Reason to be fearful?

By Tom Geoghegan
BBC News Magazine

The British public is being asked to look out for suspicious bird deaths amid fears that avian flu could reach the UK. But should humans be worried and what else is being done?

Suddenly migrating birds carry a hint of menace.

New instructions issued by ministers request that anyone who sees disease in certain types of birds should report it on a special helpline.

Although the risk is deemed low, the fear is that birds coming to the UK, especially from Russia, could be carrying the deadly H5N1 strain of the avian flu virus, which has killed 60 people in Asia.

Humans contract it through close contact with live infected birds. One way is by inhaling infected faeces which have dried out and infiltrated the air.

The latest outbreak in Turkey led the EU to ban all imports of live birds and feathers and some reports claim the virus could become the biggest threat facing the UK population.

But all the victims are thought to have had close contact with birds, and there's no evidence the virus can be easily transmitted between humans, so why the talk of a pandemic flu?

LAST CENTURY'S PANDEMICS Spanish flu 1918/19 20-40m deaths, 250,000 in UK, healthy young adults most affected Asian flu 1957/58 1m deaths, 33,000 in UK, very young and very old most affected Hong Kong flu 1968/69 1-4m deaths, 30,000 in UK, very old and those with medical conditions SOURCE: Dept of Health Q & A: Avian flu Bird watchers on flu-watch

The size of the risk to the UK is very difficult to predict, says virologist Colin Fink.

"The change that's got to take place before a human epidemic starts is the organism has to develop the ability to pass between humans and at the moment it doesn't.

"It only passes between birds and, if there's a big enough dosage, occasionally birds and humans.

"Provided it stays that way, there's no problem, but evidence suggests some similarities to the 1919 epidemic and we don't know how that started - maybe in pigs and ducks in China and then moved across."

A pandemic occurs when a virus emerges that is so different from previous strains that few people have any immunity to it.

Any confirmation that H5N1 has become capable of human-to-human transmission will increase the World Health Organisation's pandemic alert level to its highest level.

Avoid markets

In practice, that could happen if H5N1 infected someone who also had an ordinary flu virus and the two combined to make a new strain which would spread very fast.

Pandemic flu occurs about three times a century; the Spanish flu of 1919 killed up to 40m people globally, including 250,000 in the UK. Significantly, its victims were mostly healthy young adults.

Avoid live poultry in affected countries

No-one knows why this group was so affected, says Dr Fink, or whether the same would apply in a new pandemic.

The request for vigilance from bird-spotters is the first time the public has been asked to help within the UK, although people visiting Asian countries affected have been issued with travel advice.

Holidaymakers are told to avoid contact with live animal markets and poultry farms, because the droppings of infected birds are known to harbour the virus. They should also not bring any live birds or poultry products back to the UK.

The government has issued a detailed pandemic plan, setting out what it would do to minimise the spread of infection, such as stopping large public gatherings.

It has bought 14.3m antivirals, enough to cover 25% of the population, as recommended by the World Health Organisation. Half will be ready by March and the full number by December 2006.

REDUCING INFECTION Maintain good hygiene - wash hands regularly Cover your mouth and nose when coughing or sneezing Avoid large crowds of people SOURCE: Dept of Health

"If for some reason demand exceeded supply, key workers would be prioritised," says Department of Health spokeswoman Vicky Wyatt. "And then we would draw up a national treatment priority list on the basis of the at-risk seasonal flu groups - over 65s and vulnerable groups such as diabetics."

"However we don't know the precise nature of the virus so it may be it affects other groups in which case we would need to take this into account when we prioritise."

Several potential vaccines are being developed but their suitability depends on how much a pandemic strain might have mutated from the original H5N1 virus strain used to create the vaccine in the first place.

The government proposes to buy two million doses as a "strategic stockpile" to be used on priority groups while a vaccine against the exact strain is manufactured.

Farmers have been warned to adhere to the guidance issued in the wake of foot-and-mouth, which sets out how to minimise the threat of infection. It covers the moving of livestock and keeping premises clean.

Get informed

Consumers of chicken have nothing to worry about because avian flu is not a food-borne virus.

But bird-spotting is not the only way the public can help.

Getting informed about the threat and learning how to stop infection spreading would be useful, says Sarah Clark at the Health Protection Agency, who recommends reading a leaflet entitled Pandemic Flu, found on the Department of Health website (see internet links).

"It would be useful to understand the issues and understand what things mean," she says. "That's what people can be doing at the moment."

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Your comments:

It's eight years since the first case of H5N1 was seen, and it still hasn't progressed to human-human infection. If it does, the most likely method of it infecting the world won't be migratory birds, it'll be the metal birds that contain 50,000 humans at any one time all in close proximity. Bird flu would then be an environmentalist's dream. Population shrinkage and fewer flights. Provided of course said environmentalist survives.
John Airey, Peterborough, UK

I'm not too worried - SARS didn't live up to expectations, and with proper control and planning, hopefully this will be true for Bird Flu too.
Adam, UK

Excellent summary of the issues. This is far from a panic situation but vigalence is merited - far better that than a head in sand policy. Influenza virus is a fair size virus with lots of bits in it, and H5N1 is simply a description of two tiny virus peptides (H = hyaluronidase type 5 and N = Neuraminidase type 1). Imagine a wheel made of 300 spokes. If you remove two spokes the wheel remain round; essentially the wheel needs to change shape and become the right shape before a flu pandemic emerges. There are many wrong shapes and only one pandemic one. If the worst ever occurs, however, I sure hope the tube trains are shut down immediately, for there is where it will spread like wildfire during rush hour. Best precaution of all is to wear gloves, preferably leather; face masks are a waste of time. Remember too, birds don't fly from Russia to the UK direct, they do pass over most of central Europe on the way. The UK will have some warning.
Dr Chris Grant, Sacramento USA

There seems to be competition at the moment for what is the biggest threat to the UK population. Terrorism, bird flu and global warming are all favourites.
Daniel Conway, London, UK

Time to get a job as a "key worker"?
Richard Corfield, UK

I've been interested in birds for thirty years and work as a professional ecologist. I think the greatest risk of transmission to humans is through contact with feral (semi-domesticated and ornamental) wildfowl such as Mallards and Canada Geese in parks. These birds sometimes come into contact with migratory birds from Asia. The feral birds also come into close contact with people who regularly feed them. This also brings people into close proximity with their dropping which are throught to be a key source of tramsmission. Close contact between wild birds and people is relatively rare compared to close contact with feral birds. Therefore in the event of a confirmed case of H5N1 in this country immediate measures should taken to prevent contact between and feral wildfowl.
Vaughan Grantham, Wales

The actual cause of death in "spanish flu" patients wasn't the flu - it was secondary pneumonia caused by the bacteria Haemophilus influenza (so called because at one point it was believed to be the cause of the "flu" because so many patients were carrying it). This is easily treated with simple penicillin- a drug not available in 1918. It is believed that Spanish flu returned in 1957 when Britain had a big flu epidemic. The much lower death rate then was solely due to the use of antibiotics to treat secondary infections. Its also worth remembering that "normal" influenza kills 2-3000 Brits a year, so 60 deaths in the whole of asia is really pretty trivial in comparision.
Peter, Nottingham

Here we go again! If it's not terrorism, it's global warming or meteorites on a collision course with earth. The media is preying once more on our inner fears and insecurities. Although Bird/Avian/Spanish etc flu is a theoretical threat to the entire population of the planet, conversely it could also be effectively contained, or even mutate in such a way that it does not possess the potency or threat, of the worst case scenario's. Scientists line up to have their fifteen minutes of fame with dire predictions. What we should deal with is fact, and realistic predictions. Unfortunately this does not sell papers, push up viewing figures or increase web traffic. Whilst not wishing to stick collective heads in the sand, we need to take a healthy dose of realism, rationalise and not panic after reading snippets of "What if ..." doomsday scenarios.
Paul, St Albans, UK

It is not a coincidence that bird flu has spread from Asia where birds are placed in the most horrendous conditions. When will we learn (a la BSE and cows eating others in their meal) that if we rear animals on a mass scale, without concern for their well being, driven by maximising profit that such practices will eventually nip us in the butt.
Ross MacDonald, Glasgow, Scotland

I used to be research scientists at a Virus Research Institute. We had several flu experts give talks about this strain, about 5 years ago. They were predicting the worst then.... My wife and I have already bought some Tamiflu online as a precaution (we are both high risk due to medical conditions). Hopefully it will be an expensive waste of money! The Government is right to be taking this seriously, it could/will be potentially disastrous.
Dave, UK

I think the government should issue guidance to the public in the event of human to human transmission being identified. This guidance should cover things like whether to stockpile food and water, and stay indoors or not. They should also be talking to employers about the potential impact of staff staying away from work for fear of infection. If a pandemic starts in the UK, people should not be penalised for staying at home by employers. We have to put our own health, and that of our families first.
John Franklin, Uk

AS far as I understand the science, the recent recreation of a 1918 ('Spanish') 'flu analogue by a US Army group suggests that the key issue is whether, as apparently was the case for the 1918 virus, the present avian-borne virus might become more infective to humans without the prior requirement of a genetic mutation in a human host? I do not believe that many journalistic commentators have so far picked up on this point. A related possibility may be the alleged appearance in China of an anti-viral drug resistant strain. Was this the result of the alleged common use by Chinese physicians of anti-virals to treaty normal influenza in humans and the cross-transfer of anti-viral resistance from human influenza virus(es) to the avian virus?
Sandy Davidson, UK