Radical Noesis - Thinking outside the box

The Avian (or bird) flu, has had scientists around the world rattled for at least the last eight yeas - since the first confirmed cases of bird to human transmission (see the CDC Avian Flu Fact Sheet. Why? Because birds naturally (and usually harmlessly for birds and humans) carry various influenzas in their intestines. Some of those viruses can infect humans, but usually through another species - pigs for example. However, this flu - Avian influenza A H5N1- is infectious in both birds and humans. Further, it can pass directly to humans. The increasing concern is a successful mutation that allows H5N1 to pass from human to human. There are confirmed cases of Avian flu passing between humans - starting in 1997.

My understanding is that the likeliest mutation to a pandemic level might occur if someone already infected with another flu virus was also infected with the Avian Flu virus. This might be all the impetus that is finally needed for Avian Flu to make the successful leap to a wildly communicable influenza. When (not if) that happens, the outcomes are almost unimaginable. The mortality rate for Avian Flu is 50% or more. Further, it is spreading and the further it spreads, the more likely it becomes to make the switch - and to start a pandemic. The World Health Organization believes that between 5 and 150 million people could be killed in an Avian Flu pandemic, and it has already spread out of East Asia and into Romania. I presume that the wide range of potential fatalities depends on the success of containing an outbreak - and of protecting the population. Other nations have been working quite hard on this (Asian countries, and Europe), but the issue has had low priority in the United States. It has been known that a drug called "Tamiflu" increases the survival rate from the Avian flu and many European countries have been stockpiling in the event of an outbreak - not the U.S. which has only enough of the drug to treat 4.3 million people - barely enough to dose first responders. Manufacturing Tamiflu for the U.S. market has just begun - almost a year after other countries. In September 2004, Health and Human Services awarded a contract with Aventis Pasteur, Inc. for 2 million doses of H5N1 vaccine. At the same time, they publicly released the draft of Pandemic Influenza Response and Preparedness Plan.

While the United States is unprepared for a pandemic (of Avian Flu or any other disease), most of the world is not ready either. Most Asian countries have dramatically increased the monitoring and reporting, but don't have the resources to protect their citizens. Even those nations with resources are betting on a limited outbreak which can be contained rapidly. I am not sure that is realistic given today's mass transit.

If we look again at the U.S., which also has containment hopes, I have to say that I am not optimistic. Our public health systems have been consistently undermined since Reagan privatized all health care. I am not secure that an outbreak of Avian Flu would even be noticed until after people started dying in significant numbers. Imagine this. You are sick with "the flu." You go to the doctor, who looks at you and says :"You have the flu. Go home, drink plenty of fluids, and get some rest." Have you ever been tested for what type of flu you have? I haven't and neither has any of my friends or family. Now imagine the situation of those without health insurance, or the money to go to the doctor. Meanwhile, most folks work when they are sick, and most people go to school while they are sick, and most folks go to the store while they are sick, and many folks fly when they are sick? How long do you think it would take to figure out that Avian Flu has struck?

There are efforts to quiet the public's concern about an outbreak of Avian Flu. While it is true that the pandemic is not happening, health officials and organizations around the world are clear in thinking that it might occur at any time. While I have stressed that the Bush Administration is unprepared, there is no nation that is totally prepared.

Beyond the fact that the world is looking down the throat of a pandemic with a 50% mortality rate, there is the likelihood that such an event could trigger a global economic meltdown. The scenario is not difficult to predict, but impossible to prevent. We live in a global economic environment dependent on the movement of goods and services around the world. From the reading of X-rays to the food on our plates, we live in an interdependent world. Further, I would argue, that the more "developed" a nation is, the more likely it is critically dependent on the "global economy." Let's take a likely global scenario.

The Avian Flu hit human to human communicability in China. As it progresses, more and more of the workforce is laid low. Priorities switch to trying to control the outbreak. National and international quarantines are put in place. Shipments out of China first slow, and then stop. A major global economic player has just dropped out of "the game." However, everything that China exports (and imports) now sits in the docks. The scenario only gets worse if we make the (likely) assumption that the flu escaped China before severe quarantines were enacted.

In an average city in the U.S., I don't have much hope of "containment" either. At best, schools would close (and with them day care centers). Those employees would then be home, and parents with young children would also need to stay home. As increasing parts of the population contracted the flu, they would continue to go about their daily routines as much and as long as possible - spreading the virus everywhere they went. There is the possibility of infrastructure shut down as either more people take sick, or quarantine measures are put in place. The U.S. put in an order for 2 million vaccines (the effectiveness of which is likely to be low) and 4.3 million precsriptions of "Tamiflu." This is not enough for one major U.S. city. Add to this scenario that in our "privatized" health care environment we are totally unprepared for any major disaster - much less an epidemic of a killer flu. Michael Chossudovsky recently wrote "Martial Law and the Avian Flu Pandemic." In the article he discusses Bush's stated preference for calling out the military to "contain" an epidemic

While the U.S. has not, and is not prepared to deal with such an emergency on a medical level, the powers that be have pursued their "plans" for control. We currently have the Bush initiative to make the U.S. military the lead response to any emergency - including a medical one. He rightly points out that this would place the military, rather than civilian authorities (and medical responders) in authority. While this might "contain" an epidemic, it might also significantly reduce the survivability of it.

Prior to the military as the "hammer" for every problem, there was a broader design of social control and removal of democracy. Back in December of 2001, The Center for Law and the Public's Health and Johns Hopkins University drew up a plan for the CDC titled "The Model State Health Powers Emergency Act." This document was intended as a model for state legislation. Since that time, it has been introduced (in various forms) in 45 states, and passed as legislation in 37 states [AL, AK, AZ, CA, CT, DE, FL, GA, HI, ID, IL, IN, IA, LA, ME, MD, MN, MO, MT, NV, NH, NM, NC, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WI, and WY and Washington, D.C.]. Not all the states have included the entire body of MSHPEA. The Public Health Law center has a good summation of what portions of the model legislation are included in the various state legislation. The table track 29 provisions of the Model act. Four states have included large portions of it in their own legislation - South Carolina (27), Delaware (23), Iowa (22), Maryland (21).

The model legislation has some alarming inclusions:

From Institute for Health Freedom (last updated in June 2002). "- Declare public-health emergencies; - Force individuals to undergo medical exams; - Track and share individuals' personal health information without their consent; - Force individuals to be vaccinated, treated or quarantined; - Ration food and other commodities; and - Mobilize state militias to enforce state orders and impose fines and penalties. - Give local governments (in addition to state governments) new police powers, and - Tie licensing laws to the MSEHPA. Health-care facilities, doctors, and health-care providers would have to agree to abide by the MSEHPA during public-health emergencies in order to maintain their licenses to practice or run a health-care business."

Now on top of whatever plans and legislation the various states have, is the declaration of martial law and the implementation of military control of entire regions of the country (or the entire country). In other words, beyond the controls that the states could put in place, we have the full resources of the military (guns, planes, surveillance) to "contain" the emergency. This is not an issue that would be resolved in a week or two. In a pandemic environment we would be looking at months of martial law. Likely that would go on well beyond the actual epidemic, and might well be repeated the next "flu season" and the one after that and the one after that. What kind of shape would any region of the country be in after just one quarantine?

I certainly don't want to minimize the threat of a pandemic - particularly something as potentially contagious as a killer flu. But is the best and first response calling in the military? What about the changes that are necessary to actually allow the military to be the agency of note? It does place the Pentagon's push for increased domestic surveillance powers in a new light.

Once again, we are likely to suffer from an ideology that has advanced the "private sector" as "better than" the public for almost any role. This started under Reagan and has continued since that time. It has been a primary focus of the current Bush administration. That ideology has left us woefully unprepared for a public health emergency. As we saw with hurricanes Katrina and Rita, the further change of focus to "security" has further gutted emergency response at all levels, and undermined critical infrastructure. Now Bush puts forward the military as a solution to the Avian flu. Given the shortage of personnel, how could the military actually react to and control a region of the country? Certainly not through deploying troops. That leaves them largely with weaponry to seal off a region of the country. "Spy" drones flying the skies with killing capability. Satellites with weapons trained on say the west or east coasts, or the midwest, or pick your "region".

While we may indeed come to such an end, it was not, and is not necessary that we do so. If we escape a pandemic this year, we have another year (hopefully) to prepare. That is time to strengthen monitoring and reporting systems - particularly for those without access to the health care system. That is time to cooperate with other nations and agencies. That is time to re-look at investing in public health and improving local abilities to respond to critical needs.

It is difficult to say whether Bush is now so actively discussing Avian Flu is because the threat has dramatically increased, as a distraction from other issues (FEMA, cronyism, criminal activities of the neo-con "core"), or once more using fear to push us closer to a totalitarian state. However, this is a real issue. It is a global threat for which the world is unprepared. It is also frightening within the context of what the Bush administration has announced it is willing to do to protect U.S. "interests" - namely preemptive war with weapons of mass destruction (nuclear, biological, and chemical. While we might face the use of those weapons domestically to "quarantine" a region and "control" the threat, would this also be a possible response internationally? I hate to even throw that speculation into the ring, but worst case scenarios seem to be the rule of our times.

Pertinent Resources
10/04/05 Chossudovsky, CRG, Martial Law and the Avian Flu Pandemic

Bush in bird flu vaccine meeting

Delegates work on ways to contain bird flu

Key Facts About Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus

Avian influenza

Fear of Flu Outbreak Rattles Washington

Bird flu 'could kill 150m people'

Bird flu could cause global economic catastrophe

WHO Meeting Warns of Flu Pandemic

Pandemic Risk Spurs Flu Vaccine Planning

Institute for Health Freedom - MSEHPA (last updated in June 2002).

Instances of Avian Influenza Infections in Humans

Model State Emergency Health Powers Act

10/08/05 Reinberg, Forbes, U.S. Ill Prepared for Massive Flu Outbreak: Report

11/01/04 Marchione, Wa. Post, Pandemic Risk Spurs Flu Vaccine Planning