Editor's Letter

‘Unprecedented’ Avian Flu Pandemic Requires Rational Preparation

Though birds infected with the H5N1 avian flu are expected to arrive in the United States by September or October, some reports of its impact may be a bit “overblown.”

First, it is not expected to spread as rapidly among the U.S. population as it has in South Asia, since poultry is not as free-roaming here as it is there. However, businesses and communities are being urged to take rational steps to prepare for when the pandemic, a global disease outbreak, reaches North America.

Worldwide, there are many strains of avian influenza virus that can be spread by migratory fowl. These viruses can cause varying degrees of illness in poultry. But the spread of a highly pathogenic avian H5N1 virus across eastern Asia and into Europe and Africa represents a significant threat, with health professionals concerned about a potential human pandemic. This virus has passed from infected poultry to humans and other mammals, and has had devastating impacts on poultry farming in several nations.

The H5N1 strain is considered “unprecedented,” because of the high fatality rate in humans. Fifty percent of the 200 people who have been infected by H5N1 have died.

By comparison, in the 1918 flu pandemic only 2 percent of infected people died. At the American Industrial Hygiene Conference & Exposition (AIHce) held last month in Chicago, attendees were told that misinformation about a possible flu pandemic must be corrected through accurate communication. While urging careful preparation, Donald A. Henderson, M.D., MPH, resident fellow at the Center for Biosecurity at the University of Pittsburgh Medical Center, said that estimates of 40 percent absenteeism in workplaces are overblown; he believes absenteeism in the event of a pandemic will be closer to 15 percent.

“This is a type of virus we have never seen before,” Henderson observed. Almost all the human cases are the result of the direct contact with birds and only in rare cases has it been spread from person to person.

Still, he expects that the flu will spread from human to human sometime after its arrival, but that any pandemic would only last about 10-12 weeks. He added that the flu strain may become less virulent as it evolves, since other flu strains have followed this pattern.

In his talk, entitled “Impact of Biosecurity and Bioterrorism on Public Health in the Workplace,” Henderson said, “There have been a litany of suggested preparations, but many of them are ridiculous.”

AIHA’s Biosafety and Environmental Microbiology Committee has finalized a guideline highlighting the role of industrial hygienists in a pandemic and developed some practical advice for businesses to follow to keep their workplaces as healthy as possible in the event of a pandemic. According to the guidelines, industrial hygienists will:
• Be closely involved with training and provide up-to-date safe work practices and advise of the use of personal protective equipment.
• Work collaboratively with infection control and prevention specialists to devise the best protective scheme for the situation.
• Play an essential role in maintaining an adequate work force to accommodate event related
changes in workflow and production.
• Participate closely with all parties in the development of a critical path for communication
prior to and during a pandemic event.

Henderson said that the idea of closing U.S. borders or even attempting to gather contact information or somehow screen all incoming airline passengers “makes no sense at all.” Beyond the logistical challenges of such ideas, Henderson explained that flu strains can be spread by a person for a day or two before any symptoms appear, making screening ineffective in identifying many people who could spread the flu.

Quarantine measures won’t work either to slow the spread of the flu – it will run its course, he said. Instead, he urged a more rational approach of tracking the facts about any future pandemic and communicating them often to the public.

“We need to diminish anxiety and avoid panic,” said Henderson. “We will need to communicate frequently about what’s going on and change social activity as little as possible.”

Let’s hope he’s right. Thanks and good luck.