The H5N1 aka the bird flu is, for a good reason, something everyone is now talking about. The human tragedy aside, fascinating subjects are being discussed ranging from the safety of the food supply to closing all borders to the functioning of a society in case of a pandemic. A pandemic, or even the threat of one, clearly has the potential to show the greatest – or the worst – sides of humanity on an enormous scale.
All of this aside, I have a related small-scale concern that I haven’t seen being debated anywhere. When the pandemic hits, the health care system in every country of the world is going to have a crisis on their hands. Severe staff shortages will be imminent. This means that not even nearly everyone will get treated by an expert – instead, you might get an intern making life-or-death decisions under panicky circumstances. So what happens if a patient knows more about the treatment he or she should receive than the doctor, but is unable to self-supply this treatment? Will the patients treatment opinions be respected?
Consider some simple basic facts about H5N1 as an example:
- How many GPs or interns know that one possible reason for high mortality with H5N1 is a not-well-understood phenomenon called cytokine storm?
- Moreover, how many know how that is treated? (There are no guidelines, but blocking OX40-receptors seems to work and lessons from treating SARS with corticosteroids, interferons etc. should be remembered.)
- How many know that tamiflu may have to be given in higher dosages and for a longer time than the current guidelines to be effective?
- Has the more widespread emergence of H5N1-variant resistant to oseltamivir (Tamiflu) been taken into account?
The point is that I hope the healthcare professionals have efficient communication systems in place to distribute the required information to everyone and fast. The problem is that in many parts of the world, there are no such communication systems in place. There’s a danger that the latest information on treatment is only available in the so-called western countries.
Of course, the education must take place on the general public also. For one, since antiviral drugs work only if given early enough on the disease onset, it’s essential for each and every one of us to be able to identify the symptoms of a possible influenza at an early stage. On a larger scale, I wonder what stage the pandemic is really at.. WHO says 3, Recombinomics says 5 or 6. Given that 6 is the final stage, there’s more than a slight difference in those estimates.
Update: The tourist infections were a false alarm, and it appears calling the pandemic to be even at stage 5 was typical recombinomics exaggeration.
Link recap:
- Virulence May Determine the Necessary Duration and Dosage of Oseltamivir Treatment for Highly Pathogenic A/Vietnam/1203/04 Influenza Virus in Mice, Journal of Infectious Diseases
- Cytokine Storm at FluWikie
- A Critical Role for OX40 in T Cell–mediated Immunopathology during Lung Viral Infection, Journal of Expiremantal Medicine
- SARS Treatment at SARSReference
- The Use of Corticosteroids in SARS, New England Journal of Medicine
- Human infection by avian influenza A H5N1
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- Oseltamivir-resistant H5N1 virus isolated from Vietnamese girl, CIDRAP
- CDC Information about pandemics and their phases
- Casual Transmission of H5N1 in Thailand and Indonesia, Recombinomics
