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September 17, 2005

H5N1 and Katrina: Thoughts from the Reality-Based Community

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We've hesitated to bring up New Orleans and its obvious lessons regarding the looming Avian Flu menace mainly for fear of overstating many of the obvious echoes. From the beginning, it's been clear to a number of thoughtful people that despite its magnitude --one of the worst combined natural and manmade disasters in our history-- the response required and impact of worldwide pandemic would dwarf whatever pressures Katrina hitting the Gulf Coast and a city the size of New Orleans has placed on the system.

During that same week that our attention was being pulled to our own South at a press conference given as part of a meeting held in Sri Lanka, Dr. Jai P. Narain, Director of the World Health Organization's communicable diseases department said: "We may be at almost the last stage before the pandemic virus emerges... "Whether the avian influenza pandemic will occur, that is not the question any more, (but) as to when the pandemic will occur." Dr. Narain's open concerns were reaffirmed later by his own bosses at WHO.*
 
The magnitude of the warning in no way gives short shrift to the suffering wrought by Katrina by bringing attention to the looming disaster of a pending H5N1 pandemic. What's at stake are the implications of the government's response... and what, obviously, is more significant, looking forward to preparation for the looming pandemic.  What indeed are the implications of reconstruction along the Gulf Coast (estimated in the $hundreds of billions) in regard to preparing for other emergencies, most particularly, an H5N1 outbreak? 

For readers learning about this for the first time, a particularly deadly flu strain, called the Avian Flu (H5N1 virus) has been detected in a great number of domestic and wild birds since the late 1990's. It has spread across much of Southern and now Central Asia from Mongolia and Siberia in the North to Indonesia in the South killing millions of birds and an estimated 65 humans mainly in Vietnam and most recently in Jakarta, Indonesia. The flu, for technical reasons (please look to sites like H5N1Drome --there is a list of links on the site-- for more info) is compared by epidemiologists to the Spanish Flu of 1918-1919 that killed millions of people as it circled the globe three times reaping new victims in each pass.

During the last couple of weeks there have been some interesting developments on the Avian Flu front here in the US. It has been said in the press, for instance, that Homeland Security Chief Chertoff was in Atlanta on the Monday that the levees failed in New Orleans attending a meeting on Avian Flu. President Bush, in a speech to the United Nations mentioned the potential threat of H5N1. On Thursday of this week ABC's Primetime laid out in stark and clear terms the potential havoc of a pandemic that most communicable disease specialists believe to be inevitable. During this week, the HHS (Department of Health and Human Services)announced that it had ordered $100 million worth (doses to be determined)  Avian Flu vaccine from the large pharmaceutical company, Sanofi-aventis.  Another government agency announced it was sending a half million dollars to Vietnam to help monitor the disease in this hotspot.

The conclusion of all these who have studied the path of a pandemic is that prompt and vigorous preventive action is the only hope. Once the virus undergoes its fatal recombination and gathers the capability to readily pass from human to human it will be too late. There are many reasons why it will be unstoppable unless swift and costly action is taken, but we will list just a few: it will probably break out in a poor, densely populated country where the public health system will be slow to react at a point when time is of the absolute essence. Once the disease spreads beyond a small circle all of us stand to be just six steps apart; air travel moves potential carriers from continent to continent and airplanes that land in international hubs have spokes to ever wider continental reach; it will take years to produce enough vaccine --vaccine production for what is still to mutate is problematic, as are production technologies-- to matter; the only known drug to mitigate the disease, marketed as Tamiflu, will be in short supply unless production is greatly sped up and even then this drug will only act as a palliative possibly slowing the spread and reducing the number of deaths; finally, human behavior in the panic that will follow the realization of what's at stake is not likely to be level-headed.

Those of you, who've followed BlowBack with any regularity know, of with what little esteem we hold the political class and its ability to provide any sort of leadership in the face of a pending crisis and, nearly equally, our disdain for the mainstream media that has refused to report the ongoing reality.

But there is a political lesson to be learned here, after all, even we were surprised to learn to what degree, for theoretical political reasons, it appears--  this Administration had gutted FEMA after having assured us that another highly aggressive terrorist attack on our soil was likely to happen. FEMA's role in the aftermath of any such attack would be critical, we had assured ourselves, and even a highly politicized administration would have had that much sense, we assumed.
We know that the President brought with him on his August vacation a book, The Great Influenza: The Epic Story of the Deadliest Plague In History,  describing the great 1918-1919 tragic Spanish Flu pandemic. He will not be able to turn to us and say it could not have been imagined nor predicted. But that's of little importance. The real question is what can realistically be done while there is still hopefully time, against the reality of American politics today.

 The Administration has been willing to run up the national debt by cutting taxes while spending heavily on both guns and butter. It has faced no substantial accountability for the cost of the Iraq adventure mainly by the sleight of hand of keeping the cost off the books. So far the the dollar has sunk a bit but not to such a point that a national scandal broke out. Foreign bankers for their own reasons have been willing to keep buying $-denominated bonds despite the precarious situation. For the new conservatives (the old ones used to worry about deficits) the Administration represents, debt through tax cuts has the double benefit of enriching those who pay the most while strangling government's ability to provide services to those who have the least to pay.

 It was only when Katrina came along that the first reality was shed on the impact of this approach. For those keeping score, Katrina will undoubtedly cost more when all is said and done even than Iraq. That cost, probably to exceed a half trillion dollars, will not --the President purposely didn't mention it in his speech last night-- be covered by increased taxes. But beside the massive deficit increase, the effort will also require an enlarged bureaucracy no matter what the President does to avoid creating another government agency and/or tsar. 

Also against the unreal backdrop of further borrow to further spend, there are many observers who believe that the strain on the budget this time around will produce real cracks, perhaps a further push down of the dollar and ensuing rises in petroleum prices and other imports.

In other words, even if Bush understood what's needed and wanted to get behind it, he would be pushed to a wall and required to show real courage. His political base will not look at New Orleans and conclude that had they spent a few billion in federal funds for environmental defenses and levees they could have saved lives and hundreds of billions. Further, they would raise a ruckus if he were to come out and call for a huge infusion of federal funds into a national effort to combat the pandemic --even though that expense could save many more lives, and save the economic system dear to them that would be imperiled  (see BMO Nesbit Report on Economic Impact of Avian Flu Outbreak).

In order for even the most minimally meaningful action to come out of Washington, the President, already weakened in the polls for lack of credibility and leadership, would have to stand up to his conservative base and argue for what would amount to the most ambitious domestic public health project ever undertaken. He would have to agree to spend even more money against the backdrop of an already unreal budget situation. He would have to convince a skeptical public, not to mention the Democrats in Congress, that this time he knows what he is doing without at the same time scaring the hell out of everybody, and he would also have to strengthen the worldwide effort being led by the United Nations, of all entities. Do we really have to ask the rhetorical question of what the odds of this happening might be?

And so on this pleasantly warm mid-September day, we see looming on our screen, just as we saw the satellite photos of Katrina, an event that could truly alter history and we find it absolutely impossible to remain silent. It's our fate to belong to what Administration insiders like to refer to as the "reality based community" at a time that may, alas, truly require nothing more than a wing and a prayer.

In the near future we plan to offer some ideas on what we all might do.

* Readers who want to get filled in on a daily update of statements, news, and opinions on the Avian Flu are invited to start at H5N1Drome and to also follow some of the links on the site that point to other places on the Web where the potential pandemic is being regularly covered.

Posted by dymaxion at 01:43 PM


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