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Monday, 10 January, 2000, 16:13 GMT
Flu: Planning for the big one

Graves of victims of the 1918 Spanish flu pandemic


The death of 33-year-old Welsh rugby star Kieron Gregory is a disturbing reminder that even for the young and fit, flu can be a killer.

Flu nightmare
Mr Gregory died of a heart attack after being admitted to hospital with the flu-like symptoms of chest pains and a headache.

The news came as Professor Liam Donaldson, the government's chief medical officer, claimed the UK was in the grips of a flu epidemic.

Yet medical experts are quietly counting their blessings. Like edgy seismologists monitoring tectonic movements on America's West Coast, they are still braced for the Big One.

In this case it would be a flu pandemic - a highly virulent strain that would cause infection on a global scale and maybe wipe out millions of sufferers.

A poster warning of the virus that killed 40 million
The Spanish flu pandemic of 1918-19 claimed 40 million lives, including 280,000 in the UK, in less than 12 months.

No war, famine or other virus has ever killed so many people in such a short period.

Since then there have been two other pandemics, in 1957 and 1968, each of which also killed millions around the world.

"People have no way of predicting when another novel virus will arrive," says Alan Hay, director of the World Health Organisation's influenza centre at the National Institute for Medical Research in London.

"All we can say is that it will happen."

Virologists at the WHO's headquarters in Geneva are constantly on the look out for "novel" or "new" flu viruses.

The strain currently now sweeping across the UK is not a new flu virus, but merely a variant of one that has been present in previous winters.

Genetic jump

The virus has simply drifted and, to a greater or lesser degree, we have partial immunity.

A novel virus however, would constitute a genetic jump or shift in the makeup of the virus. It is this, coupled with the characteristic of being communicable between humans, that has the makings for a pandemic.

Chickens were slaughtered in Hong Kong after the 1997 virus was detected
Recently, there have been scares. The outbreak of chicken flu in Hong Kong two years ago struck 18 people and killed six of them.

But evidence suggests the virus in question, which became prevalent in a live bird market, was generally only communicable between birds and humans.

Human to human transmission was either not possible or "probably very inefficient", says Mr Hay.

Public health supervisors quickly ordered all chickens and other birds in the market be exterminated and the virus was defeated. Without such swift action, the strain could have adapted and spread between people.

So are we ever likely to see a repeat of suffering on the 1918 scale?

Global threat

Potentially we have a worse situation because of the explosion of international travel in recent decades.

The 1957 attack of Asian flu took six to seven months from being isolated in China to peaking as an epidemic in the UK. Some estimates say today it would take just four days for a deadly virus to circle the globe.

Experts with the WHO are on constant lookout for a new flu strain
The Department of Health document Planning for Major Incidents recognises this, noting the global spread of the next pandemic could "reasonably be expected to be faster than previous pandemics".

But advances elsewhere mean the death toll could be greatly limited, especially in developed countries, says John Oxford, professor of virology at the Royal London Hospital.

Improved communications and the WHO monitoring work mean a deadly strain could be isolated more quickly, allowing medics more time to formulate a vaccination.

Production facilities also now exist to make large quantities of the vaccine - although the full process might take six months - and there are now three new anti-viral flu drugs.

Finally, antibiotics, while ineffective against viruses, would be crucial for tackling infections that many victims would develop as a result of flu.

And while the UK Government may be under fire for being caught on the hop over the current epidemic, it is one of only 12 countries around the world to have developed an action plan for dealing with a pandemic
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See also:
05 Feb 99 |  Health
Race to find key to killer flu
10 Jan 00 |  Health
Flu crisis deepens

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