In the small Gulf Coast community where Dr. Ralph Kahler practices, questions about avian flu are a regular part of the job. As a local infectious disease expert, he has a lot of people turning to him for answers.
And he doesn't have a lot of reassuring answers to offer."I really don't see anything that we could do on the local level," says Dr. Kahler. "We're really dependent on the federal government and the Centers for Disease Control, vaccine and drug makers."
Local doctors would do everything they could, he adds, disseminating any vaccines that could be available and providing supportive care for anyone affected, but that's "about all we can do. Tamiflu has been used. But if a true pandemic comes, it will disappear in short order."
There are three possible scenarios for how this situation will develop, says Michael Cooperstock, a University of Missouri-Columbia infectious disease expert. First, nothing could happen. Second, minor mutations in the avian flu virus could take place gradually and it would be months or years before the virus would become a serious threat to humans. Third, the virus could be just one mutation away from being able to pass easily between humans and a worldwide pandemic would take place as the virus infects people within a few weeks or months.
It's the third scenario that has alarmed infectious disease experts the world over. But local providers say their ability to react is severely limited.
If there were a case involving someone who may have traveled through an infected area, Wanda Hooper, a Nurse Epidemiologist and Certified Infection Control Officer at Saint Thomas Hospital in Nashville, says that they would be put in a negative pressure room and monitored along with any staffers that would watch over them.
But there isn't much that health officials could do for the population as a whole, she adds, "because there's not a vaccine."
When President George Bush recently appeared at the National Institutes of Health to unveil a newly updated plan to combat the possible outbreak of an avian flu pandemic, the emphasis came down hard on new funds for more and better drugs.
Congress is being asked — and will likely eagerly provide — more than $7 billion to stockpile drugs like Tamiflu and Relenza that show an ability to ward of the H5N1 virus that has panicked populations around the globe. Some of that money will be earmarked for developing experimental vaccines for the virus. And there will be more money for a national pandemic infrastructure that can be activated to spot an outbreak when it occurs and move to contain it as swiftly as possible.
As Bush noted, no cases of avian flu have been detected in the United States. The 60 people who have died to date in Asia have contracted the H5N1 virus from birds. And in order to threaten populations, the disease would have to mutate into a human transmissible disease, a process that could easily render any antivirals and vaccines currently in development either useless or significantly less effective.
To try and prevent that from occurring, health officials in China, Indonesia and elsewhere have moved to eradicate any potentially infected flocks. In mid-November, Chinese officials reported two fresh outbreaks of avian flu and moved to quarantine 116 people who may have been exposed. Officials from the World Health Organization were swiftly dispatched to determine if the flu had killed a 12-year-old child last month, potentially one of the latest victims.
Just waiting for a human-to-human outbreak to occur, though, is both politically unacceptable and dangerously at odds with global attempts to control what could conceivably be the worst epidemic since the Spanish flu swept the globe in 1918 — if in fact the worst-case scenario comes to pass.
"If we wait for a pandemic to appear," said the president, "it will be too late to prepare, and one day many lives could be needlessly lost because we failed to act today."
But the administration has also come under fire for being slow to recognize the potential threat. France and the U.K. had already moved to line up supplies of antiviral drugs even before the disease appeared in Romania and Turkey. And in the U.K., health officials have outlined plans to use schools and other public places to treat the sick.
Global fears have added intense pressure on Roche to cut prices and increase access to Tamiflu. Roche says that while it's open to discussion, the manufacturing process is complex and that the company is rapidly ramping up production.
But gaining access to more Tamiflu is no panacea, says David Reddy, who runs the company's pandemic task force.
"The preparedness of society will need to be much greater," Reddy recently told reporters. "How are we going to keep the wheels of society turning? There won't be enough intensive care units or respiratory equipment."
That's yet another question providers in the U.S. are equally unprepared to answer.
