Post Magazine: Can We Stop the Next Killer Flu?

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Hosted by Joel Achenbach
Washington Post Staff Writer
Monday, December 12, 2005; 1:00 PM

Scientists like Jeffery Taubenberger aren't just sitting there waitingfor a pandemic. They're gearing up for the war between bugs and humans.

Joel Achenbach, whose article about the scientific quest to understand thegenetic mysteries of the avian flu appeared in the Dec. 11 issue of  Washington Post Magazine , was online to field questions and comments.

Joel Achenbach is a Magazine staff writer.

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Joel Achenbach: Let's roll! I hope you had a chance to read the Avian Flu story that ran yesterday. I just had a nice chicken caesar, and last night we roasted an entire turkey. So it's birds everywhere you look. I will try to answer your questions as bestest as I can, but will use my adult prerogative to express uncertainty on matters that are beyond my very limited expertise.

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San Antonio, Tex.: Joel, you mention in your article that the host for the 1918 flu pandemic is perhaps a strange bird--or perhaps mystery mammal--perhaps never studied by virologists. You call this mystery beast "an odd duck."

Given that Taubenberger is studying a number of viruses--human, pig, horse--is Taubenberger even remotely close to making an educated guess about which bird or mammal is the vector for the 1918 flu pandemic?

Also, did Taubenberger give you any probabilities about how likely it is that A/H5N1 will mutate to the point that is is transmissible human-to-human?

Joel Achenbach: Great questions.

Taubenberger -- let's call him JT -- says that 1918, though a "bird flu," just didn't look like other bird flus down at the codon level. Meaning, on very close scrutiny, there's something odd about the genetics of the virus. So he postulates that it evolved, at least part of the time, in a bird that hasn't been sampled (most bird flu samples come from very obvious critters -- chickens, ducks, geese -- in what might be called Streetlight Science, where you look for your lost car keys under the streetlight), or in a mammal such as a horse.

Taubenberger doesn't know the odds of H5N1 becoming contagious among humans -- he is struck that it hasn't so far, and wonders if that's because there's a roadblock. But like most scientists he agrees it's a potential major threat and ought to be studied carefully -- it DOES kill people.

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Miami, Fla.: Do you think that the fears being raised are not a bit overblown? Remember Y2K?

Joel Achenbach: We do tend to overblow fears, as a society. On the other hand, we have political leaders who, in some cases, barely even believe in the future. Like many issues this is one in which you needs grown-ups to make grown-up choices that take cost and risk into account. Personally I am not hugely worried YET about this particular strand of flu -- H5N1 -- simply because we don't know what its virulence would be if it mutated or reassorted into a human flu. More broadly, I think it's the government's job to anticipate problems that can't be addressed by the private industries, and that means helping rebuild the vaccine production capacity of the country and having hospitals and local authorities ready for the Big One when it does happen.

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McLean, Va.: Joel... why do you suppose the 1918 flu was so quickly erased from the world's collective memory? My mom only knew that her dad had suffered from a serious flu at Ft. Meade and had nearly died (ten years before she was born) but knew nothing of the scope of the pandemic.

I mean, come on... Bodies were piled up in major US cities and it was never even mentioned in school history classes during the rest of the century?

Joel Achenbach: The Forgotten Plague. I think that a pandemic striking in September 1918 was inevitably going to be overshadowed by the events of World War I, which was still happening. Moreover, authorities played down the crisis and there wasn't the kind of news media then to play it up. And maybe the ultimate reason is that disease -- sudden, lethal -- was much more a part of ordinary life pre-antibiotics.

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bc in Mt. Airy, Md.: Joel-

Has researching and writing this Pulitzer-prizeworthy article changed the way you're (as a husband and father) thinking about or preparing for the possibility of a pandemic?

By the way, "alpha nerd" and "...the human face of the future will be covered with a mask." are some nice turns of phrase.

bc

Joel Achenbach: I'm surprised they haven't just called off the Pulitzer competition already and declared me the winner.

My stepfather yesterday gave us all Christmas presents: surgical masks. Real top-notch HEPA-filter types. We're safe now.

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Rockville, Md. (Clinical Research Statistician): The sole driver-variable to avian flu is the proliferation of factory-farming and related mass-slaughter of captive flocks. One exposure and it's all over. If the practices associated with factory-farming and mass-slaughter were abolished, the risk would be reduced nearly immediately; poultry would be more expensive, but not much.

So who's resisting? The poultry industry, that's who. The same people who are now - today - lobbying for avian-flu related subsidies. It's like robbing a liquor store, then demanding a line-item for convicted liquor-store-robbers - and actually getting it.

So why no press coverage? This is all public-record.

Joel Achenbach: I do think we need a story on who exactly stands to benefit from the billions proposed in Avian Flu spending. The Post ran an advertisement today on the Fed Page saying "How Bad Will the Pandemic Flu Be? As Bad As 500 Katrinas." That's very much the worst case scenario. The groups sponsoring the ad include some public sector and medical associations, so it doesn't look like poultry industry money to me. About factory farming: I'm concerned that there are 18 billion chickens on the planet right now. I'm concerned that the vast majority come from a dwindling number of species -- everyone wants the big-breasted types in order to have more white meat for chicken nuggets. But so far the outbreaks have occurred not on factory farms but in relatively impoverished areas of the developing world -- Indonesia, Vietnam, China, Thailand.

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Chicago, Ill.: Greetings,Will my holiday turkey be safer from avian flu if I use my industrial pressure cooker or my deep fryer?

Or should I just order carry out Chinese food?

washingtonpost.com: Joel, if you need cooking tips to share, please call upon your producer, who knows a thing or two in the kitchen...

Joel Achenbach: At the moment the biggest threat posed by turkey is that you might choke on it.

Kim, do share tips on how to cook a turkey. My Mom and I cooked one yesterday and we darn sure killed anything alive in that bird.

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Seattle, Wash.: Is anyone aware that Homeopathic treatment cut the death rate from 1918 flu pandemic as much as 90?

Joel Achenbach: I hadn't heard that. If I get the Avian Flu I will ask for the strongest drugs known to Man.

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Washington, DC: I read the article with great interest, particularly the part about the 1918 Spanish flu pandemic. One of the things that was not mentioned is the role of the gas attacks during WWI. Mustard gas (and other gasses) often left men permanently debilitated due to respiratory problems. Perhaps these men were the thousands of petri dishes for the creation of the Spanish flu variation.

Joel Achenbach: But a lot of the sickened soldiers were in military bases far from the front lines. I've heard it suggested (and maybe someone out there can clarify this point) that the odd mortality of the 1918 bug was due to the virus's ability to trigger a hyperimmune response -- a cytokine storm, as they say. And thus a lot of very healthy people with healthy immune systems died as their antibodies ravaged the lung cells containing the virus.

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Washington, D.C.: I actually consider the re-created 1918 flu virus to be a greater threat than the Avian flu. If it escapes the confines of the CDC labs in which it is now being studied, there would be no immunity against it and it would kill millions (as it did in 1918). Why isn't a vaccine being manufactured for this virus?

Joel Achenbach: You're mistaken. There's an H1 flu bug currently in circulation that is the descendant of the 1918 virus, and anyone who has been exposed to that bug (most of us, probably) has some immunity to the 1918 virus. Moreover, although flu CAN escape from a lab -- one of the three strains in circulation is apparently an escapee from a Soviet lab in the 1970s -- the CDC has multiple layers of security to keep that from happening. Keep in mind that this is not a mouse than can scamper out of the building.

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Toronto, Ontario: Is it true that taking a flu vaccine will boost your immunity and make the odds of getting the Avian Flu lower?

Joel Achenbach: The flu vaccines won't work against H5N1. The protein coat of this new Avian Flu is so different. It may be true that taking antiviral drugs could be useful in helping contain the rate of spread of an Avian Flu outbreak, but that's all the more reason to let that limited antiviral supply remain available to be used where it can really be of use. Just doping yourself now (with no H5N1 even within thousands of miles of here) wouldn't make sense.

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Seattle, Wash.: Interesting that you mentioned the dwindling number of species in your answer above. Folks who save heirloom seeds, such as Seed Savers Exchange, mention the danger of losing genetic diversity - putting all our eggs in one basket, so to speak. Have you done any research on that?

Joel Achenbach: Preserving biodiversity is one of those huge issues that would benefit from getting a fraction of the publicity and hype that Avian Flu has gotten. Not to say that AF isn't a big deal: But if you really care about the world we're bequeathing to the coming generations, seems like we could do much better to preserve genetic variation (but now I'm just parroting E.O. Wilson).

I did, as it happens, talk to some poultry scientists earlier this year for a piece I wrote for National Geographic about the 18 billion chickens and the implications thereof. One practical problem for the poultry industry is that monocultures make it hard to find new genes that might permit improvements in livestock (including disease resistance).

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washingtonpost.com: Joel, I sure hope you and Mom are owners of an instant read thermometer. This is how you cook the bird to a safe temperature but without fossilizing it and rendering it, um, inedible. Stick that baby in the inner thigh (ouch, I know) and see if it registers 165-170 degrees.

Joel Achenbach: Kim, we got that bird up to about 825 degrees, I kid you not. The bones melted.

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Morrisville, NC: Is it alarmist or merely prescient for folks to purchase supplies like Tamiflu, canned food and bottled water, and even a shotgun and a few shells now rather than waiting for disaster to strike? I've seen newspaper stories mocking folks who set aside these items as bizarre survivalists, though if avian flu lives up even partially to its billing I can't see such activity as anything other than an exercise in common sense. Hey, the people mocked Noah, and look where that got them (-joke-).

Also, I'm rather sick of the nonsense put out by public health officials that stockpiling Tamiflu is somehow antisocial, since there is a -fixed- supply of the drug at present. Well, hello geniuses, the reason there's a fixed supply is that the drug is under patent, a legal nicety that can be suspended for a grave public emergency. Additionally, putting pressure on the fixed supply will only force Roche to develop alternate licensing agreements with other suppliers, thus increasing the supply of Tamiflu and actually lessening the shortage. NOT stockpiling Tamiflu is antisocial because THAT leads to shortages, when you follow the economic logic more than one step away from the shortsighted idiocy that characterizes public health. In other words, the supply of Tamiflu must be seen as dynamic, influenced by public demand for the drug as well as US government ability to ensure that the patent monopoly on the drug does not turn into a mutual suicide pact.

Joel Achenbach: I have a feeling you're already well-stocked with everything.

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San Antonio, Tex.: Did you discuss cytokine storms with JT? I thought these "storms" of the immune system were supposed to be protective and beneficial rather than harmful? Do we/you/JT know that cytokines caused the hyperactive immune-system response in the 1918 flu outbreak, therefore causing the W-shaped mortality curve you addressed in your article??

Joel Achenbach: I don't know that cytokines caused the W-curve. In fact I'm trying to get my teenager to do a school paper on that. I'm afeared, dear reader, that I don't understand the unusual mortality of 1918 and was just throwing the c-storm out there as one of the ideas I'd heard somewhere along the way.

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San Antonio, Tex.: How can we rebuild vaccine production capacity in this country when we haven't solved the thorny issue of vaccine liability for pandemic vaccines?

Joel Achenbach: I think Congress is noodling this at the moment. Trial lawyers obviously don't want to give vaccine makes a blanket waiver that they can cook up anything they want and fear no consequences. Vaccines are, rarely, lethal, and a huge issue that I didn't get into in the story is whether there should be widespread vaccinations of schoolkids every year to reduce the overall mortality of the annual flu season. The theory is, schoolkids are vectors. Reduce the number who get the flu and it might cause a huge drop in the number of deaths every year, particularly among babies and the very old. The not-inconsiderable problem is that a handful of healthy kids would die of the vaccine itself.

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Anonymous: Isn't the bird flu really the most concrete evidence against intelligent design? You'd think a virus designed by a supreme being would be a little bit better at figuring out the human-to-human transmission thing. But maybe, since humans are obviously cock of the walk, the virus was designed that way on purpose?

Joel Achenbach: You have a series of suppositions that do not lend themselves to any kind of experiment or falsifiability.

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Washington, D.C.: Joel,

I thought your article was a very nice primer on the flu and its genetics, but I take issue with some of your conclusions. Among other things, there is no indication that H5N1 -won't- become a human pandemic.

But this is what bothered me the most, this statement:

"Perhaps what's truly different today is not that we're more vulnerable to disease, but that we're less tolerant of it. The idea of a loved one being swept away by a pestilence is unthinkable."

I think you highly underestimate Americans (and others) of the 20th century. None of them could tolerate the idea of their family members dying from a pestilence either, I guarantee you.

Joel Achenbach: I'm confused by your first statement -- the article doesn't say that H5N1 won't become a human pandemic. We don't know if it will. It can cause flu in humans and it's very possible it will mutate or reassort to become a human pandemic. On the other hand, it's been around for a few years and it hasn't yet, so it's possible it won't -- but who knows?

As for the more important point: Prior to penicillin, which was introduced during World War II, people commonly died of what we would consider routine infections. I'm not saying that their loved ones grieved less. Only that it is, for most of us, "unthinkable" that a cut could lead to a fatal infection.

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for Tamiflu Stocker: Recent word from Asia indicated that Tamiflu might not be effective against Avian flu.

We follow the same advice that we have followed for years: Get rest, drink lots of water, eat a well-balanced diet, and wash your hands frequently and thoroughly, and NEVER EVER shake hands with a nose picker (that's assuming that the practioner of the above rules is not a nose picker too!).

These rules have kept the flu out of our home for years! -- Thanks, MOM!

Joel Achenbach: Great advice, Mom, but do you have to ask people directly upon introduction if they're nose-pickers? That seems a bit direct.

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Oxford, Miss.: After reading John M. Barry's "The Great Influenza" one thing I was convinced of was the advantage of getting a flu shot. The best evidence presented in the book was that those individuals who contracted the early form of the virus (the very young and very old) were much less likely to die from the second, more lethal mutation. What was your take on Barry's book? I found it extremely repetitive in places.

Joel Achenbach: I think he's a terrific writer, I read parts of the book relevant to my story and also his new afterword that directly addresses H5N1, and which probably is slightly more pessimistic than the viewpoint of some observers.

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West Lafayette, Ind: Last year the media hyped "The summer of the shark" in which every shark attack was followed by a media frenzy. When the summer was over it turned out that there were fewer shark attacks than average. It seems the same thing is happening again, and instead of "shark" or "mad cow" we have "avian flu." Is there any scientific basis for how this flu season is going to be different from any other, or are reporters trying to create a story where there really isn't one?

Joel Achenbach: David Baltimore, president of Caltech, had an Op-Ed in I think the WSJ in which he went through the be-scared, don't-be-scared equation and ultimately decided that we ought to be kind of scared, all told. The media did not invent H5N1. In 1997 it started killing people, and it's different from other flu strains. I think our own David Brown has been a leader in presenting this story and getting it out there for the public and for political leaders to think about. David is a doctor who really knows this topic from top to bottom (and who was kind enough to review my story before publication). That said, of course the media collectively hype all kinds of doom stories. And as a society we're collectively waiting to be punished for our hubris. The End of The World is for some people a doctrinal certainty.

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Washington, DC: Someone very knowledgeable about the danger of H5N1 suggests that people store 5 weeks worth of food in order to whither out a pandemic if/when it starts and hits the U.S. Do you think this is wise advice? Premature?

Joel Achenbach: I'd say you ought to have a week or two of stuff sitting around in case we have a bad ice storm and lose power.

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San Antonio, Tex.: How much government funding is Taubenberger receiving for his work? How large is his staff? How many automated sequencing machines does he have at his disposal for his PCR analysis?

Also there are three different ways to manufacture vaccines. I read that the bird flu vaccine uses reverse genetics techniques. Do you know anything about this technique? How safe is it? Are producers of the flu vaccine working with a killed or attentuated vaccine or a live virus vaccine?

Joel Achenbach: San Antonio, thanks for dropping by. I can't answer all those questions in this "chat" format -- got blistas on my fangers already -- but Taub has a fairly small operation, and probably will wind up elsewhere in the government medical community when AFIP closes. I don't know his current budget. He has a couple of post-docs working in his lab and a few sequencing machines. As for flu vaccines, I believe -- emphasis on believe -- that NIH uses a killed virus and the FluMist people use a live one.

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Corvallis, Ore: It would seem to me that Dr. Robert Webster has developed the most appropriate tool for tackling avian flu. His engineering of a common human flu (I think it is an H1N1) to carry the surface proteins of H5N1. This engineered virus has been grown in eggs and is now produced as a vaccine. Rather than use this limited supply of virus as a killed, injectable vaccine, has anyone considered the possibility of intentionally releasing this virus and infecting humans around the world? Allowing this virus to then spread naturally through the human population would invoke a similar level of immune response as the vaccination, but for a vastly larger population. Akin to fighting fire with fire. Each significant strain of H5N1 could be treated in the same manner and over time, the human susceptibility to H5N1 would be greatly reduced. Such a tool could remove the teeth from newly evolving influenza and render the danger of a severe pandemic to a footnote of history. Has there been any thinking along these lines? It may seem radical but considering the potential toll of H5N1, I think the idea deserves consideration. Dane Rogers

Joel Achenbach: I have a feeling that's a public health policy [LET'S GIVE PEOPLE THE FLU!] that wouldn't go over big. But it's the first I've heard of it.

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Arlington, Va.: This may sound odd, but I am interested to hear about the dangers of avian flu transmission in the opposite direction, because I live with a parrot. He never ventures outside, of course, but should I be concerned that potentially I might bring home the avian flu and infect him just through living in close proximity? I have heard that respiratory illnesses travel between human beings and pet parrots quite easily.

Joel Achenbach: Birds can't get human flus. That's what JT told me. That's my position and I'm sticking to it.

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Seattle, Wash.: Besides funding the manufacture of vaccines, what is the government doing to prepare for a pandemic? Should we have any confidence that they would do better than the response to Katrina? Or should we just hope that a new administration is in place before it hits?

Joel Achenbach: Go to HHS.gov and look at their monstrous report on pandemic flu preparedness. It's funny that you mention Katrina: that storm more than anything helped create the current buzz over Avian Flu, as we all realized that, when the Big One hits, no one will save us.

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Boodleville, Md: Great article, Joel. One observation and one question.

First, though there's been a fair amount of discussion about the fear that the current Avian Flu might mutate into something much more easily spread human-to-human, all the assumptions have implied that when a virus mutates, it becomes worse/more lethal. But sometimes when viruses mutate, they become less lethal, or completely harmless, or non-contagious. In short, just because a virus mutates doesn't mean it necessarily gets worse. Trouble is, we don't know the odds.

OK, the question: the Avian Flu is H5N1 (I understand that because I'm reading John Barry's excellent "The Great Influenza" and because of your article). Is it possible to be immunized against other viruses that contain those components? In other words, could there be a vaccine against, say, H5N3 and one against H1N1, that, together, would protect against the H5 and N1 antigens? Alternatively, would it be possible to "graft" H5N3 and H1N1 vaccines to get something turns out to protect against H5N1?

Keep up the good work.

Joel Achenbach: Good question and I just don't know if they can mix-and-match the vaccines like that. I know that Kanta Subbarao at NIH is trying to make vaccines against all 16 bird flu subtypes.

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Lone Star State: Sanofi Pasteur is now in clinical trials of its avian flu vaccine at Johns Hopkins and with the senior population at Vanderbilt University. Is Taubenberger's work only looking at the genetic structure of various avian flus, or is he providing the information he learns about avian flu to the two bird flu vaccine production companies, the Emeryville, Calif. Chiron and the French Sanofi Pasteur?

Joel Achenbach: I think JT is consulting with vaccine makers, but I don't know if he's consulting with the commercial operations or just with government researchers.

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Denver, Colo.: How does the risk of a catastrophic bird-flu epidemic compare with the risk of a catastrophic meteorite strike, in the coming decade?

Joel Achenbach: This is the last question. Thanks everyone for showing up today!

Answer: Flu is more likely.

But here's advice: Cross at the crosswalk, and look both ways first.

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Joel Achenbach: If anyone wants more chatter on this, stop by my blog, washingtonpost.com/achenblog. Thanks!

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