A Bird in The Head
Avian Flu Isn't About to Get You. Panic May.

By Marc Siegel
Special to The Washington Post
Tuesday, January 31, 2006

Bird flu fears are being stoked again by a rash of reports of deaths abroad from the virus. The human toll from bird flu in Asia and Europe has reached at least 82. Even though all cases so far have been traced to contact with birds and there is no evidence that the disease is being passed from human to human, the prospect of transmission is what worries ordinary people the most.

That fear is unnecessary, says New York internist Marc Siegel. His new book, "Bird Flu: Everything You Need to Know About the Next Pandemic" (John Wiley & Sons, Inc.), addresses some common fears surrounding the illness. We've excerpted and adapted some of the book's questions and answers here.

How likely is a human bird flu pandemic?

The government has reason to consider worst-case scenarios as it attempts to protect us, but I do not think a massive bird flu pandemic that kills many millions of people worldwide is about to happen. This form of H5N1 (the flu strain responsible for the deaths) appears to have been around since the 1950s. In the past eight years it has infected millions of birds, but documented human cases have been rare. We don't know how many thousands of people have developed antibodies to this virus and not gotten sick from it, so it may not be as deadly to humans as it seems to be. If it mutates sufficiently to infect us routinely, it may do so in a way that causes it to be far less lethal.

Should I prepare emergency supplies of food and water just in case ?

Absolutely not. Bird flu is one in a long line of things we've been warned about, and for which we supposedly need some kind of "safe room" with an ample supply of food and water just in case. First it was anthrax, then West Nile virus, then smallpox, then SARS. In each case we were warned that we had no immunity and could be at great risk.

The national psyche has been damaged by all these false alarms. On alert for potential threats, we're worrying more and more of the time. The emotional center of the brain, the amygdala, cannot process fear and courage at the exact same moment. If we could train ourselves to filter out dangers that don't threaten us by setting our default drives to courage or caring or laughter, we'd be a lot better off.

Should I wash my hands more frequently ?

Go ahead -- hand washing is good protection against all respiratory and gastrointestinal viruses -- but don't use bird flu as the excuse.

In the fall of 2005, the purchase of hand sanitizers was up almost tenfold. I'm sure this is a response to the fear of getting bird flu -- a way to reassure yourself that you are doing something to protect yourself. I would never discourage hand cleansing, but keep in mind that any quick remedy for bird flu fears also reinforces the notion that bird flu is almost here, when there is no evidence to support this. The same is true for avoiding poultry. It may make some people feel safer for a brief moment, but it also reinforces the misconception that our poultry supply is at risk.

Are there specific medical supplies I should stockpile against bird flu? What about Tamiflu ?

To the first question, the answer is no. As for Tamiflu, it's a bad idea to stock up on this medicine, even if it is found effective at reducing symptoms in humans -- something that's not yet been proven.

Taking an antiviral drug in the absence of a real threat risks reducing its effectiveness.

Tamiflu is an expensive drug that has approximately a three-year shelf life. Since bird flu most likely won't mutate to a form that can routinely infect humans over the next few years, chances are that if you stockpile Tamiflu, you will either misuse it or be compelled to throw it away when it is out of date.

Plus, without a doctor's instructions, how would you know when to take it? When there's a rumor of a sick parrot in a cage at the airport? When a human gets avian flu in Madagascar? The first time someone sneezes when you're near the poultry counter of your local market?

How can I protect myself in general against airborne viruses ?

Hand washing helps. Be conscious of how often you shake hands or casually kiss someone at a party. A sneeze or a cough can propel a virus 10 to 12 feet. Cigarette smoke also spreads respiratory viruses, so smokers (and smokers' friends) have to be very careful when they are sick to not blow smoke in a crowded room.

Isolating sick people is the best protection against the spread of flu. Unfortunately, a patient may be spreading the virus for several days before becoming clinically ill. Close contacts of people who are ill with a virus should anticipate the possibility of getting sick, and they should limit their interactions with others, especially in the "window period" between their likely exposure to the virus and the time when symptoms usually emerge.

What are the chances of bird flu getting me ?

Right now, almost nonexistent for anyone who does not have direct contact with birds in Asia.

The concern about the disease is based on the fact that the H5N1 pathogenic avian influenza is a very aggressive killer of birds. As it spreads in birds, the growing amount of virus may increase the chance that it will mutate to a form that routinely infects humans.

In the meantime, it is important to realize that not a single bird in the United States has been found to have this flu strain. Also, most of America's poultry is not killed in the open, where H5N1 can easily spread.

Bird feeders are safe; pigeons are safe; and if you encounter a dead bird, do not assume that it died of bird flu. If you are worried to that extent, it is a sign that fear is becoming virulent, rather than that H5N1 is spreading.

I am so bombarded with bird flu warnings in the media that I feel I should do something. What should I do ?

Eat right and get plenty of exercise -- the same things your doctor always tells you. Right now, the best thing you can do is to not obsess about it and to continue with your regular routines. Personal attention is better paid to a healthy lifestyle and a display of positive emotions like courage and caring than to worry about health threats that may never materialize.

What are the chances of bird flu coming to the United States ?

The chances of an infected human bringing bird flu to the United States on a plane are practically nonexistent, simply because there are so few cases of human bird flu. But even if someone brought bird flu here, it would not spread because there is no human-to-human transmission with bird flu in its current state.

It is very unlikely that a live bird will pass bird flu to North America, though bird smugglers do exist and Pacific flyway birds can occasionally make it across Siberia to Alaska. It is far more likely that some chilled or frozen poultry containing H5N1 will arrive here, mislabeled or smuggled from Asia. In that case, the virus would be destroyed as soon as the poultry was cooked, and the virus would not be transmitted to humans or other animals.

What if the worst-case scenario does occur and the H5N1 bird flu does mutate to a form that can infect me? What if it comes here to the United States in that altered form? What would I do then ?

Stay calm, listen to public health advisories and avoid crowds.

Beyond scaring ourselves unnecessarily, is there real danger in overreacting to fears of a bird flu pandemic?

Yes. Consider what happened in 1976. Fearing an emerging swine flu pandemic, public health officials pressed drug makers to produce a vaccine in record time. Once they did, a mass immunization program geared up quickly.

More than 40 million U.S. residents were vaccinated between Oct. 1 and Dec. 16. Then the program was abruptly halted. The problem: More than 10 states reported cases of Guillain-Barré syndrome, a neurological disorder, in those vaccinated. Twenty-five people died. The flu never came. ·

Marc Siegel last wrote for the Health section about smoking and exercise. Comments: health@washpost.com.