members because three of them had avian flu. Her father-in-law is the 80-year-old man with confirmed H5N1 but no symptoms. The health department was to have given her family members masks, but hadn't yet done so, she said.

"Ever since they were discovered to be infected, villagers don't want to stay close to us," she said.

In today's update, the WHO said the Vietnam Ministry of Health has confirmed 10 human cases of H5N1 avian flu, of which 3 were fatal. Some of the cases were detected this month, while others date back to late January, the WHO said. Today marked the first update of the WHO's case counts since early February.

"This notification of cases follows new reporting procedures established within the Ministry of Health in collaboration with WHO staff in Hanoi," the WHO said.

Overall, the WHO has logged 69 human cases, including 46 deaths, since January 2004. Those include 51 cases and 33 deaths in Vietnam, 17 cases with 12 deaths in Thailand, and one fatal case in Cambodia.

The statement said cases have occurred in three phases: from January through March 2004 (35 cases, 24 deaths), from August through October 2004 (9 cases, 8 deaths), and December 2004 to the present (25 cases, 14 deaths).

On the prevention front, authorities in three countries have announced new plans to stem the advance of avian flu in poultry as well as people.

Vietnam's Institute for Veterinary Research will vaccinate ducks in the southern Mekong Delta region in April, using vaccines imported from China and the Netherlands, China's Xinhua news service reported yesterday.

Hong Kong announced a plan to increase oseltamivir supplies more than five-fold, spending $33.1 million (US) on a stockpile big enough for roughly 1 million people, according to a Xinhua story yesterday. An amended flu preparation plan calls for more than 20.5 million doses to be stockpiled over the next 12 months.

Other countries, including France, Britain, New Zealand, Sweden, Canada, and the United States, have also announced plans to order the same drug, Reuters news service reported today.

In Thailand, authorities have already begun stockpiling oseltamivir, an antiviral treatment thought to reduce the severity of H5N1 flu in people, Reuters reported. However, the cost of purchasing oseltamivir from Swiss drug maker Roche is prompting Thailand to contemplate making its own supply.

"Hopefully, if the active ingredient which we are importing from India proves to be good quality, we will be able to produce the drug in an emergency case in six months," Suwit Wibulpolprasert, a senior advisor on health economics at the Thai Healthy Ministry, told Reuters.

A Thai doctor with the WHO office in Bangkok told Reuters that the challenge of delivering the drug within 48 hours of illness is daunting in countries such as Cambodia and Vietnam because of a lack of awareness or sophisticated disease surveillance.

Oseltamivir is less effective if initiated more than 48 hours into the illness, said Dr. Somchai Peerapakorn. "It's still not a very good tool, but it's the only tool."
http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/mar1105avflu.html

 

[LMonty911]

Vietnam provides new numbers on avian flu cases, breaking information logjam

Helen Branswell
Canadian Press


March 12, 2005


TORONTO (CP) - The Vietnamese government reported 10 human cases of avian influenza to the World Health Organization on Friday, breaking a five-week silence on the human toll the strain known as H5N1 has taken in that country.

The cases are not new; they had been widely reported in media dispatches coming out of Vietnam in recent weeks.

But for reasons that remain unclear, Vietnamese officials had withheld the information from the WHO. That has raised concerns that agency officials might learn of dangerous changes in the virus's transmission pattern - if such changes occur - too late to try to stop or slow the development of a flu pandemic that would be expected to kill millions around the globe.

The head of the WHO's influenza program said the agency believes the information flow problems are being resolved.

"We feel that the . . . logjam is now broken," Dr. Klaus Stohr said, noting there are two additional cases - a veterinarian and a nurse - for whom laboratory confirmation is still pending.

The newly reported cases bring the human case count since mid-December to 24, with 13 fatalities. (Three of the 10 newly reported cases involved deaths.) WHO's official tally since January 2004 is 69 cases and 46 deaths.

The latest report from Vietnam does not cover seven people who had fallen ill in January but who were initially ruled out as H5N1 cases. Retesting of samples from those people suggested they were infected by the virus.

"We're still looking to get more details about these cases. But we expect to get those shortly too," said Dick Thompson, director of communications for the WHO's communicable diseases branch.

While the WHO welcomed the new numbers, it is still waiting for crucial information about the cases from the Vietnamese Ministry of Health.

The agency needs to know what kind of field investigations are being done to determine the details surrounding each human case so that it can better assess what is going on with the virus and whether the risk of a pandemic arising has increased. Raw numbers aren't enough to go on, Stohr said.

"It's a question of seeing that the right things are being done," he explained.

"If a case is positive in a hospital, fine. That's not the piece of information which will allow you to decide whether rapid intervention is necessary now or not.

"The piece of information is: Has somebody gone to the village? Do you know whether the husband, the family members, the neighbour is still OK? Is there something cooking in the village?"

Vietnam has not yet provided that level of detail, but Stohr said the WHO will persist.

"We will keep on insisting that a full spectrum of information is being shared."

The head of Canada's National Microbiology Laboratory agreed getting that information on a timely basis is critical.

"It could make a big difference in terms of the timeliness of alerting and ramping up of activities," Dr. Frank Plummer explained.

"The kinds of measures that we might need at points of entry and in hospitals. . . . The level of concern and alert would increase if there was (evidence of) significant and sustained human-to-human transmission."

The only way to learn that is to check the close contacts of those sick with H5N1. The goal is early identification of clusters of cases - people who may have been infected by the sick person, not by sick chickens. That could signify the virus has acquired the ability to spread easily among people - a development that would signal the start of a pandemic.

"It's like looking for mushrooms," Stohr said. "You won't find many mushrooms if you don't find the first one. So you have to look for the first one and then look if there are others nearby."

http://www.canada.com/health/story.html?id=ddefa268-afcd-4e97-8a81-85b7d93b8c30

 

[LMonty911]

Conditions favour emergence of a pandemic virus
12 March 2005

Avian influenza which has infected many animals and a few people in Asia has brought the world closer to an influenza pandemic than at any time since 1968, says virologist Lance Jennings.


"Conditions favouring the emergence of a pandemic virus are increasingly being met," he said yesterday.

The virus is not thought to have mutated to one easily spread between humans, but research published yesterday in the latest New Zealand Medical Journal predicted up to 3700 deaths in New Zealand from a first wave of pandemic influenza and up to a million people infected.

There were three major influenza pandemics in the 100 years to 2000, and world health authorities are concerned that bird flu will become the first flu pandemic of the current century.

Dr Jennings, of Christchurch, said the bird flu - scientifically known as H5N1 virus - was now endemic among poultry in parts of Asia, and was expanding its host range to tigers and domestic cats in Thailand.

Transmission between domestic cats had been demonstrated in experiments, and ducks without symptoms have been shown to excrete highly infectious virus. It had also isolated from pigs on farms in China, fuelling concerns of the possible emergence of new virus from the mixing of different forms of influenza in pigs.

Probable human-to-human transmission had been reported in Thailand and Vietnam, though sustained human-to-human spread had not yet been proven.

"The current mortality rate of recognised human cases of avian influenza in Thailand and Vietnam is 70 per cent," he said. "If there is a pandemic involving avian influenza, then deaths could be dramatically higher".

Dr Jennings said in an editorial in the NZ Medical Journal yesterday that statistical modelling suggested that a future influenza pandemic would cause between two million and seven million deaths worldwide, and New Zealand was unlikely to escape.

He was commenting on research published in the journal yesterday by Nick Wilson and Michael Backer of the Wellington School of Medicine, and public health consultant Osman Mansoor, which predicts more than 6000 New Zealanders may die, if and when a form of bird flu spreads between humans and reaches this country.

However, that death toll could be as high as 6210 people dead from 20,806 cases of serious illness.

In the peak week of the epidemic, 42 per cent of all public hospital beds would be required for pandemic influenza cases, according to the United States computer model, created by the Centre for Disease Control (CDC) in Atlanta.

The Health Ministry's influenza pandemic action plan, issued in October 2002, says that if a pandemic is declared, regional medical officers of health will have the power to cancel public events and gatherings.

"It is likely that some difficult decisions will be required in limiting hospital care to those where it would most likely affect final health outcomes," the researchers said.

The research published yesterday said the most likely range of hospitalisation in a flu pandemic is between 6900 and 16,200.

"It is likely that these levels would overwhelm current hospital capacity for much of the epidemic," the report said.

The estimated number of cases of epidemic influenza requiring medical attention is likely to be 325,000 to 759,000, and for the peak week of an eight-week epidemic the average general practitioner would be consulted by around 80 people with influenza.

Potentially, the number of medical consultations could reach as high as 1.1 million and strain the resources of general practitioners and primary care nurses in some areas.

The workload would be particularly acute in those parts of the country that are relatively under-served by GPs, such as the West Coast.

The public could be encouraged to use a telephone "healthline" service staffed by a registered nurse "so that the need for face-to-face consultations with GPs and nurses is reduced", the report said.
http://www.stuff.co.nz/stuff/0,2106,3214765a7144,00.html

 

[LMonty911]

Commentary

H5N1 Antigenic Drift in Northern and Southern Vietnam

Recombinomics Commentary
March 11, 2005

>> So far, 9 viruses have been isolated from specimens
collected from southern Viet Nam.

Results show that:

(1) These viruses belong to group Z and are genetically highly similar to
the viruses isolated in 2004, including A/Vietnam/1194/2004 and
A/Vietnam/1203/2004, which are the prototype vaccine strains recommended by WHO for pandemic influenza vaccine production.

(2) Except for one virus, all the rest are antigenically closely related to
A/Vietnam/1194/2004 and A/Vietnam/1203/2004.

(3) At the receptor recognition site, there appears [to be] an avian
receptor preference.

The conclusions so far:

(1) Very little mutation has been observed since last year [2004].

(2) There is no need to change the prototype pandemic vaccine strain
selected by WHO last year [2004].

(3) Genetically, the viruses continue to show resistance to amantadine. <<

The detail provided above show that H5N1 in the south is undergoing antigenic change, which while not unexpected, is cause for concern. Although WHO continuously announces that new isolates have not reassorted, reassortment does not change the sequence of individual genes it merely reshuffles existing genes. The genetic change is via mutation and recombination. This genetic change can cause antigenic drift which makes antibodies generated by infection or vaccination less effective, which is why new human vaccines are made twice a year, once for each hemisphere.

Even vaccine changes at this rate can fail to keep pace with influenza A. This has been clear with H3N2. After using Panama for 5 years in a row, the H3N2 vaccine component was switched to Fujian for the current season. However, a California strain emerged in the northern hemisphere and has swept across the United States and around the world. This emergence has correlated with clusters of student deaths and more recently nursing home deaths. The monitoring of California -like strains is largely done by identifying reduced titers, which show that the strain is also present in southeast Asia. The co-circulation of H5N1 and H3N2 could lead to dual infections involving H3N2 and H5N1.

However, H5N1 is clearly evolving in the absence of detection of human avian reassortants. The host range of the virus has expanded. More recent isolates are more likely to grow in lab animals such as mice and ferrets. Moreover these isolates also tend to be neurotropic. Thus, the absense of reassortants has not prevented H5N1 genetic change, which is clearly evident in one of the nine isolates mentioned above.

Since there are only nine isolates, the significance of the one that was not antigenically closely related to the pandemic prototype isolates is unknown. These isolates would appear to be from the south, and all of the officially confirmed cases from the south have died this season.

However, there are reports of additional atypical cases that were initially said to be negative, but were positive when tested in Japan. Retesting of these seven in Ho Chi Minh City produced 4 positives, indicating that the test in Vietnam was not run properly initially. The repeated negative result on three however, indicated that the test lacked sensitivity. Media reports indicated that a more sensitive test would be used in the future. Additional media reports suggested another lab also generated negative results on these samples, which also raises questions about the sensitivity of tests being run in that lab.

Initial reports had indicated that the seven patients had recovered. However, more recent reports indicated some of the seven had died. Since media coverage of patients in the south abruptly stopped just before the Tet Lunar New Year on February 9, the true situation in the south is unknown. Government announcements indicate new outbreaks in poultry in the south almost daily, bit there is no information on the cases who were hospitalized or died before the news halt.

The situation in the north is also unclear. Thai Binh has been declared H5N1 free since February 5, and before that the number of reported poultry H5N1 in the province was relatively low. However, geographical and familial clusters from the province have been reported and these cases clearly involve human-to-human transmission. Recent data indicate that there has been evidence for dual infections in people in Thai Binh for over a year, which can lead to recombination and genetic instability. The above report on the 9 isolates does not include data on the isolates from the north. Reports indicate that northern isolates from last year were genetically distinct, even when isolated from sisters of a fatal suspect H5N1 case.

Thus, there is evidence for antigenic drift in both northern and southern Vietnam. This change could limit the effectiveness of a pandemic vaccine. The two H5N1 prototype isolates are virtually identical differing by just one amino acid in hemagglutinin and three amino acids in the neuraminidase.

Thus, antigenic drift will move away from both prototypes simultaneously.

http://www.recombinomics.com/News/03110501/H5N1_Antigenic_Drift.html

 

[LMonty911]

Second Thai Binh Nurse With Bird Flu Symptoms Hospitalized

Recombinomics Commentary
March 12, 2005

>> Dao Trong Bich, deputy director of the medical center in Thai Thuy District in northern Thai Binh province said the 41-year-old woman had cared for a 21-year-old man who tested positive for the H5N1 virus and remains in critical condition.

The nurse was admitted to Hanoi's Bach Mai Hospital Thursday with a high fever, coughing and a lung infection - typical bird flu symptoms, a doctor there said on condition of anonymity. Test results to confirm if she has bird flu are expected next week, the doctor said. <<

This is another apparent cases of human-to-human transmission of bird flu in Thai Binh, although it is unclear if it is from the 21 year-old-patient of 26-year-old nurse. However, since the 21 year-old developed symptoms Feb 14, his sister Feb 21, and the first nurse Feb 26, is more likely that the H5N1 transmission chain was extended from nurse to nurse if teh second nurse developed symptoms recently.

However, if she developed symptoms earlier, and was transfer to Hanoi, or remained at home with symptoms, the transmission could have been directly from the patient, who transferred to Hanoi on Feb 20.

In either event, H5N1 appears to have become more efficient at human-to-human transmission, which is cause for concern.

 

[LMonty911]

http://www.canada.com/national/nationalpost/news/issuesideas/story.html?id=a65a2c02-be22-4a1f-b786-59182ec90c13&page=2

They kept smiling
Colby CoshNational Post
Saturday, March 12, 2005

EDMONTON - Increasing attention is being paid in the Canadian press to the possibility of an avian influenza pandemic -- a potential wave of new disease against which we have no existing immunological defence, and which could wash over the whole world like the Spanish flu, which killed 50 million in 1918 and 1919. The World Health Organization is currently monitoring an outbreak in Asia, where 42 people have died from the H5N1 variety of influenza A in six weeks. There is no ironclad evidence yet that H5N1 is being transmitted between humans. But that hasn't prevented the media from painting lurid sketches of a Canadian apocalypse, with bodies stacked up on street corners and hockey rinks converted to morgues.

If H5N1 undergoes the fatal mutation into a human-transmissible form, pandemic is a real possibility. Just how likely that might be is an open question. It's suspicious that no epidemiologist who ends up in a newspaper ever seems even mildly skeptical about the chances of a pandemic. Despite perennial warnings, our species has enjoyed 35 years of ever-intensifying population growth and international travel since the Hong Kong flu pandemic of 1968-69. And the swine flu scare of 1976 taught us that disease anxiety sometimes has its own costs.

One daily warned us on Wednesday that a flu pandemic could "thrust the planet into unprecedented social and economic chaos." But what was the Spanish flu if not a precedent? Carried on the ebb tide of a world war, as soldiers surged across the globe from Spain to Siberia, it struck at the most vulnerable moment imaginable and targeted the young with special ferocity. Medicine had barely emerged from its scientific prehistory; the people of 1918 didn't have antiviral drugs -- and didn't even know whether a "virus" was an organism or a substance. The public health apparatus of the day barely merits the name.

But they got by. Their experience was nasty all right -- and I don't mean "nasty" the way SARS was nasty: Toronto had nearly 50 flu deaths a day in October, 1918, and Montreal suffered 150 a day over its worst fortnight. What's remarkable in retrospect is how smoothly life proceeded.

The authorities in most cities and towns found it prudent, when the first wave of the epidemic hit not long before Armistice Day, to close schools and theatres. Church services were cancelled in some places. But shops, hotels, law courts, stockyards and most businesses remained open to serve the reduced traffic. The general availability of food and goods was largely unaffected, and stores encouraged housebound customers to place orders by telephone. Contemporary newspapers offer few signs of "economic chaos" arising from the epidemic; the classified ads, and even the society pages, remained the same size as ever. In the cities, the 1918 Victory Loan fundraising campaign continued apace without the customary mass meetings, collecting plenty of cash through advertisements and door-to-door canvassing. In the countryside, the wheat harvest, which then required the formation of threshing crews, was the biggest in Canada's history.

If the Spanish flu is relevant, we can expect a new pathogen to hit hardest wherever people are either extremely crowded or extremely isolated. We no longer have the cramped mining towns that were devastated by the 1918 pandemic, nor are our northern communities quite so immunologically vulnerable. But no one's saying we would get off easy. Canadian hospitals ran out of room almost instantly in 1918, and school buildings had to be turned into pesthouses. There were hundreds of ill people for every nurse and thousands for every doctor, and in this respect we may not be much better off now. Many patients, today as then, would probably have to take their chances being attended at home without significant professional help.

One concern is that we have many more people living singly than the Canada of 1918 did. People without housemates to care for them were a crippling strain on the ad-hoc systems devised locally to meet the pandemic. But we have advantages, too. We will no longer need to help sick families and individuals gather wood and coal to heat their homes. Local authorities had chronic trouble in 1918 obtaining scarce motor transport for caregivers. And much time and effort were wasted on enterprises like disinfecting telephone receivers and making sure feet (yes, feet) were kept dry.

Our one true weakness may be a general unfamiliarity with large-scale infectious disease -- our lifelong experience of medicine as virtually omnipotent. Our post-Victorian forebears could be killed anytime by an ear infection or an inflamed scratch; they possessed few illusions about death. And yet they were almost unnervingly cheerful. In Edmonton, one November, 1918, flu circular from the authorities concluded with the words "Keep smiling." Even after four years of wartime slaughter and austerity -- years endured only to be punctuated by global disease -- no one thought this cretinous or trivial. The recriminations and carping that accompanied SARS, which took only 800 lives worldwide, suggest we may not bear up nearly so well if Big Flu really does emerge.



http://www.canada.com/components/pr...aspx?id=a65a2c02-be22-4a1f-b786-59182ec90c13#