Symposium gives hope against avian flu

Should all the hype about avian flu cause the world to panic?

No. At least, not yet…. Should all the hype about avian flu cause the world to panic?

No. At least, not yet.

“Better safe than sorry” seemed to be the mantra of “Avian Flu in Asia and at Home,” a symposium sponsored by the University Center for International Studies Asian Studies Center and the Graduate School of Public Health Wednesday.

“We have to play mind games, consider numerous scenarios that could possibly confront us,” said Loren Roth, UPMC senior vice president and chief medical officer. “We cannot think this will not happen … I regard most of that as denial, at least denial of the possibility that it could occur.”

So far, scientists haven’t documented any human-to-human transmission of the dreaded H5N1 avian flu strain. However, the advanced mutation capabilities of the virus convince scientists it can – and probably will – evolve the ability to spread this way.

“Flus don’t cause much harm in bird species,” said panelist Gabriel Leung, an associate professor of translational public health at the University of Hong Kong. “It’s only when they cross species to humans that a pandemic would result.”

According to Roth, once avian flu spreads from one human to another, it’s only a matter of time – a week to three months – before a large number of cases emerge.

Roth, also an Avian Flu Task Force chair at UPMC, said, “The ultimate best thing to do here is prevention and the ultimate best prevention is a vaccine. Unfortunately we don’t have any commercial, available vaccine … ready to be distributed.”

While scientists can’t predict if and when a pandemic will occur, they have been ardently monitoring and planning in case of an outbreak.

Of the documented cases in Asia and Europe, more than half of the people infected with H5N1 have died, although there remains the possibility that only the most severe cases have been reported.

“The brutal truth is we’ve probably had more cross-species infections in recent decades than we’ve heard about,” Leung said.

Experts agree that an outbreak caught in the first generation stage – that is, before the infection jumps from human to human – would be easy enough to contain.

However, they worry that an outbreak in an area such as rural Asia might not be discovered early enough.

“The ideal scenario would be to identify a first case of human infection and douse the area with Tamiflu,” Leung said.

But identifying the first case before it infects others is easier said than done.

Leung’s proposed plan in the case of an outbreak included steps of quarantine, isolation and preventative medicines.

According to Leung, international travel restrictions would delay the spread of avian flu but not the overall attack rate, as the virus spreads three times as fast as SARS.

Avian flu can infect three generations in as little as three days, as opposed to SARS, which takes 10 days to spread as far.

Andrea Gambatto, an assistant professor at Pitt’s School of Medicine, thinks quarantines won’t be necessary with an effective vaccine.

He and his team of associates succeeded in developing a vaccine earlier in the year which is highly effective in animals and possible to mass-produce, and could provide significant protection in the case of an outbreak.

Leung proposed that containment measures coupled with vaccination would best stop the spread, but, referring to Japanese society as “more communalistic,” noted that quarantine and isolation might not work as well in the United States as they did in Asia during the SARS crisis.

“I daresay you’re safest here in this part of the world,” Leung said. “But I find it very difficult to believe it could be contained completely, even in a U.S. setting.”

“In Singapore they used Internet-linked cameras to enforce home quarantines. Here that’s how we treat criminals,” Leung added. “Here you can’t tell people to wear a mask and lock themselves in their houses … because of the liberal values that Americans hold so dear.”

Roth was more optimistic about the cooperation of the public.

“I think people will get the idea and they will by and large be cooperative,” he said. “Assuming they’ve not been infected, they’ll want to hide in their houses.”

Roth went on to list UPMC’s plans in case of an outbreak, stressing the safety of his staff as paramount.

“I’ve got to protect the staff,” Roth said. “It cannot be that I ask people to come in and die.”

He cited an approximate expenditure of $100,000 on protective materials such as face masks and the Tamiflu vaccine.

According to Roth, one of the biggest problems in the case of an outbreak would stem from panic and hypochondria.

“The minute I have dead birds in North America, I have people who think they have avian flu,” Roth said, adding that the hospital has considered setting up satellite treatment centers to avoid overflow in case of an outbreak.

Some presenters made an effort to brighten the gloomy discussion.

Leung concluded his PowerPoint with a joke.

Associate political science professor Wenfang Tang, who moderated the talk, noted that threats like SARS and avian flu help to make the Chinese government more responsive to social and media pressure.

“The health problems aren’t so good for you and me … but they are good for political change in China,” Tang said.

He also illuminated one positive aspect of a global health threat like avian flu – increased international cooperation to find a solution.