Maybe. Influenza, shortened to flu, is caused by a virus, appropriately named Influenza virus. It spreads around the globe following the fall-winter months causing massive respiratory infections annually. Besides humans, a wide variety of birds and mammals are infected with various strains of influenza. There are three types of Influenza viruses, designated A, B or C.
Type A, is associated with most epidemics, and most deaths. In the USA, between 20,000 to 40,000 people die yearly from influenza.
Type A can be further subtyped into 16 categories for a protein present within the virus called hemoagglutanin (designated H), and another 9 categories for a protein called neuraminidase (designated N). These categories reflect mutations that have occurred within the protein, that allows them to be distinguished from each other using an antibody test. These two proteins, along with others, are involved in setting up flu’s infection process.
These subtypes are designated H1 through H16, and N1 through N9. A typical shorthand for a influenza virus might be “Influenza virus A (H5N1),” which is the designation for the avian influenza virus referred to as bird flu, and shows it is type A, containing the H5 and N1 proteins. While any combination of these two protein genes is presumably possible, in practice, only a few of the 144 possible combinations (i.e., 16 times 9 = 144) seem to be found in outbreaks.
Influenza virus genetic material is broken up into pieces, just as our own is, into chromosomes. Eight distinct chromosomes in the case of Influenza type A are present, each coding for the production or one or two proteins. The H and the N protein coding genes are carried on different chromosomes.
For many decades, the only human infecting subtypes were H1N1, H3N2 and H2N2 (this latter hasn't been detected in some time). Other combinations were known to infect a wide variety of animals, but of all the possible combinations, only these three subtypes were isolated from humans (very rare exceptions).
There are two ways a influenza virus can mutate. One by mutations involved during genetic material replication, which tend to be limited in scope, and can occur on anywhere on any chromosome.
The other method of mutating is potentially far more dramatic in creating a new virus combination, that can have new infection outcomes. This is where two or more different subtypes of Influenza type A viruses infect a host organism at the same time, and end up replicating together. When the chromosomes from each sort themselves out and are repackaged into new virus particles, some will contain only the chromosomes from one or the other infecting virus, but most will contain a recombination or reassortment of chromosomes from each parent virus. This produces a wide variety of possible viruses (hundreds of millions of infectious viral particles are released by each infected host). These new viruses can infect other hosts with a much different infectious outcome … milder or harsher infection.
In 1918, an new mutant form of Influenza virus type A (H1N1) swept the world, and left millions of dead in its wake. This virus did not act like any other flu virus. Instead of attacking those under 5 years of age and those over 55 years, it zeroed in on those between 20 and 40 years of age. It was particularly lethal. And many rapidly died not only within hours of major symptoms, but of hemorrhagic symptoms (bleeding out of blood vessels into the surrounding tissues). Very atypical for flu.
It is flu’s penchant for annual epidemics, occasional pandemics, and the historical precedence of the 1918 flu that shook the world that has those interested in infectious disease worried. We used to have a flu pandemic about every 11 years in the 20th Century. But that stopped in 1977, for reasons unknown. Now we are long overdue.
Worldwide influenza virus surveillance has been in place since the 1950’s. China is the focal point, because all new isolates come out of Asia (fair evidence this is due to livestock rearing practices).
In the last 15 years a disturbing new trend has emerged in which human isolates of influenza virus have turned out to be unique subtypes belonging to the H5, H7 and H9 subgroups. Something is up. Either we are just getting better at detecting rare human infections with other H types, or new environmental factors are pushing influenza evolution to break out into new hosts.
Will it be "avian flu" that kills a lot of people? I don't know. Probably not. But it will be something, and we are long overdue for a widespread outbreak. It doesn't hurt for individuals to prepare.
What can I do to prevent my family getting infected?
Not much. Good diet. Fit and well exercised. Well slept. Low stress. Well heated and ventilated home. All help fight off infections and survive infections.
Influenza is highly infectious, well adapted to infecting humans. The virus is expelled in enormous numbers in sneezes and coughing which flu induces. Inside a house or building, the virus particles drift in the air or settle onto surfaces and survive for hours to days depending upon the environmental conditions. Outside in the daylight influenza has a much worse time of surviving.
The two routes of common infection are inhalation and eye contact. Obviously, being near a sick person is the major risk factor, generally through inhalation of virus particles. Being in a room, like a restroom where a sick person has been is a risk factor. In this case, the route of transmission is touching a contaminated surface and transferring flu virus to your eyes by rubbing them. We do this subconsciously all the time. Just put black charcoal on your fingers if you don’t believe me, and see how fast black marks show up on your face.
Influenza is extremely sensitive to any hand soap (antiviral or otherwise). Washing with soap and water frequently will rapidly and effectively decontaminate your hands. Washing your face might help too. Decontaminating surfaces may also help. Again simple detergent/soaps are all that is required to kill the virus.
A face mask may help, but is not a good barrier against the virus unless the mask has a “N-95 rating” or higher. N-95 means 95% of particles 0.3 microns or larger are blocked. Make sure the mask fits well around the face. Any gaps, will be the path of least resistance, and you will breath through the gaps, not the mask. In addition, the masks may remind you not to touch your face.
Goggles can also prevent infection through preventing rubbing your eyes.
While a mask worn by a sick person may lessen the spread of infectious viral particles into the surrounding areas, this is a respiratory virus, and those infected will already be struggling for breath. Placing a mask over their face will make breathing even harder, and should NOT be done.
Regrettably people are often at their most infectious before they start showing much in the way of symptoms.
There is no vaccine for bird flu (a.k.a., H5N1). The government promises one any year now. Don’t hold your breath. And it may not work. I will leave the arguments for, or against, vaccines for others. I will say one possibility is to get vaccinated against the regular flu. It may prevent a concurrent infection between an H1 or H3 strain (that the vaccines are currently made against) with the bird flu strain, which presumably would be worse.
Similarly elderly and other compromised individuals can get vaccinated against pneumonia. Having a current respiratory infection of any kind may predispose you to bird flu by lowering your resistance to secondary infection and damaging your lungs making infection by another virus more likely.
FEMA used to recommend having a one week supply of food, water and supplies for each family member -- since upped to two weeks post-Katrina. In the event of a devastating nationwide outbreak, you can expect grocery supplies might be limited, travel might be restricted and even utilities may fail due to non-reporting utility company personnel. An outbreak of flu is likely to plague an area for up to 6 weeks, so you ought to plan for your family accordingly. Supplies should include anti-fever, anti-cough remedies. The rest is too extensive to list here.
[The Mormon’s have a good point for their younger members. They say when you are young, the odds of losing your job are fair at this time in your life. And it is comforting, if you have a several month supply of food to tide you through the tough times, until you are working again. Good advice, as is the advice to only buy those storable things you like and will eat.]
What can the government do to prevent my family from getting infected?
Two words: Not much.
All flu flies on the wing. It comes across oceans via birds. It also comes on cruise ships, airliners, etc., but even trying to identify sick passengers and quarantining them, would not halt a flu outbreak.
Vaccines are promising. But under today’s “approved” method of vaccine production, chicken eggs are used to grow virus. [You know, chickens, the thing avian flu infects and kills.] It takes a lot of time to develop enough vaccine for everyone. Six to nine months to be precise. There are few companies still making vaccine (two remaining I believe) for use in the USA. Regulations and lawsuits have killed this once numerous field. Government regulations.
Remember a couple of years ago when there was a flu vaccine shortage? It wasn’t that there wasn’t flu vaccine. It was that the company couldn't find a piece of paper that recorded data during a part of the vaccine manufacture, that caused the government to force them to chuck the lot of vaccine. Probably perfectly fine vaccine, but not government approved.
New ways of making vaccine exist: faster, better, cheaper, safer. But it would cost a lot to get government approval of the process, before manufacture could even begin. Too much, so it is not done… except for pets and livestock that don’t have the rigorous government approval process.
So bird flu vaccine is still years away. Oh, there is a small supply made every year for the well placed in government, but an actual supply for the commoner who is footing the bill … no that is still YEARS away. Understand it is not the technology that restricts the supply of vaccine, but government regulation of the marketplace.
In fairness, flu’s ability to mutate makes keeping up with an effective vaccine every year difficult, and stockpiling impossible. Indeed, every year a new vaccine is made (all old vaccines are useless) and the mutants selected to vaccinate against are guesses from the end of last season. Remember, the manufacturers need a 6-9 month lead time for product to come to market. Newer technologies could have this down to 6 weeks, but…. But truthfully, the annual guesses as to which mutants will be in circulation have been pretty good the last decade. Still, there is no guarantee a avian flu vaccine will prove effective.
Antivirals? There are a few chemicals known to have anti-viral activity against some flu strains. These prescription only antivirals can be stockpiled, are stable at room temperature, and have long shelf lives, and are actually inexpensive. Unfortunately, the data on the H5 strains isn’t promising. And flu strains are notorious for rapidly developing resistance to these prescription drugs. Also, they have to be taken at the first sign of infection, or they will not work. Many things cause early flu like symptoms that are not flu, nor affected by antivirals. By the time we know we are really sick, it is too late for antivirals (of course family members and friends of sick people who are as yet symptomatic could take the antivirals if they were available). You can bet key members of government will not have a problem getting these drugs.
What is the government doing to prevent my family from being infected?
Two words: New Orleans. There are undoubtedly many pandemic outbreak plans in your state. Whether they will be activated, or even remembered, is another question. New Orleans government had practiced (supposedly) a hurricane drill eight short months before Katrina hit, yet NOT ONE government official bothered to implement their plan. Those 500 school buses were sitting in a lot being flooded out instead of evacuating residents as a result. Etc.
So I am sure they have plans for slaughtering potentially infected livestock and quarantining arriving passengers from foreign countries. Heck, I had input into some of those plans. I am sure they can “close” the border. I am sure they can call out the military and the national guard to patrol the streets, and posse comitatus be damned. I am sure they can implement curfews. I am sure they can pick up bodies and have mass burials. But don't count on them to deliver water, food, medical supplies or care, other supplies, fuel, heating fuel, keep the utilities running, provide protection from looters, have hospital space or care for your loved ones, etc.
And if they know you have prepared ahead and are sitting on a stash of supplies for you and your family, don’t be surprised if they are more than willing to machine gun your family of “hoarders” – live at five – to redistribute your provisions as they currently redistribute your wealth. The government is methodical at that.
Who are you, and why are you so cynical?
In my life I have worked as a laboratory manager, a microbiologist, a clinical virologist and a molecular biologist. I have devoted my life to understanding how infectious diseases, especially viruses, successfully infect a person. I had participated for years in extensive flu virus surveillance programs, isolating, identifying and subtyping of types of flu virus circulating in the State of Arizona.
I was hired by the state government in 1999 to participate in a new program the federal government was funding to establish a bioterrorism response in all 50 states. In January of 2000, I founded and headed up Arizona’s public health laboratory’s section devoted to bioterrorism detection. I came to this task with the idea of creating a program that would be capable of rapidly responding to any emerging infectious outbreak whether manmade or natural … it made no difference.
I felt then, and still feel today that bioterrorism is a joke. Oh, it can scare a good percentage of the populace, as it did in August of 2001 with the East Coast anthrax letters, but kill a lot of people and spread … not as readily done as the government promotes.
But, a worldwide pandemic (natural disease outbreak) – that has happened many times in the past, and the world is long overdue (not counting the sexually transmitted AIDS) for another epidemic, flu epidemic, or other deadly respiratory spread infection.
I am cynical because I hired a really good microbiologist to help me with building this program. We were ready to go when the anthrax letters occurred. The response from not just the state’s public health lab, but assistance from other sectors was amazing. And we were one of the few states who kept up with testing and response demand in a timely manner.
Please understand, this was a major operation of which the lab played a role, but involved preparation, pre-planning of actions, and people who carried out the plan and adapted to solve problems. Epidemiologists, law enforcement, and other member s of government(s) and the private sector pitched in or had coordinated to carry this off. Arizona’s program worked pretty good. I gave it a B, which pissed off those in charge who wanted A+’s stamped on everything, but I figured there were things we could have done better. Corrections were put into place after the fact. But overall, there was no turf fighting, which destroyed many a state’s responses, and the entire government apparatus teamed up to work pretty effectively. It did this, not because of great leadership, but because the leaders wisely stated our objectives up front, opened the checkbooks and stayed out of the way.
I used to defend public health. While I knew of horrific stories that were done to people in the name of public health, I said my oath to defend the people of Arizona from all enemies foreign and domestic, didn’t specify two legged enemies or any legs whatsoever. And there was no short term gain for public health (which strives to prevent outbreaks and disease situations) that a private business could make a profit taking over. But my mind was changed ….
After the anthrax letters my annual budget went from around $180,000 to over $3 million. I hired six additional microbiologists and molecular biologists. I helped bring expensive equipment and new procedures into the lab. And I trained people, who in turn trained people, and so on. I had an amazing crew, and I hoped I was assisting other departments in filling out deficiencies that would make the laboratory as a whole more responsive to new demands.
With that kind of money comes envious eyes, and bureaucrats who want to make sure the release of credit is controlled, is only good news, and falls unto themselves. I have rarely been ill in my life. But age caught up with me. During a 4 month medical leave I watched as my people were chased from my department by my boss. I had all of my supervisory powers stripped upon my return, and was soon forced out. I know this is sour grapes. But I was appalled when I heard many months after I left that a program that was one of the best in the nation had been reduced to literally being unable to perform even the most basic duties. Years later, my boss is still there, though they have finally hired a competent replacement for my position who hopefully has things working again.
Every government agency has a mission statement. Almost every government department has a similar mission statement. The mission statement is the justification to the taxpayer to their money that is forcibly taken from them and spent. Other than that it is complete bullshit.
The real purpose of government is to make your bosses look good. Make a boss look bad, even once, and you are done. Make the boss look good — and even if you are a compete and utter moron, responsible for the ineffective and failing missions of government — you will go far. Be a enthusiastic, hardworking, far thinking employee, and eventually get rewarded with stagnation, seclusion, and hostility from upper management. [I have many an amusing tale to tell from 11 years of government service.]
If you die you serve as an example to others of why they need government. Fear, and the belief that government protects is all government needs to thrive. Even when it not only fails to protect, but is the cause of the fear. Perception of offering protection is the only sop required to manipulate a gullible public into rubber stamping government’s every atrocity. Failure in government is rewarded, often well. Failure cannot be rewarded for long in business, as survival of the fittest eliminates those less able to provide what you want.
While I can see little profit for companies in planning for an outbreak. Without disastrous regulations and frivolous lawsuits where culpable damages merely have to be alleged, not demonstrated, the costs of producing products to combat possible outbreaks might make sense – and you would pay for stockpiling storage costs and all the materials that turned out not useful – which might make any product rather expensive. Perhaps a businessman would take the risk of stockpiling. Perhaps a businessman would think of something I did not. Either way, the marketplace would decide, instead of the government. At least the market place provides in weeks what the government promises to provide in years.