Pandemics and Societal Resilience

Emerging news that a new variant of H5N1 has emerged in SE Asia has prompted a resurgence in media coverage and business continuity managers to start dusting off their pandemic flu plans (see for instance http://goo.gl/SdsQz).  This new variant has so far killed all 8 people in Cambodia that it has infected.

Whilst I would not want to trivialise this threat, I often wonder about the context of such stories.  Cholera is a disease that receives very little coverage in the UK and yet this infects 3-5 million people every year and leads to 100-120,000 deaths per year, it is extremely virulent and affects both children and adults and can kill within hours.  Like flu, many people who are infected do not exhibit any symptoms but they will be infectious to others, for cholera this is 75% of those infected.  Of the remainder only 20% develop acute symptoms which may lead to death if untreated.  Those with low immunity, such as those compromised by HIV or malnourished, are at greater risk.  In many respects, one could be writing about flu.

The major difference for many of us living in the UK and other “developed” economies is that Cholera is seen as a thing of the past.  C19th London often suffered outbreaks but John Snow was able to show that it was related to pollution of drinking water by sewage.  Few realize that one of London’s outstanding features, the Victoria Embankment alongside the Thames, was part of a huge sewerage scheme to send London’s polluted waste downstream.  The development of the flushing toilet and the major engineering schemes for sewage treatment led to a huge public health benefit which we now largely take granted.

However, in 56 countries across the world, Cholera continues to infect and to kill.  This is largely because sanitation is poor or non-existent.  In some places this is because it has never existed – such as the rapidly developing shanty towns and slums that surround many of the world’s cities.  In others the systems have broken down though conflict, neglect or lack of resources.

Perhaps more surprisingly for those in developed countries, simple actions such as washing hands with soap are not common place.  Whilst we have seen benefits from the campaigns in the UK to wash your hands as part of the response to pandemic flu, the idea that some countries never do this would never have occurred to many of us.  Of course, if water is at a premium and is often the source of infections and there are no industrial processes making soaps, then it becomes obvious that hand washing would not be a natural thing to do.  One of the simple initiatives to address Cholera and other similar diseases is the promotion of hand washing across the world, and October 15th is Global Hand Washing day (see http://www.globalhandwashingday.org/) and let me recommend that you check this out and see if there are ways for you to promote this, perhaps through the Corporate Responsibility programme.

An interesting development is that the source of all Cholera outbreaks has been identified.  It seems that Cholera originates from the Bay of Bengal, modern day Bangladesh and historically India.  Analysis published in Nature shows that there have been several waves of Cholera and that we are currently in the seventh cholera pandemic.  Each wave starts from the same region and evolves over time and according to local conditions before gradually dying out, to then be replaced by the next wave.  Again, this is remarkably similar to flu.

Bangladesh is particularly susceptible to flooding and largely uses “hanging toilets”, that is to say that people defecate into a water course such as a river, and this is used as drinking water by people downstream.  Identifying the problem is only one part of the issue of course.  There are cultural and economic issues in introducing hand washing, and 40% of the world do not have toilets.  The scale of the problem is huge but the knowledge and tools to resolve the issues are available.  The same issues apply to other diarrhoeal diseases which kill 1.5 million children per annum.

So the next time you dust off your pandemic flu plan, just give a thought to the millions for whom pandemic flu is the least of their worries, and consider that greater societal resilience should also include consideration of how to address mass diseases for which we already know most of the answers.

Tracking influenza

An interesting development since the arrival of pandemic flu has been the entrance of Google into the arena, with Google providing data on the progress of flu across the globe.  Initially this appeared when we knew the latest outbreak as "Mexican Flu" and has been steadily updated since.

Essentially, Google uses the search terms being used by all of us and links these terms to the countries in which we are searching.  They soon found that this provided a surprisingly accurate indicator of the progress of flu and led official figures by several weeks; after all compiling official figures takes time and may require diagnostic confirmation.  Google simply looks at what people are looking for and builds a picture from there.

Is it accurate? Well not in the sense of showing precise numbers per country but yes, in the sense of providing an overall picture of where flu is prevalent and increasing and where it may be declining.  So it is useful as an indicator and is likely to show trends more rapidly than official data, it is therefore of some use to the professional seeking to anticipate the threat, or at least anticipate management questions about the threat.  See www.google.org/flutrends.