October 17, 2005
Counterpoint
M.D. Patrick Cunningham sent the following email to Instapundit today regarding avian flu hype:
As a medical researcher, I want to make a gentle but sincere plea to the blogosphere to calm down this flu hysteria just a bit. The main way that flu kills is by predisposing its victims to "superinfection" by bacterial illnesses - in 1918, we had no antibiotics for these superimposed infections, but now we have plenty. Such superinfections, and the transmittal of flu itself, were aided tremendously by the crowded conditions and poor sanitation of the early 20th century - these are currently vastly improved as well. Flu hits the elderly the hardest, but the "elderly" today are healthier, stronger, and better nourished than ever before. Our medical infrastructure is vastly better off, ranging from simple things like oxygen and sterile i.v. fluids, not readily available in 1918, to complex technologies such as respirators and dialysis. Should we be concerned? Sure, better safe than sorry, and concerns about publishing the sequence are worth discussing. Should we panic? No - my apologies to the fearmongers, but we will never see another 1918.Patrick Cunningham M.D.
Assistant Professor of Medicine
Section of Nephrology
University of Chicago
I emailed Glenn the following as my response:
I am not a doctor, nor a biologist, nor a chemist. In any way that matters, I am completely unqualified to challenge the theory of Patrick Cunningham M.D. that the avian flu is over-hyped to the point of hysteria.
I'm going to do so anyway.
I, too, thought little at first of the media-darling pandemic, because I still remember the doom and gloom of Y2K, which wasn't that long ago. Hype alone doesn't do it for me. Then I read this article in the Raleigh, NC News and Observer, and decided to do some reading. I wasn't happy with what I found, and among those unhappy surprises, was the concept of "surge capacity."
To quote Dr. David Weber, medical director of hospital epidemiology at UNC Hospitals in Chapel Hill:
"Wal-Mart doesn't have a three-week supply of TVs; they may have a 12-hour supply," Weber said. "We've designed our hospitals the same way. We don't have surge capacity for anything, be it a bioterrorist attack, the avian flu, whatever."
In other words, if a pandemic does hit, it will happen with such speed that it will overwhelm the medical system by sheer weight of numbers, in an extremely brief amount of time. Having 50 ventilators in a hospital is a great thing, until you need 500, along with every other hospital in the region. The hospitals will fill up quickly, and after that, people will be largely on their own, and essentially left to fend for themselves at home, where technologies aren't that different on the internal medical front where they were in -- you guessed it -- 1918.
To me (and more importantly, the North Carolina Division of Public Health, and UNC epidemiologists interviewed in the N&O article) it seems like Dr. Cunningham's premise amounts to whistling past a graveyard.
I would love to be very, very wrong.
Sincerely,
It seems that a lot of the experts are blindly focusing on what we might have the knowledge to do, but not on the technical capability we have to execute their schemes in the compressed period of time in which a pandemic will likely occur.
What I've seen from the medical community so far (and what they've gotten wrong) makes flu pandemic planning look like Hurricane Katrina evacuations in a lab coat.
cunningham is DEAD WRONG:
the 1918 flu killed HEALTHY YOUNG PEOPLE (not just the infirm and the old and the very young, as in a noremal flu epidemic).
and they DIED IN A FEW DAYS!
therefore they did NOT DIE FROM SECONDARY INFECTIONS - as cunningham WRONGLY ASSERTS - ["The main way that flu kills is by predisposing its victims to "superinfection" by bacterial illnesses - in 1918, we had no antibiotics for these superimposed infections, but now we have plenty."]
antibiotics will have ZERO EFFECT - for those with the flu or as a prophylactic.
if the 1918 flu were to strike today, we would fare just as badly. perhaps worse because the world is - in a fiogurative senmse - a smaller place inwhgich more people from more places interact closely and spread germs.
IF ND WHEN the current bird flu morphs into a human2human from, we are "cooked" - until a vaccine is made and is made available - which will take alot of time.
we do not even have the inductrial capaciy to make enough, RIGHT NOW.
be prepared; hard timers are coming. i know not when. but PROBABLY within the next few years and maybe next year.
Posted by: reliapundit at October 17, 2005 08:58 PMGeez, reliapundit, what are your credentials for making such a harsh condemnation of Cunningham's statement. Seems that every year we have a flu scare that stampedes people to get flu vaccinations. Could there be an agenda here? It also seems that every year the same proportion of people with or without vaccinations get the flu with much less then the predicted number of deaths. Is this going to be the year for a wide spread flu epidemic? No one knows. After 'crying wolf' every year who can believe CDC.
Oh, yes, in all those past years, I have never gotten a flu vaccination (I am 70 now) and I have never gotten the flu. Could be that Cunningham is right about at least one thing.
Posted by: docdave at October 18, 2005 06:26 PMfacts are facts. you can look it up: most of the 1918 victims were young men - 18-35, and most died in 3 days.
they did not die from secondary/"superimposed" infections as cunningham ERRONEOUSLY offered.
therefore, his argument that antibiotics and other medical interventions to deal with these superimposed infectioins is WRONG.
that is NOT to say we will have a pandemic at all. the bird flu does NOT have to mutate into a human2human form.
but if it does, it can spread VERY fast, and kill a lot of people before it burns out and before any vaccine is available to a significant percentage of the population.
these are facts.
like'em or not. a fact is a fact.
this is not fearmongering. we shouold be prepared. and arguing that we have plentantibiotics around is NOT a good way to get prepared.
we need a sense of URGENCY about this POTENTIAL problem becasue the downside is so bad.
and by the time it is an EMERGENCY it will be too late to do ANYTHING.
okay?
Posted by: reliapundit at October 18, 2005 10:00 PMReliapundit is right about the demographics of death in 1918. A fabulous book from a couple of years ago about the 1918 influenz, called Amazon.com: Books: The Great Influenza: The Epic Story of the Deadliest Plague In History pretty much spells out the details. Apparently that flu hyperactivated the immune system and the strongest humane systems were in the young adult range. It's unclear whether, if that flu were to strike today, modern antibiotics would be of any use in quelling this immediate and violent immune system response. I'm with CY that this is something different and worth being afraid of. I'd rather have an over reaction now, which results in vaccine research and drug stock piling, then place my hopes in a belief that this might end up being a tempest in a teapot. We're long overdue for something like this, and the 50% mortality rate for those who have gotten avian flu demands vigilance.
Posted by: Bookworm at October 20, 2005 08:57 PM
