Busalacchi 1 Katie Busalacchi Dr.

Squier Chicken Culture 9 December 2011 The Threat of H5N1 In 1918, the outbreak of Spanish influenza devastated the worlds population. Before the year ended, the virus would claim up to 100 million lives. The strand that caused the outbreak, H1N1, possessed the deadly combination of being able to pass from animal to human, then easily from human to human. The recent resurgence of H1N1, coupled with the emergence of a new strand, H5N1, has raised the question of how prepared the global, modernized world is for an avian influenza outbreak. Although no one can definitively predict when the next pandemic will occur or what virus will cause it, it is likely that the next major pandemic will be of avian origin. Ultimately, proper measures are not being taken to ensure that H5N1 is not the source of the next global health catastrophe. The virus has already proven itself more deadly than its 1918 counterpart. Based on scientific research, studies of social stigmas, and current attitudes of both the general public and scientific community concerning the virus, it seems very likely that the virus will manifest and cause a devastating global health crisis due to the general lack of preparedness. If drastic measures are not taken to curb H5N1s development or prepare for its inevitable appearance, it will mutate into the most deadly pandemic the world has ever seen and have dire consequences for humanity.

Busalacchi 2 The major distinction between the H1N1 avian influenza and the current H5N1 variety is virulence. Defined by Dr. Milena Veselinovic, virulence is human transmission and the resistance to existing therapeutic agents. 3 The factor that made the H1N1 virus so deadly was its ability to travel from an infected individual to a healthy individual before killing its first host. H5N1 has not yet mastered the ability to pass from human to human. Currently, the only way to contract the virus is via contact with an infected chicken. 1 The contact can be with a live chicken, as in live poultry markets or cockfights, or with dead chicken, as is common with poultry workers. Although many people come in contact with live chickens or raw poultry on a daily basis, there are relatively few cases of H5N1 in humans. Although the virus does not yet have the ability to travel from human to human, it is more deadly than the H1N1 strand of 1918, and is just as resistant to treatment as its predecessor was in its prime. There are currently no vaccines available to protect against H5N1 in humans. 9 Even more disturbingly, the virus has a mortality rate nearly twice that of the 1918 strand.8 To date, nearly 60% of reported cases of H5N1 have resulted in the death of the patient. 4 Experts estimate that a sustained mortality rate of 35% worldwide is likely in the event of a pandemic. 3 Just as the two strands share a high mortality rate, many of the same symptoms are manifested as a result of both viruses. In addition to the common symptoms of lower respiratory infections, fever, and nausea, both have been proven to affect the central nervous systems of some victims.11 Additionally, unlike the seasonal influenza, which tends to affect the young and elderly the most, both H5N1 and H1N1 are known to affect young adults and healthy, middle-

Busalacchi 3 aged people more than any other age group. 1 The high mortality rate in an otherwise healthy demographic clearly exemplifies the viruss dangerously deadly quality. Although it is clear that the virus has the potential to be incredibly deadly, the scientific community and general public alike are not in total agreement about whether it poses an actually threat to society. There are two main arguments given to justify the lack of preparedness measures taken. The first, taken by many members of the scientific community, is that if H5N1 could adapt to transmit from human to human, it would have done so already6. The other point of view, taken primarily by members of the general public, is that modern medicine would be able to control the virus in the case of an outbreak 10. Both views are neglecting to consider key factors that will contribute to the spread of the virus. The complacency produced by both of these responses will inevitably lead to a pandemic that will be worse than it should have been. The idea that if it were ever going to happen, it would have happened already is simply a way of brushing the issue aside without having to think about it any further. The fact is that most viruses fester for years before morphing into a form capable of devastating the population 8. The H1N1 virus is estimated to have been evolving for somewhere around eleven years before the pandemic broke out. 8 H5N1 was only discovered around 15 years ago, so it is only a few years behind the pace of its highly virulent relative8. An additional argument that proponents of the it would have already happened theory like to use is that the conditions leading up to the 1918 outbreak were unique, and no modern scenario could possibly yield the same outcome. Again, this is simply an uninformed conjecture. The horrible conditions that lead to the 1918 pandemic were those experienced in the trenches of World War I. 8 Soldiers were forced to live in tightly packed and unsanitary quarters while

Busalacchi 4 experiencing high levels of stress. Under such stress, immune systems were weakened and the men were extremely vulnerable to disease. The influenza virus merely capitalized on the mens susceptibility. Because their immune systems were compromised so severely, the soldiers on the front lines were incapable of fighting off the virus. It spread like wildfire from camp to camp, claiming countless lives in its path. With virtually no place to care for or quarantine the sick, entire camps were infected with the virus in a matter of days, if not sooner. When victims survived the virus, they unfortunately only made the situation worse for others. The virus had an opportunity to mutate every time it infected a new individual, so each time the virus was passed on it was a little different than it was before. So it was really a lose-lose scenario; either a man died from the virus, or he allowed it to mutate then passed in on, killing countless others after him. With millions of soldiers acting as petri dishes every day, the virus quickly mutated into the highly virulent form that would cause the worse pandemic in human history. Although many scientists assert that no such conditions could ever arise again, they are once again mistaken. As standards of human cleanliness have steadily improved over the last 100 years or so, the standards of cleanliness in the meat industry have steadily decreased. The worst instance of grossly unsanitary conditions is in the poultry industry. The conditions modern factory farms are very much like the conditions found in the trenches of World War I. Dr. Michael Greger describes the role that the industrialized poultry industry plays in the spread of avian flu in his book Bird Flu: A Virus of Our Own Hatching 8. The so-called broiler chickens sit literally beak to beak with no room to move let alone to spread their wings. Bred to produce large amounts of breast meat, many of these chickens become so heavy that their legs

Busalacchi 5 cannot support their body weight, and they are literally left to sit in their own feces. The virus spreads easily through fecal matter, so virtually when one chicken is infected, a large percentage of the other chickens in the factory will soon be infected as well. Additionally, the chickens are bred to be as efficient as possible, and as a result are genetically very similar to each other. Due to their genetic similarities, the broiler chickens are all susceptible to the same diseases. 8 Beyond the fact that the infection of one chicken could wipe out an entire supply, the spread of the virus in chickens poses a serious threat to humans. Just as on the war front, the virus mutates each time it is passed to a new host. The more hosts in which the virus is able to mutate, the more likely it is to mutate into a form that can successfully spread from human to human. So ultimately, although many scientists believe that the virus would have already mutated into a highly virulent form if it were ever to do so 6, the truth is that the virus is constantly mutating. It is only a matter of time before the virus mutates into the perfect combination of being able to pass from one host to another before taking the life of the first victim. Compared to the amount of time needed for the outbreak of 1918 to adapt to its virulent form, this fatal mutation in H5N1 is overdue. While it is certainly concerning that the scientific community is not in agreement with the potential deadliness of the virus, the more troubling reality is that the general public is not adequately concerned about a possible pandemic. According to a Harvard University study, 78% of those surveyed were not concerned about being infected with the avian flu. 10 The reality is that many people are largely uniformed about avian flu. Whether the product of the governments failure to inform the population, or a forced ignorance on the part of the

Busalacchi 6 population, this lack of knowledge can be incredibly dangerous in the event of an actual pandemic. The topic of avian flu is one about which the majority of average citizens know very little. In a Harvard University study, many people are under the impression that bird flu can only be caught by contact with an infected chicken.10 In other words, a significant percent of the population ins unaware that the avian flu, once transmitted to humans, can spread just as the season flu can, if not more quickly and effectively. Calling the mutated, virulent form of influenza avian flu is a misnomer, or at the very least leads to a lot of confusion. The avian flu does begin as a virus that is extremely harmful to birds, but will do little if any harm to humans in this state. Many strands of the bird flu begin in wild fowl, such as geese.8 Because the respiratory system of a goose is so different from that of a human, it is impossible for the virus to spread directly from goose to human. The chicken, however, serves as the perfect bridge from wild fowl to human. 8 Containing similarities to both the respiratory systems of wild geese and humans, the chickens respiratory system provides an ideal place for the virus to transform. Once a relatively harmless infection affecting a flock of wild animals, the virus could now have the ability to wipe out an entire population. Although it may be more intuitive to blame the outbreak of avian flu on wild, dirty birds, it is actually the wild birds contact with the industrialized chicken that is the most problematic. It is unfortunate for society that we have chosen to make the chicken, which can so easily transmit a fatal virus to us, a staple in our diets.

Busalacchi 7 Not only is the general public largely ignorant on the nature of the bird flu, but they are also prone to overestimate the ability of modern science. The general opinion is that even if a pandemic were to break out, modern medicine is advanced enough to stop its spread. Unfortunately, this is also not true. The process used to manufacture vaccines has changed very little in the past hundred years. In the best-case scenario, vaccines could be manufactured within six months of the initial outbreak of the virus. 8 If the pandemic is caused by H5N1, or some other highly virulent virus, antibiotics will arrive months too late to have a respectable effect. An additional problem posed by producing vaccines for virulent strands like H5N1 is that they often destroy the medium in which they are formed. In particular, H5N1 vaccines cannot be manufactured in the traditional manner, in an egg, as they would destroy the egg in which they are being developed. 2 Additionally, it is impractical to assume that, once produced, vaccines could be distributed effectively in a short amount of time. It would be difficult to vaccinate the Western world, let alone impoverished or developing countries. Even if antibiotics could be manufactured and distributed in a timely fashion, humans will have no preexisting resistance to this newly developed strand of the flu, and will therefore be unable to use their own immune system to help fight the virus in any capacity2. Ultimately, the battle against H5N1 will not easily be won. Beyond the looming scientific facts, there are many other factors that will contribute to the initial breakout of the H5N1 pandemic. Every illness has some form of social stigma that comes along with it. From a clinical standpoint, stigmas tend to have adverse effects on the prevention of the spread of disease. 9 Specifically, when it becomes socially unacceptable to

Busalacchi 8 have a certain illness, people are much less likely to seek treatment for it. 9 In many cases, the fear of social alienation outweighs the fear of illness. In the case of avian influenza, a popular point of view is that government health agencies have overreacted and blown the actual threat of a pandemic out of proportion. In fear of appearing gullible or paranoid, people chose not to report flu-like symptoms. Rather than erring on the side of caution, as should be done when a pandemic looms in the near future, people decide to cover up their illnesses, as this is what is socially acceptable. If the virus is not caught in its earliest stages, it will be virtually impossible to contain 8. As cases continue to go unreported, people will continue to unknowingly be exposed to the virus. At a certain point, too many people will have contracted the virus to receive medical care, and the pandemic will have begun. Even if individuals do decide to seek medical attention in a timely fashion, most hospitals will not be adequately equipped to treat the large influx of patients suffering from the avian flu. In many places around the world, hospitals are already incredibly understaffed. In the event of an H5N1 pandemic, even most well equipped hospitals will face problems they have never encountered before. Because of the damage it can do to the lower respiratory system, H5N1 poses unique health risks. Many patients infected with H5N1 that have been hospitalized have been placed in respirators. 7 Additionally, since the virus has an affinity to spreading around the body, patients often experience failure of other organs such as the liver or kidneys. 7 Generally, intensive care units do not have the resources to treat the mass amounts of patients that will need urgent medical care in the event of an H5N1 pandemic. The unpleasant truth is that most countries do not even have enough beds to hold the large number of patients that will

Busalacchi 9 require treatment. Although it is true that medical advances could allow for more effective treatment, not all patients will be able to receive such treatment. The healthcare system in which we place so much faith will suddenly be obsolete. The scenario that will unfold when H5N1 finally mutates into a virulent form is not pleasant. Despite the comforting idea that modern science can fix any problem, the world is neither prepared medically nor culturally for this pandemic. In order to curb the effect of the pandemic, a major change in mindset needs to occur. The main difficulty in doing this lies in the consumers demand for a good buy, especially concerning the purchase of poultry. People search for the product with the lowest pound to cent ratio, not bothering to consider the implications of their purchases. Although it may seem to be a win for both the consumer, who is saving money, and the manufacturer, who is able to sell a product cheaply while still profiting significantly, both parties will eventually lose. The poultry industry is at constant risk of losing entire warehouses of chickens. Whether it comes in the form of avian flu or some other disease, the chickens are too genetically similar and too stressed to effectively fight off any disease. At virtually any moment, a new strand of disease could wipe out an entire inventory of chickens. Similarly, the same customer who is eager to save money on mass-produced poultry will likely suffer when the avian flu eventually develops into a virulent form. Finally, people tend to believe that the bird flu is not a significant threat, and are therefore not taking enough preparedness measures. The world is no way prepared for a breakout of H5N1. From the scientific communitys disagreement over the realistic threat of the virus, to the publics ignorance of the virus, to the

Busalacchi 10 hospitals unpreparedness, any effort to suppress the virus once it breaks out will be futile. The only way to possibly stop the spread of the disease is to begin preparing now. Antibiotics should be tested, people should be better informed, and the poultry industry should be cleaned up. Ultimately, the only long-term solution is to change the current practices in producing poultry. If the chickens were not kept so close together and under such stressful conditions, the virus would likely not mutate into a virulent form. As a society, we have adapted our hygienic practices to stop the spread of disease; it is time we took similar measures to change the practices in raising poultry.

Busalacchi 11 Bibliography 1. Loeffelholz, Michael J (03/01/2010). Avian influenza A H5N1 virus. Clinics in laboratory medicine (0272-2712), 30 (1), p. 1. The article discusses the nature of the 1918 pandemic and presents predictions for future pandemics as well as preventative measures and treatment options. 2. Sambhara, Suryaprakash (09/01/2010). H5N1 Avian influenza: preventive and therapeutic strategies against a pandemic. Annual review of medicine (0066-4219), 61 (1), p. 187. The article presents methods by which a pandemic could be prevented. 3. Veselinovic, Milena (10/15.2007). Avian Influenza A/H5N1. Acta Medica Medinae (0365-4478), 46(3), p.44. The article discusses the scientific nature of the virus, with special emphasis on its ability to spread and mutate. 4. Loeffelholz, Michael J (03/01/2010). Avian influenza A H5N1 virus. Clinics in laboratory medicine (0272-2712), 30 (1), p. 1. The entry discusses the epidemiology, diagnosis, and possible vaccination against the H5N1 virus. 5. Huang, Chaoyang (08/21/2010). A single dose of DNA vaccine based on conserved H5N1 subtype proteins provides protection against lethal H5N1 challenge in mice preexposed to H1N1 influenza virus. Virology journal (1743-422X), 7 (1), p. 197. The article discusses possible vaccinations against H5N1, and the timelines in which

Busalacchi 12 these vaccines could realistically be manufactured. 6. Kaye, Donald (12/01/2010). H5N1: 800-lb gorilla or lightweight?. Infectious disease news (1056-9251), 23 (12), p. 32. The article discusses the pandemic potential of H5N1. 7. Gomersall, Charles D (06/01/2006). Avian Influenza (H5N1) Implications for Intensive Care Intensive Care Medicine (0342-4642), 32(6) p.823 The article discusses logistical concerns with treating H5N1 patients in the case of a pandemic 8. Greger, Michael. Bird Flu: A Virus of Our Own Hatching. New York: Lantern Books. 2006. Print. 9. Barret, Ron (9/17/2008). Stigma in the Times of Influenza National Science Foundation. (0022-1899), 34(7) p. 35 The article discusses the role stigmas can play in the spread of illness, specifically influenza 10. Blendon, Robert J. Harvard School of Public Health Project on the Public and Biological Security:Avian Flu Survey www.hsph.harvard.edu/disasters/articles/LoreeBlendon.pdf. Web. 6 Dec. 2011.