Avian Influenza – A Valid Threat?

The world is more in tune with anything infectious disease-related than it has been in quite some time, and it is because of this many have been startled to hear the term "avian influenza" start to get tossed around in the headlines once more.

So what is all the fuss about? Is avian influenza really something that you need to worry about? And if so, is there anything that you can do? We'll answer these questions and more below, so let's dive right in.

Table of Contents

• 01

  Why the Talk About Avian Influenza?

• 02

  What is Avian Influenza?

• 03

  Pandemic Influenza and Bird Flu

• 04

  Is Bird Flu Really a Threat?

• 05

  The “What If” Game

• 06

  Frequently Asked Questions

Why the Talk About Avian Influenza?

Two main stories have been circulating around, raising the specter of viruses once more: Cambodia and China.

In Cambodia, an 11-year-old girl recently died in the Prey Veng province after contracting H5N1. She was in contact with 12 people while she was ill, four of whom later grew sick with flu-like symptoms.

H5N1. (Image courtesy of NIAID at Wikimedia Commons.)

Meanwhile, a 56-year-old woman in China died on March 16 from H3N8, making her the first human death

from this variant in recorded history. There have been two other human cases of H3N8 infection in the past (both in China last year), but this lady was the first actual human death from H3N8.

These medical cases have caused some people to fear that bird flu is the next virus that will sweep the globe. But before attempting to respond to those fears, we must first ask the question: what are these viruses?

What is Avian Influenza?

Influenza is caused by viruses within the Orthomyxoviridae family. To current knowledge, there are four different classifications: A, B, C, and D. Avian influenza, otherwise known as bird flu, falls into the influenza A category.

The thing about influenza is that it can cause illness amongst a wide range of living things. Dogs, pigs, horses, birds, humans – they can all get different variants of it. Influenza is no laughing matter as it is, and anybody who has come down with it can attest to its ability to knock you down flat for several days. Typically, this involves a severe cough, a fever, feeling terrible, running a fever for several days, and being absolutely unable to get out of bed.

The main "regular" subtypes of influenza that humans get are H1N1 and H3N2, while the main bird flu subtypes are H5N1 and H3N8. Laughably, H3N8 doesn't really cause any issues for birds whatsoever, and a little bird can get sick with that and still operate just fine.

(Image courtesy of H3N2 particles)

As we've discussed before in our deep dive into animal-caused diseases, the problem comes when we see spillover from the animal kingdom into humanity. First, you have something that only impacts seagulls and geese, and the next thing you know, you're seeing it start to pop up in humans.

That's how bird flu works.

Anytime you end up with a spillover event, it can make for a very lethal and contagious disease agent that can wreak havoc.

A turkey dead from bird flu, 2016. (Image courtesy of Rose Shpernik at Wikimedia Commons.)

Let's say you have a wild duck that has come down with a bad case of the sniffles. He has the regular bird flu every 2-3 years. But then this duck goes to the park. An old woman is sitting on a bench on the tail end of recovering from influenza, and she's decided to get out for some fresh air. She brought a sandwich with her, but she still had no appetite. So, after three or four bites, she tosses the remnants to our sick duck friend.

Sick Duck eats the sandwich and ends up getting human influenza inside of his system now as well.

What can then happen inside that little duck's system is something of a viral blender. A mix-and-match game can be played among the different influenza strains, with parts of one and parts of another being added to each other, with the end result being a novel strain of influenza. Now, that duck has an influenza bug inside of it that the world has never seen before, which is highly lethal and incredibly contagious.

Fluffy the Cat kills our little sick duck while she's making her evening rounds through the park and then heads back home. Back at home, Fluffy licks her owner's hand when he scratches behind her ears, and then the owner goes and eats a piece of pizza before washing his hands. He now ends up with Sick Duck's novel influenza in his system, becoming Patient Zero at the start of a new global health threat.

Because it's a novel strain that humanity has never experienced, there is no inherited immune response. Fifty percent of all who become infected end up dying within seven days, and they give their illness to an average of four people. In Patient Zero's case, this means that he spreads the bird flu to four others, who then spread it to 16 others, who then spread it to 64 others, and so on. By the end of two weeks, you end up with 43 dead people from a virus rapidly spreading throughout the community.

So when you hear about the threat of bird flu, this is what epidemiologists are worried about.

Pandemic Influenza and Bird Flu

Looking throughout history, we find that influenza reaches pandemic levels at a regular rate of occurrence. So regularly, we can predict when they'll happen with surprising reliability. The answer? Every 30-40 years.

Over the past 100 years, we've witnessed four specific pandemic influenza events, starting in 1918 with the Spanish flu (H1N1).

(Image courtesy of Grave digging during the Spanish flu. )

The more you study Spanish flu, the more significant variance of figures you discover. Still, some research suggests that this pandemic originated in China, was spread via the Chinese Labor Corps, and then spread throughout the rest of the world from there. Some estimates have infected up to 50% of the globe's population, with American life insurance claims spiking 745%.

Then there was the Asian Flu Pandemic (H2N2 – caused by ducks becoming viral "blenders"), the 1968 Hong Kong influenza (H3N2 – believed to have mutated from the Asian Flu Pandemic strain), and the 2009 swine flu (H1N1) pandemic. While it's hard to get accurate data on the Spanish flu, every other flu pandemic that we have seen in the past 100 years has (or is believed to have) originated from a spillover event.

(Image courtesy of Asian Flu, 1957. )

So if we look at history, we find that pandemic influenza is most certainly something that can and does happen, and its originating from an animal is also the norm. But then, what does this mean for the current cases of bird flu that we're hearing about?

Is Bird Flu Really a Threat?

First, let's look at the two news stories that have been making their rounds, beginning with Cambodia. The specific virus that caused that little girl's death (the H5 clade 2.3.2.1c) has been present in the country for years. It's not as if this is something that has suddenly popped up out of nowhere that we're completely unfamiliar with.

Admittedly, it is bizarre that this little girl died from this clade, but this virus isn't novel. There have even been a few other cases of people contracting this virus. This by no means makes this little girl's death any less of a tragedy, but from a policy perspective, this isn't something that anybody needs to panic about. Something to keep an eyeball on? Sure. But something to be terrified of? No.

What about China, though? Is there any extra cause for concern there?

For starters, we must consider that this woman who died already had several pre-existing medical conditions. These make the body react weirdly to everyday stressors – including infectious agents. You'll see reports indicating that this woman had regular contact with poultry, but very few of these reports tell you what the nature of these contacts looked like. If she came into contact with these birds in local markets, they likely came from massive confined animal feeding operation (CAFO) businesses. These environments are notorious for being disease breeding grounds, which is why these animals are pumped full of so many antibiotics.

(Image courtesy of Chicken CAFO )

This lady did not get sick because she raised chickens in her backyard. She got ill because of pre-existing conditions, being in the wrong place at the wrong time, and getting her food from an (unwittingly) unsafe source.

But what about beyond these two cases mentioned above? Outside of them, are there potential health risks associated with bird flu that we need to consider? Surely, all risk from this doesn't just go out the window, does it?

Of course not.

Getting sick is still getting sick, and bird flu always has the potential to become something much more significant than just a tiny, isolated outbreak.

Take the case of 1997 Hong Kong, for example.

Here, bird flu was first found in human beings, causing 18 people to become sick and six of them to die. While these numbers are insignificant in comparison with the population size of Hong Kong, consider that 33% of those who came down with this specific strain of bird flu ended up dying (elsewhere, you'll hear that the mortality rate was 50+%. Either way, those aren't great odds for survival). It wouldn't have taken much for this to have ended up being a much worse event. Thankfully, it didn't.

So, clearly, bird flu is a potential pandemic just waiting to happen.

H5N1 is well-rooted in Southeast Asia, and it's not going anywhere. The same goes for other types of influenza). They're here to stay. And this is something of a two-edged sword. For starters, this means that avian influenza is widespread. It's all around you; you've just never noticed it. That is room for gratitude because it means that this isn't a threat you've ever had to worry about.

The other side of the blade is that it is much more likely that influenza will mutate into something more lethal.

(Image courtesy of H5N1.)

The “What If” Game

So now, let's play the "what if" game. What if bird flu ended up becoming a pandemic? What if we were talking about an event with far-reaching consequences? What would things look like then? Are there steps that we could take?

While this author doesn't believe that the current state of bird flu worldwide is anything to be concerned about, there is some advice here that you may find helpful. (While discussing infectious disease post-2020 as a charged issue, if you look at the below advice through a 2019 lens, you'll likely agree with all of it.)

Don’t throw away or shun your chickens.

There is, quite literally, no need to be afraid of your backyard chickens. This is the advice we're commonly seeing touted worldwide; quite frankly, it's stupid.

(Little girl holding a chicken, 1899.)

If you live in southern China and wake up in the morning to find that all of your chickens have mysteriously died without any apparent reason, then yes, stay away from your chickens.

If you live in America and you have a small backyard flock you use to raise eggs and meat, keep on living life.

This author believes that there are several reasons why bizarre viruses consistently originate in China. Here are two of them.

For starters, the pollution there is absolutely atrocious. To wake up in Beijing and not be able to see the sun through the smog is the norm. (If you see a picture of Beijing with clear skies, it's because several days before the scheduled photo shoot or politician visit, all manufacturing is mandated to cease.) This smog plays havoc on peoples' lung health long-term, making them more susceptible to respiratory infections.

Secondly, if you look at Chinese farming operations, they're nothing more than confined animal feeding operations (CAFOs). These are massive buildings where many animals are shoved in as possible. This increases animal stress (lowering their immune health), forces them to live in unhygienic conditions, and makes for a viral breeding ground.

(Image courtesy of Hog CAFO. If you’re interested in reading more about these, check out this book here. )

Within the United States of America, you likely have clean air to breathe. You probably aren't living next to a CAFO. You likely won't use the fork you've been eating to serve yourself at the restaurant with your friends. And you can receive adequate professional healthcare promptly.

With all this in mind, there's no reason for you to shun your backyard chickens.

If You Have a Sick Chicken, Goose, or Duck, Just Shoot It

There's no reason to keep a sick chicken. Those birds cost $15-$30 to replace. It's far better to cull a sick bird from your flock so that your entire flock doesn't get infected than trying to nurse that thing back to health. Shoot it and then use a shovel to throw it off into the woods.

Chickens are not pets. They're food sources. You can get another.

This author also believes that taking "preventative measures" by killing all of your healthy birds is ridiculous. Imagine trying to stop a human flu outbreak in a nation by killing all healthy people. Humans are inherently worth more than animals, so this isn't a perfect analogy, but understand the point: "If it ain't broke, don't fix it." (Also, there's no need to use a sledgehammer to crack a walnut.)

Learn How to Wash Your Hands

This is one of the most important steps you can take. Understand how to wash your hands properly, do so every single time before you eat, and don't touch your face throughout the day if you can help it.

It sounds like a simple fix, and it is, but we should be thankful that something so simple can be so beneficial. No, washing your hands isn't a cure-all – there are plenty of people out there every year who are diligent hand washers who still come down with infectious illnesses – but there's no denying that this is a considerable step somebody can take to better protect their health.

Stay Away from Sick People

Obviously, if your kids are sick with influenza, you must be there to care for them. There's no way around it (and if you refuse to, frankly, you're a terrible parent/person). That isn't to say that you need to hold your toddler up to your face so they sneeze in your mouth, but you do need to take care of them. Locking them in their room for weeks at a time as you slip food underneath the door is not that.

A man protects his family and then deals with the consequences.

If you can help it, though, stay away from sick people. There is no problem with shying away from somebody at the workplace who has a fever, publicly states they feel terrible, and is hacking and sneezing all over everything. It is possible to be polite but firm here.

I don’t know if this fits here or not, but I thought it was funny.

And when you can't stay away from sick people? When it's family that's sick, you work in healthcare, or you need to go out for medicine or food amid a truly lethal bird flu pandemic? Well, then you'll want to turn to using quality PPE.

Keep High-Quality PPE at Hand

While this author by no means thinks that you need to be worried about the two flu headlines that we've heard of late, keeping a high-quality gas mask at your house is one thing that you could do to make sure you're as prepared as possible should there be a true global flu pandemic in the future.

Here is how this PPE could be beneficial.

In the event of a Matt Damon Contagion-style pandemic (great movie, by the way), medical services across the globe would be rocked to the core. Healthcare workers would suffer high fatality and illness rates, many would just quit (due to fear), and the few remaining workers would be further overwhelmed by the large numbers of violently ill patients that kept showing up in the emergency room.

This would mean that should you or a loved one come down with bird flu during a Black Death-level event, seeking professional medical care may not be feasible.

Consider the following.

During the eradication of smallpox, one of the problems that kept happening (particularly in Asia) was that smallpox would just randomly pop up in a community, and members of the eradication effort would then have to rapidly travel to that zone to try to stop smallpox from causing an epidemic. These workers quickly realized that they did not have the manpower, money, or resources to vaccinate the world's entire population against smallpox. So, instead, what they did was develop a technique known as "ring vaccination."

Exhibit A of why you don’t want smallpox. (Image courtesy of Wellcome Images at Wikimedia Commons. )

A case of smallpox would pop up, the eradication team would move to the area, and they would give a smallpox vaccine to the family members who had been in contact with the case. Given that smallpox was virtually a death sentence, the vaccine primarily worked, and that people were more than happy to receive it, ring vaccination worked in this instance.

What if we combined the same concept with the understanding that hospitals are overwhelmed? What if there were a "treat-in-place" protocol (which is different from shelter-in-place)?

With a treat-in-place, somebody in a household of four gets sick. Let's say the older son. In this instance, we'll also say that all treatments for the novel bird flu pandemic are palliative. Antivirals don't touch it, Tamiflu doesn't really work, and that's all there is. In such a case, taking the son to the hospital may not be warranted. He would receive better daily care at home, no advanced treatment at the hospital, and going there would only expose his family to other sick people.

If this all were to be the case, with a treat-in-place protocol, the family members would take care of their own, using high-quality PPE to protect themselves as they care for their ill.

But if this was instituted by Americans across the country, this could be a phenomenal civil defense measure that would reduce the load on hospitals and clinics across the country, give better personal care to millions of sick people, and we'd likely see reduced death tolls due to this better level of care as well. A single nurse taking care of 25 pandemic patients alone will be unable to give the level of care that a mother and father could to their one ill child.

(Image courtesy of Spanish flu. )

While you may scoff at the notion of one nurse having that large of a patient load, thinking it would be illegal and against hospital protocol, during a Black Death-level pandemic where the rest of the healthcare workers have quit, sick people keep showing up. The hospital is packed, and this isn't an unreasonable ratio to anticipate.

Will a single nurse assist with medications, restrooms, food and drink, and other necessities of daily life for 25 patients as well as a mother and child can do for their own son? Not even close.

Treat-in-place would also reduce community spread. Fewer sick people would be heading to the hospital, meaning there would be fewer sick people healthcare staff would have to come into contact with.

This, of course, necessitates the possession of palliative care treatments and PPE before such a pandemic ever were to take place. The market speaks, and if people wait until after the pandemic starts to hunt for this PPE, they'll be doing so simultaneously as millions of other people. Their chances of getting the PPE they need in a timely manner would grow slim.

For these purposes, this author believes one would be well-served with a few boxes of disposable neoprene gloves, Clorox wipes, and a CM-6M (you would need your eyes covered if you didn't want to get sick with Black Death-level bird flu, too), and a few containers of ParticleMax P3 Virus Filters.

This PPE stockpile would allow one to clean down hard surfaces, safely handle dirty laundry, and enter a room with a highly lethal avian influenza strain with minimized risk.

Use Discretion and Get the Facts

Is the current talk about bird flu something you must worry about? No.

But does that mean that bird flu isn't a potential threat? No, absolutely not.

To deny that a novel bird flu that can infect humans is nothing to worry about would be foolish. However, there's only so much that you can do, and to just constantly sit back and live terrified about every other viral threat in the world is to make yourself a prisoner of your own design.

Mark Twain was correct when he said that he'd lived through many terrifying times, most of which never happened. Why do you wear a seat belt when you're driving, though? It's because you recognize that the consequences of your not doing so could be severe. You're not living your life absolutely terrified every time that you sit behind the wheel. You know that there's something you can do – drive safe, pay attention, and wear a seat belt – and so you do so and live your life.

(Image courtesy of QuoteFancy.com)

Why not approach infectious diseases in the same manner? If you can do something about it - do something about it. If you can't, well, then what is the use of worry? Take the steps you can take, and then you've done what you can. Laying aside a full-face respirator is one of the easy things you can do to protect yourself if a bird flu pandemic ever happens.

What do you think, though? Do you like the idea of treat-in-place? Are there other considerations to take into account here? What do you think about bird flu? Let us know your suggestions in the comments below.

Frequently Asked Questions