Fatal Flu

Qinghai Lake is a long way off the beaten path, but in August and September the huge salt lake in northwest China is a great place for bird-watchers, as hundreds of thousands of migratory waterfowl rise and wheel above its shallow, fish-rich waters before beginning long journeys back to their winter feeding grounds in Europe, Alaska, and Australia.

This summer, they leave behind a less edifying sight: thousands of birds, dead and rotting, washing up on the Qinghai beaches. Tests show that the birds died from infection with a virulent strain of avian influenza that goes by the designation A (H5N1). This is very bad news for breeders of domestic ducks, geese, and even chickens, because their closely confined flocks can be devastated by infections from their wild cousins from afar.

It is even worse news for humans, because this strain of "bird flu" also kills people. In 1997, half a dozen residents of Hong Kong succumbed after picking it up from infected domestic birds. After a brief reappearance in 2003 in Hong Kong, H5N1 broke out with a vengeance in early 2004 in Vietnam and Thailand, killing thousands of domestic fowl, requiring the destruction of millions more, and killing 23 people—more than half of those who became infected. Scariest of all, the Southeast Asian outbreak provided evidence for the first time that people were not just catching the flu from birds but from each other.

World health experts have been issuing ever more alarming warnings that the H5N1 flu strain, if it becomes easily transmissible between humans, could sweep the world in a matter of months, as did the last big pandemic flu outbreak in 1918–19, which killed more than 20 million people worldwide, up to 700,000 of them in the U.S. Until last year, though, health officials found it difficult to get the attention of politicians in a position to act. Even before the Qinghai outbreak, there was indirect evidence that avian flu was well established in China, but the Chinese government, following the same if-you-don't-mention-it-it-will-go-away policy that allowed the SARS virus to spread unnoticed, won't talk about it. Scientists who asked to study live Qinghai birds, to see if they were carriers of H5N1, were told to mind their own business. And, of course, the highest authorities in the U.S. have been preoccupied with more urgent issues, like Terri Schiavo, school prayer, and gay marriage.

Nonetheless, growing pressure from the scientific and health communities has slowly forced the issue on authorities. Scientist-bureaucrats ranging from Anthony Fauci, the infectious-disease chief of the National Institutes of Health, to Centers for Disease Control and Prevention Director Julie Gerberding recently issued warnings that the threat of a pandemic outbreak is both severe and immediate. Even President Bush's choice to head the Department of Health and Human Services, Mike Leavitt, chosen primarily for his reputation as a ferocious welfare and health care "reformer," has begun to beat the drum to attract attention to the possibly imminent threat.

But even before last year's outbreak in Asia, a lot of basic work behind the scenes had been done to prepare some nations, if not the world at large, for a superepidemic that could begin as soon as this winter and is almost certain to hit within five years. Although this planning as been ill-supported, underfunded, and poorly coordinated, the fact it's happening is good news. The bad news is that, so far, virtually all the preparation, including that in metropolitan Seattle, has been done to ensure that society at large survives the devastating impact, with little attention paid to helping individuals improve their chances of survival.

Geese at Qinghai Lake in northwest China, where thousands of birds have died from avian influenza. (China Photos / Getty Images)

Pandemic influenza is a worldwide threat, but fighting an out-break has to happen country by country, town by town. The people charged with developing a local response in this area are headquartered in a warren of anonymously comfortable offices on the 12th floor of the Wells Fargo Tower in downtown Seattle. A conference room off the lobby is walled on three sides with tables of organizational and procedural charts and decision "trees," all in print small enough to challenge even the clear-sighted.

It's an impressive display, but closer inquiry reveals that the work of Public Health–Seattle & King County's medical preparedness section has really only begun. Headed by Michael Loehr, who came to head the office after two years managing King County's blanket emergency-preparedness plan, the office first had to establish liaison—and credibility—with leaders and personnel in some 40 municipalities and a dozen or more state and regional agencies. "Since 9/11, police and fire and emergency workers all around the county had expanding emergency capacity, buying new equipment," says Loehr. "They expected us to give them guidance, and we were absolutely not ready. Next, we have to build up our health care coalition"— there are 20 medical centers countywide, dozens of group practices, and thousands of individual physicians—"to plan how to cope with a 25 percent to 30 percent infection rate, a several-hundred percent rise in inpatient demand, a third of staff and medical personnel out sick at any one time."