The Fumento article is a long read, with many references to look up, so it's taken quite a while to write a response. Actually, I'm glad Blast posted the link. I actually learned quite a lot of new things from running down the various references and then seeing if my understanding of the sources jives with Fumento's. I disagree with a lot of the arguments that Fumento makes based on the evidence he cites. I mean, when I read the sources themselves, I don't think he's coming to the correct conclusions. Unfortunately, maybe my comments will be too detailed for many, particularly if you haven't read Fumento's essay or the references he cites, but hopefully some of you may find something interesting or informative in my comments. If you're interested in the topic, I encourage you to read the references. (I haven't read any of the books, though) Fumento focuses on H5N1, so I'll restrict myself to talking about his arguments about H5N1 even though there's no guarantee that H5N1 will be the next pandemic.
Many people who disseminate information about avian flu have an agenda, some beneficial, some selfish, many with both. People in public health and gov't need to understand the worst case scenario in order to prepare properly. For these people, burying your head in the sand just isn't acceptable. Unfortunately, information essential for planning purposes (e.g. worst case scenario) is not necessarily beneficial when widely circulated in public since it scares the heck out of people who assume the threat is imminent. Then there are the scientists and doctors actually doing the frontline research and treating the people actually getting sick. Some have selfish motives, but in general, I think they try to present the facts objectively and fairly. Then there's a whole layer of people in between--including, but not limited to: book writers, the press and media and a slew of so-called experts or "talking heads" who appear over and over again (Remember all the formers generals on TV during the Iraq invasion?). Their primary motivation--or their superiors or employers--are usually not to the whole unbiased truth and not so benevolent. It's this last layer that causes much of the hysteria, and on that count, I would agree with Michael Fumento that the media often overstates its case or tends to selectively report only the worst possibilities and not the whole story.
Then again, looking at Fumento's
biography, he seems to have made a career, and a living, as a contrarian, so just keep that in mind when he makes arguments that tend to greatly minimize the threat. He has written books and made many TV appearances saying the opposite of what the press is generally reporting. He also doesn't have a medical or science background, but he is an attorney. Perhaps this is just a pet peeve, but he also peppers his article with references to the Wikipedia (22 references). No offense to Wikipedia, which I think is great and a useful reference, but for a topic like this, relying so much on Wikipedia strikes me as a bit intellectually lazy. You'd never publish a print article with so many references to the Wikipedia. Anyway, read his essay, then my comments, and decide for yourself.
His lack of medical expertise shows through with his misunderstanding of viral classification. But it's a crucial point since he relies on it a lot to play down the threat.
Not all H5N1 is created equal! H5N1 is a subtype, but even within the subtype, there are genetically distinct variants that can have significantly different characterstics in terms of lethality, what kinds of hosts it can infect, incubation period, etc. Fumento states, almost in a hushed whisper, "It's practically a state secret that the discovery of H5N1 in poultry dates back not to 1997 but rather to 1959, when it was identified in Scottish chickens." That's true, but that H5N1 variant is NOT the one that is circulating today. He seems to imply that we have faced the exact same H5N1 threat since 1959. That is not true. For one thing, the Scottish strain was restricted solely to poultry, and that virus' veterinary designation is chicken/Scotland/1959. Here's one news link
here if you want to read more. (Note the ominous headline compared to what the article is actually saying about this chicken outbreak, which is actually a pretty good newspaper article) In contrast, today's strain (actually strains--there are two main H5N1 strains floating around now and a third new strain in northern Vietnam recently emerged) have jumped the species barrier and have killed humans, as well as spread to migratory birds, like ducks, pigs, and even killed tigers (cats rarely are bothered by influenza). If anything, Fumento's point that H5N1 has existed for decades without problems just bolsters the point that this virus, which is now infecting and killing birds like crazy all over the world and starting to kill some humans, has recently gone through some significant changes and is acquiring some of the multiple characteristics necessary for a human pandemic.
Blast, Fumento's point about mild cases seemed to have interested you, so I'll address that next. It's true, its possible that mild cases have been missed, but in reality, we don't
want mild cases. When a disease first jumps the species barriers, they tend to be extremely lethal because the new species has never been exposed to anything like it. Once their immune systems evolve to become accustomed to a new disease, then milder cases become more common. But that just makes it easier for the disease to linger in this new species, spreading wider and wider and killing a larger number of this new species. But anyways, so he cites a medical study to say millions of people have already been exposed to avian flu. The study says that in some rural areas in China, 2-7% of people have antibodies to the H5 subtype. That article was published in 1992, well before the 1997 Hong Kong outbreak and the first human deaths from H5N1. Let's flip that around--so that means 93-98% of these rural Chinese, who literally live with chickens and ducks and pigs and other potential carriers of H5N1, have NO prior exposure to an H5 flu strain, and 2-7% may have some residual resistance to a different H5 strain than what is currently worrying experts. How many people in America sleep and live and actually handle lots of birds? Not many. When was the last human H5 flu epidemic? We've never had one. So basically no one in the US or other Western countries has ANY prior exposure to H5 flu. That's not so encouraging. I don't mean to sound alarmist, but its just a fact.
Actually, sorry, that's not really addressing the mild or symptom-less (asymptomatic) cases issue. Actually, there hasn't been a whole lot of data available to answer that question. To answer this question, you need to draw blood from everyone in the community and see if the antibodies exist, and that's just not practical or affordable in these poorer countries. From Fumento's reference to
this journal article, you can see 11 separate citations, covering a total of about 2,500 people. From the 1997 Hong Kong outbreak, results showed 2-10% of those tested (like poultry workers) had been exposed, and most without symptoms. Then the rest of the citations are from 2004-2005 and they show no asymptomatic cases found among contacts of patients (family, friends, neighbors, hospital staff) who came to the hospital. That would suggest that at least in Vietnam and Thailand where these recent blood analyses were done, if you got infected with H5N1, the infected generally became sick enough to go the hospital and there weren't any (or not many) mild or asymptomatic cases. However, if the only person(s) infected in an area were asymtomatic or mild, then its possible that they would avoid being noticed by authorities, but there's no hard evidence to confirm whether that occurs much.
This WHO report, which Fumento uses elsewhere says that the virus infecting humans now are different from anything before 2003, so those 1997 HK results may not be applicable today, and the fact that the recent blood analyses show zero asymptomatic cases is consistent with the appearance of a new, distinct strain that hasn't had the time to evolve into a milder strain yet.
By the way, going back to the prior exposure issue, I learned something new from this
this article that Fumento cites that says that there is evidence that flu outbreaks in the late 19th century were due to a similar subtype as the Spanish Flu (H1N1). That would explain why older people were not affected as severely by the Spanish Flu--most may have already had residual resistance from these past flu epidemics, but not the younger adults (children generally don't die from flu epidemics anyway). Imagine how bad the Spanish Flu could have been if the older folks did not have any prior resistance at all. (Actually, this is just speculation, since it has not been proven that the old folks really had any residual immunity).
Fumento states in his "The Human Threat" section that, "Another scenario is that somebody with human flu could contract avian flu at the same time and the two flus could "reassort" into hybrid avian-human flu...The World Health Organization has just reported that there is no evidence this has occurred with H5N1." That's true, apparently there is no evidence that H5N1 has acquired any genetic material from human flu strains--yet. He cites
this WHO study as evidence. He fails to mention that the same study also states that samples from recent human cases show a strain that is distinct from anything before 2003 (another counter-argument to his point that H5N1 has been around since 1959 with a constant threat level since then) and that there is recent evidence that the virus is spontaneously mutating (antigenic drift) away from the avian strain. Doesn't mean the virus is pandemic, but it's not standing still either.
Fumento later states regarding the chance that the virus will mutate into an easily transmissible form, "And remember, those tumblers have been turning for at least 46 years, since the Scottish outbreak." Well, that's sort of true. Remember, the Scottish strain is not the current strain. The current strain is not even exactly same strain as the 1997 strain. Personally, I think it's more apt to say that in terms of acquiring the ability to pass person-to-person easily, the mutation clock starts whenever a new strain emerges, and the latest strain emerged in the last couple years. Or put another way, imagine acquiring pandemic qualities like playing a board game, instead of a single throw of the dice. Sometimes, the genetic roll of the dice moves you closer, and other times, it moves away. But overall, H5N1 has gotten much, much closer to becoming a pandemic strain compared to the 1959 version of poultry H5N1.
Actually, this most recent strain is getting even more worrisome. See Laurie Garret's Foreign Policy
article (read it yourself and see if she sounds like some stark-raving hysterical writer that Fumento paints her as) or
this WHO report. It appears that a new genetically distinct strain has very recently emerged in northern Vietnam that is becoming more pandemic-like. It seems more infectious than the older strain in southern Vietnam, the age range is expanding so it infects infants and very old people unlike other H5N1 clusters, each disease cluster is lasting longer, implying that more than just chicken-to-human transmission is occurring, and it is less lethal (35% fatality), giving it more chance to spread to other people. These observations are consistent with genetic changes that make H5N1 more adaptable to human physiology. Oh, many of us have read in the news a while ago about a strain of avian flu that is partially Tamiflu-resistant. Well, that's this strain. So, this newest strain has all the right (wrong) ingredients except one. If this particular strain acquires the ability to easily pass from human-to-human, it would be a perfect candidate for this pandemic that we're worried about.
In the section "Misunderstanding the Spanish Flu" Fumento makes the case that most people died from bacterial pneumonia, not viral pneumonia as is popularly reported. Fumento seems to rely a lot on this Stanford webpage, but I read it and I don't really see the authors as saying that most Spanish Flu sufferers died from bacterial rather than viral pneumonia. The webpage is more about how early 20th century medical ideas first developed and how the doctors/scientists tried to prove their hypotheses. I don't know the exact extent of science's understanding of the virus at that time, but it was still rudimentary. They knew that there was something smaller than any bacteria that they could see in a microscope or filter out that seems to cause some diseases, but that was about the extent of their knowledge. Anything more was just a theory. If you read the webpage, it says that scientists back then often interchangably used the concept of bacteria and virus when trying to find the cause of influenza. And there was no way to test for a virus in a patient back then, only for bacteria.
Read the Stanford
webpage (just one page) and then consider this. The mere presence of bacteria in the lungs of Spanish Flu victims does not mean the same thing as saying they died
from bacterial, rather than viral, pneumonia. We can routinely culture many disease-causing bacteria from the noses of perfectly healthy people. I may also be losing my hair. Does that mean that these bacteria is are causing me to go bald? Not necessarily.
Well, I think it's inconclusive whether bacterial pneumonia was the true killer of the Spanish Flu, at least from what he presented. (Perhaps his book citations are more informative, which I did not look up.) But put the Spanish Flu aside for the moment. That's ancient history. If we talk about H5N1, it has been shown to cause massive lung tissue damage from the dreaded "cytokine storm" effect, leading to viral pneumonia. Sure, these patients can also develop bacterial pneumonia, secondary to the viral pneumonia, but killing the bacteria with antibiotics doesn't help if you have too little functioning lung tissue left to breathe. SARS also unleashes a cytokine storm on its victims. Unfortunately, there's very little modern medicine can do about the loss of lung tissue.
There's too much in Fumento's article to comment on to go on, so I'll stop here. Already spent way too long on this. My last comment is a personal comment that I didn't appreciate Fumento's diminishing of past people's effort and his Monday morning quarterbacking. Yes, sometimes people overreacted and goofed, but sometimes nothing happened because concerned, responsible people acted. Take SARS. People were worried that SARS would become a global pandemic. It could have. It didn't. Fumento says, "See? It was all hype." He doesn't give any credit to the tireless work of doctors, nurses, scientists, and healthworkers who worked very, very hard to contain the threat across many countries. It worked. Did humans single-handedly stop SARS? Probably not. It most likely died out on its own. But we certainly put a significant dent in its spread and the loss of human life (but SARS is not anywhere nearly as transmissible as influenza). I would hope that people remember to give credit to the people who prevent disasters from happening in the first place through their efforts. Thanks for reading this far. <img src="/images/graemlins/smile.gif" alt="" />
Oh, so what does this mean--is the threat overblown or does Fumento have his head buried in the sand? I think the media is making people worry unnecessarily through too much coverage about worst case scenario stuff. Some coverage is good. Look at how public pressure finally got us some avian flu preparation funding from Congress. However, for those who have to deal with this threat as part of their job, I think H5N1 is worrisome, but no one knows if it will be the next pandemic disease or how deadly it will eventually be
if it became easily transmissible between people. And for people like these, who need to know the facts and the logical consequences of these facts to make rationale decisions, I personally wouldn't want someone like Fumento interpreting the medical literature for me. You're better off reading the stuff yourself and coming to your own conclusions.
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