“Cytokine Storm” , the W Factor
Official scenarios of an unfolding Avian Flu pandemic, while harrowing, tend,
unfortunately, to over narrowly depict the threat. The projections, as would be
expected, all tally up the terrifying number of potential deaths --ranging
anywhere from 5 million to 150 million, the percentage of the population
stricken as the disease peaks --from 25 to 50%-- and the potential for a
breakdown in certain basic related services like the number of available
hospital beds and the space in official morgues able to store the surplus of
corpses. For anyone who has lived through an extraordinarily disruptive event,
and few of us still alive have seen anything like a worldwide pandemic, it's
clear that any estimate of the full mayhem has to take into account the massive
problems that can easily cascade out of control when basic services and supplies
are suddenly cut off or break down.
It's projected that once the H5N1 virus outbreak occurs --that earthshaking
moment when the virus recombines in such a way that it can pass easily from
person to person-- it will be only a matter of days, even hours, before
populations on every corner of the planet are being stricken in wave 1 of
several circum-global sweeps.
The first major indications of pending chaos for most populations that have come
to rely on their public health systems, will occur when they find that there are
enough anti- flu drugs available to cover just a tiny percentage of the
population, those designated essential. Most people, those who have not been
following particularly closely, will also be shocked to find out that there are
not even limited supplies of the vaccine that might have proved effective. It's
likely that these shortages alone will set off anger and panicky behavior among
people as they begin to realize the vulnerabilities and start to look outside
the system for ways to protect themselves and their families.
But where the gravest underestimations in the projections occur, is in limiting
the scope of disruptions to events that directly emanate from the health
emergency. The various impacts of the spreading disease, will in effect, widen
like the rings on still pond. In Washington, back in 2001, a small number of
postal workers died and several buildings, including the main postal
distribution facility and the Hart Senate Building, were closed as the anthrax
mail attack touched homes and businesses from Florida to Connecticut. However,
for each real event, the impact snowballed exponentially: buildings all over the
country were closed each day, public transportation systems were shut down,
people stayed away from work and bills went unpaid as people refused to open
their mail for fear of contamination. In relation to the relatively small number
of fatalities, the cost in disruptions was totally out of all proportion.
Imagine then, if possible, an unprecedented peacetime emergency that hits every
segment of society all over the world, simultaneously and in successive waves.
So, move your gaze out to satellite level and view an entire planet in turmoil,
a planet --very different from 1918-20 (the last major pandemic) in the
way it relies on a very intricate and complex logistics system that stretches
from one end of the globe to the other. Ironically --and their are many twists
to this story-- the vulnerabilities around this kind of collapse, may be
greatest in the most advanced countries that have systematically built a highly
complex system of dependency on the sound functionality of supply chain systems,
energy, and communication systems. Advanced countries like the United States no
longer manufacture most of their most basic items and the key components of
things that are assembled inside the country have finely tuned their
just-in-time inventory systems to the point that warehouses and normal
stockpiling have become a thing of the past; as a result, today, goods are
off-loaded in Los Angeles and sold off the shelves of a Wal-Mart in Sioux City
just days later.
Now, imagine how quickly the most ordinary and basic products will disappear off
the shelves of drugstores, supermarkets and the big box stores when it becomes
clear that factories in Asia have shut down for lack of available workers, that
ships are being stopped before they reach US harbors and that there are no
domestic manufacturing facilities to take up the slack or railroad workers and
truck drivers to move ordinary goods.
In a recent talk, Michael T Osterholm PhD, MPH,Director, Center for Infectious
Disease Research and Policy Associate Director, DHS National Center for Food
Protection and Defense, noted that there are only two facilities in the world,
both in China, that produce the entire globe's supply of surgical quality
facemasks. These face masks, in particular, and the common hygiene rules of soap
and water may just become the only defense available for most of the world's
populations.
Combine this with a world in which the percentage of healthy people will be
diminished by those who stay home from work for fear of getting infected, and
one where basic services begin to break down as fire and police services turn
spotty for lack of personnel. As all human contact becomes potentially fatal,
people go to great lengths to avoid contact with strangers. The already
overstressed US military, particularly the National Guard under the command of
the Governors, will see not only the ongoing strains of the Iraq War but the
added burdens of home service even while their soldiers fall into a particularly
vulnerable age group because of the way healthy immune systems over-react,
something called the "cytokine storm". Because of this phenomenon, for instance,
the average life expectancy in the US during the Spanish Flue outbreak dropped
from near 60 years to 18 as the disease struck hardest at those who would
ordinarily be the most likely to survive. This inversion of the age expectancy
chart is called by demographers, perhaps ironically in the present context, the "W
factor".
Another irony, is that our modern world, one we imagine more hardened to disease
attacks, is actually less able to retard the spread of the plague as air and sea
routes act as an efficient dispersion mechanism and as the highly refined supply
nodes potentially shut down. Influenza is caused by a virus and thus cannot be
impacted by antibiotics --and vaccine capacity and manufacturing methodologies,
of the one weapon that could have possibly impeded the attack, have little
changed in the last half century. The pharmaceutical companies, as we learned in
last year's shortage of common influenza vaccine, have found little profit in
building production capacity so there are only 9 countries in the world that
produce vaccines.
The greatest irony, of course, is that if an enemy like Osama bin Laden, were to
have the potential to unleash such an apocalypse, governments would be readily
allocating hundreds of billions of dollars for defense against the pending
attack. But the same politicians who have never seen a weapon system, no matter
how expensive, they couldn't love would balk at massive expenditures labeled
public health.
Compare the $4 billion allocated by Congress so far for Avian Flu, to the near
100 billions spent so far fruitlessly to build an anti-missile weapon, or that
new standard, the cost of being bogged down in the Iraq War, $4 billion a month,
that isn't even counted as part of the annual $400+ billion military budget.
We've called here on the Dymaxion Web, in a first step, to bring awareness of
the pending crisis to a world public. To some degree there has been a major
change in the way Bird Flu is being talked about around the world. Here in
Italy, where we are writing this piece, there is almost daily television
coverage of events in Russia, Rumania, Greece and Turkey.
The next step is for politically aware populations to begin pressing their
leaders for the kind of expenditures that take into account the major impacts as
we've laid them out, probably underestimating ourselves the full extent of the
danger. It is likely too late to do much in terms of medicines and particularly
the vaccines, but we can make real and proper plans that ensure the kind of
backup systems that will be needed to keep essential supplies and services
moving. The H5N1 virus is a kind of neutron bomb, it will leave the physical
world intact but its damage to populations will no doubt be enormous. In recent
weeks we've had demonstrations of just how unprepared we are to meet commonly
recurring terrestrial events like hurricanes and earthquakes. Governments, most
particularly the US, need to take another look at how we are spending money to
defend ourselves from real threats. Homeland security should be turned around
like a great ocean liner by Michael Chertoff and the Administration and given a
clear mandate to arm against this pandemic that may miss us this year but,
according to those best positioned to know, will happen! It's time to wake up
and see this defining challenge for what it is.
