How serious is the current pandemic risk?
The risk of pandemic influenza is serious. With the H5N1 virus now
firmly entrenched in large parts of Asia, the risk that more human
cases will occur will persist. Each additional human case gives the
virus an opportunity to improve its transmissibility in humans, and
thus develop into a pandemic strain. The recent spread of the virus
to poultry and wild birds in new areas further broadens opportunities
for human cases to occur. While neither the timing nor the severity of
the next pandemic can be predicted, the probability that a pandemic
will occur has increased.

Are there any other causes for concern?
Yes. Several.
• Domestic ducks can now excrete large quantities of highly
pathogenic virus without showing signs of illness, and are now
acting as a “silent” reservoir of the virus, perpetuating transmission
to other birds. This adds yet another layer of complexity to control
efforts and removes the warning signal for humans to avoid risky
behaviours.
• When compared with H5N1 viruses from 1997 and early 2004,
H5N1 viruses now circulating are more lethal to experimentally
infected mice and to ferrets (a mammalian model) and survive
longer in the environment.
• H5N1 appears to have expanded its host range, infecting and
killing mammalian species previously considered resistant to
infection with avian influenza viruses.
• The behaviour of the virus in its natural reservoir, wild waterfowl,
may be changing. The spring 2005 die-off of upwards of 6,000
migratory birds at a nature reserve in central China, caused by
highly pathogenic H5N1, was highly unusual and probably
unprecedented. In the past, only two large die-offs in migratory birds,
caused by highly pathogenic viruses, are known to have occurred: in
South Africa in 1961 (H5N3) and in Hong Kong in the winter of 2002–
2003 (H5N1).

Why are pandemics such dreaded events?
Influenza pandemics are remarkable events that can rapidly infect
virtually all countries. Once international spread begins, pandemics
are considered unstoppable, caused as they are by a virus that
spreads very rapidly by coughing or sneezing. The fact that infected
people can shed virus before symptoms appear adds to the risk of
international spread via asymptomatic air travellers.

The severity of disease and the number of deaths caused by a
pandemic virus vary greatly, and cannot be known prior to the
emergence of the virus. During past pandemics, attack rates
reached 25-35% of the total population. Under the best
circumstances, assuming that the new virus causes mild disease,
the world could still experience an estimated 2 million to 7.4 million
deaths (projected from data obtained during the 1957 pandemic).
Projections for a more virulent virus are much higher. The 1918
pandemic, which was exceptional, killed at least 40 million people.
In the USA, the mortality rate during that pandemic was around 2.5%.

Pandemics can cause large surges in the numbers of people
requiring or seeking medical or hospital treatment, temporarily
overwhelming health services. High rates of worker absenteeism
can also interrupt other essential services, such as law
enforcement, transportation, and communications. Because
populations will be fully susceptible to an H5N1-like virus, rates of
illness could peak fairly rapidly within a given community. This
means that local social and economic disruptions may be
temporary.

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