Experts predict next World Pandemic will start in animals
Pastor Dale Morgan
Experts predict next World Pandemic will start in animals*
By Steve Sternberg, USA TODAY
Bonnie Henry calls it the most surreal episode of her life. A deadly
microbe from China infected a hotel guest in Hong Kong, hitchhiked on a
jumbo jet to Toronto and turned a local hospital from a sanctuary for
the sick into the incubator of an epidemic.
For Henry, the doctor in charge of Toronto's operational response to
SARS, the scenario was science fiction come to life. On a bleak day in
March 2003, she ordered the hospital, Scarborough Grace, to close to new
patients. She helped reopen a shuttered tuberculosis hospital and
ordered 13 ailing health workers to check in.
"We called them and said: 'Don't kiss your kids or your spouse. We'll do
what we can for you,' " she says.
What worries Henry is that SARS, or severe acute respiratory syndrome,
may be a rehearsal for something worse. "I absolutely think it's
inevitable," says Henry, who is now director of public health emergency
management in British Columbia.
A report by the non-profit Trust for America's Health, to be released
next week, asserts that infectious diseases from the developing world
are anything but "a back-burner concern."
The report, "Germs Go Global: Why Emerging Infectious Diseases Are a
Threat to America," cites National Intelligence Estimates that conclude
outbreaks of new and resurgent infectious diseases, many of which
"originate overseas," kill more than 170,000 people in the USA each year.
The death toll would climb much higher in the event of a new global
pandemic or bioterror attack. Infectious diseases, the report concludes,
have become "a matter of national security."
"The three deadliest events in human history were all infectious
diseases," says medical historian David Morens of the National Institute
of Allergy and Infectious Diseases. "The 1918-1919 flu killed 50 million
to 100 million people. The Black Death killed 25 million people, and
AIDS has killed 25 million or more.
"There are lots of reasons to think more will be coming."
The leaders of Google.org, Google's philanthropic arm, regard the threat
as so pressing that the organization today gave out $15 million in
grants to epidemic investigators. Google's goal is to exploit technology
— high-resolution satellite imagery, powerful computers and ultra-fast
genetic analysis — to identify "hot spots" where new infectious diseases
might emerge, detect and identify new microbes and establish
early-warning networks in developing countries so that local authorities
can stamp out outbreaks before they go global.
Larry Brilliant, the organization's executive director, says the global
economic meltdown makes a pandemic more likely by forcing governments to
cut public health budgets. "Nature has her own timetable. She doesn't
watch Dow Jones. We are inevitably and inexorably moving toward a pandemic."
SARS yielded to old-fashioned public health measures: travel
restrictions, isolation and quarantine. But the episode shows how
quickly a jet-age contagion can spread. In six weeks, the virus spread
worldwide, infecting 8,273 people and killing 775, reports the U.S.
Centers for Disease Control and Prevention.
In Canada, 44 people died and 432 became ill. More than 15,000 people
were quarantined. U.S. doctors treated 27 imported cases, none fatal.
"We don't have anything but dumb luck to thank for not having a SARS
outbreak in the U.S.," says Ian Lipkin of Columbia University, whose
team has used genetic tools to identify more than 75 viruses and who
received $2.5 million from Google.
That's because a doctor from Singapore who visited New York for a
medical meeting was well enough when he reached the airport to be
cleared to fly home. He made it only as far as Frankfurt. Had he entered
a hospital in New York and infected fellow patients or hospital
personnel, Lipkin says, New York might have had its own health-care
outbreak, joining the ranks of Vietnam, Toronto and Hong Kong.
Waves of new outbreaks
Ever since Surgeon General William Stewart famously declared in the late
1960s that it was time "to close the book" on infectious disease, new
outbreaks have come in waves, among them: Legionnaire's disease,
hantavirus, West Nile virus, bird flu, salmonella, drug-resistant
tuberculosis and AIDS.
In a typical year, infectious diseases kill about 57 million people, 26%
of all deaths worldwide, according to the World Health Organization.
Three diseases — AIDS, tuberculosis and malaria — account for about 6
million deaths. A pandemic inevitably would send the toll much higher.
One of the scariest diseases is bird flu, H5N1, which has killed
millions of birds but few people. That's no reason to write it off. Of
387 people infected as of Sept. 10, WHO reports, 245 have died.
"If you look at acute threats that can wipe out millions of people in a
matter of weeks, we're still at risk," says Mike Ryan, WHO's director of
epidemic and pandemic response.
How to avert the next big one? That's one of many questions on the
agenda this month at a joint meeting of the Infectious Diseases Society
of America and the Interscience Conference on Antimicrobial Agents and
Chemotherapy in Washington, D.C.
To get answers, public health experts are expanding research into how
outbreaks get their start. A study in the journal Nature in February
offers a critical clue. Researchers analyzed 335 outbreaks worldwide
between 1940 and 2004. More than 60% of epidemics, including HIV and
SARS, began when a germ leapt from wildlife into humans.
What may be most surprising is that germs don't make the leap more
often. "There are 50,000 vertebrate species," says Peter Daszak of
Columbia University, an author of the Nature study. "If you assume each
one has 20 unknown viruses, that makes a million unknown viruses in
wildlife."
Opportunities for microbes and humans to mingle are growing, he says,
thanks to global warming, deforestation, urban crowding and the
encroachment of humans and animals into one another's habitats.
Predict and prevent
Scientists aren't willing to sit back and wait for the next deadly
surprise. Given the likelihood the next epidemic will start in animals,
human and veterinary infectious disease experts, once worlds apart, have
conceptually merged their approach into what they call "one health."
"After West Nile, there was a new awareness that we had missed the boat
by not thinking about birds," says Columbia's Lipkin, who led the study
that identified West Nile virus in humans in 1999. "Birds were dying all
over New York. Nobody paid any attention."
The Google.org grants illustrate how enterprising researchers are
attempting to exploit technology in the battle against disease
outbreaks. They include:
•TheGlobal Viral Forecasting Initiative, $5.5 million of an $11 million
grant co-funded by the Skoll Foundation to collect and analyze blood
from humans and animals in infectious-disease hot spots in Africa and
Asia to spot outbreaks before they start.
•The University of Columbia Mailman School of Public Health, $2.5
million to support Lipkin's effort to speed up the identification of new
disease-causing microbes.
•The Woods Hole (Mass.) Research Center, $2 million to use satellites to
map forest loss and human encroachment into animal terrain.
•ProMed Mail and Healthmap, $3 million to join forces and use the
Internet to track and map diseases. ProMed was founded in the mid-1990s
by members of a biological weapons defense group. Now sponsored by the
International Society for Infectious Diseases, ProMed sends out daily
alerts on scores of outbreaks. Healthmap scours the Internet for news of
outbreaks and posts their coordinates on a map.
"We had the first report on SARS," says Jack Woodall, a ProMed founder.
"We picked it up off a teacher who belonged to a chat group that
included Chinese teachers."
The next epidemic?
Chikungunya may well become the next epidemic to reach the USA. Carrying
an African name that roughly means "bent over," chikungunya is a
mosquito-borne illness that causes severe flu-like symptoms and muscle
aches that may last a lifetime.
In the past two years, the disease traveled from East Africa to
French-speaking islands in the Indian Ocean, afflicting 266,000 people,
swamping hospitals and causing 255 deaths, says Antoine Flahault of the
L'Ecole des Hautes Etudes en Santé Publique in Paris, who coordinated
the research into the island outbreaks.
From there, the virus leapt to the Indian mainland, infecting more than
1.5 million people and killing up to 90,000, most of them elderly.
Today, it is making its way through Southeast Asia, aided by a genetic
mutation that enabled it to adapt to the tiger mosquito, also found in
the USA.
In August, chikungunya turned up in Ravenna, Italy, a city on the same
latitude as Bangor, Maine, carried by a South Indian man who was
visiting relatives, according to a report in Lancet. Tiger mosquitoes in
Ravenna feasted on the visitor and caused a local outbreak, spreading
the disease to more than 250 people.
Researchers from the University of Marseille reported last year in The
New England Journal of Medicine that chikungunya turned up in more than
1,000 people returning from outbreak areas to Europe and the USA. "It
clearly has the ability to come to the U.S.," says Larry Madoff of
ProMed and Harvard University.
Unfortunately, so do countless other plagues, and for the moment,
there's no way to reliably predict which ones will turn up.
Brilliant, of Google, likens the situation to a race between conditions
that make a pandemic more likely and technological advances that will
enable local health officials to prevent outbreaks or shut them down.
"SARS demonstrated for the first time in human history that we could
detect a new epidemic across multiple countries and put the beast back
in the box," says Ryan of WHO. "Next time the world may not be so lucky."