Seeking to avoid or at least mitigate the worst - Veterinary Practice
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Seeking to avoid or at least mitigate the worst

PERISCOPE continues the series of reflections on issues of current concern

WHEN swine flu was first identified as the cause of human deaths in Mexico, the whole world held its breath. Was this the start of a new human disease pandemic that would spread across the world causing untold numbers of deaths and economic and social disaster?

No one knew, but Governments on all continents were sufficiently worried by the prospect to try and contain the disease by the quarantining and treatment of suspected sufferers, the tracing of all known contacts, and the closure of institutions like schools and workplaces.

In the UK, at least, we have now abandoned this policy. Swine flu has proven to be too infectious and too rapidly spreading to contain, so the strategy has changed to one of treatment of those clinically affected and the hoped for production of a vaccine at the earliest opportunity.

Contrary to the wishes of many of the “red-top” tabloids, there has been no evidence of any panic amongst the general public, though how those newspapers expect such panic to manifest is not quite clear.

I for one cannot imagine hoards of screaming people leaving their homes in the city in search of some remote outpost from which to man the barricades against an unseen but greatly feared enemy. Not if it means them missing the next exciting episode of Strictly at any rate.

No, in most situations such as this, people tend to behave pretty rationally and simply recognise that there is little they can do about it other than follow government advice, remain vigilant to the early signs and symptoms of illness, and perhaps make a passing effort at tightening up on the normal hygiene practices of themselves and their loved ones.

Fortunately, at present swine flu remains a fairly benign disease with relatively few deaths compared to the number of confirmed cases, probably less in fact than from a typical winter flu epidemic. Whether it remains benign is the question exercising the minds of public health experts across the globe.

Turning point

Any significant increase in the virus’ pathogenicity could turn what is currently a minor inconvenience into something that actually brings to fruition the worst fears of all of us. We have to hope that if that worst case scenario materialises that the vaccine will not be far off and that Tamiflu and its ilk continue to be effective treatments.

Outbreaks of diseases like swine flu give succour to various pressure groups with vastly different agendas. Already the antifactory-farm-pro-sustainable-agriculture lobby has blamed the huge “factory” pig farms in Mexico as being both the source and cause of the recombinant flu virus.

I don’t know if that is a true representation of the facts but it is a convenient and sufficiently emotive piece of propaganda that is probably, to many people, a more persuasive argument against the evils of intensive livestock production than the animal welfare and waste-of-resources arguments that are more frequently proffered.

A similar case has previously been made concerning avian flu and it may well be that it genuinely does come down to basic maths and probability: the more animals infected at any one time with avian flu or swine flu then the greater the likelihood of a virus mutation or recombination to produce a highly infectious and highly pathogenic zoonotic infection.

Disease and pestilence have featured large in human history since as far back as we can trace. The seven plagues foisted on ancient Egypt; the “black death” of the previous millennium; the influenza pandemic after the First World War; smallpox; TB; HIV infection; etc.

Controlling diseases

One by one we have learnt to control these diseases through hygiene, immunology, and antibacterial and antiviral treatments. That, and the ability to ensure security of food and water supply, are the keys to the exponential growth in the world human population over the last hundred years.

Today we know more about the cause and spread of disease than ever before and we have more in our armoury with which to control it too. There is, though, no room for complacency because in the modern world we have also created the situation where highly infectious diseases can spread more rapidly over a wider area than at any time in our history.

Huge urban populations live cheek by jowl and mix freely at work and leisure in confined spaces such as offices, cinemas and restaurants. Persons commuting daily to work from places tens or even hundreds of miles away mean that multiple and widespread foci of infection can occur almost simultaneously in much the same way as FMD manifested initially in 2001.

And then, of course, we have air travel where even the geographical divide of vast oceans and mountain ranges is no barrier to the spread of emerging infections. Put all the above together with the current intensity of pig and poultry production and it is easy to imagine that there is a disease producing cauldron that at some point in time really will spawn the deadly zoonotic virus we all fear.

If swine flu continues to be benign, then we can probably thank it for demonstrating so clearly just how quickly the worst case scenario could be on us. We can look at the exposed shortcomings of our current emergency plans and hopefully correct them so that when (not if) the real thing occurs (and that could be as soon as a mutation of the current swine flu virus in the next few weeks or months), we are able to avoid or at least mitigate the worst.

We must have well-funded disease research, diagnostic, reporting, and emergency planning institutions that attract the best and brightest people and which give them the tools and political support to do their work. Just think what could be achieved with just a fraction of the cost of replacing our nuclear deterrent or for the price of 20 or so almost certainly now defunct Eurofighter fast jets.

It could mean the difference between life and death for literally millions of people across the world. It is all a matter of priority.

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