M: "What is your academic background and current position?"

G: "I have background in both agriculture and medicine. I graduated from the Cornell University School of Agriculture and the Tufts University School of Medicine. I'm now the Director of Public Health and Animal Agriculture at the Humane Society of the United States."

M: "Let's cut to the chase: there's human flu, pig flu, bird flu... what kind of flu are we talking about here?"

G: "Avian influenza has existed for millions of years as a harmless intestinal water-borne infection in aquatic groups, like ducks. Under extreme conditions, though, this virus can mutate into a form much more dangerous to birds, and particularly more dangerous to human beings as well."

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H5N1 LETHALITY

M: "What is H5N1, and what makes it so unique and of special interest?"

G: "H5N1 is a strain that started killing people in 1997, in Hong Kong. The significance is that no human being has ever, to our knowledge, been infected with an H5 virus, and therefore there is global universal vulnerability to such a virus --- no one has any prior immunity. The reason that the seasonal regular flu doesn't kill more people, doesn't infect more people, is because we have immunity to last year's flu. Every year the flu virus mutates just a little bit, just enough to keep infecting people, but every few decades a strain comes along to which there is essentially zero immunity and it spreads like wildfire around the globe, thereby triggering what's called a "flu pandemic." There's been a number in the past, there will be a number in the future. The concern, though, is about H5N1 in particular because most flu viruses are the cause of relatively limited illness, yes... here in the United States this could mean more than a million Americans come down with the flu every year --- may kill as many as 30,000 Americans, mostly the elderly, the infirmed, small children... but young healthy people are out of work a few days, feel pretty lousy, and live through it.

H5N1 is different. H5N1 is like no flu virus that we've ever seen before... it's killing over 60% of people that have come down with it --- a coin toss whether one lives with this disease. In 2006 it was more like 70% dead, in the first cases in 2007, more like 80% dead. These are Ebola statistics. It doesn't sound like the flu at all. If this flu were to trigger, were to mutate to a form easily transmittable from one person to the next, it would spread around the world as another flu pandemic, and if it retained any semblance of its current human lethality it could be a truly catastrophic event."

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SLOPPY MUTATIONS

M: "In your book, "Avian Flu," you refer to the virus as a "tiny terrorist" and producing "mutant swarms," yet you also say that in terms of its mutations, it's very sloppy. Why is this a problem?"

G: "RNA viruses, in general, have no kind of "proofreading" mechanism when they multiple, unlike DNA-based organisms like human beings. Obviously if our cells divided and didn't have an exact copy of the progenitor cells, we could come down with cancer or worse. That's where birth defects come from --- some kind of mutation in the DNA. But our bodies have evolved a DNA proofreading mechanism. Each cell is an exact copy or attempts to make an exact copy of it's parental line.

RNA-based organisms, however, based on the biology of the replication of the RNA, don't have a proofreading mechanism, so each progenitor virus in this case, is a slightly different mutant. In fact, most of the viruses that get spawned from its host are actually useless, so crippled from its mutation, that it cannot go on and replicate further, or be infectious, or hurt anyone. Well, you might think that evolutionarily that seems crazy, that the vast majority of one's progenitors would be unable to reproduce further. The reason why this has been maintained by evolutionary history is because that gives these viruses an edge: they can rapidly rapidly evolve. When placed under new environmental pressure, or in a new host for example, even though 90% of the reproduced viruses may be useless, among that small 10% there may be one even better adapted to that new situation, and therefore after a few generations can evolve more rapidly than the host. That virus is kind of the ultimate parasite... able to "overwhelm" or be one step ahead of the host's immune system, otherwise we would rapidly evolve immunity to it. So if you look at something like the chicken pox virus, we get chicken pox one time, hopefully, and we never get it again because our body remembers that same chicken pox virus. But the reason we get the flu, year after year, is because the virus is just one step ahead of us --- changing just enough to evade our initial defenses.

If you think about the viruses that we can't make vaccine for, essentially can't make universal vaccines for, something like HIV or influenza, these are RNA viruses that mutate so rapidly we can't pin them down with a vaccine. That's why every year we have to make an entirely new flu vaccine, because the virus keeps changing. Of all the disease threats in the world, we're most concerned about RNA-based viruses because of their ability to mutate, to bring us new surprises. AIDs has indeed infected 20 - 25 million people in the past decade, but there's only one virus on the planet capable of infecting billions, and that's influenza."

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EPIDEMICS/PANDEMICS

M: "Guess that's one of the reasons you mention in your book that great quote from a microbiologist: "Never underestimate an adversary with a 3.5 billion year head start." What's the difference between a pandemic and an epidemic?"

G: ""Epidemic" from its roots means essentially "upon the people." "Pandemic" means "upon all of the people." An epidemic, like most natural disasters, is relatively limited in both time and space. You're talking about an earthquake, a terrorist attack, or a hurricane. Whereas a pandemic, by definition, occurs everywhere. That's the entire world. It's a disease outbreak affecting the entire world. AIDs, for example, has been described as a pandemic... yes, it's been a pandemic in slow motion, but over the last few decades it's literally killed millions of people on every populated continent around the globe. Now influenza can similarly cause a pandemic, but can do it in a space of a matter of months. It can literally infect half of humanity. In fact the last time that bird flu jumped species from birds to people, back in 1918, the virus killed 50 to 100 million people around the globe --- the worst plague in human history and it did that in a very short amount of time. It basically killed more people in 25 weeks than AIDs has killed in 25 years."

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1918 & EMERGING DISEASES

M: "...in your book you pointed out that more people died from that plague than in all of World War I."

G: "Yes indeed... in fact, no war, no plague, no famine, has killed that many people in so short in time as the 1918 pandemic, and we didn't learn until October 2005 where this pandemic came from. It's kind of the ultimate medical detective story... what was that masked killer virus? Back then we didn't have the kind of DNA fingerprinting techniques we have now. We were able, this is straight out of "Jurassic Park," to dig up a corpse discovered frozen in the Alaskan permafrost that died in 1918, get tissue from her lungs, and re-create the genetic code, letter by letter, of the entire virus. This has been done up in Toronto and Atlanta. We have the 1918 virus back, we can study it and, lo' and behold, it was a wholly avian virus... it was a bird flu virus that jumped species, and in light of the unprecedented appearance of H5N1, and its unprecedented human lethality, we put those two together and that is when alarm bells went off around the world."

M: "How unusual are emerging infectious diseases like this one?"

G: "Over the past 30 years more than 30 new diseases have emerged at a rate really unprecedented in the history of medicine. Emerging infectious diseases have gone from a mere curiosity in the field of medicine to a whole discipline that's moved to center stage. Medical historians have called this time in which we live in the age of "the emerging plagues," some of which come from animals."

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FLU ORIGINS

M: "This is kind of confusing in that the mainstream press implies it's all an Indonesian or Chinese problem with large open markets and wild birds, yet in your book, you make the case that this isn't necessarily correct?"

G: "Chickens used to peck around the barnyard. Now we cram tens of thousands of birds into these filthy football field-sized sheds where they stand beak to beak in their own waste. It's a veritable breeding ground for disease, in fact, if you go back to a number of new emerging diseases we can trace them back to these industrial practices --- something that really didn't exist decades ago. Let's look at mad cow disease, a familiar story from these industrial cannibalistic feeding practices. These antibiotic-resistant so-called "super bugs." How many of them are because of the mass feeding of millions of pounds of antibiotics in the animal's feed? The animals aren't sick at all, it's just to promote growth and prevent illness from this stressful and unhygienic environment. Now we have these antibiotic-resistant super bugs, and we as physicians, are running out of good antibiotic options. The way we raise animals has global health implications.

Now, much of the focus has been on these small backyard free range flocks, but that's missing the larger picture. One needs to take a step back and say "where's this virus coming from in the first place?" People have been keeping chickens in their backyards for thousands of years, and birds have been migrating for millions. This is more of an unnatural disaster of our own making. What has changed recently to bring this all upon us? Why do we have a flu virus with unprecedented lethality? Why, over the last decade or so, has there been an exponential increase in the number of highly pathogenic outbreaks of bird flu viruses? Why has there been an unprecedented of bird flu viruses affecting human beings, not just H5N1, but four other chicken flu viruses have infected people from Hong Kong all the way to New York City? What has happened recently is the industrialization, the intensification of the global poultry sector, particularly down in southeast Asia. They cram these chickens by the thousands into these warehouse scenarios, and because of a number of factors inherent to those kind of systems, seems to have birthed a virus unprecedented in history that may very well lead to disaster."

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FACTORY FARMING

M: "Some of the factory farming-related statistics you've presented in your book are unbelievable in scope. I'll be putting several in the Mad Cowboy Newsletter. Yet, according to industry and government officials, we have the "safest food supply in the world?"

G: "Well, that's according to industry, and they love to parrot that phrase. It's simply not true. In fact, a number of Scandinavian countries are far ahead of us in even just the most basic food safety measures. The kinds of things that happen in this country... we don't even have mandatory food recalls for contaminated meat we are at such a primitive stage in terms of protect the health of Americans."

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SPREADING FLU

M: "I was quite surprised when I realized from your book that it's not just a "flying bird" issue regarding transmission of avian flu. What's the current thinking?"

G: "Once it goes human, then it spreads just like the regular flu, and that's from person-to-person in closed confined spaces, people coughing, sneezing, or touching a contaminated object like a doorknob and touching one's face, one's eyes, nose, and mouth. It spreads by global commercial airline travel all around the world. Particularly children are considered as kind of a "super spreader" of this disease... they can be infected up to a week before they start showing symptoms, and so school closures are considered a primary containment strategy.

In birds, currently the primary spreader is the poultry trade in birds and bird products. People don't realize that in globalized trade we export chicken meat around the world and likewise. Thailand was the fourth leading exporter of chicken in the world. People don't realize that the meat they buy in the supermarket may come from another hemisphere. In this globalized system it's very easy for viruses to be shipped around. In fact there has evolved duck viruses that are used to the cold wintering in Michigan lakes, and freeze quite well, and they can be found in frozen poultry products ordered from China. So there's a real concern about bringing fresh or frozen poultry products into one's household if there's any potential infection. Although migratory birds may indeed play a role, the primary role considered by the Food and Agriculture Organization (FAO) of the United Nations is the transport of live birds."

M: "In your book you raised the issue that during the Pennsylvania bird flu outbreak (17 million birds killed in the 1980s) they found signs of the virus on flies and small animals?"

G: "Literally... on houseflies, garbage flies... you know, the industry claims that their operations are "biosecure," that the virus could not get into the environment, into these factory farms... but I've yet to find a factory farmer knowing how they intend to keep flies out of these poultry sheds. They have these huge ventilation fans, people have to walk in and out --- there's no way you can keep this contagion out of a heavily contaminated environment, and so the factory farms are what changed the mild, low pathogenic harmless virus into a highly pathogenic type. Instead of trying to take away the fuse by somehow locking the birds inside, one really has to take away the explosive --- one has to take away the opportunity for this virus to mutate into a highly pathogenic form, a relatively new phenomenon seen only since we started raising birds in this fashion."

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BIRD FLU IN U.S.

M: "You've noted that the United States has reported more bird flu outbreaks than any other country in the world since the mid-1960s. What is the reason for this and how is it contributing to a possible pandemic?"

G: "We've picked up this virus every year for decades. Minnesota is avian flu capitol of the world. That's because they have a very large turkey industry, they're the "land of 10,000 lakes" and all those lakes means migratory aquatic birds. But it's important to recognize that these were low pathogenic strains... up to a third of juvenile ducks can be infected with this virus, but it doesn't hurt the ducks. The ducks don't hurt the virus and the virus doesn't hurt the ducks. This has been going on for millions of years. No one gets hurt --- unless you take one of these ducks to a live bird market or something, one of these "viral swap meets," where it can infect a land-based terrestrial bird like a chicken, then the virus can mutate into an airborne variety which can become much more dangerous to people."

M: "I love that phrase "viral swap meet." I notice that you coin many creative phrases and clearly had some fun in choosing chapter titles in your book... "One Flu Over the Chicken's Nest" indeed!"

G: (laughs)

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PANDEMIC IMPACT/PREPARATIONS

M: "Without getting too gruesome, I wonder if you can discuss, should the virus mutate to easy transmission among humans, what this might mean to more than just deaths? Impact on social infrastructures? That it's not just AIDs on steroids?"

G: "Certainly. Some segments of infrastructure wouldn't be able to survive a 30 to 40% employee absenteeism. In our "just in time" global delivery system, we no longer have warehoused stockpiles of food --- even one good winter storm can empty out grocery shelves. Can you imagine if a storm would last for months? All international trade could eventually collapse. The World Bank has estimated that even a moderate pandemic could cost the world a trillion dollars.

Part of this really comes back to what we can do to prepare in our communities and in our families. Much of it comes down to being able to "shelter in place" and stay at home and having the supplies to do that, as there is a concern that even if there were supplies available, one would want to minimize one's contact with other people so as to limit one's risk."

M: "What is your opinion of the how our government is preparing for a possible pandemic?"

G: "Well... much better than they were in the past. Ever since 1970 there's been a process in Washington to try and come up with a Pandemic Preparedness Plan, and only recently, in fact this last month, federal guidelines for mediating the impact of this next pandemic were released to States and localities. So it's been a slow process, but they are ramping up. For example, by 2012, we should have the vaccine production capacity to cover Americans six months after the pandemic strikes. Of course, that's only after the pandemic strikes, but that's certainly significantly better they we're at right now.

The question is: what does one do during the first six months of a pandemic? The government has set-up a website [here] with information and a checklist for schools, for families, and for faith-based institutions to help them prepare for the next pandemic."

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CRYING WOLF?

M: "I guess the "Devil's Advocate" position here is, well... are professionals like you "crying wolf," I mean, what are the real odds that we could have the kind of incredibly destructive pandemic potential you're describing?"

G: "Unlike Y2K, unlike SARs, influenza has a track record... we know what influenza is capable of... the last time a bird flu virus jumped from birds to people, it became the worst plague in human history and 50 to 100 million people lost their lives. We know another pandemic is inevitable, we don't know when, we don't know how bad it will be, but with this unprecedented spread of this truly unprecedented virus in terms of human lethality, we need to make practical concrete preparations. That's why all leading health authorities on the planet now are urging governments to prepare for the next pandemic. This is not like 1976, for example, with the swine flu affair, in which President Ford ordered the vaccination of millions of Americans after the death of a single person from a swine flu variant. The World Health Organization [WHO] disagreed, the British government disagreed... they thought the U.S. government was over-reacting from this one fatality. Indeed, it turned out, it wasn't a problem at all.

But this is different... there's now a consensus among the medical and public health community around the world that this is perhaps the greatest health threat facing humanity currently. Things to that effect have been said by the Head of the CDC [US Centers for Disease Prevention and Control], by the Director General of the FAO --- not something to be dismissed lightly, not some kind of "conspiracy theory" by some kind of marginalized opinion. This is the mainstream public health and medical opinion: the global populace should prepare for another pandemic."

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