Remember that flu thing?

Today, in the Department of Potential Global Crises We Like To Think Underfunded Government Offices, IGOs and NGOs Are Dealing With: Avian Influenza. More specifically: human-to-human transmission of H5N1 Avian Influenza in Pakistan.

Remember bird flu? It seems like a year or so ago much attention was given to the fact that the H5N1 flu virus, which was spreading, well, virulently among bird populations (especially in Asia), might spread to humans, creating the next flu pandemic. And, as predicted, some humans who worked with infected bird species did get sick, and many of the ones who got sick died. I even remember hearing questions about whether some of them had transmitted the virus to their families.

But since then, we seem to have gotten our heads planted comfortably back in the sand. Yet outbreaks continue, and the situation continues to look dire.

Now, we have an outbreak in Pakistan where, from the currently available evidence, it appears that a veterinarian working with infected birds caught the virus and transmitted it to at least one of his brothers. Two men died ten days apart (one of whom may have been the vet, or maybe not — it's not clear from the reports). The ten-day lag tends to indicate that the disease spread from one person, to another, to another. There have also been recent cluster infections in other Asian countries where human to human transmission is suspected.

When it can do that easily is when all hell will break loose.

I've heard of various interagency "drills" promoted as evidence that governments and health providers are getting ready for the outbreak of pandemic. Those drills mainly seem to be exercises in vaccinating a whole lot of people at once, a capability that will be nice to have but which is useless at the forefront of an outbreak because a vaccine won't exist until weeks, maybe months, after an outbreak begins.

What I haven't heard of are the kinds of preparations that will actually help reduce transmission: for example, the stockpiling of masks, gloves, disinfectants, and other simple tools to help reduce public exposure. There will be a run on such supplies the moment an outbreak is confirmed, and there's no reason to think that manufacturing plans have such excess capacity that they will be able to increase production to anything resembling the scale that will be demanded in a crisis. There won't be enough to go around, and yet we will need to count on practical measures like masks and hand-washing, and not Tamiflu or vaccine, to save people in the first wave of a flu pandemic. (Also interesting - Scott McPherson thinks telecommuting won't work in a pandemic.)

The flu is going to kill many more people than terrorism will, but preventive measures against the flu will never get the kind of funding and support antiterrorism measures do. I expect this will prove to be a mistake.