PREVENTING A WORLD PANDEMIC Part 1-2-3-4 - Der Spiegel

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]PREVENTING A WORLD PANDEMIC
[/SIZE][/FONT][FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1][SIZE=+1] The Bird Flu Hunters
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By Ullrich Fichtner, Ansbert Kneip and Gerald Traufetter

Bird flu has spread across the globe, but so far it poses little danger to humans. The World Health Organization has launched an ambitious project to battle the pandemic before it jumps the species barrier. The hurdles are many.

[/SIZE][/SIZE][/FONT][FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Each question about the virus triggers thousands of new questions. "We're in the middle of the problem," says Professor Yuen, a man who clearly has trouble sitting still, as he walks to the blackboard in the windowless conference room in Hong Kong's Queen Mary Hospital. The felt marker in his hand quickly glides across the surface, and within a few minutes the professor has outlined the global history of influenza in black and white. After listing annual figures, along with abbreviations identifying the different strains of the virus -- H2N2, H1N1 -- he taps the hastily written figures and, with the top edge of his glasses forming a line across his pupils, he asks: "And what do we learn from this? We learn that we know nothing, and that every calculation is taken from thin air."

[/SIZE][/FONT][FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1] Yuen Kwok Yung is Director of the Department of Microbiology at the University of Hong Kong, Co-Director of the Pasteur Institute, a member of the famed British Societies for Pathology and Surgery and an honorary member of all Hong Kong institutes relevant to his field. He has been a teacher and researcher for the past two decades, has discovered new bacteria, has explained the world of fungi and spores, bacilli and viruses to countless students, has written close to 300 scientific papers and, together with his research team, decoded the SARS virus in Hong Kong. If anyone has the answers, he ought to be the one. But when his lecture turns to H5N1, he says that he too faces more questions than answers. What's more, everything Professor Yuen and his colleagues in other research laboratories have learned about this virus in recent years -- a considerable amount -- has only made them more concerned.

[/SIZE][/FONT][FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Yuen, a man driven by a sense of inner urgency, takes us on a hurried tour of his institute. The Department of Microbiology lies high up in the hills above Hong Kong, its windows affording a milky view of the bay and the dense, overpopulated city. It was here that they discovered the SARS virus in 2003 and, in 1997, helplessly studied the blood and tissue samples of a child, the first human victim of the H5N1 virus in history.

[/SIZE][/FONT][FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The three-year-old boy from Hong Kong died on May 21, 1997, of a pathogen that had previously affected only animals. Researchers the world over began looking into why the young boy had to die. The hunt was on.[/SIZE][/FONT] [FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Soon Yuen and his team were examining the virus under the microscope. At first its structure was indecipherable, but as the analyses progressed, the researchers unraveled its code. But the deeper the researchers penetrated into the world of H5N1, the more puzzles they found.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The question of questions -- still -- is whether the virus will jump from human to human like a cold, through an act as simple as a kiss, and whether it can then grow just as virulent as the original strain which spreads like fire through geese and ducks. If so, mankind faces an epidemic of unknown proportions, a flu pandemic that could be even worse than the notorious 1918-1920 outbreak which claimed the lives of at least 20 million people worldwide.
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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]This time around, doctors want to head nature off at the pass. The World Health Organization calls the effort mankind's first attempt to control a pandemic before it even starts. If successful, it would be the first time humanity thwarted a dangerous new virus.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Achieving this lofty goal would require constant and thorough monitoring of the entire globe. It would need a center of operations where all information about possible cases of the virus would be collected and correctly interpreted -- a sort of global emergency call center, staffed around the clock, which could be notified immediately when more people than usual show up at some local hospital in some isolated village, complaining of fever.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Geneva, Headquarters of the WHO[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Precisely this kind of effort is underway in a former movie theater in the basement of a Geneva high-rise. The building houses the headquarters of the WHO, and until recently the theater was used to show short instruction films about healthcare.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]But now the cinema seats have been removed, and the WHO has installed conference tables, computers, monitors and microphones. Everything, starting with the matte black computers, looks expensive. Instead of a movie screen, the front wall now holds six modern plasma TVs, which together form a giant flat screen.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The room, now called the "Strategic Health Operation Centre," is the agency's command post in its worldwide fight against influenza viruses, but also against Ebola, cholera, polio and the plague. It's from this base that WHO officials hope scientists will discover the sources of epidemics before they become a threat. It also represents the organization's ambitious move to gain control over the vagaries of nature, with the hunt for H5N1 presenting a model for the future.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Each morning at nine o'clock, about 30 WHO experts meet to discuss the situation. The room offers seats for 14 people; for the rest it's standing room only. The giant composite screen shows a computer map of outbreaks around the world. The words "Acute Diarrheal Syndrome" are outlined in yellow next to El Salvador. The color is significant. It means that this is a new incident about which officials have very little reliable information to date -- and also means that it could be an infectious disease. Cholera, for example. Purple is the color for "Ongoing Events," such as meningitis in Sudan and polio in Somalia.[/SIZE][/FONT]


[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Brown indicates outbreaks that are still being observed and for which there are no updates and no new infections, but also no all-clears: cholera in Angola, respiratory illnesses in China. Finally there is influenza -- bird flu -- highlighted in places like Azerbaijan and China.

[/SIZE][/FONT] [FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The group includes experts on the various regions of the globe, as well as specialists in individual diseases. Their job is to assess just how much of a threat the reports shown on the screen pose. The respiratory illnesses in China, for example, are not particularly worrisome. It just happens to be the time of the year for lung-related problems in the region. The scene at the Strategic Health Operation Centre conveys the reassuring impression that everything is under control, that there is no acute worldwide danger. But the situation would turn critical if there was a sudden jump in respiratory cases, or if they began occurring at a different time of the year.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The man whose job it is to keep a close watch on all this is a 46-year-old German named Thomas Grein, head of the "Alert and Response" team at the WHO. He and his staff make sure all current outbreaks of illness do in fact appear on the screen during each morning's meeting. His work represents the attempt to be faster than the illness itself.
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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Grein, who studied medicine in Germany, went to Australia before completing his state examinations. He later ran a hospital in Papua New Guinea and ultimately ended up at the WHO as an expert in infectious diseases. He's a wiry man who wears his shirt open at the collar and sports a sun burn from his last trip to Indonesia. His German is peppered with words and phrases in English, the unofficial language of record at the WHO.[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]"We haven't missed a single major outbreak in recent years," he says.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Hong Kong, Queen Mary Hospital[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Back in Hong Kong, Professor Yuen shows off refrigerators filled with test tubes, and in passing greets employees busy working with cell cultures in flat dishes. Almost 80 technicians work around the clock, seven days a week in his laboratories, which are considered among the world's finest. But ever [/SIZE][/FONT][FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]since H5N1 came into the world, Yuen's laboratory staff has been struggling to re-establish a routine. Everyone here seems to expect a suspicious saliva sample to appear any day -- the evidence that the deadly bomb of a worldwide flu epidemic has been ignited.[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Back in 1997, when the first wave of H5N1 rolled through Hong Kong, patients were admitted who died within days of developing pneumonia or from kidney failure. But others, who had also contracted the virus, recovered quickly and without lasting damage. The killer virus was so puzzling, in fact, that it took researchers a while to realize that it was part of the Influenza A group.
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Re: PREVENTING A WORLD PANDEMIC Part 2 - Der Spiegel

Re: PREVENTING A WORLD PANDEMIC Part 2 - Der Spiegel

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PREVENTING A WORLD PANDEMIC

[SIZE=+1] The Bird Flu Hunters (2)

[/SIZE][/SIZE][/FONT][FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]When experts at laboratories in London, Rotterdam and Atlanta studied the material from Hong Kong, they first believed that they were dealing with faulty samples, and it took many weeks before the new abbreviation for fear, H5N1 -- also known as avian influenza or bird flu -- had been spelled out.

[/SIZE][/FONT] [FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]From the start, in laboratory tests, the virus behaved in completely unexpected ways. It reproduced far faster than every other known influenza strain; it survived in environments that would have killed other pathogens immediately; it kept appearing in different forms, with constantly changing surfaces and new variants; and it was always highly pathogenic.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Yuen's department, especially virologist Guan Yi, immersed themselves in the field of veterinary medicine to follow the source of the new disease. Working secretly at first -- even off the radar of state supervision -- they collected samples of sick and dead birds in China. Later, when it became impossible to conceal their work, they received official permission to travel throughout the country.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]One of their most promising sources of material and information was practically at their doorstep in neighboring Guangdong Province, a region of small farms where man and beast have lived side-by-side for generations. Guangdong is the world's most densely populated region, says Professor Yuen, "when it comes to both humans and chickens." This makes the province an incubator for pathogens and a wide range of viruses. In fact, many waves of the flu that have struck mankind in the past had their beginnings in Guangdong.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]At Lake Qinghai in northwest China, in May 2005, the researchers witnessed a mass dying of birds, when the virus killed 6,000 bar-headed geese, gulls and cormorants within hours. They visited the habitat of the wild birds and the places where migratory birds stopped to rest, and they went to poultry markets, where they took more than 160,000 samples.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Though now common knowledge for more than a year, what the researchers discovered was unheard-of until articles from Hong Kong were finally published in the respected scientific journals Nature and Lancet. The world discovered, through the findings of Guan, Yuen et al., that wild birds also contract the virus, that migratory birds must be involved in its transport, that transmission apparently takes place between wild animals and domesticated animals and that H5N1 isn't a single virus. In fact, it seems capable of constant mutation. Even more alarming, H5N1 is clearly on its way to overcoming even greater barriers than between domestic and wild animals -- namely the barrier between animals and human beings.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]A flu virus can best be pictured as a microscopic body covered in cone-like appendages, which are formed by two groups of proteins, hemagglutinin and neuraminidase, or H and N. There are 16 subtypes of hemagglutinin and 9 of neuraminidase. The H protein allows the virus to attach itself to host cells.[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]For H5N1 to become a pandemic -- that is, transmissible from human to human -- the virus has to mutate. This change could take place in chickens, but the virus might also find another host, such as a person who has already contracted a conventional flu and who subsequently catches H5N1 through contact with (for example) an infected chicken. The different flu strains could mix their materials in the cells of this person and produce a new virus that would easily jump from human to human. That would be extremely dangerous -- because antibodies against this new mixed strain couldn't possibly exist yet.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]In June 2005, Professor Yuen published what he knows about human infections with H5N1 in the Hong Kong Medical Journal. His conclusions are all the more devastating because they reveal just how little the scientific community knows about flu viruses in general, even though scientists learned how to break them down into their individual components long ago. It's almost as if all the pieces to a puzzle were spread out on a table, but no one knew what the final picture was supposed to look like.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Geneva, Headquarters of the WHO

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]In Geneva, Grein's team, hoping to learn about a new outbreak as early as possible, has created an informational network that circles the globe. When the highly pathogenic and fast-acting Marburg virus surfaced in Angola last year, it quickly killed several hundred people. But the WHO averted a catastrophe by promptly dispatching experts to the country.[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]One hundred and sixty of the WHO's national bureaus send regular information to the center in Geneva, which also receives official reports from health ministries -- although the health ministry reports, coming as they do through official channels, often arrive far too late to be of particular use.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]It's no longer possible to conceal an outbreak of an infectious disease nowadays, says Grein, because the world has moved so close together. Rumors spread wherever large numbers of people fall ill at the same time, and rumors soon end up in the local media, as possibly exaggerated and certainly not medically substantiated news. But the reports tend to get posted on the Internet, where doctors in Geneva can read them. The WHO garners more than half of its information from Internet sources.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Each day, more than 1,000 reports that could somehow be relevant are posted on the Internet. The first reader of these reports at the WHO is a computer program, a search engine that looks for key words in seven languages, including Chinese. Each day 200 to 250 reports make it through the screening software, reports that Grein and his team must then review. Only a handful of these reports require more careful scrutiny, and maybe only one report per day is cause for true concern.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]In 2005, there were 225 such alarming reports, including 54 reports of cholera and few of yellow fever, Ebola and polio. "Influenza/acute respiratory syndrome" was in second place, with 23 suspicious reports. These are the cases in which Grein gets the local WHO personnel involved. In most cases, he says, his colleagues already have more details. They know whether the rumors are true, they've already contacted the hospitals in question and possibly offered assistance to local health authorities. The WHO can send teams to affected countries, but only with invitations from their governments.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]As the team leader, Grein usually flies along to the site. In 2004, for example, he went to Vietnam, where cases of humans contracting the bird flu virus had been reported. Grein contacted his man in Bangkok, Mark Simmerman, and they met in Hanoi. At that point, no one knew whether the victims had caught the disease from humans or poultry. Their families, employers and doctors had to be questioned. Who had been in contact with whom and when? Which path could the virus have taken?

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]This process is meant to produce recognizable patterns of infection, providing answers to questions such as: Who falls ill, and at what point, when the virus jumps from animals to humans? And what would this type of cluster look like if H5N1 were transmitted from human to human?[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Three patients had died by the time Grein left the country, and all three had become infected via contact with chickens. Given the situation, this was good news. But Grein also knew that the disease would return. His colleague in Bangkok, Simmerman, moved to Hanoi to be closer to the front between the virus and human beings.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Hanoi, Vietnam, WHO Office

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The WHO offices are in a colonial building south of Hanoi's old downtown, only a block from the "Market of December 19," where long rows of merchants sell vegetables, fresh meat, eggs and grilled dogs. Each morning, Mark Simmerman sees firsthand how fear of the virus is changing Vietnam. At stand 282, Ms. Ba has been selling nothing but dead chickens since January. Three plucked birds lie on a stand, top-quality, free range chickens with purple stamps on their skins, one from the slaughterhouse outside Hanoi and one from the government inspector who examines and gives his stamp of approval to poultry each morning between five and six a.m.[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Ms. Ba has never objected to the rules. They make sense to her, she says. After all, 93 people have fallen ill with the H5N1 virus in Vietnam, and 42 of them died -- more than in any other country in the world. She is nostalgic for the good old days when the narrow alleys between booths were full of live poultry, making the market a much livelier place. But, she adds, resistance would be pointless. "The inspectors are very, very strict," she says.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The WHO's Mark Simmerman has nothing against such severity. He's a pale American who wears a tie in hot, humid Hanoi, a man who seems intent on not making any mistakes. It would be a mistake, for example, to publicly criticize the Vietnamese authorities. It would also be a mistake to exaggerate or understate the risks posed by the virus.[/SIZE][/FONT]

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Re: PREVENTING A WORLD PANDEMIC Part 3 - Der Spiegel

Re: PREVENTING A WORLD PANDEMIC Part 3 - Der Spiegel

[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]PREVENTING A WORLD PANDEMIC

[SIZE=+1] The Bird Flu Hunters (3)[/SIZE][/SIZE][/FONT][FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]http://service.spiegel.de/cache/international/spiegel/0,1518,415816-2,00.html[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]
<script type="text/javascript"> <!-- OAS_RICH('Middle2'); // --> </script><!-- www.spiegel.de/international/artikel@Middle2 --> [/SIZE][/FONT] [FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Simmerman concedes that the business of inspections is difficult, given Vietnam's agricultural structure and its confusing communal hierarchies. The country, with its 11,000 communes, has 8 million "backyard farmers" who keep a few chickens. "A few," in this case, can mean anything from 5 to 500 birds. And then there are about 2,000 large-scale chicken farms. It's practically impossible to trace every dead chicken in this country. Instead, Simmerman takes a diplomatic approach and says: "Vietnam is well-prepared."

[/SIZE][/FONT][FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]He meets almost daily with officials from the health ministry to discuss ways the WHO's prevention plan can be used to avert the threat of a pandemic. But, as has so often been the case in the history of the UN, clear intentions rub shoulders with a murkier reality. In Vietnam's case, the WHO's recommendations are likely to fail because of a lack of medical and technical equipment, logistical capacity, communication among government agencies, reliable data and trained personnel. To make matters worse, poultry is smuggled into Vietnam from southern China every day and sold in black market stalls on the outskirts of Hanoi.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Simmerman rejects the criticism. Instead, he asks: "So? Does that mean we shouldn't make plans? Does that mean we shouldn't put together the ideal situation? I want to find out what we know, not what we don't know. We have a virus that occurs in birds. We have a virus that has already spread a great distance, worldwide, in fact. This means that we must act. At least we have to try."

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]A drive into the countryside north of Hanoi offers a glimpse of the enormous task the WHO has undertaken. It leads through farmland where, in one roadside village after the next, chickens and ducks roam free in every small courtyard, in places where the boundaries between stalls and human residences are fluid, where man and beast live in seemingly idyllic harmony.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The region was already the site of a high-level alarm in early 2005, because it appeared that human-to-human transmission of the H5N1 virus had already become reality. Hospitals were admitting infected people who had not been in contact with poultry but had still contracted the virus. A decline in the death rate also caused uproar in the medical and scientific community. In the past, 80 percent of those infected had died -- a rate that had now dropped to only 34 percent. This sort of decrease is dangerous because it often shows that the virus has adjusted itself to its new host. There were clusters, or small groups of people, such as families, within which the virus may have been transmitted.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]But in their laboratories, the scientists found nothing to support the assumption that this was a local outbreak of a human-to-human pandemic. However, they were also unable to find clear evidence to disprove the hypothesis, because autopsies are prohibited in Vietnam. As a result, what the rest of the world knows or believes about the outbreak remains unsubstantiated and hypothetical. Based on the most recent information, it appears possible that "limited" human-to-human transmission has already taken place. The fact that they did not lead to a global pandemic can only be interpreted as a good sign.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Oxford University Professor Jeremy Farrar, who treats flu patients in Vietnam, believes that fears of a global catastrophe are exaggerated. Farrar argues that "if it were so easy for the virus to jump from chickens to people, it would already have done so on a large scale."

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Veterinary brigades have descended upon Vietnam's farms and villages in the past year to vaccinate 240 million chickens against H5N1 -- an astonishing operation. All farmers were required to register themselves and their animals at registration offices set up specifically for this purpose, with the government imposing penalties on those who refused. After that, and because no further human cases of H5N1 disease surfaced, the government declared the country "free of bird flu."

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Whether this is true is anyone's guess. Even Simmerman, the cautiously diplomatic WHO officer, calls the government statement "tricky." "When a statement is phrased in such absolute terms," he says, "it's highly likely that it'll end up being proved wrong."

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Geneva, Headquarters of the WHO

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Indeed, the entire world has already been proved wrong, especially Europe. So much so that the virus trackers at the WHO's command center in Geneva have been able to keep meticulous accounts of H5N1's trail of devastation. Europe's governments and societies have felt safe for the longest time, trusting in the superiority of Western hygiene and the safety of the European agricultural industry. For Europeans, H5N1 was an Asian problem. But when the first dead birds were discovered in Turkey last October, it was clear that the virus had made its way to Europe's borders.[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]It had already taken a long journey, a journey monitored by WHO personnel.
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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1] The 1997 Hong Kong outbreak, in which 18 people fell ill and six died, at first seemed to be an isolated occurrence. But the virus returned in 2003, more aggressively than before, breaking out in South Korea, Vietnam, Indonesia and, once again, in Hong Kong.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]In 2004 it reached Thailand, Japan, Malaysia and Cambodia, where it wreaked havoc on poultry farms. But it was wild birds that took H5N1 farther afield. In the spring of 2005, large numbers of birds died at central China's Qinghai Lake, where Professor Yuen had taken so many samples. The lake is an important resting and nesting site for migratory birds. In the summer, the birds carried the virus to the north and west, into Mongolia, Russia and finally Kazakhstan. In October it reached Romania, Croatia and Turkey, and was in Ukraine by December.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Europe, which had felt so safe, wasn't ready, and Turkey became a test case to demonstrate that lack of preparedness. Of 12 infected people, four children died, three of them from the same family, infected by sick chickens the children had been playing with.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]On January 6, Grein and a four-person team went to Turkey and flew to the Kurdish city of Van, where Grein introduced himself to the local crisis team, taking pains to appear modest and avoid creating the impression that the WHO team had come to the region as inspectors. Grein asked many questions intended to ascertain that H5N1 had not been transmitted from human to human in Turkey -- an eventuality he was fortunately able to rule out. According to the WHO's most recent information, fears that the virus had changed in Turkey, making it easier for it to jump to humans, proved to be unfounded.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Nevertheless, the rate at which the virus was flying around the world had increased. Although it took eight years, from 1997 to the end of 2005, to infect 15 countries with avian flu, since the beginning of this year H5N1 has taken only four months to appear in 30 new countries, including Iraq, Israel, Gaza, Egypt, Pakistan, Myanmar, India, Nigeria, Niger, Cameroon and Burkina Faso. Nowhere in Europe has the bird flu spread as quickly than in Germany, where more than 300 cases demonstrate that the virus has found a foothold in most German states. However, Germany's infectious disease precautions have prevented human infection, as evidenced by the negative blood samples taken from those who had been in contact with infected animals. The fact that there were two deaths -- two poultry farmers who committed suicide out of despair for their livelihoods -- shows how quickly the virus can produce hysteria. Hysteria can be deadly, but so can carelessness.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Grein is especially worried about Africa. Nigeria, for example, was unprepared for the arrival of the virus. The country had no emergency plan for this type of outbreak: There was no coordination among government ministries and no crisis task force that could have been assembled. It took almost four weeks until the pathogen was detected in early February and reported to the WHO. It took nine days for the members of a crisis task force to begin work in the capital, Abuja. By early March, the WHO was already reporting 130 contaminated poultry farms in 11 provinces. In early April, the virus reached the slums and backyards of Lagos, a city of 15 million people, and probably as many chickens. To this day, the WHO lists Nigeria under its category "Human disease carriers: none." It would be amazing if that were true.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Since 2003, 113 people have died of avian flu, including 37 in the past four months alone. Whether the WHO manages to avert a flu pandemic depends first and foremost on how quickly it detects the outbreak in the first place. Computer models used at WHO have yielded a critical number: 21.[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Mankind has just three weeks to bring a pandemic under control.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Within 21 days of the first human-to-human transmission, everyone who has been in contact with the first person to contract the disease from another human must be found, examined and isolated. Each of these people will be given antiviral drugs, as will doctors, nurses and laboratory workers. For the first three weeks, the number of those who were in contact with the first patient or his family and acquaintances is still relatively small. But it increases exponentially, and after three weeks an outbreak is no longer controllable. WHO officials have prepared a list of alarm signals. If three or more individual medical workers suddenly fall ill or die, this could be the point of departure of an epidemic. If five or 10 normal citizens fall ill or die without having had significant contact with birds, this is interpreted as an alarm, as it is when a laboratory detects a new type of virus containing both human and avian genetic material. By this point, perhaps 10 of the critical 21 days have already passed.

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Can a country protect itself? Would it be effective to close borders and deny entry to anyone from affected regions? "That's an illusion," says Grein. "You have to assume that the entire world is so networked and mobile today that closing a border would give you a few days' respite at best. No more than that."

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Hong Kong, Queen Mary Hospital

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[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Hong Kong has experience with new epidemics, and the city's population is already familiar with what it's like to live in a nightmare the rest of humanity can only imagine. When the SARS virus was raging in 2003, six years after the first wave of H5N1, the city became a stage for an apocalyptic drama.
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http://service.spiegel.de/cache/international/spiegel/0,1518,415816-3,00.html
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[Snowy Owl]

Re: PREVENTING A WORLD PANDEMIC Part 4 - Der Spiegel

Re: PREVENTING A WORLD PANDEMIC Part 4 - Der Spiegel

[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]PREVENTING A WORLD PANDEMIC

[SIZE=+1] The Bird Flu Hunters (4)
[/SIZE] [/SIZE][/FONT] [FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]
<script type="text/javascript"> <!-- OAS_RICH('Middle2'); // --> </script><!-- www.spiegel.de/international/artikel@Middle2 --> [/SIZE][/FONT] [FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Hong Kong's enormous downtown shopping malls were silent and empty. Subway trains, normally jam-packed, rattled through tunnels without a single passenger, even during rush hour. Restaurants were forced to close, supermarkets were shuttered and movie theaters went dark -- all because no one ventured outside anymore, except when absolutely necessary.[/SIZE][/FONT][FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]During the SARS outbreak, everyone hid behind masks and avoided even the slightest human-to-human contact. If everything goes wrong, H5N1 could be a replay of those days in Hong Kong, except on a much larger and more damaging scale. It's a scenario that Professor Yuen likes to conjure up whenever the discussion turns to politics. As a scientist, he's a natural skeptic. As a professor, he talks about nature being "so full of surprises, so overwhelmingly complex."

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The virus's never-ending genetic mutation is random, and it has repeatedly adapted to new host animals. At first it raged only in domestic birds, where its range was restricted, but then it was discovered in wild, migratory birds that transported it across great distances. Then the virus "learned" to destroy the immune systems of mammals, killing cats, tigers and pigs. It began killing people with growing frequency, including individuals who had not been in direct contact with birds.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]As a scientist, Professor Yuen -- like many of the virus hunters who are tracking H5N1's global path of destruction -- is anxious to find the right balance between alarm and caution, the right words for a threat that, though frightening, remains unreal for many. As a politician, Professor Yuen imagines the worst-case scenario, the devastating, all-encompassing flu pandemic that will "in all likelihood occur in the near future."[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Such talk has led to the culling of 200 million birds worldwide, representing a financial loss of $20 billion. It's also prompted the UN official responsible for flu epidemics to issue a renewed warning -- just recently -- that the world must be prepared for a pandemic.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]In Hong Kong, such talk has led to an official effort to separate human beings and animals as much as possible. In December 1997, for the first time in Hong Kong's history, all poultry in the city was culled within three days, a mass killing of 1.5 million animals. When the virus returned in 2001, another 1.4 million chickens, geese and ducks were slaughtered, and after a third wave in 2002, 919,000 birds were destroyed.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The city government has decided to build a central slaughterhouse out in the New Territories, so that all live poultry can be permanently banned from markets. Professor Yuen supports this policy. The government has appointed him its scientific advisor, and he is campaigning for a major break with tradition -- a shift away from fresh markets to a city that gets its food supply through more industrialized channels. This would have an enormous impact on the city, permanently changing its appearance and its character. But, says Yuen, the proposed move is part of an effort to avert an epidemic by introducing strict hygiene and, as such, ought to convince people to bid farewell to tradition.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Animals, not just birds, have become a problem in the overpopulated city of 7 million, with a number of neighborhoods hopelessly overcrowded. When reports emerged that domestic cats could also catch H5N1, Hong Kong's garbage collectors began finding dead cats lying on the streets below the apartment building windows of their former owners.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]A ban was recently imposed on transporting live birds on buses and subways. The importation of new songbirds was stopped long ago. And in the city's major corporations, including banks like HSBC, the emergency management officers are making plans for doomsday. Will a third of the bank's 30,000 employees die if H5N1 becomes a pandemic? Will half of them simply not show up for work? Will the bank be forced to close all its branches?

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The emergency management officer keeps up with everything the WHO and the universities know about bird flu, meeting with scientists and consulting with doctors. He's constantly improving the company's virtual private network so that it doesn't loose touch with its employees if the day of days ever becomes a reality and the world suddenly comes to a standstill. He prepares lists of relative importance, from A+ to D -- "completely indispensable" to "dispensable." At the top of his list are the major futures transactions, IPOs, mergers and acquisitions. Window cleaning and cafeteria operation are at the bottom.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]A "crisis committee" consisting of representatives from HSBC's ten key departments already holds regular meetings in the HSBC Tower. The committee scrutinizes and fine-tunes scenarios and is already assigning responsibilities should the pandemic ever become reality. It seems an eerie planning game from a European perspective, but in Hong Kong, after the city's many experiences, it's merely proof of a sober sense of reality.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Hong Kong has experience with new epidemics, and the city's population is already familiar with what it's like to live in a nightmare the rest of humanity can only imagine. When the SARS virus was raging in 2003, six years after the first wave of H5N1, the city became a stage for an apocalyptic drama.[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Hong Kong's enormous downtown shopping malls were silent and empty. Subway trains, normally jam-packed, rattled through tunnels without a single passenger, even during rush hour. Restaurants were forced to close, supermarkets were shuttered and movie theaters went dark -- all because no one ventured outside anymore, except when absolutely necessary.[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]During the SARS outbreak, everyone hid behind masks and avoided even the slightest human-to-human contact. If everything goes wrong, H5N1 could be a replay of those days in Hong Kong, except on a much larger and more damaging scale. It's a scenario that Professor Yuen likes to conjure up whenever the discussion turns to politics. As a scientist, he's a natural skeptic. As a professor, he talks about nature being "so full of surprises, so overwhelmingly complex."

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The virus's never-ending genetic mutation is random, and it has repeatedly adapted to new host animals. At first it raged only in domestic birds, where its range was restricted, but then it was discovered in wild, migratory birds that transported it across great distances. Then the virus "learned" to destroy the immune systems of mammals, killing cats, tigers and pigs. It began killing people with growing frequency, including individuals who had not been in direct contact with birds.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]As a scientist, Professor Yuen -- like many of the virus hunters who are tracking H5N1's global path of destruction -- is anxious to find the right balance between alarm and caution, the right words for a threat that, though frightening, remains unreal for many. As a politician, Professor Yuen imagines the worst-case scenario, the devastating, all-encompassing flu pandemic that will "in all likelihood occur in the near future."

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Such talk has led to the culling of 200 million birds worldwide, representing a financial loss of $20 billion. It's also prompted the UN official responsible for flu epidemics to issue a renewed warning -- just recently -- that the world must be prepared for a pandemic.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]In Hong Kong, such talk has led to an official effort to separate human beings and animals as much as possible. In December 1997, for the first time in Hong Kong's history, all poultry in the city was culled within three days, a mass killing of 1.5 million animals. When the virus returned in 2001, another 1.4 million chickens, geese and ducks were slaughtered, and after a third wave in 2002, 919,000 birds were destroyed.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The city government has decided to build a central slaughterhouse out in the New Territories, so that all live poultry can be permanently banned from markets. Professor Yuen supports this policy. The government has appointed him its scientific advisor, and he is campaigning for a major break with tradition -- a shift away from fresh markets to a city that gets its food supply through more industrialized channels. This would have an enormous impact on the city, permanently changing its appearance and its character. But, says Yuen, the proposed move is part of an effort to avert an epidemic by introducing strict hygiene and, as such, ought to convince people to bid farewell to tradition.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]Animals, not just birds, have become a problem in the overpopulated city of 7 million, with a number of neighborhoods hopelessly overcrowded. When reports emerged that domestic cats could also catch H5N1, Hong Kong's garbage collectors began finding dead cats lying on the streets below the apartment building windows of their former owners.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]A ban was recently imposed on transporting live birds on buses and subways. The importation of new songbirds was stopped long ago. And in the city's major corporations, including banks like HSBC, the emergency management officers are making plans for doomsday. Will a third of the bank's 30,000 employees die if H5N1 becomes a pandemic? Will half of them simply not show up for work? Will the bank be forced to close all its branches?

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]The emergency management officer keeps up with everything the WHO and the universities know about bird flu, meeting with scientists and consulting with doctors. He's constantly improving the company's virtual private network so that it doesn't loose touch with its employees if the day of days ever becomes a reality and the world suddenly comes to a standstill. He prepares lists of relative importance, from A+ to D -- "completely indispensable" to "dispensable." At the top of his list are the major futures transactions, IPOs, mergers and acquisitions. Window cleaning and cafeteria operation are at the bottom.

[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]A "crisis committee" consisting of representatives from HSBC's ten key departments already holds regular meetings in the HSBC Tower. The committee scrutinizes and fine-tunes scenarios and is already assigning responsibilities should the pandemic ever become reality. It seems an eerie planning game from a European perspective, but in Hong Kong, after the city's many experiences, it's merely proof of a sober sense of reality.
[/SIZE][/FONT]
[FONT=Verdana, Arial, Helvetica, Geneva, sans-serif][SIZE=-1]
http://service.spiegel.de/cache/international/spiegel/0,1518,415816-4,00.html
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