The Fear Contagion

Suppose that a government official today decided to round up exposed people and move them to a space like the Superdome in New Orleans. It's unlikely that even a crowded Superdome could replicate the conditions on the Western Front. But, depending on how densely packed people were, you could expect the flu strain trapped among them to increase in virulence. You'd be breeding a deadlier flu.

If you let people walk around freely, only those strains mild enough to allow people to stay on their feet would spread easily.

If quarantine won't work, what would? What about medication? Kilbourne is not optimistic about the vaunted (and expensive) antiviral drug Tamiflu, which can be taken to prevent or treat flu. "The problem with antivirals is that they are untried on any mass basis," says Kilbourne. "How long are you going to keep people on antivirals? Also, we don't know about any side effects of the newer antivirals. Older antivirals cause neurological problems in older people."

Kilbourne thinks that preventive vaccines are our best, and only, strategy for combating a pandemic flu threat. The new vaccine, developed with National Institutes of Health sponsorship, shows some ability to protect. But Kilbourne, who in 1969 developed the first reassortant flu vaccine (one made by combining snippets of genetic material from different flu strains), isn't enthusiastic. First, the new vaccine must be given in two doses, at very high concentrations. And it's hard to grow. Kilbourne adds, "We don't have enough if a pandemic happened tomorrow."

Still, vaccination is the gold standard for pandemic preparation -- once we know that a contagious human disease is emerging and the risk of vaccination becomes less than the risk of disease.

That's a long way from now. Despite all the hysteria, there isn't a shred of evidence that a pandemic is actually on the way. Developing new flu vaccines is a useful thing to do. Pandemic or not, flu kills thousands every year. But devising quarantine plans is useless.

Author's e-mail:

orentw@mindspring.com

Wendy Orent, an Atlanta-based writer, is the author of "Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease" (Free Press).