Last week, another young man in Indonesia died of Bird flu. That makes over 100 deaths in that country alone.

At the same time, isolated cases in various countries from VietNam to China have been reported in humans, and the diagnosis of various strains of bird flu in chickens or wild birds has been reported in places as widely separated as Niger/Nigerian border area to China andN Viet Nam.

This is devestating to the poultry industry in those areas. People in the US don’t realize that with the increase in wealth due to globalization, that poultry farms have been popping up all over the world to supply the demand for chicken meat and eggs.

There are several strains of bird flu around, and the one that worries scientist the most is the H5N1 strain that has killed several hundred people world wide.  And if that isn’t bad enough, since June, scientists at the CDC have issued alerts to watch out for cases of human human transmission due to the virus mutating to affect humans from another bird influenza strain, the H7 strain that is much more common in North America.

So in today’s paper, there are reports of an outbreak of an unknown disease with high fever and pulmonary symptoms in Northern Sumatra. Is it bird flu? Thirteen people are sick, and there has been birds infected with the H5N1 strain of influenza in the area. Not all those sick have had contact with birds or chickens, making the worry of human to human transmission part of the worry. And if so, is this the start of a new epidemic of human flu that echoes the 1918 outbreak that killed more people than World War I?

Right now, the WHO (World Health Organization) puts the level of the alert at 3A: Limited human to human transmission. Even if the epidemic in Sumatra turns out to be human to human transmission, it doesn’t mean an epidemic: like SARS, it could be contained in the area by simple quarantine measures.

But public health departments figure it’s not “if” but “when” the flu will hit. And if not the bird flu, another mass epidemic. Anyone reading history will find out that epidemics have arrived periodically throughout history, and that when trade and civilian or military travel is common, that disease tends to move with the people.

There is a lot of preparation going on in various countries. If such an epidemic strikes, it will:

… disrupt our everyday way of life,” said DHS Assistant for Health Affairs and Chief Medical Officer Dr. Jeffrey Runge. “This guidance was developed to ensure that our nation’s critical infrastructure remains up and running and we address the needs of all of our citizens, enabling the country to recover from a pandemic more quickly.”

Yes, there are medicines, and yes there is a vaccine.

But the crisis will bring up a taboo subject in America: Medical rationing.

As part of developing the guidance, HHS held day-long public engagement and stakeholder meetings throughout the country and received more than 200 written public comments on the goals and objectives of pandemic vaccination. In all the meetings, stakeholders and the public identified the same four vaccination program objectives as the most important:

• Protect persons critical to the pandemic response and who provide care for persons with pandemic illness
• Protect persons who provide essential community services
• Protect persons who are at high risk of infection because of their occupation and
• Protect children

So grandmom comes last.

Except not quite.

You see, if all the doctors and nurses are sick, a lot more people will die. If the electricity goes out because people are sick, ditto. If there are no cops, utility workers, garbage collectors, or truck drivers to deliver food, the cities could quickly descend into crisis.

As for grandmom: After docs investigated the last flu epidemic, they found often the “high risk” groups had bad immune systems. So the vaccines didn’t work.

But most of them caught the flu from their grandkids. Hence if you vaccinate the kids, grandmom can stay home from church and the senior center and stay safe.

Of course, the bad news is that the vaccine and the anti viral medicines don’t work in a lot of the cases… some people say they don’t work that well at all. But lessons from the 1918 epidemic showed that many of the deaths were from bacterial pneumonia, which can be treated with antibiotics, and also that old fashioned quarrantine might help isolate the most vulnerable from infection.

The bad news is that, in the last epidemic, the hospital where I worked in Minnesota had two young people who almost died from MRSA, resistant staph (germ) pneumonia…

In the meanwhile, the states and various countries are stockpiling anti viral medicines that treat the infection and lower the death rate.

Just in case.

bird flu map from CDCwebpage.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket and she writes about medical subjects at HeyDoc Xanga Blog.