"Think of a fast moving highly contagious disease that wipes out 5% of the world population (50 million people). Half a million of them in the U.S&.bodies pile up in the streets. There arent enough morticians to bury the dead. Nor are there enough doctors and nurses to tend to the sick. The churches close, the schools shut. Telecommunications and transportation grind to a halt. The public succumbs to hysteria and panic. Police protection fails. Order decays. Productivity dives. Sounds like a scene from a science fiction film, doesnt it? But what if I told you, it already happened? What if I told you it was the pandemic flu that swept across America and around the globe in 1918? Or if I told you that this glimpse into the past might be a preview to our future. An avian flu pandemic is no longer a question of it, but a question of when."

1. The Avian Flu virus has been around for five years.
2. Named N5H1, the virus has crossed the species barrier, i.e., it has been transmitted from birds to humans.
3. Presently, there has been only one case world-wide in which human-to- human transmission of Avian Flu has been highly suspected. It is not inevitable that rapid or efficient human-to-human contact will develop, but it is possible.
4. To date, 52% of those who humans who have contracted the disease have died.
5. We must prepare for the potential of a pandemic - a world-wide spread of the disease.
6. Right now, Avian Flu is a bird problem.
7. Right now, Avian Flu is not in the United States.
8. The Department of Agriculture and the Department of Interior have been handling bird viruses for many decades.

1. Symptoms of the "bird flu" are similar to "regular flu":
   1. high fevers,
   2. headache,
   3. muscle aches,
   4. a feeling of prostration, where you just feel like you want to be in bed.
   5. This lasts for several days and it is possible to get respiratory complications.
2. "Regular flu" causes 200,000 hospitalizations each year in the United States and results in 36,000 deaths each year.
3. "Bird flu" has the same constellation of symptoms but goes on to be more serious. Lung problems develop which can cause death.

1. Some genetic modifications of the virus due to mutations must take place, or the virus must "re-assort" itself.
2. This will most likely occur by the virus exchanging genes with another virus that has the capability of transmitting from human-to-human efficiently.
3. The efficiency of a virus causing illness addresses its infectivity.
4. This means that a virus with very low human-to-human efficiency of transmission causes illness very rarely when one person who is infected comes into contact with another person who is not.
5. If the Avian flu virus had the efficiency of the seasonal flu, you would have seen an explosion of cases in Southeast Asia.
6. At present, the Avian flu virus does not have the genetic capability to efficiently go from human-to-human and we hope it never does.
7. It is not inevitable that human-to-human transmission will occur.

1. A vaccine was developed from a Vietnamese patient 18 months ago.
2. This vaccine is safe and does cause an immune response that should protect humans from Avian Flu.
3. The United States does not have the vaccine-production capacity to make enough vaccine.
4. The vaccine used in birds cannot be used in humans.
5. Once the production capacity is established, it will take six months to produce enough vaccine to supply the United States.
6. It will take three years to develop the production capacity.

1. We would rely on anti-virals such as Tamiflu.
2. It is not guaranteed they would work.
3. There is good evidence that they would reduce the severity and therefore the mortality of the Avian Flu.
4. The same principles which are beneficial in avoiding "regular flu" should work on avian flu.
   1. Wash our hands thoroughly after contact with anyone who is sick.
   2. Avoid shaking hands with some one who is sick.
   3. Avoid crowds, particularly if you are susceptible to infections.
   4. Get rest, stay hydrated and well nourished.

1. In 1918, healthy adults were affected the most.
2. The virus, which caused the 1918 pandemic, was a new virus which means there was no immunity in the population.
3. It infected hundreds of millions and 50 million died.
4. In 1968, there was a flu pandemic which was a new virus but it was rather mild compared to 1918.
5. The Avian Flu virus N5H1 is a new virus also.
6. Children were not as severely affected by the 1918 pandemic. The reasons for this are not clear but there are some speculations about why that was the case.

1. Because of the way viruses evolve, it is probable that there will be another pandemic.
2. It may be 15 or 20 years, but it also could be sooner.
3. It is this fact which necessitates, the United States rebuilding its ability to produce immunizations to flu.
4. There are two limitations to the rebuilding of our vaccine production capacity:: one, is a market must be guaranteed; two, a mechanism for compensated anyone injured by the vaccine must be established without the survival of the manufacturer being at risk.
5. The probability of a pandemic is still very low.
6. Yet, because the consequences are so unimaginable, we must assume:
   1. The worst-case scenario
   2. That it will happen
   3. That preparedness is not a waste even if it doesnt happen
   4. That even if it doesnt happen soon, it will eventually happen

1. Surveillance is the greatest protection. This means that the sooner an outbreak is identified and reported, the quicker a response can be mounted.
2. For the past ten years the international medical community, led by the World Health Organization has been developing a surveillance system.
3. The key is transparency. If nations conceal the outbreak of a potential pandemic, it will spread.
4. The weakest link is surveillance in Asia, which needs to be and is being improved.
5. It will take 6-12 months from now, to ensure that we have an adequate, sensitive, and responsive surveillance system in all countries.
6. These systems will pick up the next SARS, Ebola, Marburg or West Nile virus.

1. Detected early enough, some models suggest that "social distancing," "quarantine-like" measures and the rapid distribution of antivirals may significantly slow down, or even stop the emergence of a pandemic viral strain.
2. This requires very rapid action, very quick deployment and very sensitive surveillance.
3. The World Health Organization has been building a global stockpile of 3,000,000 treatment courses of Tamivir.
4. The United States has stock piled 4,300,000 treatment courses of Tamiflu and has order enough to have 75,000,000 treatment courses available by mid-2007.