Global health officials are warning that H1N1 swine flu could bloom into a pandemic. Yesterday, the World Health Organization declared a Phase Five alert. Epidemiologist and virus hunter Nathan Wolfe, of the Global Viral Forecasting Initiative, says it never should have gotten to this point. In an op-ed in today's New York Times, Wolfe argues that if global public health functioned differently, we probably could have detected the virus before it spread so widely.
Still unsure of how to spot swine flu? This video from the Centers for Disease Control explains the symptoms.
Todd Zwillich: Just a quick update, we have 91 confirmed cases of H1N1 here in the United States. According to CDC, 2500 cases suspected in Mexico. That's a quick update of where it stands at this point. Of course the WHO, the World Health Organization, has their grading of the H1N1 outbreak at level 5 which is on the verge of being graded in their index as a pandemic. So already there are cases in 10 countries, as we mentioned 91 here in the United States and the WHO is increasing their threat level, but what if we could have prevented this outbreak before it even happened? There's an epidemiologist and virus hunter, his name is Nathan Wolfe, and he's arguing in an Op-Ed in this morning's New York Times that we could've done just that. We could've prevented this outbreak if we only knew where to look and if our surveillance was strong enough and detailed enough. Nathan joins us now from Atlanta, he's director of the Global Viral Forecasting Initiative, and he's a visiting professor in Human Biology at Stanford University. Nathan, why do you think we could have detected this virus before it started to spread?
Nathan Wolfe: This is a virus like many others. The majority of the important infectious diseases in our history and the diseases that are outbreaks, they all come from animals. You could name a disease and I could tell you where we think it came from, but HIV, SARS, ebola, so-called "bird flu" the H5N1 virus, these are all animal viruses that entered into humans. And basically what we do is we work with people who are highly exposed to animals throughout the world and we monitor them over time, we collect specimens from them, from the animals that they're exposed to, and what we've demonstrated in places like Central Africa is we can catch the moment which these viruses enter into human populations. That gives us a huge leg up, because we can characterize the virus, we can understand it's immunological and genetic signatures. We can work to try to contain the virus early before it gets to major cities and spreads around the world, help to develop diagnostics and vaccines, so this Swine flu is not an anomaly. We're sort of responding to it like it's something brand new, but really it's part of this long term history that we have with viruses which is very much accelerating as we become interconnected as a global population because of planes, trains and automobiles that really sort of make us one village.
Todd Zwillich: Well, with all of the hundreds and millions of people who work in agriculture and work in close proximity to animals around the tropical zones of the earth where most flu originates, and with all the probably billions of animals that they're surrounded by, you could do this kind of surveillance but isn't it the case that there are so many opportunities for a virus to jump that it would get by your nets even if you had 100 or 200 or 1,000 epidemiologists up close and personal?
Nathan Wolfe: That's a really good question. I mean, one of the things that sort of propels our thinking is that a smaller percentage of the earth's human population is mostly in touch with these animals increasingly, so as we go by in time, people become more and more specialized, and jobs become more and more specialized, so we think that a smaller percentage of the world's population is accountable for most of the interaction with animals. That gives us some hope of being able to cover them. But our monitoring system sort of goes beyond the animal interface. I mean, that will give us many of the viruses that are there, but we also work in regional centers in these sort of viral hotspots around the world to be able to see what's going on in those regional centers, so you have to have a combined package. But we definitely feel that we need to be moving towards prediction of these things.
Todd Zwillich: In addition to prediction, there's also prevention in the clinical sense, and since we're talking about this we've been emphasizing all morning the very basic advice that people can take upon themselves. Washing their hands, being vigilant, staying home from work if they're sick, and while we're talking about it I want to just hit that point again, I want you to listen to something, some advice we got from a listener, Marai, who's a nurse, who has her own advice from the front lines about how to prevent the spread of any flu virus, including H1N1:
Marai [on tape]: I am a public health nurse, and I finally heard what I think is the most important thing about this flu epidemic, whatever it is, is to cough into your elbow. It is important not to sneeze into your hands and then wipe your hands places, it defeats the whole purpose, and sneezing into your elbow is key.
Todd Zwillich: Alright, we just wanted to hit that point real quickly if we could since we're talking about flu, to make sure that people know just how easy it is to help themselves and their families prevent getting sick. So Nathan, from the front lines and the tropical zones, to spot viruses early and prevent them from spreading, what do you need? Do you need money? Do you need political will? What is it?
Nathan Wolfe: Well there's starting to be sort of a front line of activity to move towards prevention. This is sort of where cardiology was in the 50s, where it was mostly dealing with heart attacks but people starting to recognize what's going on. Organizations like USAID are increasingly putting funding into pandemic prevention. But we think really much more is needed. Prevention of pandemics needs to be part of the portfolio of all of the major biomedical research funders, including groups like NIH and CDC which obviously has started to do some of this. WHO, all of these organizations, a percentage of their portfolio needs to be focused on thinking about not just our own effort, which is sort of the human-animal interface, but work like modeling, organizations like Health Map. It's certainly some of the philanthropy is like Google.org and the Skoll foundation sort of started to lead this effort, but I think that there's a lot of partners that we could use in really trying to prevent these things. These are common phenomena, and they will continue to occur. Swine flu is not a one off, it's part of a steady trend. Viruses like this will continue to enter into the human population, and we need to be pushing forward efforts like ours and the Global Forecasting Initiative, but also similar kinds of efforts elsewhere and really make this a main effort. An ounce of prevention really is worth a pound of cure.
Todd Zwillich: Alright, well Nathan Wolfe is director of the Global Viral Forecasting Initiative, he's a visiting professor in Human Biology at Stanford, he is one of the people on the front lines of trying to predict and head off flu viruses and other viruses before they can get out into the human population, he wants to do more of it. He's got an Op-Ed in the New York Times this morning.