Uniting Against a Possible Pandemic

By Pat Bailey

Walter Boyce Carol Cardona Christian Sandrock Warner Hudson

The foursome began comparing notes last spring and came together in August, shortly after the first influenza-infected wild birds and ducks were discovered in Siberia—a wildlife health expert, a poultry veterinarian and two physicians.

They had each watched as H5N1—soon to be a household name for a deadly bird flu—simmered in Southeast Asia, killing thousands of birds and several dozen people, then moved north into China and north again to Siberia.

Though the virus was appearing in farm-raised poultry as well as wild birds and ducks, the wildfowl seemed to pose the more imminent threat to the United States. Migratory birds, following long-established flight paths, might carry the viral disease from Siberia into Alaska, where infected birds would mingle with flocks from the Pacific Flyway. Upon their southern migration, those birds could carry H5N1 down the Pacific Coast and into California.

“There was an awareness that each of us, whether in poultry, wildlife or human health, was seeing the same train heading down the track straight toward us,” recalled Walter Boyce, a veterinary professor and director of the UC Davis School of Veterinary Medicine’s Wildlife Health Center. “It became clear that questions and answers cut across disciplines and species, and that we could help each other.”

And so in the last weeks of summer, the team of Boyce, Carol Cardona, Christian Sandrock and Warner Hudson formed. Already juggling commitments to students, labs, patients and colleagues, the four decided it was incumbent upon them to help inform the news media—and through them the public—that the bird flu was on the move.

The Team

Carol Cardona is a UC Cooperative Extension veterinarian—one of only a small number of poultry veterinarians in California. In her research lab, she focuses on poultry viruses, including avian influenza, and how to prevent the diseases they cause. Away from campus, when not tending to twin infant daughters, she can be found advising large- and small-scale poultry producers on how to best protect the health of their birds.

Boyce, who is equally at home with mountain lions, bighorn sheep, crows and magpies, is an expert on how diseases impact wildlife. Through the Wildlife Health Center, he is participating in a nationwide surveillance effort, looking for avian influenza viruses in wild ducks, geese and other wild birds.

On the human-health side of the team are Warner Hudson and Christian Sandrock from UC Davis Medical Center. Hudson, a physician and public health expert, moves in countless advisory capacities between academia, industry, and state and federal government. Sandrock is a pulmonary, critical-care and infectious-disease physician, and an authority on emergency medical preparedness, particularly for pandemic diseases. Should a human case of avian influenza one day show up at the medical center, he may well be the attending physician.

The Disease

For decades, scientists and medical professionals who track infectious diseases have been eyeing influenza. A genetically nimble group of viruses, influenza is constantly reshuffling its molecular components. That’s why every year, as the winter months approach, a new vaccine is unveiled to deal with the strain most expected to cause fever, chills, sore throats and coughs across the country that season.

In the United States alone, influenza annually sends about 200,000 people to the hospital, killing 36,000 of them. But such seasonal influenza pales in comparison to the pandemic influenza that could develop if just the right genetic mutations should enable H5N1 or some other novel influenza virus to spread from person to person.

Getting the Word Out

With that awareness, the avian influenza team stepped forward. They would inform but not panic; persuade but not preach. After a September news media briefing in Sacramento, names and numbers for the four quickly found their way into the Rolodexes and BlackBerries of journalists in newsrooms across the country. Their phones began to ring and have not stopped since.

Together, they have logged hundreds of interviews with news reporters, elected officials, health-care providers and community groups. They have been quoted by the New York Times, Los Angeles Times, Washington Post, USA Today, ABC and NBC network news and Forbes magazine, to name just a few. They have good-naturedly answered the same questions over and over and over again, squeezing in phone calls and on-camera interviews between classes, on the road and in the air.

Sandrock recalls a steward yelling at him as he lingered on the runway at Los Angeles International to take a reporter’s phone call. And there was the interview with National Public Radio from the medical center’s intensive care unit and another with CBS radio, conducted via a phone line normally used for ordering shark food at the Monterey Bay Aquarium.

In every interview, the messages are the same: The H5N1 strain of avian influenza is not yet in the United States, but it is coming—in birds, if not in people; if not today, likely within the year. The current strain of H5N1 does not easily infect people, but when it does, more than half of them die. A new and more deadly variety of avian influenza could emerge at any time. The best protection is simply good personal hygiene—wash hands frequently, cover your mouth when you cough, stay home when you’re ill.

As the months passed, the four helped each other deal with the press of the news media, and along the way they developed a deep respect for their complementary disciplines.

“Understanding the relationship of wild animals and agriculture to humans is really critical,” Hudson told staffers for a local congressman during a recent briefing in Sacramento. He stressed the need for policymakers to include veterinarians, as well as human-health professionals, in planning for a potential influenza pandemic.

“The key is linking the experts at universities with the public officials and the private sector, and getting everyone to transcend whatever ‘silo’ he or she is in,” he said.

The foursome found that their collaboration opened up new areas of teaching and research that cut across human and veterinary medicine, and public and wildlife health.

For example, the four teamed up on a televised continuing medical education round-table on avian influenza. Cardona, Boyce and Sandrock also are preparing a “Flu School” curriculum they hope can be used to update veterinarians, health officials and the general public here and abroad on avian influenza. And Boyce and Cardona are collaborating with colleagues at UCLA on a $35 million federal grant proposal that would fund a center devoted to research and rapid testing for influenza viruses in wildlife, domestic animals and humans.

What’s At Stake

At UC Davis Magazine’s press time, the H5N1 virus had appeared in people in nine countries, infecting 208 and killing 115 of them. No one knows just how the tale will play out. The virus could cause a global pandemic in both birds and humans, or it could sputter out. Some scientists say that if this strain hasn’t yet mutated into a highly contagious human virus, it likely won’t. But the stakes are too high to underestimate its potential.

“This outbreak is more widespread than we have seen before,” Cardona said. “Also, if this virus were to appear in the United States, it could cause a panic and could collapse the entire poultry industry without a single infection in commercial poultry flocks.”

Boyce suspects that the H5N1 virus will not have a terribly significant impact on California’s wild bird populations. It’s likely that West Nile virus will cause more wild bird deaths than influenza, he predicts.

“I’m more concerned that possibly misguided control efforts or panic could really impact wildlife and their environments,” he said. “At one extreme, there might be counter-
productive calls to kill wild birds or drain their wetlands.”

Even more subtle and insidious, he suggests, is the psychic wedge the virus might drive between people and nature.

“What really concerns me is the potential for people to come to fear nature,” Boyce said. “If you are afraid of the birds outside your window, it could change your relationship with your environment—to one where you want less wildness instead of more.”

And so, the foursome presses on to inform the public, industry and government agencies so that all can cooperatively plan for the arrival of a serious influenza virus in whatever form it may appear—hoping for the best, preparing for the worst.

Related stories:

Introduction

The Top 10: Epidemic Hall of Infamy

Predicting Future Epidemics

A Big Look at Small Invaders

Ducking Bird Flu and other Contagious Diseases

Pat Bailey writes about the agricultural and veterinary sciences for UC Davis.