Bird, Swine Flu Just a Warm-Up; Deadlier Pandemic May Be Next

Review by Jeffrey Tannenbaum

Dec. 8 (Bloomberg) -- Alan Sipress needed more than a pen and paper to report on bird flu. To interview the mother of two victims in Java, he showed up wearing a white hooded jumpsuit with goggles, a respirator and rubber gloves that made it hard to take notes.

Bird flu, before it was pushed out of the news by swine flu, made headlines earlier this decade as the potential killer of tens of millions of people worldwide. That may seem like a false alarm. But avian flu hasn?t gone away, and in ?The Fatal Strain: On the Trail of Avian Flu and the Coming Pandemic,? Sipress, a Washington Post editor, shows why it or another flu strain may break out at any time as a mass exterminator.

A thorough reporter who knows how to tell a story, Sipress digs deep into influenza and the world?s capacity -- or lack of same -- to cope with it. He shows that governments and people are often reluctant to acknowledge the presence of infections, that flu may foil containment efforts, and that nations are short on vaccines, hospitals and everything else needed to combat flu.

His message amounts to that of a horror movie: ?Be afraid. Be very afraid.?

The so-called Spanish flu of 1918 killed an estimated 50 million people -- including 675,000 Americans, more than the U.S. death toll in all the wars of the 20th century, according to the book. ?Until recently, Spanish flu was considered the worst-case scenario,? Sipress writes. ?Bird flu has made the experts reconsider.?

444 Cases

The current wave of bird flu in humans began in 2003, according to the World Health Organization, and 15 countries have recorded a total of 444 laboratory-confirmed cases. Indonesia and Vietnam have been hit hardest. (The U.S. hasn?t had any cases.)

There have been 262 deaths recorded as the virus killed more than half its known victims, an enormously high fatality rate. Most of the victims caught it from contact with birds or their droppings rather than from other people. What?s more frightening, Sipress writes, is the possibility that the flu strain, called H5N1, will mutate into a form that is more easily transmissible between humans, which could cause untold numbers of deaths.

Flu viruses are highly prone to mutation. In addition to mutating on their own, the strains can mix with one another in a process called reassortment, creating microbes that are new and potentially even more deadly. The world has just been lucky that another flu with the virulence of the 1918 outbreak hasn?t emerged.

?A few genetic tweaks and millions could perish,? Sipress writes. That happens when a flu virus with a high mortality rate spreads easily among people but without killing so rapidly that victims die before passing along the virus.

Economic Fears

For fear of hurting their economies by scaring off tourists or forcing the slaughter of birds, Asian countries were often slow to acknowledge bird-flu threats, Sipress writes. Ordinary citizens can be oblivious to the threat and engage in what may be high-risk behavior, such as exposing themselves to infected birds at cockfighting matches, including one that Sipress witnessed in Thailand.

The witch doctors still used by many Asians are powerless to stop flu, Sipress writes, and the most advanced medical systems in the world may not be much better. A powerful pandemic would overwhelm hospitals and drug supplies, and outstrip the world?s capacity to make vaccine.

?Though governments have recently taken steps to gird the world for a pandemic, too little has been done,? Sipress concludes.

The book arrives just as swine flu, or H1N1, is making news. As of October, swine flu may have killed as many as 6,000 people in the U.S., according to the Centers for Disease Control and Prevention. The case fatality rate for swine flu is tiny next to the rate for bird flu in Asia, but far more people catch H1N1 in the first place and human-to-human transmission is routine.

As there is only the briefest mention of this outbreak -- officially a pandemic -- in ?The Deadly Strain,? the author?s warning about ?the coming pandemic? seems oddly out of date. On reflection, it is no less valid.

?The Fatal Strain? is published by Viking (386 pages, $27.95). To buy this book, click here.

(Jeffrey Tannenbaum is an editor on the health team at Bloomberg News. The opinions expressed are his own.)

To contact the reporter on this story: Jeffrey Tannenbaum in New York at

Last Updated: December 8, 2009 00:01 EST