Stanford Panel Addresses Possibility of Bird Flu Pandemic
By Jenny Lim
STANFORD - On Jan. 19, a panel of Stanford medical experts delivered a dose of advice about bird flu: Be prepared.
Three doctors and three nurses presented their concerns about the possibility of a bird flu pandemic during a Stanford Health Library program last month. The health professionals also discussed Stanford Hospital's disaster plan for a local outbreak of bird flu and the ways people can minimize the chance of infection.
The panel's presentation at Fairchild Auditorium followed a showing of a one-hour PBS documentary, "H5N1 - Killer Flu."
The film had all the makings of a sci-fi flick: A mysterious disease annihilates bird flocks. Unsuspecting humans touch the sick animals and contract the deadly infection. The virus spreads rapidly from birds to humans. Person-to-person transmission of a lethal virus is a mutation away.
But the program's 100 audience members weren't watching a horror movie. The film documented human cases of bird flu in Vietnam, where 42 people have died from exposure to the virus. The documentary sketched out the process by which bird flu attacks the human body, destroying the lungs and brain.
"The general consensus among scientists who are studying this is it's not a matter of if we are going to have a pandemic; it's a certainty," said Dr. Lucy Tompkins, Stanford Medical School's Chief of Infectious Diseases and the panel's moderator. "It's a matter of when."
The bird flu has the potential to spread easily because most humans have never been exposed to the avian strain of influenza, also called the H5N1 virus. While most people have been introduced to the H3N2 strain - the common flu - they have no immunity against H5N1, Tompkins said.
According to the Center for Disease Control Web site, a worldwide outbreak would begin if the H5N1 virus were to mutate into a form that could be spread from person to person. In December, the World Health Organization reported a conservative estimate of pandemic fatalities would range from 2 million to 7.4 million deaths. A worst-case scenario would kill tens of millions.
Scientists are particularly worried about bird flu because of its high mortality rate, Tompkins said.
The WHO has documented 161 laboratory-confirmed human cases of bird flu in Cambodia, China, Indonesia, Thailand, Turkey and Vietnam since 2003. As of Feb. 2, 86 of those patients had died. The most cases have occurred in Vietnam, where 93 people have contracted the illness. An Iraqi girl died of bird flu Jan. 30. She was the first confirmed case in the Middle East.
Dr. Eric Weiss, chair of Stanford Medical Center's Emergency and Disaster Preparedness Committee, said the hospital's disaster plan for a pandemic is an "all hazards approach" towards any catastrophe.
"We have to focus on preparing for everything," including a pandemic, an earthquake or a bio-terrorist attack on a shopping mall, he said.
Weiss said the hospital lacks the capability to deal with a surge of patients at the time of a pandemic. Stanford's hospital beds are always occupied, even when there are no disasters, he said.
"What we realize with a pandemic is that we're going to have to expect people to take care of themselves at home," Weiss said. The hospital is developing a triage system to treat the sickest patients and those with the highest potential to survive.
The hospital is also stocking equipment such as beds and ventilators, though it is not stocking medication, Weiss said. That's because it is unclear what medications would be needed at the time of a pandemic, he said.
Should an outbreak occur, infection control nurse Debra Johnson recommended commonsense defenses against infection: hand washing; staying away from public places; and "respiratory etiquette," such as covering the mouth when coughing.
The California Department of Health released its flu pandemic preparedness plan Jan. 18, the day before the panel's presentation. The 170-page plan outlines CDHS emergency management organization and the operations of a flu pandemic response. The document states there could be more than 35,000 deaths in California, depending on the virus' virulence.
But Dr. Robert Siegel, a Stanford microbiology and immunology professor, questioned the inevitability of a pandemic.
"I think we need to downgrade this from a certainty into a possibility," Siegel said during the panel discussion.
He said the timing of a pandemic is an important factor in predicting the best treatment of bird flu. In a few years, there may be differences in vaccine strategies or a decreased rate of vaccine efficacy, Siegel said.
"So it doesn't necessarily make sense to put all our effort into what we know is a possible threat," he said. "We know that the H3N2 (strain) is going to be around year after year, and it kills. H5N1 is not a certainty."
Contact Jenny Lim at jennylim@stanford.edu
