Stopped Worrying about Avian Flu?
The dastardly and mutating G5N1
This will get you going again. Start with latest UN report.
By Crawford Kilian
Published: December 22, 2006
TheTyee.ca
If I were writing the synopsis of a science-fiction novel about a
flu pandemic, I'd treat it like any SF story -- as a thought
experiment, taking known data and using them like a submarine captain's
periscope to glimpse another world.
And if I were to base my thought experiment on the WHO report published last month, I'd probably use the following passage on page 15 as my starting point:
One especially important question that was discussed is whether the
H5N1 virus is likely to retain its present high lethality should it
acquire an ability to spread easily from person to person, and thus
start a pandemic...should the virus improve its transmissibility
through adaptation as a wholly avian virus, then the present high
lethality could be maintained during a pandemic.
So let's base our synopsis on a virus that keeps its "present high
lethality." The Spanish flu of 1918-1919 infected about a third of the
human population, as far as we can tell, and killed about two to three
per cent of those it infected.
That was a very high case fatality ratio (CFR). Most discussion of
H5N1 has assumed an avian flu pandemic would inflict a similar
mortality. Given our far larger world population, that's a very
discouraging prospect.
But H5N1's present CFR, worldwide, is just under 60 per cent. In
Indonesia, it's 76 per cent. In Vietnam, it's 45 per cent. (Cambodia's
six cases have all been fatal, but that's a very small number.)
Well, in this SF novel, let's assume that a human-to-human (H2H)
mutation breaks out with the capacity to infect one in three, and with
the same CFR that it now has -- 60 percent. Let's give it a gimmicky
title: H2H 60.
Outbreak on Tuesday, pandemic on Saturday
Given the speed of modern transportation, we can safely assume that
a Tuesday outbreak of "H2H 60" in Indonesia or southern China is all
over the planet by Saturday. Some infected persons arrive in, say, Sao
Paulo when the disease has already been reported in Cairo or Paris. The
Brazilians isolate incoming cases, ban further flights into the
country, and perhaps win a few weeks' respite.
But H2H 60 entrenches itself in the major cities of Thailand, India,
the Middle East, Africa, and Europe. It escapes from Heathrow in the UK
and JFK International in New York City, not to mention Los Angeles, San
Francisco and Vancouver. It arrives in Germany from Afghanistan and
Iraq, where wounded Canadian and American soldiers have contracted it
en route from the battlefields.
The first cases of course go into the hospitals, and instantly
challenge those hospitals' basic hygiene. We have had many recent
reports about filth in the U.K.'s hospitals, and Clostridium dificile
in Canada's. The first cases of H2H 60 expose our hospitals as little
better than the charnel houses that drove Semmelweis insane 200 years
ago.
So the hospitals in London and Los Angeles and Vancouver implode. As
with SARS, a third of exposed nurses, doctors and staff catch H2H 60.
But now three out of five of them die, and three out of five of their
patients also die.
9-11 to the tenth power
If the outbreak starts on Tuesday and reaches around the world by
the next weekend, the following week is 9-11 to the tenth power. No
skyscrapers are falling, but air travel ceases. So does most ocean
shipping.
Cross-border travel of any kind is suspended. But when H2H 60 breaks
out in San Diego and Mexico City, neither American nor Mexican border
guards are on the job. Americans flood south into Baja while Mexicans
flood north into Arizona and Texas.
In the north, the Vancouver outbreak quickly crosses to Seattle and
Spokane, as well as Calgary, Toronto, and Ottawa. Where the border
holds at all, it's held by small groups of guards, police and local
residents who have sealed themselves off on both sides.
In some communities, through luck or draconian measures, H2H 60
doesn't penetrate. Like Treasure Island in San Francisco Bay in
1918-19, those communities seal themselves off and suffer not a single
flu fatality. But across the rest of the world, the pandemic is
unstoppable.
The first wave, and the second
In this thought experiment, let's assume that the first wave of H2H
60 infects 10 per cent of the population in two months. So within eight
weeks of the original outbreak in Asia, 30 million Americans are sick
and 18 million are dead. Canada suffers 11 million sick and 6,600,000
dead. The U.K. -- England, Scotland, Wales, and Northern Ireland -- has
20 million sick and 12 million dead.
Staggering as this toll seems, it's paltry compared to the deaths in
Asia in the pandemic's first two months: China sees 130 million fall
ill, with 78 million dead. India loses 65 million. Twenty-four million
are infected in Indonesia, and almost 15 million die. Worldwide, 360
million are dead.
This is just the first wave. The second, five or six months later,
takes almost 850 million additional lives. By the time the pandemic has
run its course, two billion people have been infected and 1.2 billion
have died. If H2H 60 is like Spanish flu, most of the fatalities are
children and young adults. Deaths have been worst in Africa and Asia.
That brings the post-pandemic population down to 4.8 billion -- the
number of humans on the planet in 1985. We do not, however, simply
return to the happy days of Ronald Reagan and Margaret Thatcher and
Deng Xiaoping. We have lost engineers, health-care workers, skilled
workers, scientists, administrators, teachers, farmers. We have lost a
generation of children, and almost every woman pregnant during the
pandemic.
What if and what's more
A good science-fiction novel isn't just "what if" -- it's also
"what's more." If avian flu sustains its 60 per cent case fatality
ratio, the "what's more" includes the collateral damage: those who die
of diabetes, heart disease, cancer, and violence.
The collateral damage also includes those who die because no one has
made or transported their medication, and those who die of simple
starvation. And it includes those who are simply traumatized by death
on a scale not seen since the Black Death arrived in Italy from the
Black Sea in 1347.
North Americans have a big ecological footprint; some reports say
that to give all six billion people our lifestyle, we would need five
earths. After a pandemic with 60 per cent mortality, that footprint
dwindles.
Most of us have to live on what we can grow ourselves, or purchase
what is grown within a day's bike ride of where we live. Whether it is
a sack of potatoes or a bag of runner beans, its price is far higher
than today's.
We pay for it with gold or jewels or sex or brute labour. And if we
can't, we have to hope that some small shred of charity remains in the
hearts of those with some small surplus.
No hiding place
My synopsis doesn't hold out much hope for those who hole up. They
expect to live on the bottled water and freeze-dried meals stored in
their basements, to listen to news bulletins on their hand-cranked
radios, and then to emerge -- with their dogs and cats -- into a quiet
new post-pandemic world.
Having lived through the Cold War debates on whether to admit your
neighbours to your fallout shelter, I expect these persons to be killed
or robbed precisely because of their foresight. Never mind that some
are buying weapons to defend themselves -- someone with more weapons
eventually turns up on their street. Vancouver, San Antonio and
Manchester are no different from Kigali in 1994 or Darfur in 2006.
But my synopsis offers one small hope: some of us are ready to die
to support our institutions. After a quarter-century of hearing that
government is the problem, not the solution, our lives depend on people
who reject that view.
Just as soldiers give their lives to gain a hundred meters of
ground, my synopsis shows police officers who go up alone against armed
mobs, and doctors who go into hospitals full of corpses. It shows
technicians who risk their lives to keep the water not just flowing,
but drinkable. Some of my characters are truck drivers who carry food
to strangers though they may bring disease back to their own children.
For more than a half-century, the industrial West has taken itself
for granted: the food will grow, the oil will flow, the turbines will
spin electricity. An H2H 60 pandemic would smash those assumptions to
bits. The pandemic's aftershocks might well cost another billion lives
-- not just in the West but also in AIDS-ridden Africa, in Third World
sprawls like Jakarta and Mexico City.
But I won't write the novel I've synopsized. Since at least H.G. Wells's War of the Worlds, we in the wealthy nations have fantasized about losing it all, about suffering the fate we've inflicted on others.
But such novels (including Vonnegut's Cat's Cradle and Shute's On the Beach)
haven't done a thing to move us off our self-destructive course. A
novel about H2H 60 wouldn't save a single life, no matter how many
copies it sold.
We will save lives by accepting the implications of the WHO report
and similar expert assessments, and by taking concrete steps to prevent
a pandemic before it spreads. The same is true of global warming and
the destruction of the world's fish. Playing "let's pretend" about
these threats will only distract us from a life-or-death struggle.
http://thetyee.ca/Views/2006/12/22/AvianFlu/