Avian Flu--The “Inevitable Thinning of the Herd?”
By Joseph E. DiCorpo, M.M.Sc., P.A., Sc.D.

Over the last 12 months we have all been inundated with headlines, news flashes, print articles and even e-mails about Avian Flu (H5N1 Virus).  The very frequency of the announcements may in fact have made us somewhat disregard them.  So what is it important for us to be aware of?

We all know that Avian Flu is real and that there have been approximately 275 cases to date of bird to human transmission of the virus.  In these cases we have seen a very high mortality—nearly 85%--with most of the diagnoses being made by the post mortems examination of blood and tissue samples. Almost all of the human cases have occurred in rural and impoverished areas of the world, where victims have been in close contact with infected birds in living conditions not usually seen in Western Society.  The virus has spread from Asia across the Middle East and has now appeared in Turkey, Cyprus and parts of Europe.  It appears to be only a matter of time before it reaches the United States.

The current question is whether or not Avian Flu will mutate into a form that is easily communicable between human beings.  According to recent evidence from the National Institutes of Health, a re-examination of slides from the 1918 World Influenza Pandemic indicate that year’s virus may have made a rapid transition from animal to human transmittable form.  When and where that mutation will occur—or even if it will or will not occur—for Avian Flu is debatable.  

What is important to realize is that whether it is the Avian Flu or some other virus, a world pandemic is inevitable.  A simple theorem, widely accepted in zoology and botany states that when a population begins to near an unsustainable size, nature decreases it through some means.  This theorem is called the “Inevitable Thinning of the Herd.”

Thinning of the Herd is seen anytime the population of a species begins to over-consume and exceed the available natural resources of its environment.  Consider that in the past 50 years we have doubled a world population that has taken approximately 2000 years to build.  The present world population stands at 6,496,102,627. 

Consider the chicken example.  In less than ten years, the world population of domestic chickens increased by 160%, from 13.5 billion in 1998 to 35 billion in 2006.  More than 20% (7 billion) of the world’s chickens are in Asia, where “free range” farming practices give birds access to each others’ feces and people and livestock live in close proximity, creating a primary methodology for viral transmission.  So far the U.S. has been spared—or at least delayed—from outbreaks, most likely attributable to Western chicken farming practices.  While industrialized chicken production may leave much to be desired from various perspectives, factory farming conditions keep chickens separated from their feces, flocks housed in different coops and person-to-bird contact limited.  These factors, plus the ability to isolate infected birds, decrease the risks of human infection.

In any case, the combination of massive chicken population growth together with careless husbandry in parts of the world has resulted in nature’s inevitable response:  forced thinning of the herd, in this case through Avian Flu.

As we saw with chickens, population growth alone does not guarantee a worldwide pandemic.  But when combined with other changes to living conditions and elements of society it appears to be inevitable.  Evaluate the evidence:

In the past 50 years:

• We have doubled the world population, and have unevenly distributed that increase into urban versus rural areas.
• We have destroyed almost all natural and geographical barriers to human face-to-face interaction through advancements in travel and aviation, especially between these urban areas. Airborne infections can now be spread throughout the world in a matter of hours via airplane.
• To be more competitive in a global marketplace we engage in “just in time” manufacturing and inventory control for most of our industries. This means that we are critically dependent upon the daily delivery of supplies for almost all our healthcare manufacturing, distribution and even retail sales, leaving little or no in-house inventories or resources to call upon during a disaster.
• To be more competitive in the global economy, we have spread our pharmaceutical manufacturing chains around the world, losing much of our domestic capability to manufacture pharmaceuticals. In the process our pharmaceutical supply chains have become very fragile.
• In the past twenty years, we have closed many hospitals and decreased the number of community hospital beds in the U.S. to contain healthcare costs.  There are presently only 4,919 community hospitals in the country, with a total bed space of 808,127 beds.
• For cost containment purposes, we have forced hospitals to operate at a much higher occupancy rate than ever before. Many hospitals in urban areas of the U.S. operate at 95% to 105% of capacity.

The significance of all this is that if the U.S. sees an outbreak of communicable disease—and any type of influenza may be that eventual culprit organism—the country will have critical resource shortages for handling the crisis.  The assumption we all tend to make, “just take the patients to the hospital,” will be the first supposition exposed as a falsehood.  On any given day in the U.S., there is a significant dearth of hospital beds.  It has been estimated that all major American urban areas on an average day have no more that 2,000 beds available.

If, in fact, a wide-scope disaster were to occur in the U.S., here is a snapshot of what we would see:

• All elective surgery would be cancelled, creating over time an increase in the number of beds by about 40%.
• All Recovery Room or Post Anesthesia Care Unit (PACU) beds would be turned into ICU Beds. This would increase the number of ICU beds by about 10%.
• All Admission Units would be turned into regular nursing units. This would increase the number of regular beds by about 5%.
• The National Guard, Reserve, and Regular Armed Forces would deploy as many Field Hospitals as possible. Depending upon logistics this might increase the number of beds by about 12%.

But what little consolation these statistics may provide is also deceiving.  Consider that National Guard and Reserve medical personnel who are currently staffing civilian hospitals would be commissioned for disaster duty, leaving a gaping inadequacy of healthcare personnel around the country.  Shortages in medical supplies, pharmaceuticals and equipment would occur quickly.  The healthcare system as we know it would be severely compromised.

So what can we do to better prepare for the arrival of a pandemic?

• Force our leaders in government make the Pandemic Disaster Preparedness program a reality.
• Fully fund the Vaccine Production Initiative. Congress recently allocated only $3 billion in response to a request for $10 billion.
• Ensure that all American pharmaceutical companies have adequate domestic raw materials, production capabilities and distribution reserves, and that these are regularly certified, monitored and inspected by the Federal Emergency Management Agency (FEMA).
• Expand and fund FEMA’s National Disaster Medical Service in conjunction with U.S. military medical services divisions so that we are capable of significantly expanding our community hospital bed capacity in the advent of an outbreak.
• Implement the recommendations of CDC for better monitoring of international arrivals to the U.S. from any country identified with any communicable disease outbreak.

A global pandemic is not an “if it will happen” scenario, but a real, “when it will happen” threat. It is vital that we plan actively and fund our preparations now.  People once believed “the levees will never break.”  We should not make the same mistake twice.