The World
Health Orangisation has not seen fit to change its level of pandemic
alert (3 – Human infection(s) with a new subtype, but no human-to-human
spread, or at most rare instances of spread to a close contact).

The
1918-19 pandemic saw global mortality of the order of 50-100 million
from a global population of two billion, of whom some 50% are estimated
to have been infected. A pandemic is possible when a novel influenza
virus emerges. And, yes, there is a distinct possibility of a
completely novel human-infecting strain of flu emerging – and the H5N1
strain means that likelihood is currently greater than it has been for
a long time.

Does this mean a pandemic will happen now? No,
not necessarily. Some people are suggesting there is a 10% chance of a
pandemic. Flu epidemics and pandemics are essentially inevitable as the
influenza virus is perpetually changing. Whether it is the bird flu
that leads to the next pandemic or it is another strain some years away
is perhaps a moot point.

A significant proportion of the deaths
caused by the 1918-19 pandemic came from secondary infections and
complications, particularly pneumonias. We are much better equipped to
deal with such infections these days. So should a pandemic of such a
grand scale in terms of cases or proportion of the world population
infected happen again it seems very unlikely that the mortality would
be of such a magnitude – at least in countries with a decent health
infrastructure (and one which stays intact in the face of a huge surge
in demand).

So perhaps it is not just a matter of how
Australia and other wealthier nations cope but how some of more
populous nations with lesser resources and infrastructure may cope, for
example, India, China, Nigeria, Indonesia. Perhaps a greater awareness
of the possibility of a pandemic may help ensure preparedness efforts
are increased.

Migrating birds are not a grave threat to
Australia – both distance and the species that migrate to Australia
apparently mean that this is a very unlikely route for transmission of
bird flu into Australia. Food, eggs, etc is marginally more likely but
the risks are quite low. More likely is that should a human strain
emerge then someone will carry that virus back unwittingly and without
symptoms.

Should we panic? No. Should we expect our governments
to be planning for the possibility of a pandemic? Certainly. The WHO
has published a pandemic plan and has been encouraging national governments to prepare for some time now.

Australia
is towards the front of the pack when it comes to preparedness and the
Minister, Tony Abbott, seems to appreciate the dangers flu may pose.

When
flu epidemics and pandemics do emerge they tend to pass quite quickly –
the rapid onset is followed by as nearly a rapid decline. For example
while the 1918-19 flu struck Britain in three waves spread over 46
weeks the vast bulk of the deaths occurred in three short periods, and
even those were concentrated in a couple of weeks around November 1918.

So no real need to rush out and stock up on N95 face masks, Tamiflu or Relenza, stocks of food and so on.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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