A Pandemic of Fear

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By Marc Siegel
Sunday, March 26, 2006

Fear is a deeply rooted emotion -- one that can serve as a lifesaving response to imminent danger. But because we humans often magnify risk, fear can also cause us to overreact to remote threats, such as bird flu.

According to a significant study published in the prestigious British journal Nature recently, the H5N1 bird flu virus is at least two large mutations and two small mutations away from being the next human pandemic virus. This virus attaches deep in the lungs of birds but cannot adhere to the upper respiratory tract of humans. Since we can't transmit the virus to each other, it poses little immediate threat to us.

So why did the "flu hunter," world-renowned Tennessee virologist Robert Webster, say of bird flu on ABC that there are "about even odds at this time for the virus to learn how to transmit human to human," and that "society just can't accept the idea that 50 percent of the population could die . . . I'm sorry if I'm making people a little frightened, but I feel it's my role."

I'm sorry, Dr. Webster, but your role is to track influenza in the test tube, not to enter into broad speculation on national television. By your way of thinking, we should all be either building an escape rocket ship or killing every bird we see before it can kill us.

Fear causes the public to blur the distinction between birds and people, and so, as the H5N1 virus infects flocks of birds in Pakistan and Israel, nightly news watchers track the path to the United States. The poultry industry cringes as migratory birds that may be carrying H5N1 make their way closer to the northern shores of North America.

But though this bird flu appears to be quite deadly in many species of birds, killing 10 out of 10 chick embryos in test-tube conditions, we humans are a different matter. In 1997 in Hong Kong, for example, where there were 18 human cases of bird flu and six deaths, thousands of people were screened, and 16 percent developed antibodies but never got sick. There appears to be a spectrum of disease in humans, not nearly as deadly as many media reports have supposed.

Even if the H5N1 virus does mutate enough to spread easily among the upper breathing tracts of humans, there are multiple scenarios in which it would not cause the next massive pandemic. In fact, the Spanish flu of 1918 made the jump to humans before killing a large number of birds. Not only do we have vaccinations, antibiotics, antiviral drugs, public information networks, steroids and heart treatments that were lacking in 1918 to treat victims of the flu; in addition, the growing worldwide immunity to H5N1 may lessen the outbreak in humans even if the dreaded mutation does occur.

Even as the virus spreads in birds, the chances of a mutation occurring over time appear to be less likely. For every doomsayer who declares that "it's not a matter of if, but when," there is a sober scientist who says that H5N1 may well dead-end in animals and not be the next pandemic virus.

If H5N1 spreads in pigs (a soup of viruses) and exchanges genetic material with another human flu virus before passing to humans, the result is likely to be far less deadly. The swine flu fiasco of 1976 is an example of the damage that can be done by fear of a mutated virus that never quite lives up to 1918 expectations. About 1,000 cases of ascending paralysis occurred from a rushed vaccine given to more than 40 million people in response to a feared pandemic that never arrived.

Even the word "pandemic" scares us unnecessarily. The word simply means a new strain of a virus appearing in several areas of the world at one time and causing illness. The last flu pandemic, in 1968, killed 33,800 Americans -- slightly less than the number who usually die here of the flu in an average year. We certainly don't need to think in end-of-the world terms for that kind of pandemic.

Cooking a chicken or turkey kills any influenza virus 100 percent of the time, yet the fear of H5N1 bird flu is already so rampant in Europe that poultry consumption is down 70 percent in Italy and 20 percent in France. In Britain people are giving away their parrots after a single parrot got the disease, and in Germany a cat died of H5N1 and the public was told to keep cats indoors. Forty-six countries outside the European Union banned French poultry exports after a single flock of turkeys was found to be infected. France, fourth in the world in poultry exports, is already hemorrhaging more than $40 million a month.

In this country I have heard from more than one farmer and several poultry companies that the price of poultry has already dropped 50 percent in some places. Imagine what will happen if a bird in the United States gets H5N1 bird flu. Our fear is growing at such a rate that our own poultry industry, No. 1 in the world, is likely to be destroyed. We are already petrified by fear of mad cow disease, another case where a species barrier protects us.

Flu changes its shape and size and is a killer worthy of respect and attention. But the most contagious virus among humans is our fear.

The writer is an associate professor at the New York University School of Medicine and the author of "Bird Flu: Everything You Need to Know About the Next Pandemic."


© 2006 The Washington Post Company

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