H5N1 viruses, named for the type of hemagglutinin and neuraminidase proteins they code for, are especially virulent. If avian virus mutates to a form that infects human beings, like the “Spanish flu” of 1918, nearly 2 million Americans could die–half of them between the ages of 18 and 40. The immune response produces respiratory distress syndrome.
To speed the process of developing a vaccine, scientists have performed the amazing feat of resurrecting the 1918 strain from a flu victim who was frozen in the Alaskan permafrost. This virus releases 50 times as many virus particles from human lung cells as the contemporary “Texas” strain. Mice infected with the resurrected strain lost 13% of their body weight within 2 days, and all died within 6 days. None died of the Texas strain.
The DNA sequence has been published, and the 1918 virus itself is being sent by mail to level-3 biosafety laboratories (AAPS News of the Day 11/15/05). Some believe the safety precautions are inadequate, citing the accidental escape of the SARS virus from a level-3 lab in Singapore and two 2004 escapes from Beijing labs.
Scientists have “constructed, and provided procedures for others to construct, a virus that represents perhaps the most effective bioweapons agent now known,” stated Richard Ebright of Rutgers University (Nature 2005;437:794-795).
The use of bioweapons for massive cleansing to create Lebensraum has been discussed. The Epoch Times reported on a briefing that General Chi Haotian, China's former defense minister, allegedly gave to senior military leaders: “Only countries like the United States, Canada, and Australia have the vast land to serve our need for mass colonization. “There has been rapid development of modern biologic technology, and new bioweapons have been invented one after another.... When Comrade Xiaping was still with us, the Party Central Committee had the perspicacity to make the right decision not to develop aircraft carrier groups and focus instead on developing lethal weapons that can eliminate mass populations of the enemy country.” Haotian expressed concerns about nuclear retaliation and advocated development of air-defense systems (Mackenzie Institute Newsletter, October 2005).
Whatever the source, the consequences of a global pandemic could be an apocalyptic disaster. In the July/August 2005 issue of Foreign Affairs, Michael Osterholm discusses what the world should do to prepare (see www.foreignaffairs.org):
“A shutdown of the global economic system would dramatically harm the world's ability to meet surging demand for essential commodities...during a crisis.... [I]ndustry heads must stockpile raw materials for production and preplan distribution and transportation support.... There would be major shortages of...food, soap, paper, light bulbs, gasoline, parts for repairing military equipment and municipal water pumps.”
There would be major shortfalls in medicines, medical equipment such as mechanical ventilators, and infection control supplies. Even now, eight anti-infective agents are limited in the United States because of manufacturing problems. Two U.S.-based companies supply most of the respiratory protection masks for medical workers around the world.
Perhaps partly because of recommendations from newsletters such as Gary North's Remnant Review, many people started asking their doctors for supplies of Tamiflu (oseltamavir), which is manufactured only by Roche at a factory in Switzerland. The drug may be effective in prophylaxis or if taken at the onset of symptoms. It is already very difficult for civilians to obtain Tamiflu; shipments were suspended because of “hoarding” (AAPS News of the Day 11/4/05). The U.S. government is stockpiling supplies, which would be severely limited and rationed. Conceivably, treating persons not on the government's priority list could be illegal, as it was during an influenza vaccine shortage.
The HHS Pandemic Influenza Plan can be accessed at www.pandemicflu.gov. Plans are being developed for the distribution of available supplies and vaccine to “predetermined priority groups.”
Roche has increased production of Tamiflu eightfold in 2 years, but it will take $16 billion and 10 years to make enough drug for 20% of the world's population, according to World Health Organization chief Klaus Stohr (San Francisco Chronicle 10/13/05). Omitted from the Chronicle's website was Stohr's statement that the drug takes a year to make and involves a potentially explosive process that would drive out all but the most sophisticated manufacturers. It would take at least two years for a generic supplier to put a plant into operation, even if Roche were to relinquish its rights (MedicalTuesday.net).
General viral resistance to Tamiflu is increasing in Japan, where it is commonly prescribed to treat routine cases of influenza; of 32 million people treated with the drug since 1999, 24 million were in Japan, and 11.6 million were Japanese children. The FDA has reviewed 12 deaths in Japanese children and concluded that there was no direct link to the drug. Two deaths may have resulted from drug-induced abnormal behavior. Side effects include impaired consciousness and hallucinations.
The U.S. government is also stockpiling Relenza (zanamavir for inhalation or injection), which has some effectiveness for influenza A and B if used within the first 2 days of illness, but is not used to prevent flu or reduce the risk of transmission.
Amantadine (Symmetrel) and rimantadine (Flumandine) have some efficacy against certain types of influenza, but in places like China, 70% of viral strains are resistant.
Some experts propose shipping supplies of Tamiflu to areas of the world where a pandemic may be beginning, in an effort to stamp it out early or slow spread. It might be more effective if used in this way; once disease occurs, Tamiflu may only shorten symptoms by a day. While it prevents some complications, it may not reduce mortality (Science 2005;309:870-871). Two independent studies, both based on data from Thailand, came up with widely different estimates of the number of drug courses needed (100,000 to 1 million vs. 2 to 3 million) to stop a pandemic (Nature 2005;436:614-615).
In the event of desperate circumstances, desperate measures might be tried. Frederick Klenner, M.D., attributes the survival of his family, while scores were dying around them of the 1918 flu, to use of a bitter tea made from Boneset (Eupatorium perfoliatum): one 8-oz cupful for children and two to three cupfuls for adults. This was frequently given for colds or fever, with “cures” expected overnight. Klenner had the mixture assayed and found they were consuming 10 to 30 gm of vitamin C at a time. Klenner used heroic doses of intravenous vitamin C (350 to 700 mg/kg) in numerous conditions. One patient with “virus pneumonia,” who was comatose with a fever of 106.8 F, received 140 gm over 72 hours, and recovered (J Applied Nutrition, Winter 1971).
Recently, Joel Kauffman, Ph.D., suggested a study of intravenous vitamin C in shingles (Herpes zoster), based on early reports of success using 2-3 gm IV every 12 hours for 3 days, along with oral doses of 1 gm every 2 hours. He noted that IV use generates blood levels 6.6 times as high as oral administration. If the treatment proves effective, he suggested that it would be preferable to mass immunization with the new shingles vaccine (J Am Phys Surg 2005;10:117). Based on Kauffman's paper, I tried this regimen recently in two patients with good results (case report in preparation).
Ascorbic acid 500 mg/cc is available in 50-cc vials for as little as $10.95 from compounding pharmacies, but it may not be easy to persuade a physician to try this, especially in a hospital setting.
Hyperbaric oxygenation is said to have saved moribund Spanish flu patients, though reports are sketchy and hyperbaric chambers are not accessible to most.
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