On April 27, China reported its first case of bird flu in the southern province of Hunan, bringing unwelcome news that the virus that had already claimed 23 lives in that nation since it was first detected in March is spreading.
This week, the World Health Organization weighed in, calling the virus – officially, H7N9, or Avian Influenza A – "one of the most lethal." By all accounts, it is also one of the fastest moving.
Is it time to panic?
Rutgers Today reached out to Janet Golden, a professor in the Department of History at Rutgers-Camden and a medical historian who has tracked pandemics across the centuries, including the 1918 global outbreak of flu that killed 50 million people worldwide.
The author of nine books, Golden co-edits the Critical Issues in Health and Medicine series for Rutgers University Press. She has received numerous grants and fellowships, including funding from the National Institutes of Health, the National Endowment for the Humanities and the American College of Obstetrics and Gynecologists.
Rutgers Today: When does an outbreak of disease reach "pandemic" levels? Are there indications that H7N9 has such a capacity?
Janet Golden: The term pandemic means that a disease has spread over a wide geographic area, but that tells us nothing about the numbers affected (whether it is epidemic in a population) or how deadly it is (the case fatality rate). The World Health Organization (WHO) and the Centers for Disease Control (CDC) in the United States keep careful watch over all infectious diseases to note their incidence, spread and seriousness. The key question about H7N9 is whether the virus will mutate so that it can be transmitted person-to-person.
The CDC created a separate site on its website for H7N9. The experts note that although all cases so far involve contact with poultry, viruses have the ability to change. That makes it conceivable that this one could ultimately become easily spread among people. What is our government doing to prepare?
The federal government maintains surveillance over outbreaks around the world and supports the development of preventive vaccines. The government maintains a stockpile of antiviral medications and monitors emerging strains of viruses to make sure they don't develop resistance to these medications. Education is another important measure. The government website, flu.gov, has information for individuals, businesses, communities and schools about planning and preparing for an outbreak and about what to do if you become ill so you don't spread the flu.
What have public health officials learned from previous pandemics that they can apply to this strain of avian flu?
There have been a number of deadly pandemics but none more so than the 1918 influenza pandemic. We didn't have effective surveillance then or vaccines or retroviral drugs. And we didn't always put in place the one measure that proved effective: quarantining the sick. In Philadelphia, for example, a parade to sell war bonds was held despite the outbreak. A crowd came together to watch the parade, and in the following weeks the numbers of deaths in the city climbed. Communities that isolated themselves from the infected or practiced strict quarantine had better outcomes. A terrific documentation of this can be found in the digital encyclopedia of the 1918 epidemic:
In a blog posted on Philly.com, you spoke of the impact of sequestration on the government's ability to protect U.S. citizens from H7N9. The American Public Health Association believes these broad cuts to federal agencies could put us at greater risk. Do you share that concern?
I am concerned. The American Public Health Association speaks for the public health of all of us when it points to the risks of cutting resources in the face of continuing and emerging threats. In the arena of public health, the federal government supplies information, resources, personnel and research that are vital to local and state efforts to prevent or control disease outbreaks. But we have to do our part too and make sure to get our flu shots every year.
What advice would you give Americans who are planning trips to China, or who have just returned?
The U.S. State Department maintains and updates information for travelers. The latest is here. Another useful source is the Canadian government updates. The recommendations boil down to this: Avoid poultry farms and markets and make sure poultry and eggs you consume are well cooked. Wash your hands. Seek medical care if you become ill. This seems like common sense to me.
So, back to our original question – is it time for us to panic?
Panic isn't helpful. Knowledge and preparation are what is needed. Those who are worried should seek information from the websites noted above; those who want to take action might write to their elected officials asking them to reconsider the sequester-derived cuts to the Centers for Disease Control and Prevention.