Spinning a cytokine storm: the likelihood of an avian flu pandemic is the subject of raging expert debate. Alarmists claim corporate America isn't doing enough to protect itself. Skeptics point to interests vested in whipping up hysteria. Either way, we have "been warned," says Michael Leavitt, secretary of the U.S. Department of Health and Human Services

Risk & Insurance, April 15, 2006 by Patricia Vowinkel

A deadly virus sweeps through towns across the globe, wiping out millions of people in days. Victims suffer from high fever. They're left gasping for air. It sounds like a plot from a Stephen King novel.

The problem is that this isn't fiction, neither past nor present.

It happened in 1918 when an especially virulent strain of influenza spread throughout the world. World health experts fear another influenza pandemic could happen again soon.

They worry that the avian flu virus that has been spreading throughout Asia and now Europe could mutate and spread easily from person to person. If so, it could trigger a pandemic that could kill millions.

The avian flu virus, known as H5N1, has public health experts running scared. Although the H5N1 virus has not yet become efficient at infecting people, experts say the conditions are ripe for the virus to mutate--as viruses constantly do---and become a human disease.

Once the virus becomes able to spread easily among people, it would not stay confined to a particular location for very long. Nowadays, millions of people cross international borders every day, and an infectious disease is just a few frequent-flyer miles away.

Experts are also troubled because the H5N1 virus bears striking similarities to the deadly 1918 virus, sometimes known as the Spanish flu or H1N1.

Perhaps, most troubling of all is that experts know pandemics happen. Experts say they don't know whether H5N1 will be the virus to cause the next pandemic. But they know pandemics happen.

In the last 300 years, there have been 10 pandemics. In the last 100 years, there have been three. The influenza pandemic of 1918 was a deadly plague that killed between 50 million and 100 million people.

It was followed by two milder influenza pandemics, one in 1957, caused by the virus known as the Asian flu, and one in 1968, caused by the virus known as the Hong Kong flu.

Experts estimate that in the next influenza pandemic, 20 percent to 60 percent of the world's population would become infected. In a mild pandemic, there could be an estimated 2 million to 7.5 million deaths. In a severe pandemic, like the 1918 flu, there could be 180 million to 360 million deaths worldwide.

As of mid-March, an estimated 184 people have been infected with H5N1 and 103 have died from it, according to the World Health Organization.

In a sign of just how concerned experts are, the WHO recently warned that the world was "closer to another influenza pandemic than at any time since 1968."

No one knows when the next pandemic will strike. The WHO categorizes pandemic risk into six stages. At stage 1, there are no new influenza subtypes circulating in humans. Stage 6 is a full-fledged pandemic. The WHO has categorized the current risk from H5N1 as stage 3, which means there are isolated human infections with a new subtype, but no, or very limited, human-to-human spread of the disease.

If the virus does mutate and become easily transmissible, it would probably sweep through local communities for a six- to eight-week period, but it could come in waves that last as long as a year or more.

Others doubt the public health sector's concerns. Skeptics believe the scaremongering has reached fever pitch.

They note that so far the virus has infected relatively few people and has remained essentially a bird disease. And even though viruses mutate, so far H5N1 has not been able to figure out how to spread efficiently among people. Perhaps it never will.

Instead, critics point to a "Chicken Little" culture whipping the public into a frenzy about a bogus health threat. Cell phones causing brain cancer, mad cow disease, Alar in apples, SARS, Ebola or Y2K come to mind.

Precedents for false alarms abound. In 1976, an influenza outbreak at Fort Dix, N.J., triggered concerns that a major flu pandemic was imminent. The federal government launched a campaign to vaccinate all Americans to prevent deaths on the scale of the 1918 pandemic. When insurance companies refused to provide coverage to the vaccine manufacturers, the government agreed to accept liability for claims, ostensibly related to the outbreak.

The pandemic never materialized. But the government ended up facing millions of dollars in lawsuits from plaintiffs who claimed that they came down with Guillain-Barre syndrome as a result of the vaccine.

Author Michael Fumento, who specializes in science and health issues, believes there is a tendency for some people to hype the threat of a pandemic and for the media to seek out the most alarmist experts.

"What we can say with confidence is that there is never such a thing as helpful hysteria," he writes. "And the line between informing the public and starting a panic is being crossed every day now by politicians, public health officials and journalists."

Fumento's article, "Fuss and Feathers: Pandemic Panic Over the Avian Flu," appeared in the November issue of the Weekly Standard.

"There probably will be another pandemic, but nobody knows when or what its origin will be," he writes. "We do know that with every month that passes, we'll be better prepared. Unless the current panic, having failed to materialize, makes us overly complacent. That's a real possibility.