POSTED: October 16, 2006

What is bird flu? Bird flu — or avian influenza — is caused by a virus that usually infects birds (particularly domestic poultry and wild waterfowl) but occasionally crosses the species barrier and infects humans — predominantly in the Far East, although it also happens elsewhere.

Does it affect people? Until recently, avian flu was thought to only rarely affect people and usually caused only mild disease, such as conjunctivitis (eye infection). Since 1993, however, one particular strain of bird flu — H5N1 — has been associated with a very high death rate when people have become infected. As of September 28th, the date of the latest World Health Organization report, more than 250 human cases in 10 different countries have been documented. Of these, 148, or more than half, have been fatal, even with intensive hospital treatment. The number of animal and human cases continues to climb and more and more countries are reporting outbreaks. Additional deaths are being reported almost daily. In 2006 alone, there have been 104 cases with 70 deaths — most in the past three months.

The WHO suspects that there are many, many more unreported cases, or cases that have been misdiagnosed as ordinary flu, dengue/breakbone fever, or severe pneumonia.

Poultry infections are in the multi-millions, and other animals, notably cats, dogs, ferrets and pigs have also been fatally infected by H5N1. Fifty-three countries reported animal infections or recent outbreaks so far in 2006, bringing the total to 59. Many of the human infections have occurred without any coincidental poultry outbreaks in the region, leading experts to suspect that some other animal (or animals) have not been identified, although some limited governmental effort is finally being made to do so.

What is pandemic flu? An influenza pandemic is a highly contagious, frequently fatal, flu strain that spreads rapidly, causing widespread illness around the world. In contrast to the 'ordinary' or 'seasonal' flu outbreaks that we see every winter, flu pandemics occur infrequently — usually every few decades. There have been roughly three every century for the past 300 years. The most serious was in 1918 (the "Spanish Flu"), which killed an estimated 100 million people worldwide. In some places, entire villages died. Smaller, less lethal, pandemics occurred in 1957 (the Asian Flu) and 1968 (the Hong Kong flu).

What is the difference between an epidemic and a pandemic? The Greek prefix "pan" means "all." A pandemic occurs over large geographical areas (usually worldwide) and affects a high proportion of the population. An epidemic, although it may be serious, usually refers to what is happening in one specific country or region.

Why are we concerned about avian flu? The avian (bird) flu that is affecting poultry flocks in Asia at the present time has increased experts' concern, and has now been found in birds in most of Europe and parts of Africa as well. Unlike the ordinary seasonal flu that kills the very young and very old, H5N1 particularly targets children and young people. This year, flu victims aged 10-29 have experienced unprecedented fatality rates of 70 to 80 per cent.

Scientists fear that this virus, which is constantly changing, may evolve or recombine with other highly infective viruses to make it a more serious threat for humans, thereby starting another global pandemic.

Is another pandemic of influenza likely? Flu viruses are constantly changing and adapting, so it is inevitable that viruses sufficiently different from "ordinary" flu strains will emerge from time to time, triggering a pandemic. Pandemics, like hurricanes, earthquakes, and tsunamis, happen periodically throughout history.

When is the next pandemic due? We don't know — it can't be predicted. The gaps between previous pandemics have varied widely, from 11 to 42 years with no recognizable pattern. The three influenza pandemics that occurred in the last century all affected large numbers of the world population, causing many deaths and huge economic and social disruption.

Where is the new virus likely to come from? Past experience suggests that it will first appear in Asia, but it could arise anywhere. Many people in the US are confused about avian influenza — expecting the pandemic to be directly caused by infected birds. However, it's far more likely that the pandemic influenza strain will arrive in the U.S. as a result of a sick traveler flying here from an infected country. H5N1 does not generally show symptoms for as much as 48 to 72 hours after a person has become infected, so identifying a carrier can be difficult. Even closing airports and borders may have little effect on the spread of the disease.

Will it arrive in winter like normal flu? Not necessarily. A new virus may not follow the usual seasonal pattern of ordinary influenza. It could occur at any time of the year. The pandemic can also arise at the same time as the seasonal flu, making it possible for people to be infected by both diseases at the same time. It's especially important for people to get their regular flu shots at the beginning of flu season. That way, if the pandemic does begin, their bodies will not have to fight off two dangerous infections at one time.

How will we know when a pandemic has started? When a new strain of influenza virus has not only been identified but is also causing illness that has started spreading easily from one person to another. H5N1 has already shown that it can spread, with sufficient exposure, from human to human to human (H2H2H) in family and neighborhood clusters in Viet Nam, Turkey, China, Indonesia, Azerbaijan, and elsewhere.

Can it be prevented? Intense international efforts are underway and, ultimately, will be aimed at trying to control a pandemic at the earliest stage. However, influenza is highly infectious — and because the whole world's human population will be susceptible to the new virus, the WHO has stated that they believe that it's extremely unlikely that they will be able to stop it. There are many places in the world where surveillance and testing is impossible due to geography, weather conditions, political climate, and poverty, and, even after admission to the hospital, testing/confirmation procedures can take days to complete. Since January 2006 alone, the virus has spread to more than 40 additional countries and has broken out repeatedly in countries that had previously been declared "influenza free zones."

As of today, H5N1 has been identified in its "low pathology," or LP, form in several states in the U.S., most recently in MI, MT, MD, PA and IL (Sept 24, 2006). The LP strain usually doesn't cause serious illness in humans. The "high pathology" or HP strain of H5N1 which is responsible for human deaths is suspected to have been found over the summer on Prince Edward Island, Canada. Unfortunately, faulty testing procedures and delayed and improper handling of the bird samples made it impossible to confirm the initial lab's conclusions. It's only a matter of time before migrating birds and/or infected humans bring the HP strain to the United States.

Is there a vaccine for avian flu? Vaccines against the H5N1 avian flu currently occurring in SE Asia are under development. These are not the same as a pandemic vaccine — if a pandemic were to emerge from this virus, the virus likely will have mutated to such an extent that these vaccines may not be effective. Vaccines must be produced using the specific virus that is causing the disease. Even under the best of circumstances, that will take six months or more AFTER the outbreak of the pandemic. Equally important is the fact that vaccine production facilities and techniques are seriously outdated or, in some countries, nonexistent. To bring vaccine manufacturing up to date is proving extremely complicated and expensive, and may take up to 10 years to accomplish.

Is there any other treatment for avian flu? One or more antiviral drugs are usually helpful in treating avian flu, but they have to be administered within 48 hours of the appearance of the first symptoms. They can also be taken, for example, by first responders, health care workers, and poultry workers and cullers exposed to infected birds or their droppings, to prevent them from getting avian flu. There is, however, increasing evidence that the H5N1 virus is developing resistance to all drugs now being used against it. The more these drugs are used, the more likely that the virus will develop resistance to them.

There are several key things the average person can and should do to protect himself and his family.

1. Talk to your doctor about getting a seasonal flu shot and a pneumonia shot. Many deaths are caused not by the flu itself, but by what are called "secondary infections," like pneumonia, strep or staph infections. Some insurance plans will not pay for pneumonia shots for certain age groups. However, it's usually possible to get the shots if you agree to pay for them yourself.
   
   
2. Practice sensible hygiene and infection-prevention. Wash your hands thoroughly and often. Cover your coughs and sneezes with something other than your hand. Make sure surfaces that you touch regularly, like telephones and door knobs, are disinfected several times a day. If you or a family member does get sick, please stay home and avoid infecting others.
   
   
3. Stockpile food, water, medications and other emergency supplies in sufficient quantities that will permit you to stay home when other sick people are out and about. If you recall what happened in New Orleans during Hurricane Katrina, you will have a basic idea of what to expect. Food and other supplies ran out in a few hours, certainly within days, and it was impossible for stores to get restocked.

It's equally important to understand that our supply and distribution system for foods and other goods operate on the concept of "Just-in-Time" (JIT) delivery. This means that stores no longer keep large inventories of products in their back rooms. They no longer have local warehouses. They get shipments to their stores several times a week and the products go directly to the shelves from the delivery trucks. There are no extras for when a lot of people suddenly need, or want, products at one time.

As more and more people become sick, there will be fewer workers available to handle merchandise and get it shipped around the country. Refrigerated trucks will be commandeered for use as temporary morgues. And as the pandemic progresses, virtually all products that we now get from overseas will become totally unavailable — including many critical lifesaving medicines, most of our shoes and other clothing, and a wide variety of food products.

How Much is a Really Tough Call and one that you need to seriously think about.

Pandemics typically occur in "waves" that go around the world just like The Wave in a football stadium. It starts in one place and then just keeps moving out in every direction. With modern air travel, we can expect a full scale, worldwide pandemic in only a few days or weeks from the first "Index Case."

A wave can be expected to last in any given area roughly 8 to 12 weeks.

This means, that in order to not become exposed, a person would have to be able to Shelter-in-Place (SIP), without outside contact, for at least the duration of the wave. For many people, especially people like first responders and medical personnel, that will be impossible. But other people will find that their schools, offices, and workplaces will all be closed — and they will be asked to stay home. These people are in the best position to take advantage of the protection SIP offers, but only if they are prepared to do so in advance.

David Nabarro, of the World Health Organization, Dr. Robert Webster of St. Jude's Research Hospital, and Dr. Michael Osterholm, outspoken leaders in the pandemic flu community, have all stated publicly that they have stored away enough food, water, prescriptions, over-the-counter medications, and other necessities to last their families for a minimum of 90 days. That is a staggering amount — and we fully recognize that most people have neither the storage space nor the financial resources to accomplish this.

But you must do as much as you can, as quickly as you can, for as long as you can. Every day that you can avoid going out into public is another day that you might avoid getting exposed to the pandemic virus. Studies of the spread of the Spanish Flu have shown that the last towns to become infected, and the last people in those last towns, had a much greater chance of survival than those who were infected first. There is no guarantee that this will happen with the next pandemic virus, but it's a helpful goal.

To help you get started in "prepping," as it has come to be called, we've provided a shopping list for two weeks worth of supplies — for every adult and teen in the household. (Babies will need baby food and formula and young children will need smaller amounts than those provided.) You can actually get by on less if you have to. Because there is no guarantee that there will be electrical power available for refrigeration, it's important to get things in small enough sizes that they will be consumed by your family in one sitting and need no refrigeration for regular storage. Try to select items that your family normally likes to eat. While it's true that most people will eat whatever is available if they are hungry enough, it's better from a psychological standpoint to have things that you already enjoy and are easy to prepare.

1. WATER — IS ABSOLUTELY CRITICAL.
It's been said that a person can live three weeks without food, but only three days without water. If the electrical system is disrupted for more than a day or two, by whatever means, you will need to have immediate access to water. You should store at least a gallon per person per day for drinking, a second gallon per person per day for cooking, and a third gallon per person per day for washing and other hygiene needs. That's more than is in the typical case of water you find at the local Wal-Mart or grocery store. (Be sure to read the labels so you know how much you are buying.) A pint — which equals eight ounces — is roughly equal to a half-liter. A quart is almost a liter. There are about four liters to a gallon.

For two weeks, that's about 16 to 20 typical-sized cases per person. We know that's a lot, especially when you have to find a pleace to store it. It's heavy and difficult to stack without crushing the cases on the bottom. Some of the bottles may leak.

So — you might want to get enough bottled water only for drinking water — and for the water that doesn't have to be safe to drink, just stockpile clean, empty plastic bottles, like the two-liter soda bottles that soft drinks come in, that you can bag and put in a closet until you need to fill them. A two-liter soda bottle holds slightly more than a half-gallon. You can also fill up your bathtubs, use the water from the toilet storage tanks, or use the water in your hot water heaters. If you have sufficient space, you can also get plastic water drums, collapsible 5-gallon camping containers, fill up children's swimming pools, or do many other innovative and imaginative things to have extra water on hand for emergencies. And, of course, be sure not to waste any of the water as you use it.

2. FOOD — certainly more than a nice to have
Matches, charcoal, sterno, propane, or some other kind of cook stove will be helpful if the electricity goes off. Large insulated thermos jugs may be used to cook pasta, soup, etc., and keep it warm.

SUGGESTIONS FOR A 2-WEEK SUPPLY PER PERSON:
• 14 regular-sized (14-15 oz) cans of vegetables (peas, beans, carrots, corn, asparagus, beets, etc.)
• 14 regular-sized cans of fruit (fruit cocktail, pears, peaches, apple sauce, mandarin oranges, tropical fruit, etc.)
• 1 large jar of peanut butter (as long as the person is not allergic to peanuts!)
• 2 small jars of jelly or jam (when opened, most of these require refrigeration, so go for small sizes)
• At least one large box of crackers (to put the peanut butter on)
• 10-15 lbs of white rice (preferably instant because it is easier and faster to cook)
• 30 cans of soup – at least half of these should be suitable for pouring over the rice or pasta as a sauce
• 14 cans of meat products – like Spam, Treet, canned ham, tuna fish, salmon, sardines, stews, chili, canned pasta
• 2 medium or large jars of prepared spaghetti sauce
• 1-2 lbs of pasta or noodles - angel hair pasta cooks the fastest if you have shortages of fuel or water
• Cooking oil – you can't cook most foods without it
• Other boxed or canned items that are easy to prepare and safe to store, like instant nonfat dry milk, evaporated milk, Instant Breakfast, breakfast bars, dry cereals, macaroni and cheese, instant potatoes, egg noodles, trail mixes, nuts, ramen soup, instant soup mixes, grits, complete pancake mixes, Bisquik, instant corn meal, etc.
• Coffee and tea, with non-dairy creamer, sugar or other sweetening
• Snacks – especially chocolate, cookies, candy bars, chips, fruit bars, popcorn, or anything else that your family likes.
• Multiple vitamins and Vitamin C tablets – to make sure you are getting all the essential nutrients you need.

3. PRESCRIPTION DRUGS AND MEDICAL SUPPLIES
When the pandemic starts, you don't want to be one of the people in line at the Pharmacy — where a lot of really sick people are going to be or in a doctors office. Ask your doctor NOW for long-term prescriptions for anything you take on a regular basis. Many health care plans permit a 90-day supply to be filled at one time. Beware of ordering prescription drugs from the Internet — too often they are counterfeit or simple sugar pills that look exactly like the real product, right down to the markings on the pills and the design of the container.

While you are stocking up on your prescription drugs, remember that you might not have electricity available, so anything that needs refrigeration, such as insulin, will have to be kept cool somehow. Consider using a generator or a cooler of some kind. Remember, too, that you probably won't be able to get dry ice or bags of ice cubes from the store. Think ahead of ways to solve this important problem.

Pick up a supply of over-the-counter flu and cold medicines, pain killers and fever reducers like aspirin, acetaminophen, and ibuprofen, band-aids and bandages, antibiotic creams, etc., as well as equipment like a stethoscope, mercury thermometers (digital ones may fail when needed), plastic urinals and bed pans, a portable bedside commode, blood pressure cuff, etc. Learn to use them properly and, if you are inexperienced in home nursing care, take a good basic first aid course as soon as you can.

You should also have plenty of bleach, vinegar, and other disinfecting solutions/sprays on hand for cleaning, clothes washing, and washing dishes, sick room equipment and other utensils.

4. PERSONAL CARE ITEMS
Items such as toothpaste, toothbrushes, mouthwash, deodorant/antiperspirant, shampoo, conditioner, combs, hair brushes, Q-Tips, dental floss, shavers, shaving soap, and razor blades all help to make people more comfortable. Not having them is generally not life-threatening, but they do make you feel more civilized.

• Baby and antiseptic wipes are very useful for people who are ill or incapacitated.
• Adult and baby-sized diapers may also be required, depending on your family make-up.
• Feminine care products and contraceptives should not be overlooked, either.
• N95 certified (or higher) protective masks; N100 respirators are preferred.
• Latex-free examination gloves (many people are allergic to latex)
• Don't forget soap, liquid and bar, both for personal care and general cleaning, including laundry and dishwashing.
• And TOILET PAPER. Lots of toilet paper.

5. EMERGENCY EQUIPMENT
Multi-purpose knife like a Swiss Army knife, hatchet, hunting knife, shovel, scissors, flashlights, candles, lanterns, batteries in all sizes, boxes of matches, a camp stove, charcoal or other fuel for it, a battery-powered radio, a rotary-dial telephone (the only kind that works without electricity), water purification tablets or water purifier, sleeping bags and extra blankets, plastic garbage bags (heavy duty and regular), duct tape, aluminum foil, paper plates and cups, plastic eating utensils, napkins, etc.

6. MONEY
Have as much cash on hand as possible — small bills, nothing larger than ones and fives, plus a good supply of coins. Fairly quickly into the pandemic, banks and businesses will close, ATMs will not be refilled, credit and debit cards will no longer be accepted, and purchases, if anything is still available to buy, will be possible only with cash. You will need to be in a position to pay with exact change because few people will have money to make change for you, and money passing through many hands will become contaminated with virus.

7. CARING FOR AND PROTECTING YOUR PETS
Mammals, such as cats and dogs, have contracted H5N1, mostly from eating infected birds. Scientists have proven, however, that cats can pass the illness to other cats (called "horizontal transmission"). Fear has already caused people in Europe to abandon their pets. Some have been taken to animal shelters, but many were just turned loose or taken in cages to the town landfill and left.

It's very likely that animal shelters will be completely filled with unwanted pets and that the shelters will be seriously understaffed. That makes it likely that most or all the animals who come in during the pandemic will be humanely killed because there will be no food, water or electricity available and few people there to care for them. If you don't want this to happen to your pets, please take appropriate action now to protect them.

We are all familiar with what happened to people and their pets in New Orleans during and after Hurricane Katrina. We certainly do not want that to happen again, so sensible prior planning is important. If you keep your pets inside and under control (on leashes) and away from other people and animals, you greatly reduce the risk of them becoming infected and a hazard to human health. In order to do this, you must commit yourself to a higher level of care and management than you might ordinarily have needed.

Cats must use litter boxes in the house instead of being allowed to run free or live in barns. Dogs must live inside and be either paper-trained or taken outside on leashes in order to relieve themselves. You will need to stockpile enough food and water for your pets to get them through the pandemic wave — just as you would other members of your family. Make sure that their vaccinations are all up to date, in accordance with instructions from your veterinarian. Make sure that their licenses and rabies tags are on their collars and the collars are on the animals, in case they happen to escape from the house.

Don't forget to have proper equipment, bowls, treats and other items available to care for your pets.

8. CARING FOR AND PROTECTING LIVESTOCK
This is a huge issue, and one that has not been considered by most jurisdictions. Much of the emphasis has been placed on protecting chickens and other poultry, but horses, goats, cattle, pigs, and other large animals are also common, and are frequently pets.

We know that pigs can get H5N1 but we don't know yet if horses and other livestock will be susceptible to a pandemic strain. They might be. After all, horses can get sick from regular equine influenza and rhinopneumonitis diseases for which we already have vaccines. But there will be no pandemic vaccines available for large animals for a long time after the pandemic breaks out, and perhaps not ever.

The best advice we can offer at this time is to talk to your veterinarian and the State Veterinarian about how a pandemic could be expected to affect your farming business and your animals. And though we recognize the difficulty involved, try to stockpile as much animal food and veterinary supplies as you can, and investigate different ways to provide emergency electrical power and, especially water, for your livestock.

Won't the government do this preparation for us? Our federal government has told us that we will be on our own because federal, state, and local governments cannot help everyone at once. If 30% of the work force is out sick or caring for the sick, everything from hospitals to supermarkets to the power grid (and possibly the Internet) might not be functioning normally. How well we fare will depend on how well we have prepared.

How can I help my community? Local communities will have to strengthen their resources in order to keep essential services running during a pandemic. Your local utilities, schools and hospitals should all be making plans. Find out what is being done in your community and how you can help.

How can I raise my community's pandemic influenza awareness? Share this message with your family, friends, co-workers, and neighbors. Some states and communities across the nation are being very proactive about getting the word out and encouraging personal preparedness. Those will be the states and communities prepared to cope.