The Coming Pandemic

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In the 1953 and 2005 films "War of the Worlds," aliens from another planet invade Earth with the purpose of destroying the human race. Nothing our military throws at the creatures can stop them. But, after several days, the aliens start dying. What is killing them? Microscopic germs that our bodies have built up immunities to for millions of years. The aliens have no such immunities, so the germs infect their bodies and kill them.

Now comes a real-life germ that may cause an "influenza pandemic" and kill millions of people.

Expect to hear the term "influenza pandemic" more and more in the coming year. An influenza pandemic is a global outbreak of disease that occurs when a new influenza A virus appears or emerges in the human population, causes serious illness and death, and then spreads easily from person to person worldwide. Pandemics are different from seasonal outbreaks, or "epidemics," of influenza.

Influenza pandemics in the 20th century, which all spread within a year of being detected, included the Spanish flu in 1918-19, Asian flu in 1957-58 and Hong Kong flu in 1968-69. The Spanish flu caused the highest number of known influenza deaths: more than 500,000 people died in the U.S., and up to 50 million people may have died worldwide. Many people died within the first few days after infection, and others died of complications later. Nearly half of those who died were young, healthy adults. The Asian flu caused about 70,000 deaths in the U.S. It was first identified in China in late February 1957 and spread to the U.S. by June 1957. The Hong Kong flu, which caused about 34,000 deaths in the U.S., was first detected in Hong Kong in early 1968 and spread to the U.S. later that year.

Now comes the avian flu, or "bird flu." Although avian influenza A viruses do not usually infect humans, there have been several reported cases of human infections and outbreaks of avian flu since 1997. Sixty-one people in southwest Asia have died from avian flu since 1997. Most cases of avian flu have resulted from direct contact with infected poultry or contaminated surfaces. Waterfowl and waterbirds carry avian flu viruses, but do not die from the disease. However, chickens and some other birds are susceptible and do get sick or die.

Over 100 million birds have been slaughtered in an attempt to contain the disease, but the World Health Organization (WHO) fears it is on the verge of mutating into a pandemic form, similar to the Spanish flu. For those humans who become infected, there is over a 50% mortality rate. The flu viruses have also been known to infect other animals such as pigs, tigers and cats in the wild.

Birds are the main carriers of the avian flu virus, known as H5N1. The current avian flu outbreak was first identified in April by Chinese wildlife authorities at Lake Qinghai in western China, where it was initially contained. By mid-May, however, the flu had spread through the lake's entire avian population, killing thousands of birds. As geese arrive in wetlands of South Asia, they excrete the virus into the water, where it can spread to other migrating waterfowl from Europe and domestic poultry.

The virus has now spread to the outskirts of Lhasa, the capital of Tibet, to western Mongolia, and to chickens and waterfowl near the Siberian capital of Novosibirsk. Russian Health Ministry experts said they doubt the outbreak can be contained on the Asian side of the Ural Mountains. Siberian wildfowl migrate every fall to the Black Sea and southern Europe. Others fly from Siberia to Alaska and Canada. Experts believe the flu virus has the potential to cover the earth in the next year.

U.S. Health and Human Services Secretary Mike Leavitt told the Associated Press in August that a flu pandemic is now an "absolute certainty." WHO also says an outbreak is "inevitable." Science Magazine wrote that the odds of a global outbreak as "100 percent." Professor Hugh Pennington, emeritus professor of microbiology at Aberdeen University, and who is Britain's leading expert on H5N1, said the virus may kill as many as two million Britons.

While scientists rush to produce vaccines, the outbreak of any disease can have a tremendous impact on fire departments. Not only will call volumes increase as a result of more illnesses in the community, but fire department personnel are also subject to contract the virus.

Here's what you can expect: The pandemic will last much longer than most other emergency events and may include "waves" of flu activity separated by months. In each of the 20th century pandemics, a second wave of influenza activity occurred three to 12 months after the first wave.

The number of fire department personnel and other health care workers such as nurses and doctors available to work can be expected to be reduced. Further fire department personnel and medical personnel will be at a higher risk of illness through exposure in the community and in health-care settings. Many will call in sick, while others may have to miss work to care for ill family members.

Resources in many locations could be limited because of how widespread an influenza pandemic would be. Expect hospital beds to fill to capacity and doctors' offices to overflow if everything comes to pass.

Another major issue is the availability of a vaccine. Several vaccines for human and poultry are in various phases of development. However, most are in short supply.

Fire departments should start laying out contingency plans now. It is important to have completed planning and preparedness activities to be able to respond promptly and adequately. Some of those contingency plans can include infection control procedures, proper body isolation procedures, and education on recognizing patients in the early stages of the disease.

The U.S. Department of Health and Human Services (HHS) supports pandemic influenza activities in the areas of surveillance ("detection"), vaccine development and production, antiviral stockpiling, research and public health preparedness. In addition, a draft National Pandemic Influenza Preparedness Plan was issued by HHS for public comment in August 2004. To view the draft plan or to obtain more information about pandemic influenza, visit the HHS website.


Gary Ludwig, MS, EMT-P, a Firehouse contributing editor, is deputy chief of EMS in the Memphis, TN, Fire Department. He has 28 years of fire-rescue service experience, and previously served 25 years with the City of St. Louis, retiring as the chief paramedic from the St. Louis Fire Department. Ludwig is vice chairman of the EMS Section of the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally. He can be reached through his website at www.garyludwig.com.

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