Download The Geopolitics of Pandemic

The Geopolitics of Pandemic
Last weekend, word began to flow out of Mexico of well over a hundred deaths
150 suspected to have been caused by a new strain of influenza commonly
referred to as 'swine flu'. Scientists, examining the flu, discovered that this was a
new strain of Influenza A(H1N1), partly derived from swine flu, partly from human
flu, and partly from avian flu strains. The two bits of information created a global
panic. This panic had three elements. First, it was a disease that was going to be
global. Second, there were concerns (including our own) that it would have a
high mortality rate. And finally, it was the flu. History records the disastrous 19181919 flu pandemic, and the news of this new strain sparked fears that the
“Spanish” flu that struck at the end of World War I would be repeated. In addition,
the scare over avian flu had created a sense of foreboding about influenza—a
sense that a catastrophic outbreak was imminent.
By mid-week the spread of the disease was being recorded around the world,
with outbreaks being counted in the dozens, and sometimes one at a time. ??
Clearly the disease was spreading, and the World Health Organization declared
a level five pandemic alert. A level 5 alert means that a global pandemic is
imminent (it is the last step before a pandemic is actually, officially declared).
However, this is not a measure of lethality -- only communicability -- and
pandemics are not limited to the deadliest diseases.
“Pandemic” Doesn’t Mean “Duck and Cover”
To the medical mind, the word 'pandemic' denotes only what it means: that a
disease is spreading globally beyond control. Pandemic in no way addresses the
underlying seriousness of the disease in terms of its wider impacts on society.
The problem is that most people are not physicians. When the World Health
Organization (WHO) convenes a press conference carried by every network in
the world, the declaration of a Level 5 pandemic seems to portend global
calamity, even as statements from experts -- and governments around the world
-- attempted to walk the line between calming public fears and preparing for the
worst.
The reason was that this was a pandemic whose prognosis was extremely
unclear, and about which reliable information was in short supply. Indeed, the
new strain could mutate into a more lethal form, and re-emerge in the fall for the
2009-2010 flu season. There are also concerns about how its victims are
disproportionally healthy young adults under 45 years of age. In the 1918 flu
pandemic, this was part of the pattern as well. (In contrast, seasonal influenza is
most deadly among the elderly and young children with weaker immune
systems).
But as the days wore on last week, the 'swine flu' appeared to be not much more
than what it was—a case of the flu. Toward the end of the week a startling fact
began to emerge. While there were over a hundred deaths in Mexico suspected
of being caused by the new strain, only about 20 have been confirmed (back up
after being revised downward earlier last the week) to be linked to the new
virus – and there was not a single report of a death anywhere in the world from
the disease, save in the United States from a Mexican child who was
transported to the United States for better care. Indeed, even in Mexico, on
May 3, the country's health minister declared the disease to be past its peak.
While little is understood about the specifics of this new strain, influenza in
general has a definitive pattern. It is a virus that affects the respiratory
system, and particularly the lungs. At its deadliest it can cause secondary
infections — typically bacterial rather than viral — leading to pneumonia. In
the most virulent forms of influenza, it is the speed with which complications
strike that forces the death rate higher. Additionally, substantively new strains
(as swine flu is suspected of being) can be distinct enough from other strains of
flu that the preexisting immunity to the flu bugs of years past does not help
fend off the latest variation.
That means that it is not a disease that lingers and then kills people, save the
infirm, old and very young whose immune system is more easily compromised.
Roughly half a million people (largely from these demographics) die annually
around the world from more common strains of influenza, with the CDC pegging
the average American deaths at roughly 36,000 per annum.
In this case, death rates have not risen as would be expected at this point for a
highly contagious and lethal new strain of influenza. In most cases, people were
experiencing a bad cold and recovering from it. Infections outside of Mexico have
so far been less severe. This distinction – clear cases of death in Mexico and
none at all elsewhere (again, save the one U.S. case) – is stark.
Much of what has occurred in the last week as regards this new virus
reminds us of the avian flu scare of 2005. Then, as now, the commonly held
belief was that a deadly strain was about to be let loose on humanity. Then,
as now, many governments were heightening concerns rather than quelling
them. Then, as now, STRATFOR only saw a very small chance of the
situation becoming problematic
http://www.stratfor.com/special_report_bird_flu_and_you.
By the end of last week, it became clear to the general public around the world
that a pandemic was a term that covered bad colds as well as plagues wiping out
millions.
A real crisis?
But all this raises the question of what how one would attempt to grapple
with genuine high-mortality pandemic with major consequences. This divides
into two parts: how to control the spread, and how to deploy treatments.
First, communicability.
Influenza is a virus which is widely present in two other species, birds and swine.
The history of the disease is the history of its transmission within and across
these three species. It is comparatively easy for the disease to transmit from
swine to birds and from swine to humans. The bird to human barrier is the most
difficult one to cross.
Cross-species influenza is a particular concern. When different pieces of virus
RNA recombine (e.g. human flu and avian flu in a bird), what comes out can be a
flu that in transmissible through humans with markers that tip off the immune
system that are distinctly avian – robbing the human immune system of the
capability to quickly recognize the disease and put up a fight.
The origin of new humanly transmissible influenza has often been found in
places where humans, swine and/or fowl live in close proximity to each other.
This obviously means in agricultural areas, but particularly in agricultural areas
where habitation is shared or in which constant, close physical contact takes
place.
Areas in Asia that are agricultural, with very dense populations, relatively small
farms and therefore frequent and prolonged contact of species has been the
traditional area in which influenza strains transferred from animals to humans
and then mutated into diseases transmissible by casual human contact. Indeed,
these areas have been the focus of concern over a potential outbreak of avian
flu. Instead, the outbreak in this case began in Mexico (though it is not yet clear
where the virus itself originated).
This is what is so important in understanding this flu. Because it appears to be
relatively mild, it might well have been around for quite a while, giving people
mild influenza, and not distinguished as a new variety, until it hit Mexico. It was
the simultaneous discovery of the strain amidst a series of deaths (and what may
now be – in hindsight – inflated concerns about its lethality) that led to the crisis.
But by the time the threat has recognized, it is already beyond containment.
Given travel patterns in the world today, viruses travel easily to new locations
well before they are identified in the first locale they strike. The current virus
is a case in point. It appears -- although it is far from certain -- that it
originated in the Veracruz region of Mexico. Within two days that the
Mexican government issuing a health alert, it had already spread as far
afield as New Zealand, about as far from Mexico as one can get. One week
on, cases completely unrelated to Mexico have already been confirmed on
five continents.
In all probability this “spread” was less the discovery of new areas of
infection, but the random discovery of areas that might have been infected
for weeks or even months. Given the apparent mildness of the infection,
most people would not go to the doctor and if they did, the doctor would
call it generic flu and not even concern himself with the type it might be.
What happened last week appears to have been less the spread of a new
influenza virus, than the “discovery” of places to which it had spread a
while ago.
This was the real problem with the variety. The problem was not that it was so
deadly. Had it actually have been as uniquely deadly as it first appeared to be,
there would have been no mistaking its arrival because hospitals would be
overflowing; Tests would not have been needed. It was precisely because it
was mild that led to the search. But because of expectations, the discovery of
new cases was disassociated with its impact. The fact that it was there caused
panic, with schools closing and discussions of border closings.
Geopolitically, the virus traveled faster than the news of the virus. When the
news of the virus finally caught up with the virus, the global perception was
shaped by a series of deaths suddenly recognized in Mexico – deaths that so far
have not occurred elsewhere. But even as the Mexican Health Ministry begins to
consider the virus beyond its peak, the potential for mutation and a more virulent
strain next flu season looms.
Now the more problematic concern: mortality.
Viruses spread faster than information about viruses. Viruses that spread through
casual human contact can be globally established before anyone knows of it. The
first sign of a really significant influenza pandemic will not come from the medical
community or the world health organization. It will come from the fact that people
are catching influenza and dying, and are doing so all over the world at the
same time. The system that has been established for detecting spreading
diseases is hardwired to be behind the curve, not because it is inefficient, but
because no matter how efficient, it cannot block casual contact, which given
modern air transportation, spreads diseases globally in a matter of days, or
even hours.
Therefore, the problem is not the detection of deadly pandemics, simply because
they can’t be missed. Rather the problem is reacting medically to deadly
pandemics. One danger is overreacting to every pandemic and thereby breaking
the system. ***As of this writing, the CDC remained deeply concerned, though
calm seems to be returning.***
The other danger is not reacting rapidly. In the case of influenza, there are
medical steps that can be taken. First, there are anti-virals that, if sufficient
stockpiles exist – which is hardly universally the case, especially in the
developing world – and those stockpiles can be administered early enough, the
course of the disease can be mitigated. Second, since most people die from
secondary infection in the lungs, antibiotics can be administered. Unlike the 1918
pandemic, the mortality rate can be dramatically reduced.
The problem here is logistic. The distribution of medications and effective
administration is a challenge. Producing enough of the medication is one
problem. It takes months to craft, grow and produce a new vaccine, and 'the' flu
vaccine is tailored every year to deal with the three most dangerous strains of flu.
The other problem is moving it to areas where it is needed in an environment that
maintains their effectiveness. But equally important is the existence of a medical
staff and infrastructure capable of diagnosing, administering and supporting the
patient. And doing so on a scale that has never before been attempted.
These things will not be done effectively on a global basis. That is inevitable. But
in the case of influenza, even in the worst case, it does not threaten the survival
of the human race or the maintenance of human existence at the level we know
it. Influenza, at its worse, will kill a lot of people, but the race and the international
order will survive.
The threat, if it ever comes, will not come from influenza. Rather, it will come
from a disease that is spread through casual human contact, but with higher
mortality rates, and no clear treatment for it. The great blessing of HIV/AIDS is
that while it boasts an extraordinarily high mortality rate and no cure exists, it
does not spread through casual contact as influenza does, limiting the pace at
which it can spread.
Humanity will survive the worst that influenza can throw at it even without
intervention. With modern intervention, its effect declines dramatically. But the
key problem of pandemics was revealed in this case, which is that the virus
spread well before information of the virus spread. Detection and communication
lagged behind. That didn’t matter in this case and it didn’t matter in the case of
HIV/AIDS because it was a disease that didn’t spread through casual contact.
However, should a disease arise that is as deadly as HIV, spreads through
casual contact, and about which there is little knowledge and no cure, the
medical capabilities of humanity would be virtually useless.
There are problems to which there are no solutions. Fortunately, these problems
may not arise. But if it does, all of the WHO news conferences won’t make the
slightest bit of difference.