The key unanswered question is:
• Will H5N1 acquire consistent human-to-human transmissibility and cause a pandemic?
I don’t know how we could know this other than in retrospect but when experts on the ground are concerned I think we should pay attention.
The U.S. Naval Medical Research Unit No.3 (NAMRU-3) conducts research and surveillance to support military personnel deployed to Africa, the Middle East, and Southwest Asia. They are based in Cairo and are working locally on the H5N1 out break throughout the region. NAMRU-3 works closely with the Egyptian Ministry of Health and Population, the U.S. National Institutes of Health, the World Health Organization, the U.S Agency for International Development and the U.S. Centers for Disease Control and Prevention. NAMRU-3 is a WHO Collaborating Center for HIV and Emerging Infectious Diseases.
The entire unit appears to have written a letter to the editor (pdf link) of Microbe the news magazine of the American Society for Microbiology. The letter references Microbe’s December issue’s article H5N1 Influenza Continues to Circulate and Change which provides an excellent review of the situation throughout the world and ends ominously:
These viruses kill more than 50% of humans that they infect. One such virus infected a family cluster of eight persons in Indonesia, and included three sequential human-to-human transmissions. Fortunately, however, that particular cluster did not expand. Moreover, in humans, the H5N1 viruses remain poorly transmissible between individuals. In over 40 years of experience with influenza, the Asian H5N1 is the most virulent virus I have encountered (R.G.W.); if it does acquire consistent human-to-human transmissibility— it will likely be catastrophic.
Should we take the article seriously? NAMRU-3 certainly does. From their letter to the editor:
We read with great interest the article by Webster et al. on the expanding range and behavior of H5N1 Avian Influenza (Microbe, December 2006, p. 559). They provide an outstanding description of how the viruses, originating in Southeast Asia, have migrated into Eurasia and the continued threat they pose to both birds and humans.
The article does give a thorough , accurate history. The letter concludes (my emphasis):
We agree with the authors of the Microbe article that H5N1 is changing in novel ways and is a continued threat. It now appears (for perhaps the first time) that the emergence of a pandemic strain could originate outside Southeast Asia. This paradigm shift further supports the need for continued global monitoring of influenza, especially in areas with high numbers of humans and domestic and wild birds living in close proximity.
If NAMRU-3 is worried enough to publicize their concerns in witting then we should listen. Dialysis units must strategize how they would get their dialyzors through a pandemic wave.
Social distancing at a dialysis unit would mean segregating shifts of staff and dialyzors from one another. Ideally no one from one shift would ever interact with someone from another shift, this would take tremendous planning, which should be done now before a plan is ever needed. And again, I believe two day a week schedules with extended schedules would be an important element in any planning strategy, which would take tremendous planning, which should be done now before a plan is ever needed.
h/t SophiaZoe