Mobilizing against bird flu. Animal quarantine personnel testing bird guano in a bird store on Taipei's Hoping West Road.

The World Health Organization has long warned the world of the advent of avian influenza. The disease has now spread from Southeast Asia to Europe. The WHO estimates that as many as 7 million people could die if a bird flu pandemic breaks out during next year's flu season between January and March 2006.

Faced with a potentially major epidemic, what preparations have relevant authorities made? What can the public do?

During a high-level national security meeting in mid-August 2005, President Chen Shui-bian announced that avian influenza was to be considered a new threat to national security. The National Security Council also ordered that information be gathered on avian influenza in the greater China region and possible routes that it could take into Taiwan, and that an impact assessment be prepared. The government also plans to invest almost NT$30 billion over the next four years in the stockpiling, R&D, and production of new influenza vaccines.

Dr. Lee Jong-wook, Korean secretary-general of the WHO, warned that it is only a matter of time before a bird flu pandemic occurs among humans; the results may be catastrophic, making SARS pale in comparison.

The highly pathogenic H5N1 strain of avian influenza first reared its ugly head in southern China and Hong Kong eight years ago. In 2003, Vietnam, Indonesia, and Turkey also reported outbreaks. Sixty of the 117 people infected so far have died. Compared with the 0.1% death rate for the latest few outbreaks of common types of flu, the 51% death rate for avian influenza is nothing short of blood-chilling.

Early symptoms for H5N1 avian influenza are very similar to those for ordinary influenza, including a sudden persistent high fever, coughing, a sore throat, aching muscles, vomiting, and diarrhea. However, between five and ten days after infection, most victims experience a "cytokine storm"--an intense inflammatory immune response--causing pneumonia, respiratory distress, and multiple organ failure. It's a vicious and rapid killer.

Migratory birds will head south with the onset of winter, possibly bringing with them the avian influenza virus to Taiwan. The close relations that Taiwan shares with nations in Southeast Asia also place us in the direct line of fire for an epidemic.

Faced with the threat of avian influenza, thwarting its arrival is the first phase in epidemic control measures. The Center for Disease Control (CDC) is doing everything in its power to prevent bird flu from entering Taiwan.

Firstly, from 10 October, travelers entering Taiwan from affected areas, including Vietnam, Thailand, Indonesia, and Cambodia, are required to fill out a Notification of Health Self-Management for Arriving Passengers and to monitor their own health by taking their temperatures once in the morning and once in the evening every day for ten days.

The CDC predicts that with the experience of battling SARS in 2003 under its belt, Taiwan won't panic when bird flu strikes. But due to the H5N1 virus' high virulence, an expected 5.3 million people will be infected, over 70,000 will be hospitalized, and more than 14,000 will die once the new strain of influenza erupts.

With this in mind, medical institutions in Taiwan are taking the threat very seriously, simulating crisis management in all types of scenarios. In the initial stages when there are fewer cases, they plan to first mobilize the negative pressure isolation rooms set up during the SARS scare, and they don't rule out the possibility of community quarantines.

Insufficient medication is currently the biggest problem facing all countries in the fight against bird flu. The only medication considered to be effective against avian influenza--Tamiflu--is flying off the shelves, but Roche Holding, which holds the patent to produce Tamiflu, can't make enough to meet demand in countries that can afford it, much less countries in Southeast Asia that can't afford the medication's high cost and where epidemics could erupt at any time.

Taiwan presently only has enough Tamiflu in stock for 160,000 people or 0.7% of the population. This is a far cry from the goal of 2.3 million or 10% of the population. Therefore, the Department of Health has written to Roche in hopes of receiving manufacturing rights to get Taiwan's Tamiflu stocks up to safe levels as quickly as possible. Health minister Hou Sheng-mou points out that the National Health Research Institutes already has the capability to produce Tamiflu. Taiwan can go into mass production as soon as a license is granted.

In addition, because in its initial stages the symptoms of avian influenza resemble those of the common cold, front-line physicians need to be more vigilant and to improve their ability to differentiate between the two. Tamiflu is only effective if administered within 48 hours of infection, but virus cultures require three to four days. Therefore, it is imperative that clinical physicians be able to diagnose the disease rapidly if the medication is to be administered in time, the disease controlled, death rates reduced, and the opportunity for the virus to spread snubbed.

Confronted with a war with microbes, humanity seems to be at its wit's end.

Mankind's trepidation is not ungrounded. Statistics show that major influenza epidemics erupt an average of three times every century. The Spanish flu of 1918 is most often compared to the current strain, because scientists have discovered that the pathogen of that scourge originated among birds, and just like the strain presently raging in Southeast Asia, mutated and was transmitted to humans. Once the virus developed the ability to be transmitted from person to person, the situation spun out of control as the disease spread throughout the world, killing between 20 and 50 million people in a matter of a few months.

Exactly when the virus will spread from bird to human, from person to person on a small scale, and from person to person on a large scale, is impossible to predict.

To prevent flu epidemics, the US implemented a policy of comprehensive vaccinations in 1976. Yet although no major epidemics took place, there were many reports of side effects from the vaccinations, and compensation claims led to years of litigation.

Confronted with the impending onslaught of this worldwide storm, CDC director general Shih Wen-yi suggests that the public avoid contact with birds, wash their hands frequently, and steer clear of hospitals. Individuals with poor immunity, including the elderly and children, and those that work with domestic animals, should receive flu vaccinations to avoid coming down with two types of flu when avian influenza strikes.

"Prepare for your enemy's arrival. Don't just sit on your hands." Confronted with a bird flu epidemic that is out of our hands, each of us should do everything humanly possible to help reduce the number of casualties and minimize the impact of the calamity.