Saturday, February 11, 2006

Coming soon to a neighborhood near you

The geographic spread of H5N1 infection in wild birds is picking up speed as it moves northward into Europe through Cyprus to Greece and now to Italy, where the"most part" of 17 swans are said to be infected in the south (Sicily, Puglia and Calabria) (CNN). Heading south from Turkey the virus roared into Nigeria last week and almost certainly is elsewhere in Africa undetected. North and east of Turkey, on the Caspian littoral, Azerbaijan confirmed bird infection as well.

While Turkey is the only non-Asian country to report human infections, many at risk countries in Eurasia and Africa have underdeveloped health and medical care systems that would be slow to detect human cases, not to mention poor veterinary infrastructure. Trying to stop or slow the spread of the virus by mass culling of terrestrial birds (poultry) has not stopped the virus from becoming endemic elsewhere and certainly has no chance of stopping it in Africa. Whether Europe can slow the spread in this way is doubtful. At this point we can expect the rest of Europe to become infected shortly and then it is only a matter of time before North and South America follow suit. Because east - west spread will be slower, the timing of this is still open but the speed with which the virus is now moving bodes ill.

The evolution of the H5N1 question as a matter of human health now depends on imponderables. We know too little about the biology of host range, transmission and virulence to be able to predict what this subtype can do, much less what it will do and when. But the world is now set up for a pandemic should the virus's biology permit it. Every community should be thinking hard what the consequences would be and begin to prepare.

The assault on "Big Government" that has taken place in the western democracies in the last three decades has done more than reduce "bureaucracy." It has also dealt a blow to feelings of community solidarity, the status of public service and the infrastructures of public health and the social services. Coping with a serious influenza pandemic will require all of these resources and quite a bit of good luck.

Good luck is in the hands of Fate. The rest is up to us.