Are We All Doomed? Well…Maybe
Bird flu is on the move again. If it adapts to humans, we’re in big trouble. It has tried before, and failed. Viruses never give up, but their life’s not all a bed of noses either.
Last week, Zeynep Tufekci wrote a very scary column in The New York Times illustrated with a dead pelican and entitled “An Even Deadlier Pandemic Could Soon Be Here.”
It described the widening spread of H5N1 avian influenza and warned that an outbreak among humans could be imminent. If that occurs, she predicted, it would kill many millions more than Covid-19 did.
I’m a big admirer of most of what she wrote about the Covid pandemic. And in this case, she is absolutely right….
In 2006, I wrote a very similar article. It was entitled “At the U.N.: This Virus Has an Expert ‘Quite Scared.’”
It was a profile of Dr. David Nabarro, who held a then-new title: chief United Nations coordinator for avian flu, which shows how worried world leaders were at the time. He had publicly predicted that, if H5N1 mutated into a transmissible human pathogen, it would kill between 5 and 150 million people.
At the time, the virus had just begun spreading out of southeast Asia. Migratory birds had carried it as far west as Turkey and as far south as Nigeria. It was adapting to mammals. It had killed 23 tigers in Thailand, was transmitted between cats and sickened laboratory ferrets.
Much more terrifying: Since its discovery in Hong Kong in 1997, it had been detected in 168 very ill humans, of whom 99 had died. Its fatality rate was nearly 60 percent. There had even been a few clusters of what looked like human-to-human spread within families.
I was fairly sure a vast, deadly pandemic was about to explode.
Not all my colleagues agreed, however. The health writers of The New York Times science staff were split, and debated each other at our weekly story meetings. If I remember correctly, Larry Altman, Denise Grady and I thought a pandemic was possible, and I was by far the most worried; Libby Rosenthal, Gina Kolata and Gardiner Harris were doubtful.
It all depended on who our favorite sources were. We weren’t experts (although Larry and Libby are M.D.’s) but we talked to lots of experts. They too were just as divided.
Our Solomonic editors finally decided to split the baby. Libby and I would write dueling profiles super-titled “The Worrier” and “The Skeptic” to run side-by-side on the front page of Science Times. This was the paper’s measured response to blatant fear-mongering by the big newsweeklies: in 2005, Time and Newsweek had both run covers warning of imminent global catastrophe.
Libby interviewed Dr. Jeremy Farrar, who was then the director of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Vietnam and had treated about two dozen bird flu victims. He argued that millions of southeast Asians had been in close contact with infected hens and roosters as farmers, as poultry workers, and even as cockfight managers who would revive their fading champs by sucking the blood and mucus out of their beaks. Fewer than 200 had fallen ill. “That tells you that the constraints on the virus are considerable,” Dr. Farrar said. “It must be hard for this virus to jump.”
Other virologists argued that only H1, H2 and H3 flu viruses had the mysterious secret sauce that let them attach to human nasopharyngeal cells, while H5, H7, H9 and other avian strains did not. (The H number describes the shape of the flu virus’s equivalent of a coronavirus spike; flu’s hemagglutinin spike does not attach to the ACE-2 receptor that Covid targets, but to sialic-acid receptors. Since 1918, all human pandemic and seasonal flus of the dominant “A” subtype have been H1s, H2s or H3s.)
In the end, Libby was right, of course. (She’s now the editor-in-chief of Kaiser Health News.)
In January 2008, I wrote a followup piece entitled “A Pandemic That Wasn’t but Might Be.”
Predicting pandemics is a bit like predicting stock market crashes. If you read Wall Street coverage, some respected sage is always certain that a crash is just around the corner. The brilliant and/or lucky stiff who correctly nails The Big One (see Michael Burry of “The Big Short” in 2008) is forever after hailed as a genius.
But the trap for geniuses is that you are now stuck in the crash-prediction business. People demand more wisdom, and the market doesn’t always cooperate. Every year for the last three decades I’ve seen at least one article headlined “Expert Who Called 1987 Crash Says America Is Doomed. Buy Gold Now!”
In early 2020, I — or, rather, the experts I interviewed — got Covid-19 right. (And I’d daresay that I got monkeypox right last March.)
But viruses aren’t any more cooperative than the Dow-Jones Index is. The 19th century financier J.P. Morgan got it right when reporters (allegedly) shouted at him: “Mr. Morgan, what will the market do?” He (allegedly) answered: “It will fluctuate.”
Part of my profile of Dr. Nabarro was about the pitfalls of predictions. As the former chief of crisis response for the World Health Organization, he said, his lethality estimates had been dead right about AIDS and about Darfur but only partly right about a 2004 tsunami and some other disasters. What usually rendered him right or wrong, he said, was how fast the world responded.
The right answer to whether H5N1 will go pandemic is “Maybe — so let’s get ready.” Which is exactly what, if you read beyond the headline, Ms. Tufekci’s column argues. IF the virus adapts to humans this time — I’m betting it won’t but, as I’ve demonstrated, I’ve been wrong before — the consequences could be awful.
Therefore, it behooves us to spend the money: Improve surveillance in birds, animals and people. Stockpile the vaccines now most likely to work in places where they can be rushed to the first outbreaks. Make seed strains from new variants. (This is one of those times when the arguments in favor of risky “gain of function” research become stronger.) Ramp up factories that don’t use chicken eggs. Pre-vaccinate those most in danger: poultry workers and health-care workers. Stockpile antivirals.
What bothers me is not being right or wrong. It’s the over-confident tone of that “OK, we can all stop worrying now” piece I wrote in 2008. The world, all the experts I interviewed then assured me, was much better prepared for a pandemic than it had been in 2006. Testing and culling had improved. Seed vaccines were ready. Pandemic response plans had been written. Masks had been stockpiled. “Another two or three years of hard work and investment” was all it would take. Not to worry.
Donald G. McNeil Jr. is a semi-retired science writer. His book: “The Wisdom of Plagues: Lessons From 25 Years of Covering Pandemics” is in the works.