Wednesday, August 10

Dave Schuler and Pundita chew the fat about battling Avian Flu

The letter from Dave Schuler at The Glittering Eye raises five points, so I have inserted my replies after each point.

Dear Pundita:
I'm back from my visit to St. Louis and trying to catch up. I've just finished reading your extremely interesting series on China and the potential avian flu pandemic. Here are my comments:

1. One small technical correction. The avian flu in question is caused by a virus. Antibiotics have no effect on viruses. Consequently, giving antibiotics to domestic fowl has little or no effect on the development of the avian flu virus. What is being claimed is that Chinese farmers have given anti-VIRALS to their domestic fowl:

Re #1. Thank you for the link; the report throws some light on the murky reading of the law in China about the use of human anti-virals on chickens. I was unaware that anti-virals are still being used in China in this fashion, although I wasn't shocked to read about reports that this is still occurring.

I think one of my recent essays mentions the overuse of "medications" during past years; a better choice of words would have been "anti-virals." But yesterday's essay specifically mentions feeding human "antibiotics" to chickens (in the attempt to stave off an avian flu outbreak in 1997) because my understanding is that this happened -- even though, as you note, it would be useless to apply an antibiotic to a viral infection. So it seems many farmers in China didn't initially realize what they were up against; by the time they did, the "1997" strain of the A(H) virus had mutated.

This said, your comment and the information in the article you reference raises the question of whether antibiotics were indeed used in the manner I described; the practice might have been limited to anti-virals. Interested readers might want to research the question on Google.

2. You mention bulldozing of villages in China by the army. If it's actually going on, our intelligence community certainly knows about it: it would show up on satellite imagery.

Re #2: Your reasoning is correct.

3. Frankly, there's probably little we can do about avian flu. By the time we know that a virulent human-transmissible version has shown up it will be too late to actually stave off a pandemic. If we don't already have stores of anti-virals (and I'm pretty confident we don't), we probably can't ramp production up fast enough to make a significant difference and I can't imagine Western governments acting fast enough.

Re #3: Stop and think: Has H5N1 put a man on the moon? We're going to beat this little bit of protoplasm. What we might not beat, unless we put more energy into it, is the Chinese Communist Party's famous Denial & Deception program, followed by the D&D program of every government who believes that if you just sit there and make the sad eyes, the rich governments of the world will come rushing to your aid.

Since the start of this blog my message to people from such countries has been, "For your own sake don't keep counting on the help." Just a change in weather patterns could eat up all the spare financial resources of the world's rich nations by the end of this decade.

True, there is only a small window of opportunity to ward off a supervirus pandemic, but we shouldn't be thinking in terms of either-or. Every intelligent action that we take to limit the spread of pandemic would help brake its spread. Every bit of effort helps.

At the end of the day we will put H5N1 out of commission; what happens between then and now depends a great deal on human efforts. Those who would say it's all in God's hands aren't thinking straight. The human race can't strengthen and mature without facing trials. So the old saying, "Pray but row away from the rocks" applies greatly to dealing with the threat of pandemic.

4. To my jaundiced eye the real problem is the conditions of life in rural China. Large numbers of people living in very close conduct with domestic livestock in poor sanitary conditions. The practice of feeding the dung of domestic fowl to pigs aggravates the situation. Sort of a "perfect storm" for developing new strains of disease.

Re #4: Pundita nearly keeled at your news about the practice of feeding fowl droppings to pigs. I had assumed that the H virus was passed to pigs simply from their snuffling around infected bird poop inadvertently plopped in their midst.

This said, the general conditions you describe about rural China apply to virtually all "undeveloped" regions of the world. Yet the nature of the virus makes it just as likely that the supervirus could materialize from a human flu bug caught by a poultry worker in a very modern, clean plant in the developed world. The human carrier of the supervirus could be anyone who is exposed to a more easily transmittable version of H5N1 and a human flu bug.

That is why rapid response, good data collection and full reporting are the key to limiting the spread of a superpandemic. The warning applies to the developed countries as well.

If you want a stomach-churning experience, read about some of the foot-dragging that took place right here in the USA with regard to a less virulent strain of the A(H) virus that spread among some chicken farms in 2004.

Some of the affected chicken farms were not Mom&Pop enterprises. But no matter the size of the business the owners faced the same situation that chicken farmers battling H5N1 were facing in the poor countries: loss of their entire business. So at that time the tendency both here and abroad was to try for half-way measures at first, such as quarantine, instead of killing the entire flock. The excuse here was that the strain as not as virulent as H5N1.

There was other astounding stuff going on in the US while the H5N1 epidemic was raging in Asia. One news report was about sending a batch of diseased chickens to market and putting them in stalls along with other livestock for sale! If I recall this was in south Texas, where a large Mexican immigrant population likes to buy live chickens then slaughter them for food as they do in their country, instead of buying supermarket dead chickens.

Then I think some official read the headlines about H5N1 and yelled, "Holy Shit!" So then they went running around looking for the diseased fowl in the open-air markets to remove them. That was like looking for a needle in a haystack until of course the chickens keeled over dead.

Don't quote me on my recollection of that report but it's in the ballpark.

The moral of the story is that the bottom line is exactly that. With many business owners, if they can find a way to save their business they will. So, since 2004 a massive education program has been going on in the USA. The CDC and the chicken dealers' association and whatnot have given the direst warnings. We hope the warnings have sunk in.

Are conditions better in China than say the US for making and spreading diseases? Sure. But H5N1 is a very democratic virus -- rich nation, poor nation, it doesn't care. Nor does it have a preference for rural surroundings or antiquated chicken processing facilities. It can strike in the most modern facility and in the middle of a big city.

This said, one can and should heap blame on China's government for massive Denial & Deception about H5N1 in their country. More than the virus itself, China's attempt to cover up the situation has been the most deadly aspect of the situation -- although China can't be singled out in this situation. Across the board, poorer countries that export chickens have been slow to report on disease outbreaks among fowl -- and until virologists yelled and screamed and jumped up and down, slow to kill off flocks.

None of the above overturns your points. In a highly globalized trade environment, traditional rural practices with regard to livestock, whether in Thailand, India, the African continent or China, are indeed a laboratory for highly infectious diseases.

The other side of the story is that man, bird and animal have been living in close quarters since our time began. We have built up a lot of antibodies. So there is a certain artificiality about the present situation -- a sign that overuse of medications and powerful disinfectants might have have weakened human immune systems.

Did you ever read Agatha Christie's Come Tell Me How you Live? It's a fascinating account of her experiences while accompanying her second husband to an archeological dig in the Middle East. That was in the 1940s, if I recall. She told of the incredible strength of the immune system of Arab nomad tribes she encountered. When it came to recovering from illness, they were like supermen in comparison to modernized peoples who are born and raised with scads of medication and in "clean" enviornments.

However, another side of the story is the tragedy that befell Tibetans when they came down from the high altitudes in Tibet to live in refugee camps in India. They did not have a tradition of bathing or washing their clothes. That tradition allowed natural oils to build up on the skin, clothes and hair, thereby protecting them from skin cancer from the merciless sun at very thin altitudes. And the sun at that altitude quickly killed the kind of bacteria present in Tibet during that era.

But in the Indian climate the traditional daily bath of the Indian and the daily change into clean clothing is vital protection against a host of bacteria that live at lower altitudes and less intense sunlight.

The Tibetans refused the Indian doctors' pleas to bathe and wash their clothes. The Tibetans died in great number; probably more died that way than at the hands of the Red Guard in Tibet.

5. By the way, face masks won't do a damned thing. They won't filter out something as small as a virus.
Dave in Chicago"

Re #5: Good point; however, I stress this isn't an either-or situation. Estimates vary but assume that roughly half the people who are exposed to H5N1 survive the experience. Assume also it will be about the same for those exposed to a supervirus. So survival for many who face pandemic will come down to the strength of their immune system.

When it comes to beefing up the immune system, every little bit helps because the less strain on the system from other challenges, the more it can muster resistance to a killer virus.

To the extent a face mask can help protect the immune system against "nuisance" challenges -- common cold germs, allergens, pollutants and so on -- it is worth it to wear one when a flu epidemic sweeps through, even though the mask won't protect against inhaling airborne virus.

There is also psychological value to wearing a mask: a physical reminder to the wearer and a visual reminder to others to take precautions during a flu epidemic: not to cough indiscriminately, not to stand too close to others if it can be avoided, and so on.

Of course wearing a face mask is an extreme measure but if the flu season this year is a doozy not a useless one.

It's vital when thinking of strategies not to overlook routine and small things when trying to build up the immune system. Start now and throughout the coming flu season to:

> Pace yourself
> Get enough sleep, sunlight, and exercise
> Remove as many emotional stresses as you can
> Eat as healthily as possible

> Tend now to minor health problems; e.g., ingrown toenail, gum disease, etc. Every small stressor you can remove from your immune system is a help.

> Wear closed shoes -- give up sandals and going barefoot in all but the most pristine outdoor environments and inside the house.

> Observe the 30 second rule when washing your hands and keep your fingernails and toenails cut nearly to the quick.

> Build up healthy intestinal bacteria by eating yogurt, etc.

> Don't go overboard with antibacterial soaps but take special precautions when handling raw meat including chicken and be sure it's properly stored and cooked -- and the store wrappings carefully disposed of.

> And for heaven's sake get a flu shot even if you hate them and think they're useless.

All the above are simple things, things we've heard for years from health experts. Now is the time to put them into practice. However, Americans tend to have a boom-and-bust approach to health matters. We go overboard or we're lax. We should aim for balance.

We need to practice patience: take tiny, regular steps to better health so we don't feel overwhelmed by the task then ditch it. Remember the story I recounted about Félix Houphouët-Boigny's approach to restoring health?
I used to know many Houphouët stories by heart. The one I remember best, after all these many years, as how he got control of his ministers in his old age. He was slowing down, unable to walk without assistance. So he consulted with his doctor; he explained that his ministers were losing respect for him because they were seeing his physical decline.

The doctor observed that it was a matter of rebuilding stamina; with old age had come a very sedentary lifestyle. The doctor warned that too much activity after all those years of being sedentary could damage his health severely and to build up stamina slowly.

Houphouët took the advice to heart. In private, he began with counting out his steps, and adding a few more steps every day, until after months of this he could walk miles without tiring. But all the while he did this, he kept up his old man's gait in the presence of his ministers.

Until one day he called them to walk with him. To their astonishment he set off at a brisk pace, all the while issuing instructions and pelting them with questions of state. Very soon the ministers (who lived sedentary Limousine Lives) were huffing and puffing to keep up with him.
Above all, remember that this is our time. Sometimes on a night the raccoon and possum members of Pundita's foreign policy team gather and we sit together, and they tell me of their clan's memories. This causes me to remember that the ancestors in our own clan went through so much to bring us to this point and that this is our time, time to show what the human clan is made of.

Many challenges are ahead but never before has so much human wisdom appeared at once, all around the world. And just in the nick of time. This earth has her own maintenance schedule, which is not always kind to living creatures. In the coming decades we will need all our ingenuity, faith and character to insure that we do more than survive, that we survive with grace. We will rise to the test.

Speaking of pacing ourselves I am glad you got some time off. As you can see by my posts, I set aside my vacation when I learned about reports of an Ebola outbreak in China. That led me to catch up on news about the latest doings of H5N1. I felt it was vital to alert Pundita readers to the many-faceted story.

Now I must follow my own advice and get a much-needed break. I will put up one more post on Wednesday night to answer a few other letters relating to earlier posts about H5N1/Virus X. Then I am going on a real vacation, so there will be no more posts until Saturday and that one will be very brief.

Best regards to you, Dave and to your 'team' -- er, pack.

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