[1]For a bustling metropolis like Mexico City, with a population of 20 million, it's not unusual for the first sign of life to return to it to be not a public religious service or a political rally, but a traffic jam. After a week-long shutdown of the city in response to the outbreak of Influenza A (H1N1), Mexico City finally returned to hustle and bustle on Cinco de Mayo. The spread of swine flu has slowed, giving Mexican government officials hope that the worst is behind them.
[2] Officials at the International Health Organization can also breathe a little easier. They have been on high alert since reports of a new flu virus first surfaced in late April. WHO and CDC scientists have found few serious or fatal cases of influenza A (H1N1) outside Mexico, and there is insufficient evidence to suggest that the disease will continue to spread in most countries.
[3] So is the world-wide closure of schools, border inspections and press conferences by government dignitaries calling on people to wash their hands a big deal? Sadly, no. As WHO officials have repeatedly emphasized, we are still in the early stages of an influenza A (H1N1) outbreak, and influenza viruses are notoriously unpredictable. For now, this new flu virus appears to be about as dangerous as the regular seasonal flu, but it could make a comeback next winter in a much more deadly way - just as the pandemic of 1918 did with catastrophic consequences.
[4]The reality is that while the extensive cooperation of health officials in the United States and other countries in responding to the H1N1 influenza A virus is commendable, the emergence of the H1N1 virus is still only a wake-up call, not a true test of our will and ability. Dr. Alvin Lednar, director of the National Center for Disaster Preparedness at Columbia University, noted, "We should look at the emergence of this new flu virus as a wake-up call, not an alarm."
[5]In the face of the influenza A (H1N1) virus, the helplessness shown by our widely connected global community to emerging diseases was exposed. Travel by air and international trade have enabled the new strain to spread to two dozen countries in less than two weeks. Of course, globalization has its disadvantages as well as its advantages. It is globalization that has allowed us to create a truly global disease surveillance system. The threat of global epidemics reminds Americans of the need to revise their old and outdated health care system. In the event of an infectious disease outbreak, everyone's position is precarious.
[Early viral defenses]
[6] The World Health Organization failed to detect the H1N1 flu in time when it was still confined to the swine flu stage because they simply did not monitor it. Only in a few countries, such as the United States, was there sporadic surveillance of swine disease, and even less in Mexico. According to the American Association of Swine Veterinarians (AASV), unusual cases were rarely reported in the months leading up to the outbreak of influenza A. This is because swine flu is common and rare. Because swine flu is so common and serious cases are rare, veterinarians don't pay much attention to it.
[7] So why are we using scarce medical resources to swab pig nostrils for viruses? Because novel viruses - including H5N1 avian influenza, SARS, and even HIV (HIV) - first lurk in animal populations and eventually spread to humans. In the flu ecosystem, the pig is a central piece. It can be infected with bird flu, swine flu and human flu, becoming a virus neutralizer.
[8]The H1N1 virus has been successfully transferred from animals to humans, and it is too late to stop it, but we should recognize that new viruses are brewing in the animal kingdom all the time. For example, the H5N1 avian influenza virus is still poised in Asia and Africa and could mutate and cause a major pandemic. Globalization has made humanity particularly vulnerable to new types of disease - a specific virus in a specific location can spread around the world in 24 hours. Of course, globalization also allows us to organize effective defenses. "The world's continuing evolution into a global village means that viruses that might have gone extinct in the past now have the potential to spread at a much faster rate," says Nathan Wolfe, director of the California-based Global Virus Prediction Initiative, "but it also means that we can build a global immune system. "
[When pandemics strike on a global scale]
[9] Occasional viruses sometimes get through even the most vigilant early-warning systems; after all, viruses are always pervasive. Widespread spread of the new flu is inevitable. While the response to Influenza A (H1N1) has shown that we can cope with pandemics better than ever before, it doesn't mean that we are truly prepared. When a highly contagious flu strikes the globe, sickening 25 to 30 percent of the population in most countries, our health care system will be crippled like an overloaded website. Professor Richard Cork of the London School of Hygiene and Tropical Medicine has studied the level of pandemic preparedness in many countries over the past five years. He found that even in developed countries, hospitals do not have enough beds, medical staff and medical equipment to cope with a possible worldwide pandemic outbreak. Most countries in Western Europe have the medical resources needed to deal with relatively mild pandemic outbreaks, but if a real medium- to large-scale pandemic were to break out - such as a pandemic like the 1918 pandemic with a high rate of infection or a mortality rate approaching 2 percent," he said. -- these countries will struggle."
[10] The situation in developing countries is even worse. Prof. Cork and members of his research team have found that epidemic preparedness is in limbo in many tropical countries, with the situation particularly dire in Africa. Some countries have no pandemic defense plans at all, and in fact high rates of local HIV infection may exacerbate the lethality of influenza. Other developing countries, however, such as Southeast Asia and Latin America, have detailed influenza defense plans that meet WHO standards. But Coker poses the question, "Can you actually implement that plan when a pandemic hits? Do you have enough medical resources? And even if you do have enough resources, can you allocate them wisely? The answer to those questions is probably no."
[11] But there are examples around the world that the U.S. can follow. Hong Kong was ravaged by SARS in 2003, but today the city has 20 million doses of Tamiflu, three times the city's population. Vacation camps built on the outer fringes of the city can be used as isolation wards. Hong Kong has also invested more in epidemiological testing and more hospital beds. "Hong Kong has really reached international gold status in terms of dealing with infectious diseases," said Peter Cordingley, a spokesman for the World Health Organization's Western Pacific regional office.
[12] Increasing our domestic capacity to produce and distribute influenza vaccine is also urgently needed. Despite the extraordinary strength of the United States as the world's center of disease research, there is still work to be done in the production and distribution of flu vaccines. For Americans, being truly prepared for a pandemic means addressing some fundamental flaws within the U.S. health care system. The first place to start is with the roughly 50 million residents who don't have any health insurance. In the event of a pandemic, they're more likely to flock to hospitals for treatment, which could further strain an already overworked healthcare system and make the pandemic even more unpredictable. Columbia University's Lednar notes, "These people are a lot like Typhoid Mary in the last century. They will spread the disease in a completely unpredictable way."
[13] The danger posed by people without health insurance also reminds us of the fact that no one can be left out of the loop when an epidemic strikes. Whether it's a pig or a human with the flu, whether it's a virus in Mexico or an infection in New Zealand, in a globalized world, the threat posed by germs that seem far away can be close at hand in a matter of hours. CDC's Besser says: "In the big globalized garden, we are as vulnerable as the weakest link in the chain." We need to keep this in mind if we want to prevent the next pandemic, or at least succeed in defeating it.