And in flew Enza

While the corporate media regularly stir up mass hysteria about such very minor problems as West Nile Virus or Eastern Equine Encephalitis, good old flu kills around 40,000 Americans in a typical year. Most of these people are already debilitated for one reason or another, usually advanced in age, and we accept this as part of our condition -- although occasionally young and healthy people succumb, for unclear reasons.

But there is always that possibility of the return of an especially virulent strain of influenza, as in 1918. That world-wide pandemic caused a dramatic spike in the death rate in the U.S. and elsewhere, killing as many as 100 million people.

Michael T. Osterholm in the new NEJM reviews our current state of preparedness. The threat of such a pandemic is substantial, because of animal husbandry practices in Asia in which swine, poultry and humans are in continual contact, giving the virus a chance to migrate among species and undergo continual genetic recombination. There are several problems:

1. Influenza vaccine production still uses a 1950s technology in which virus is incubated in chicken eggs. It takes six months and 350 million eggs to make the 300 million doses used annually. This technology is nearly impossible to ramp up to a larger scale, and slow to respond to new strains.


2. The U.S. has little or no "surge" capacity to respond to a pandemic. We have only 105,000 mechanical ventilators, most of which are already in use at any given time. Ventilators would not be available for the tens or hundreds of thousands who would need them in a repeat of a 1918-style epidemic.


3. We have inadequate plans for creating, equipping and staffing the temporary hospital space that would have to be set up in such places as high school gymnasiums.


4. If a deadly flu were to emerge in Asia, most countries would close off international travel to try to contain it. World commerce would grind to a halt and the economic effects would be devastating. Only the ability to quickly create and distribute millions of doses of vaccine, or to attempt containment using antiviral medications, could persuade countries to allow international flights to continue.

But (and now this is Cervantes talking, not Dr. Osterholm) all our time and money for emergency preparedness is going into these preposterous bioterrorism drills. The states have been given federal grants to pretend that somebody sprayed anthrax (which is not contagious) around and everybody for miles around has to show up at a particular hospital to get a dose of ciprofloxacin. These drills are controlled by public safety officials -- police and firefighters -- not public health and medical officials. They focus on issues like what to do when 10,000 cars show up at a 300 space parking lot, and people start fighting to get to the head of the line. This activity does absolutely nothing to enhance our capacity or our readiness to respond to events which are actually likely in the real world.

Oh right, 9/11 changed everything. Reality is so last century.