As was said in the pantomime, bird flu only affects birds, and I’m a bloke, so I don’t need to worry. Unfortunately, this simple truth hasn’t got through to the world’s media, and as I write we are in the middle of a major panic. As we have all heard many times, the first casualty in war is the truth, so what is the truth about bird flu and do we in Uganda need to worry a dickey bird about it?

Bird flu is an infectious disease of birds caused by type A influenza, one of the subtypes of influenza that cause human flu. The disease was first identified in Italy over 100 years ago. The disease is endemic in wild birds, many of which are not sick at all. Migratory wild fowl, especially wild ducks, are natural carriers of the viruses and pass it on to domestic birds. Since 1959, there have been 24 outbreaks of bird flu among domestic poultry, and 14 of these have been in the last 10 years. Some of these epidemics have been very costly and difficult to control for the agricultural sector. Most flu viruses remain true to their species, ie: birds, pigs, humans, horses and seals. They rarely spill over and cause infection in other species. In general, human infection with these viruses has been rare and with only mild symptoms, though the cat recently found with bird flu in Germany is a big temptation to make bad jokes about fat cats getting fatal viruses from sick chicks. The exceptions have been the famous swine flu epidemic; the 1919 epidemic, which killed about 50 million people, may have been a bird flu; and the current one, H5N1 bird flu. There are 25 types of bird flu, but only H5 and H7 have been associated with fatal epidemics. Of the hundreds of different strains of avian influenza A viruses, only 4 are known to have caused human infection, H5N1, H7N3, H7N7 and H9N2.

The first human cases of H5N1 were seen in Hong Kong in 1997, and by late February 2006, the WHO had confirmed 147 cases with 76 deaths. Not really a big deal so far. And so far all the cases seem to have been caught by very close contact with sick birds; however there is a possibility that 2 or 3 of these infections, including some of the children in Turkey this year, were caught from another human. This is the “worst case scenario” causing the current media panic: that the virus can pass from human to human and trigger a pandemic.

So what is the risk that we are all going to die from flu? At the moment, none at all. There are always flu epidemics circling the world, and Type A flus are common. Flu kills about 12,000 people a year in UK, almost all very old people who, if there was no flu, would have died from something else. Immortality has not yet been discovered. A vaccine is produced every year against the current flu viruses and is variably successful in preventing seasonal flu. However, every 15 years or so, a new virus appears that is different enough from the previous strains to produce a “pandemic,” meaning it infects everybody, and people are a lot more sick due to no immunity to that strain. We are overdue for one, as the last one was in the 80s. The big scare is that if H5N1 infects someone with a normal human type A flu, the 2 viruses will get together and produce a superbug that is as deadly as H5N1 but also easily passed from human to human by coughing. It is likely that at least 3 of the human type A flu viruses currently circulating have some genetic material that came originally from a bird flu, so this is a possibility with H5N1 too. So yes, this could be the origin of the next big flu pandemic. We are continually told that “experts” predict that from 2 million to 50 million will die. How they come up with these numbers, I really do not know.

Is there bird flu in Uganda?
Almost certainly, probably for the last 5,000 years. What about H5N1? Not as far as we know. At least, not in early March. However there wasn’t any in Egypt or Ethiopia until they went looking for it, so the same probably applies in many other countries: the more you look, the more likely you are to find it. H5N1 seems to be discovered in a new African country every week at the moment, so it may be discovered here before this goes to press. Answer: don’t look, it ruins the tourist industry.

If it does come here, what should we do?
Like all countries now, Uganda has a national plan. Uganda did very well in the last Ebola epidemic, containing it quickly and successfully, and Ebola has so far killed a lot more people than H5N1. So the plans in place are sensible and will probably be effective. On the one hand Uganda is the destination of thousands of travelers from around the world, with quite likely more than 50 different nationalities in Kampala, so flus of various severity are common, imported by British Airways 3 times a week. However, it is also warm and breezy, so the classic flu-catching conditions of hundreds of people crowded together in one room with all the windows closed seldom applies here. We escaped SARS, we may escape the H5N1 combi.

What about poultry?
If a wild duck or a flamingo brings bird flu to East Africa it may well get into the domestic poultry, just as it has in Nigeria, Egypt, and Ethiopia. Mass-produced poultry in crowded conditions are not so common, but free-range birds can easily get it from the wild birds. But will it spread out of control? I doubt it. Lots of fresh air and plenty of common sense is a great deterrent. A ban on movement of poultry is not difficult to enforce in a literate society, and the chances are that any outbreak in domestic birds will be contained without human cases, just as it has in most other countries so far.

So if the worst happens, and there is a new pandemic of a new flu, whether from H5N1 or any other type or strain, what to do?

1. Panic. Run and hide in the frozen Tundra of northern Canada and get bitten to death by zillions of mosquitoes or trampled by deranged moose. And keep away from seals as they get flu too.
2. Get this year’s flu vaccine immediately for you and your family. Complete waste of time as it won’t protect you against the next flu, certainly not against bird flu, and anyway, as there are new strains and therefore a new vaccine every year… are you going to do that for the next 70 years? At least if you get flu naturally you will have lifelong immunity to that strain, and possibly some non-specific immunity to closely related strains, which might, possibly, be useful against the avian/human combi that might, possibly, be on its way. Not surprisingly, most sensible governments recommend the vaccine for those over 65 or others who are particularly vulnerable, e.g. those with severe chronic lung disease such as bonchiectasis, emphysema or chronic bronchitis. Give it to your 2 year old if you must, but most people decide not to, and for good reason. We have it if you want it.
3. Give up smoking. Good idea. You’ll still get flu, in fact as you won’t smell so bad you may be lucky enough to get a lot closer to someone and will be even more likely to get flu! But you are also more likely to survive it.
4. There is already a virus that you get from close contact with sick chicks and it has already killed millions. So worry about that, not avian flu
5. Stock up on tamiflu. See below
6. Buy shares in Roche and Gilead. See below
7. Er…
8. That’s it

And seriously?
As soon as it happens, a lot of clever people in Atlanta will start work on a vaccine and may have one ready in 3 months. It may then be mass-produced in time for it to be useful, hopefully before 2 million or 50 million people have died.
In the meantime, there are 4 drugs licensed for treatment for flu, but 2 are known to be of no use in H5N1 or for the current type A influenza strains in USA and Europe. The other 2, zanamavir and the better known “tamiflu” are thought to be effective as a prophylaxis and as treatment if given in the first 48 hours, possibly reducing symptoms and causing quicker recovery. There are not enough studies to show if it is effective in reducing deaths in bird flu infections in humans. It is pretty harmless and so most current advice is that it should be given in all cases of severe flu in the first 48 hours and may also be beneficial if given later. It is readily available in Kampala, but is pretty expensive, not much change from 100,000/= for a course, and if given as a prophylactic to your whole family every time there is a new flu at ISU, it’s going to cost a lot more than a bottle of Zedex and a handful of brufen. My advice is as always: see your doctor and discuss it first. We should all be stocking tamiflu for serious cases, and be ready to use it, but we should be giving it for a good clinical reason rather than to maximize profits.

And here of course here comes the rub. Is the current media frenzy whipped up by those likely to benefit from sales of tamiflu? The web is dripping with conspiracy theories involving Roche, the manufacturer; Gilead Science Inc., the company in California that developed tamiflu; and a household name who may be one of its major shareholders. Good cocktail party gossip, so get logging!
What are Doc Stock and family going to do? My favourite flu treatment is a day off work, go to bed, look as miserable as possible and hope my wife takes pity on me and makes me a hot whisky. So I’m stocking up on Bushmills 16-year-old single malt and some Bushenyi honey.
Cheaper than tamiflu.