As reported by the New Britain Herald, October 14, 2005.

Chance of Bird Flu Pandemic in U.S. Likely, Experts Say

By Jennifer Schultz , Boston University News Service

WASHINGTON -- The year was 1918.

"A strange form of disease of epidemic character" had cropped up in Spain, according to press reports from Madrid. Within a year, between 20 and 50 million people worldwide had succumbed to what was later identified as flu. When the virus finally lost its strength the following year, half of the world’s human population -- around one billion people -- had been affected.

Today, experts generally agree another influenza pandemic is inevitable. It’s more a question of when than if.

But, as Dr. Joseph Garner, who specializes in infectious disease at New Britain General Hospital points out, "This isn’t 1918."

There have been significant medical and technological advances over the past century, Garner said, whereas the global community in 1918 had very limited means of preparing and treating a flu virus that came without warning.

The global health-care community is closely monitoring a bird flu, called H5N1, that is circulating mostly within countries in Southeast Asia. Since 1997, the flu has been detected in at least 10 countries and led to the deaths of 60 people. Though transmission of the flu from birds to people remains extremely rare, the World Health Organization (WHO) has confirmed 117 human cases. It is believed that most, if not all cases, were the result of human contact with an infected bird.

"To assume it won’t happen is dangerous," Garner said of a possible flu pandemic. But he emphasized that we are dealing with unknowns, and that a major outbreak could be an issue for "the near or distant future."

Officials are worried the virus will mutate in ways that make it highly contagious among humans. Since people have no previous immunity to this strain, a geographically widespread outbreak, or pandemic, could result, something both federal and state officials, including in Connecticut, have taken measures to address.

"Three times in [the last 100 years] we have experienced pandemic [flus] and they will come again," Michael Leavitt, secretary of Health and Human Services, told health officials during a recent four-nation tour through Asia, according to the department’s Web site.

"Our preparations are not yet complete nor are they adequate," he said.

The last flu pandemic was in 1968. It was first detected in Hong Kong, according to the Centers for Disease Control and Prevention, and spread to the United States later that year. It caused an estimated 34,000 deaths nationwide. Only 11 years had passed since the previous flu pandemic, in 1957-58, this one originating in China, and responsible for about 70,000 deaths in the United States. Both pandemics were the result of human flu mixing with bird flu to create a new lethal virus.

The 1918 flu, known as the Spanish flu and by far the most catastrophic, killed more people within the shortest span of time than any other known epidemic in history.

Until last week, the 1918 virus also remained the most elusive to researchers. A team of scientists in the United States under the direction of Dr. Jeffery Taubenberger, of the Armed Forces Institute in Washington, and the CDC’s Terrence Tumpey, determined the exact genetic makeup of the 1918 virus. From this they were able to confirm that the pandemic was caused by bird flu -- not an assortment of human and bird flu like those that caused the 1957 and 1968 pandemics, according to the CDC Web site.

A development like this, said Dr. John Shanley, of the Infectious Disease Unit at University of Connecticut Health Center in Farmington, is added reason to believe the current bird flu "is something of serious concern."

He has studied the flu for the last 25 years, and said the patterns of this strain have the most significant implications he has seen thus far.

Another discomforting characteristic of this bird flu, he said, is that more than half of the people infected have died -- 60 total. Furthermore, the virus has infected the old and young, weak and strong alike. Shanley said this is proof of the flu’s aggressive nature.

So what precautionary steps are being taken?

Shanley and Garner agree that the conventional hospital system would be completely overwhelmed by a pandemic. They said that quarantines might be ineffective based on the speed and force at which the virus spreads. Increased development and production of flu vaccines and treatments, Shanley said, are the best bet for avoiding or containing a pandemic.

At present, there is no vaccine for the bird flu. The U.S. government is testing a vaccine that, based on trial experiments, looks promising, according to Garner. A challenge, as always with flu vaccines, will be mass production and distribution.

"In the event of a pandemic, Connecticut would receive anti-virals through the Strategic National Stockpile," said Matt Cartter, coordinator of the epidemiology program at the state’s Department of Public Health.

Since 1997, the department has developed the Connecticut Influenza Pandemic Preparedness Plan. The working plan is a guide for how governmental agencies and private organizations can combine efforts to minimize the consequences of a flu pandemic. There are two national plans currently available and a new plan is expected this month, Carter said. Connecticut’s draft plan will require additional revision to stay consistent with federal plans, he said.

The statewide plan calls on active healthcare professionals and emergency responders, but also draws upon a large group of qualified persons who have pledged to help in the case of a widespread emergency, such as a bioterror attack or flu outbreak. Shanley loosely compared the volunteer group to the military reserves. The volunteer group has conducted mock drills of potential emergencies, with a recent drill last year called "Top Down."

"We need to have anti-virals, we need to have vaccines, we need to have the capacity to deal with the American people and to tell them what’s happening," Leavitt said in another recent meeting with public health officials. "We need state and local preparedness. Those are vital components to a comprehensive plan."