Scott McPherson's Web Presence

When I put together a government group to tackle a tough job, part of my M.O. is to reach out to the nation's experts on (name of topic) and persuade them to give me free advice.  So it is with pandemic influenza preparations.  I reach out, and they reach back.  I have found the nation's top "influenza rock stars" to be surprisingly approachable and willing to answer questions and give advice. 

One of the world's foremost influenza researchers (who shall remain nameless) told me about a year ago, "I can’t promise to have the answers though, you will be surprised at how little we actually know."  It was both refreshing and chilling to hear one of the world's most quoted and respected clinical researchers give that candid assessment.

It also points out how fragile our understanding of flu really is.  And while we make certain assumptions about the virus, we also realize that when we get one answer, we wind up with a thousand new questions.  Here are some of the previous postulates, along with the recent findings that dismiss them.

1.  Tamiflu is only good for five years. 

FALSE.  Here's what the US government will do with its stockpile of Tamiflu, if the expiration date approaches and it has not been used (meaning no pandemic yet).  The Department of Defense, along with the Food and Drug Administration, will check random boxes of Tamiflu from all of the secret Strategic National Stockpile locations.  Yes, the stockpile is under armed US military guard.  Samples of Tamiflu capsules will be tested to ensure the integrity of the capsules is OK.  Then, the FDA will stamp a new expiration date on all boxes.  However, the STATE-purchased portion of the Stockpile will not (at this time) be qualified for re-certification.  But let's face it:  If the boxes are co-located (which they are; State-purchased Tamiflu sits alongside Fed-bought Tamiflu until its distribution during the run-up to the pandemic), then basically State-purchased Tamiflu will keep as long as the US-bought antiviral. 

By the way, store your own Tamiflu in a sock drawer.  That is absolutely the best place to keep it, cool and dry.  Dr. Mike Osterholm recently told a Council on Foreign Relations Webcast that he had no problems taking seven-year-old Tamiflu. So store it carefully and it will keep its potency. 

2. The dreaded "reassortment" of influenzas -- meaning the sharing of genetic material between a human flu and an avian flu, leading to the creation of a new, pandemic strain  -- can only occur in the winter months.

FALSE.  The Institute of Research for Development in Montpellier, France, in conjunction with the Australian National University in Canberra, Australia, claim that reassortment can occur in any month, primarily in winter but not necessarily always.  Researchers Andrew W. Park and Kathryn Glass reported their findings in the August issue of The Lancet Infectious Diseases, which I can never seem to find anywhere.  Anyway, they report that between 2003 and 2005 the H5N1 virus was found in several new host species, including tigers, leopards, pigs, raptors, and domestic cats.  But the greatest concerns are, first, the frequency with which the virus is found in domestic ducks, because the ducks have close contact with people, along with the isolation of the virus from pigs in China and Indonesia, because receptors in their respiratory tracts make coinfection with human and avian strains and thus generation of reassortant strains possible.   Surveillance data from the Pacific basin from 1954 to 1988 show a marked variation in human influenza A activity, the authors say. They found that while consistent seasonality of viral activity between December and March occurs in Japan, patterns were not uniform across the rest of the region.

"Periods of moderate to high activity typically last longer in tropical and subtropical regions than in temperate regions, and they occur more frequently than once a year," Park and Glass write. "It is not prudent to assume there is a short period of risk of reassortment."

3.  Influenza only travels an arm's length away when someone speaks, coughs, or sneezes.

FALSE.  A May, 2007 study from Queensland University in Australia shows that droplet nuclei can travel well over a meter from the exhalant.  The liquid component dries in the air, but the solid, dry residue can travel considerable distances, carried by a breeze or air conditioning system.  According to Professor Lidia Morawska, this could lead to better-designed workspaces, improved ventilation systems and filtration technology.  So maybe wearing masks should be mandatory in a pandemic (again) -- not to prevent catching flu, but rather to prevent spreading it. 

4.  Insects cannot spread flu.

FALSE.  A North Carolina State University study supports initial Russian research that common houseflies can transmit influenza.  Specifically, H5N1 has been found in the guts of houseflies and blowflies in poultry and wild bird outbreak areas, and previous studies during Pennsylvania's struggle with bird flu in the 1980s showed similar results.  the virus may only live for 3 hours, but that is more than enough time to deposit the virus in a poultry shed or other environment.

5.  Cluster cases of H5N1 are rare.

FALSE.  A recent study conducted by the Ministry of Health in Jakarta, Indonesia -- supported by the US Navy's NAMRU-2 lab and the US Centers for Disease Control -- shows that 39% of all Indonesian H5N1 cases from July 2005 to June 2006 grew out of seven blood-related family clusters.  That same study revealed that, while 76% of all H5N1 human cases appeared to be poultry-related, they could not identify the source of the remaining 24% of cases.

6.  The "cytokine storm" that killed so many young adults in the 1918-19 pandemic and is killing so many young people today who catch H5N1, could be reversed and the patient would be saved.

WE'LL GET BACK TO YA ON THAT ONE, BUT IT LOOKS FALSE.  A brand-new study, conducted by the Pope of Influenza, Dr. Robert G. Webster of St. Jude's in Memphis, refutes the theory.  Quoting the study: "These results demonstrate that inhibition of the cytokine response to infection with highly pathogenic H5N1 influenza virus is not sufficient to protect mammalian hosts from death."  So we must continue to focus our research on the virus itself, rather than wasting time on shortcuts that lead to dead-ends.