Prudent or Paranoid?

People say I’m close to bird flu’s Ground Zero. Here’s how I’m preparing for the Big One.
By Melinda Liu
Newsweek
Updated: 2:06 p.m. ET Oct. 26, 2005

Oct. 26, 2005 - The deadly H5N1 virus is creeping closer to China’s teeming cities—and to me in Beijing. On Wednesday, Chinese media revealed yet another outbreak of avian influenza, the third report in little more than a week. Over the summer H5N1 killed thousands of birds in four outbreaks, but they were all in the remote hinterland of western China, in the Central Asian enclave of Xinjiang or near the Tibetan plateau.

Last week, though, the virus hit closer to home. Thousands of chickens were declared dead in Inner Mongolia, less than a day’s drive from Beijing. Then came Tuesday’s report of dead geese in Anhui province, on the bustling east coast. Wednesday’s news was an H5N1 outbreak among birds in Hunan, a populous southern province.

China has yet to report any human deaths due to bird flu. But a lot of people are betting the fast-mutating H5N1 virus, which is endemic in China, will find a way to spread between humans here. I’m not taking any chances. My husband and I have purchased more than $600 worth of Tamiflu already, enough to treat the entire NEWSWEEK staff in Beijing. Tamiflu is the antiviral medication that experts tell me might lessen the severity of avian influenza in humans, if taken within 48 hours of exposure.

Some of my friends think I’m crazy to stock up on a drug that may or may not help me survive a flu pandemic that may or may not be able to spread among people here. On the other hand, I sat next to a Western television journalist at dinner recently who said he’d purchased thousands of dollars worth of Tamiflu, and was having more shipped in from abroad. Meanwhile, in Hong Kong pharmacies, Tamiflu and another antiviral drug, Relenza, are flying off the shelves.

When my husband picked up a couple more 10-pill courses of Tamiflu yesterday, the pharmacist took pains to tell him the pills should be taken only after exposure to the H5N1 virus, or when exposure is imminent. Some entirely healthy people are popping Tamiflu already, the pharmacist said.

This is not good. If a healthy person has taken Tamiflu over a period of time, and then becomes infected with influenza, there’s a better than 10 percent chance of the virus becoming resistant to the antiviral. If the person is later exposed to avian influenza, resulting in genetic mutation, the result could be an especially malevolent flu virus resistant to Tamiflu.

Instead, the treatment helped alter H5N1 genetically to create a more virulent, amantadine-resistant strain of the virus. “We’re more and more concerned that [amantadine] might not be that useful any longer,” says World Health Organization (WHO) representative Henk Bekedam in Beijing. That’s why so much hope is now pinned on Tamiflu and Relenza, even though they’re much scarcer and more expensive.

It’s not like I relish the thought of living in or near what many people think will be the Ground Zero of bird flu. I’m not sure I have much choice. If the virus begins human-to-human transmission, border crossings around the world would start slamming shut—between nations, between provinces, between cities, maybe even between neighborhoods. A few days ago a Chinese health ministry official declared his nation would seal its borders if even a single case of human-to-human H5N1 transmission is found.

That sent jitters throughout the expat community here, and on Tuesday Foreign Ministry officials tried to calm such concerns by calling the report “inaccurate.” Still, don’t bet on open skies and porous borders for long—except maybe for the migrating wildfowl who currently function as an airborne Influenza Express. If and when this thing becomes a pandemic, hopping on a plane to fly to the West may not be an option for me. What government will welcome an arriving planeload of passengers from China, the place where experts believe the H5N1 virus was born?

The whole question of shutting down borders would become irrelevant very quickly at any rate. WHO’s Dr. Julie Hall in Beijing tells me one Western government recently war-gamed what would happen if it closed its borders to slow the advance of a bird flu pandemic. “It delayed things by just three and a half days,” she says. “If there’s a large cluster [of human deaths] many countries will close their borders, but that may not do much good.”

Hall gave China high marks for improving its surveillance system in the wake of the 2003 SARS disaster, when authorities tried to cover up the severity of the crisis that eventually sickened 8,000 people worldwide and left 770 of them dead. But a flu pandemic will be much worse than SARS. She warns against complacency: “We can’t just say, ‘Ah, we did OK during SARS so we’ll be all right in the face of a flu pandemic'.”

The pandemic crisis wouldn’t restrict itself to overflowing hospitals and dying medical staff. Widescale absenteeism, illness and death could disrupt everything from food supplies and transportation to garbage collection and mortuary services. SARS was a medical problem, albeit a serious one. A flu pandemic could tear the fabric of societies and economies around the world.

Take the problem of maintaining social order. Even without a pandemic on their hands, Chinese leaders are obsessed with keeping the lid on escalating mass protests. I’m sure that’s why domestic Chinese media is under orders to downplay—or outright ignore—news of the recent H5N1 outbreaks. There’s a name for this tactic, nei jing wai song, meaning the government takes the problem seriously but isn’t conveying its worries to the public. To tell it like it is “could easily lead to panic,” says Zhong Dajun of the nongovernmental Dajun Economy Research Center. “It would be terrible.”

The fact is, many Chinese are hopping mad already about what they perceive to be unsatisfactory health services. In three quarters of Chinese hospitals, angry patients or their relatives have actually beaten doctors and staff to retaliate for shoddy treatment or exorbitant fees. One disgruntled patient stabbed a well-known doctor to death at a clinic in Fuzhou—and many Netizens who commented on the murder in Internet chat rooms wound up siding with the killer. Hospitals have hired bodyguards to fend off such attacks. Even Health Minister Gao Qiang recently admitted that doctor-patient relations in China are “tense” and unlikely to get better anytime soon.

So how much worse would things get when Chinese citizens discover that hospitals don’t have enough respirators to go around? Or that some authorities have been trying to cover up the severity of the crisis? Or that cadres have been hoarding Tamiflu and now stocks have run out?

As Hall puts it: “the only thing that spreads faster than viruses is panic.” To plan for both the medical and nonmedical challenges ahead, I asked my husband, a retired Australian diplomat, to help draft a bird flu contingency and business continuity plan for the NEWSWEEK bureau. He conducted research on the Web and consulted friends in the business of corporate security—who themselves were busy crafting bird flu contingency plans for their clients.

Now I have a meaty 17-page business continuity scheme for the office, and I’ve briefed my staff on the plan. It explains everything from the basics of personal hygiene to how to take Tamiflu properly; from how we might work from home to the procedures we’ll use to decide when to stop working altogether—and start focusing on sheer survival.

I’ve started stockpiling canned tuna, dried noodles and other staples. The contingency plan calls for storing a couple month’s worth of food. Two weeks ago, about the time we bought our first batch of Tamiflu, my husband and I also got inoculated for routine seasonal flu. Nobody wants to become the “mixing vessel” in which H5N1 and human flu viruses mix and match.

All of this has become the target of some good-humored ribbing from friends. This whole bird flu thing is overblown, they say. After all, H5N1 has been around in China for years—maybe much longer—and so far only birds are dying on the mainland. They point to the latest news reports speculating that Southeast Asia, which has seen the most human deaths, will wind up being the front line of any human pandemic. I hope they’re right and that I'm just being paranoid.

News of H5N1 in Korea is equally hard to find. It appeared in this country in 2003. Right now, everyone is thinking, "This is someone's elses problem." That's how a really big problem becomes a really huge problem.