Why should I be concerned?

Influenza pandemics happen. They are inevitable, like hurricanes and earthquakes(1).

  1. The last severe flu pandemic was in 1918, when the H1N1 influenza A virus emerged from bird populations and gained the ability to infect humans(2).

  2. Between 1918 and 1919, the Spanish Flu claimed between 50-100 million lives around the world; more than were killed in all of World War One(3).

  3. The 20th Century saw two other flu pandemics, the Asian Flu of 1957 and the Hong Kong Flu of 1968. These pandemics were the results of slight mutations in existing human flu viruses, unlike the novel virus responsible for the disastrous pandemic of 1918.

Every year the world experiences seasonal influenza, which normally kills thousands of elderly people world wide and occasionally young children. Flu spreads incredibly quickly and a slightly mutated strain circles the globe every year. Because of previous experiences with a similar virus and vaccinations, most of us don’t worry about seasonal flu, especially if we are young and healthy. Because the Spanish Flu resulted from a newly emerged flu for humans, virtually no one had immunity. When we encounter a novel flu virus, our immune system can act against us. Overreacting to the invading virus, the immune system overloads the body in what is called a “cytokine storm” and causes massive internal damage. In 1918, there were many more flu deaths between the ages of 15 and 45 as from the seasonal flu (as seen below):

 

graph 2
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“The difference between the influenza mortality age-distributions of the 1918 epidemic and normal epidemics. Deaths per 100,000 persons in each age group, United States, for the interpandemic years 1911–1917 (dashed line) and the pandemic year 1918 (solid line).”(4)

Today, one of the most likely candidates for the next flu pandemic is H5N1. The virus, which has circulated in bird populations for decades, began infecting people in 1997. 18 people were confirmed with having caught the virus from chickens in a Hong Kong live wet market; 6 of them died. The virus resurfaced in humans in 2003, and since then it has infected a confirmed 328 people and killed 200 of them:

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Additionally, several cases of human to human transfer of the virus has recently been confirmed by the World Health Organization and Center for Disease Control(5). Like the Spanish Flu of 1918, H5N1 finds most of its victims between the ages of 5 and 40 (seen in graph below):

graph 3
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With the inevitability of flu pandemics and the rapid mutation of the highly virulent H5N1, the situation seems quite dire. Historically, traditional pandemic theory says we can expect the next pandemic to arrive in 3 waves, each lasting 6 – 8 weeks separated by several months at a time. Though medical technology has come quite far since the last severe pandemic, medical professionals are not optimistic about our capacity to manage the next. Vaccines, our primary weapon against the seasonal flu virus, take months to develop and produce after a strain has emerged. Experts predict they will be unavailable for the first 4-6 months of a pandemic. Antivirals are also used to fight flu once symptoms appear, but they are severely under-stocked and are already encountering resistance from H5N1(6). With the American health system already pushed to its limits at current capacity, the immediate influx of critical patients will cripple the system at the onset of a severe flu pandemic.

Perhaps the most threatening aspect of a flu pandemic is worker absenteeism. Studies predict 30-60% worker outages worldwide for the duration of a pandemic(7). The global economic system based on just-in-time delivery of all goods will be significantly jeopardized under these conditions, experiencing shortages in every sector as illustrated in this manual (PDF). Additionally, critical infrastructure will suffer from supply and worker shortages, affecting our police, firemen, medical personnel, electrical workers, truck drivers, etc. When all the implications of a severe flu pandemic come to light, the disastrous implications are endless.

But all is not lost. As Dr. Nabarro of the World Health Organization said, "...we have god given time to prepare"(8). For the first time in human history, we have the ability to track a virus before it turns pandemic. We can be the first generation in human history to prepare for a pandemic. Our government is talking about it, but plans lack immediacy and communications with local communities(9). The media reported on “Bird Flu” sensationally when H5N1 re-emerged in 2003, but reporting has fizzled out (despite the growing number of cases every year between 2003 and 2006). Today, almost every community in America remains all but entirely unprepared. That leaves we, the young, educated students of the nation, who will inherit the future and have the most to lose, who must inform and prepare the nation.


Some organizations have begun to prepare and can serve as examples for future actions from communities and industries across the nation. One example is our very own Columbia University, who this summer released a plan to cope with the next severe flu pandemic, as well as an FAQ designed to educate students and faculty(10). Some towns, like New Canaan in Connecticut, have begun to inform their citizens and urge community and individual preparation(11). And every day, more people are learning about the potential H5N1 pandemic. Many are stockpiling in their homes for their families. Some are taking action to prepare their neighbors, businesses, and local communities. As students, we cannot sit idly waiting for our parents and leaders to take notice and prepare. We will inherit the future. Our lives are most threatened by this virus. We have the power to have our voices heard. We must take action now to prepare our families, our communities and our nation. 

As students, we are influential members of vast and important communities: our college campuses. With thousands of people, including students, faculty and other staff, our universities must be prepared to act as community leaders in the event of a pandemic. One example of a good university plan is that of Columbia University, which both informs and outlines procedures for mitigating the effects of a pandemic on campus: http://www.columbia.edu/cu/studentservices/preparedness/Besides canceling classes and evacuating, campuses should prepare to accommodate students and faculty members who may not be able to return home in the event of a pandemic due to quarantines and closing of borders, both internationally and locally. A university like Columbia, which is home to many students from distant nations and states, should stockpile food, water and medicine for members of its community who may not be able to evacuate in the event of a prolonged disaster.

As centers of academia and study, universities should be leaders in the effort to educate the nation on the threat of pandemic influenza. They should also act as major forces for preparation as leaders of their local communities and educational authorities on the national level. Students and faculty alike must come together to help put this country on the right track towards preparing for this inevitable disaster.

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Reference:

  1. Medical News Today, “Bird Flu Pandemic Inevitable”
    http://www.medicalnewstoday.com/articles/16945.php

  2. Center for Disease Control, “1918 Influenza: the Mother of All Pandemics”
    http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm

  3. Washington Post, “World Death Toll Of a Flu Pandemic Would Be 62 Million: Study Examined 1918-19 Outbreak”
    http://www.washingtonpost.com/wp-dyn/content/article/2006/12/21/AR2006122101466_pf.html

  4. Taubenberger, J; Morens D (2006). "1918 Influenza: The Mother of All Pandemics"
    Emerg Infect Dis 12 (1): 15–22. PMID 16494711

  5. Center for Disease Control, “Key Facts About Avian Influenza and Avian Influenza A (H5N1) Virus”
    http://www.cdc.gov/flu/avian/gen-info/facts.htm

  6. Medpage Today, “Avian Flu Virus Showing Resistance to Tamiflu”
    http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/tb/1850

  7. South Canterbury District Health Board, “Why Worry About Bird Flu?”
    http://www.scdhb.co.nz/index.php/pandemic-planning/why-worry-about-bird-flu

  8. Avalution Consulting, “Using Our Time Wisely”
    http://www.avalution.com/Perspectives/Lists/Posts/Post.aspx?List=84617ae8%2Def98%2D4ebb%2D9dda%2Db6f73f4b5466&ID=29

  9. North American Pan For Avian & Pandemic Influenza: August 2007
    http://www.spp.gov/pdf/nap_flu07.pdf

  10. Columbia University, “Pandemic Flu Response”
    http://www.columbia.edu/cu/studentservices/preparedness/

  11. New Canaan’s Office of Emergency Management, “Guide for Preparing for a Pandemic Flu and Other Emergencies”
    http://newcanaanready.org/PDF/FluFlyer-new.pdf

 

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