Why worry about bird flu?

Legionnaire’s disease. West Nile Virus. Ebola. SARS. Swine flu. These and others have thrown up public health scares in recent years, but none has turned into anything really major*.

Now the media are getting us all whipped up about a coming bird flu pandemic. What’s so different about this one that makes anyone think it will turn out to be anything other than an addition to the list above?

I’m not saying a pandemic can’t happen; I just think the odds are very good that it won’t. But since that’s just an opinion based solely on the record of these other scares, I am curious to know if there is any evidence that makes scientists think that this one is really different.

*Yes, I know AIDS is major, but the only thing keeping it that way is lack of education or willful neglect.

Also, I put this in GD because I’m not sure there really is a factual answer to this. Mods are free to disagree and move to GQ.

There is a potential for “bird flu” to become a pandemic. The experts say that it is only a possibility, but the media is treating it as an almost sure thing. Seems to me that you actually answered your own question. There is nothing that the public can do about it right now, so we don’t really have a need to know. However if it does turn into a pandemic then we’ll all want to know what has been done to get ready for it (a la FEMA vs. Katrina).

A possible 7.4 million deaths is nothing to sneeze at (sorry, really bad pun). But as long as everybody stays safe, washes their hands, and keeps healthy, we can hopefully keep outbreaks low.

This, unfortunately, isn’t going to be the case with Third World countries, which is why I hope the U.N. is stockpiling vaccine and getting out there to educate people about the dangers.

I’m not doctor and I’m working from memory here: Legionnare’s spreads from poorly maintained HVAC systems IIRC. West Nile spreads by mosquitos. This limits the spread of both of these (i.e. they don’t spread human to human afaik). Ebola and hemorrhagic fever aren’t generally airborn (they spread by contact)…and they kill so fast that its difficult for them to spread widely (if you die before you can get out of the village you caught it in then thats as far as it goes). Also, they are more tropical diseases IIRC so they won’t thrive in colder climates. SARS and Swine Flue ARE dangerous (look what both of them have done in the past, especially in China)…they just haven’t materialized into wide spread world wide pandemics (yet). They (and ‘bird flu’) are so dangerous because they have longer incubation periods, take longer to kill you, and worst of all are air born. All those factors COULD potentially make them a nightmare.

Remember that the absolute worst pandemic in history was a flu variant (Influenza Pandemic at the turn of the century). ‘Bird flu’ has the same potential to wreak havoc. Whether it will or not is another story.


Don’t blame the media for this. The medical and scientific communities have been pushing the panic button on avian flu for many months now - at about the same level of apocalyptic rhetoric - with practically nothing seen in the media. In fact IMHO the media has been surprisingly slow to pick up on it, and for some reason really only did so now that u.s. politicians on both sides have begun to start to talk about it.

Thanks to all the posters. I was of the opinion that the media was just yet again going for hype, as they usually do. But I hadn’t really considered that, at times, media hype can be extremely valuable in getting politicians to act responsibly. And the responsible thing to do is to shell out aggressive funding to produce an effective infrastructure for dealing with any pandemic, not just bird’s flu.

My meager understanding is that most of the deaths from the 1918 flu epidemic was from bacterial infections that set in after the flu first hit its victims. Today’s wide availability of antibiotics should seriously mitigate the potential threat there.

It was the scale of the thing. On such a scale a health system would quickly be overwhelmed and folks would die of things that are preventable. I agree though that modern mdeicine would mitigate somewhat the potential threat. I still think that its a serious threat even today, and not one to be taken lightly. Just lookup sometime the world wide annual death toll from influenza (its pretty small in the states and Europe, but larger in developing countries IIRC)…and this is without an extremely virulent version running amok.


Yes, but the current bird flu is very deadly very quickly.

Let’s say we’re in the media, assessing the right response to the threat bird flu. To do so, we want to calculate the expected number value for the number of people who will die. That value is calculated as the probability of an outbreak multiplied by the number of people anticipated to die should an outbreak occur.

When a new, potentially devastating disease arises somewhere in the world, how do we assess the risk of it. The probability of any particular disease becoming a pandemic and killing millions worldwide is very small. However, the potential expected deaths should the pandemic occur is huge. Thus the product can still be huge and worthy of attention.

For instance, let’s suppose the odds of bird flu going pandemic are 1 in 20, or .05. Suppose the expected worldwide deaths during a pandemic are 10,000,000. Then the expected value for the number of deaths from bird flu is 500,000, or half a million. That’s more deaths than the tsunami last year, and almost 500 times as many as Katrina.

Actually, as far as I remember, I’ve always heard flu specialists warning that a major and deadly pandemic was unavoidable sooner or later (more or less like a major earthquake in the US west coast). So, it has been a major cause of concern for…essentially forever.

Well, no, the number of deaths would be either 10,000,000 or 0, nothing in between is even possible much less expected. Bipolar distribution, not Gaussian. The number that matters is 1 in 20.

IOW, the average person has one ball and one tit.

Certainly it is a matter of fact that the world is overdue for another pandemic and the world failing to be ready for this one would be unconscionable. But that is the difference this time, isn’t it? This time we have a good guess at what the next pandemic will look like and can be prepared. The chest beating of the scientific community has been along the lines of making sure that the levees are fixed, even if we do not know that this will be the year of a Katrina. And while the US has been slow to pick upeparedness speed, others have heeded the call. The WHO has a pandemic task force with a rapid response team. There is an international plan in place and fortunately for us it is not run by Bush’s FEMA. Models show that a rapid response of three million courses of Tamiflu at a ground zero would stall an initial outbreak in its tracks (see Science 8/5/05, for example) and give the rest of the world time to respond. Roche Labs has, without much fanfare, donated those three million courses to the WHO. Vaccine development and production has been moved up in priority. And this avian flu may not even be able to reassort into a pandemic capable strain, or may lose much of its deadliness as it does. Concern and preparedness is prudent (because even if this strain doesn’t do it, another eventually will), but the sky is not falling. And for sure, don’t forget about the flu that is the devil we know. Perhaps preparedness for a pandemic strain will include improvements to the systems to produce and supply those vaccines more reliably as well? We can only hope.

Well, sort of. But that’s sort of like saying that NOAA’s always been warning about hurricanes, so what was different about the Katrina warning? The fact is that WHO has been specifically warning about the pandemic threat of this particular flu using increasingly scary language since at least January. It’s been all over the science magazines and journals, e.g. The Lancet published an editorial in March entitled* Avian Influenza: Perfect Storm Now Gathering? *, etc. and if you were listening all of the infectious disease people have been talking about this flu all the time all year. I’m not saying that means it’s definitely going to hit - I’m just saying that the rhetoric isn’t coming from the media. The direction this rhetorical flow went: medical community---->politicians---->media for the most part, as I observed it.

I agree with that. Actually, I thought that what I said was supporting this idea (it’s not a media invention, it’s been a worry within the medical community for a long time).

Oh I see. I thought you were implying that this particular scare is coming from the media since you thought the medical community wasn’t doing anything different.

I can’t find it on line, but there was a critique of the avian flu scare in The New Republic a few months back. Their take home points:

The avian flu will be a bust, just like every other flu scare/epidemic since the big one in 1910

Why is it that people focus on the epidemic of 1910 and don’t analyze why all the flu epidemics since then haven’t had nearly the same impact?

The reason why there was a pandemic was due to the specific conditions of World War I - i.e. thousands upon thousands of young people squeezed together in very close proximity at a time when they were extremely immunosuppressed. This allowed the level of virus in the environment give rise to a pandemic.

Their point was - unless we experience a World War I like scenario we aren’t likely to have a repeat of the early 1900’s.

Remember - just because some scientist says something doesn’t make it any more likely to occur than not. Think of all the scientists who fortold the Y2K bug.

Many effort hours and lots of money went into making sure that the Y2K problem fizzled. What would have happened without that effort is unknowable - certainly not the End Days scenarios predicted by some media, but certainly not nothing. If nothing else there would have been a decent economic impact and some ripple effect thereof. Of course the problems were triaged to make sure the more critical things were taken care of first.

It’s unknown, until it happens, whether we’ve been dodging a bullet by luck. If health care organizations, doctors and governments do a good job and stop another pandemic from happening it will be a non-event with regards the media. Nothing happening is not news.

Net, pandemics happen. The last one was in the 1960s (1968?) and was a bit of a fizzle. How severe they are is somewhat up to us, and a bit luck of the draw of the particular illness.

[nitpick]The Spanish Flu pandemic was in 1918, not 1910.[/nitpick]

First off, scientists are not saying that this particular virus will turn into a pandemic. They are saying that it is a significant risk and that we are, by historical measures, overdue for a pandemic. A pandemic is very likely to occur sometime, just like an earthquake is likely to hit LA and a hurricane was likely to hit NO. No one can say exactly when. This particular virus is the equivilant of a hurricane in the gulf picking up steam heading towards NO. It could fizzle. It could veer. This virus may not be able to reassort into a potent human transmissable bug. Or it may lose its deadliness as it does. No one knows. But not being prepared would be stupid indeed.

For some actual facts see the CDC’s pandemic page.

1918 was indeed the big one and caused 500,000 deaths in the US alone, 50 million deaths worldwide. 1957 had fewer deaths, 70,000 in the US. 1968’s pandemic had 34,000 US deaths. Not exactly a fizzle but no 1918. No one knows what made the 1918 bug so bad. Guesses include features of the bug itself (although it fatality rate was much much less than the avian’s is) or features of society. Expert estimates of a medium level pandemic hitting an unprepared contemporary US would be anywhere between 89,000 to 207,000 dead and $71 to 166 billion in costs. A more potent bug would dramatically swamp the ability of the healthcare system to care the ill and result in many more deaths. OTOH, costs and deaths could be minimal if the world takes advantage of knowing what is possibly over the horizon and gets a jump start on vaccine development/production and puts in place plans to slow a nascant pandemic at its start with vigous measures at an idenitified groud zero. Which is exactly what is being done. So with any luck this will fizzle, eiher because the avian flu can’t do it, or because we were ready for it. Again, no need to panic. Big need to have international plans in place and then be able to sleep easy.

If an avian flu virus becomes anything like the one in 1918, what are the chances of it doing more damage than back then? If it does the same damage percentwise, you are looking at something like 120-130 million people dead worldwide (~2 billion people worldwide in 1918, while something like 6 billion now). Of course now we have a greater knowledge of viruses, we have methods of isolating it, seeing it coming and dealing with quarantine. On the converse side, we also have much more global movement, an exponential amount more.

So are the two at equilibrium, or does the knowledge tip us towards being safer if it were to strike, or in more danger because of the increased global travel?