H7N9 and MERS Pandemic Scares
If you believe the World Health Organization, the H7N9 and MERS viruses are "a threat to the entire world." In truth, pandemic scares seem almost as predictable as leap year. Every few years, public health authorities present another "end of the world" scenario for our titillation--like another release in a vampire film saga. Going back just 10 years, we had the SARS scare in 2003, avian flu in 2005, and the Swine Flu in 2009. In each case, public health authorities warned of the coming epidemic; the media jumped on the literal bandwagon with a vengeance, each trying to top the next with lurid headlines proclaiming the imminent end of life as we know it. Even alternative health bloggers felt the need to join the chorus and terrify you with tales of the coming zombie wars unless you bought some products and built your immune systems. In each case, I suggested that the threat was nowhere near as dire as presented and that the ultimate impact of each "epidemic" was more likely to be economic and psychological than actually health related.
I also pointed out that while building your immune system was always a good idea, it might actually be counterproductive under several of the pandemic scenarios we've seen over the years unless you had a natural anti-pathogen on hand to lessen the viral load if necessary. The problem is that many of the viruses in question tend to kill by unleashing cytokine storms in your body, which means that the stronger your immune system, potentially, the greater the danger. (We'll talk more about that later.)
In any case, they're at it again as H7N9 and MERS (Middle East Respiratory Syndrome) are now in the news. Fortunately, although the health authorities are still headlining their announcements with "potential" end of life as we know it cautions, the media has been a little more responsible in passing those threats on--tending to downplay them a bit. And even the alternative health press, although it has hyperbolated the threat a bit, has put little energy into their stories--almost as if they're merely going through the motions.1,2
If it were a case of the world becoming smarter about these things, that would be comforting. Unfortunately, I don't think that's what's happened. I think it's more about the boy (health authorities) crying wolf once too often so that people have become jaded and are now pretty much tuning these warnings out. If true, that's not so good. Although, the two new outbreaks do not appear to be pandemic worthy, one day, some virus will be. And if people have come to believe that every warning is hyperbolic nonsense and to be ignored, when that day comes, they will ignore important warnings and we will all be in for a world of hurt.
In any case, as usual, I will try and give you an accurate assessment of the two new viruses. In the process, I will once again try and give you the tools you need so that you can rationally analyze for yourself whether or not they, or any future virus, constitute true threats. Developing this skill could truly save your life, because, as surely as money makes whores out of politicians, some day a true epidemic will arrive. And those who recognize it first will be able to stock up their medicine cabinets with natural defenses before store shelves are cleaned out in an orgy of panic buying. Remember how unavailable iodine pills were after Fukushima?
A new strain of bird flu has been found in birds and people in China. This one is H7N9 as opposed to the H5N1 that we saw in '05. Incidentally, flu viruses get their names from the combination of proteins on the outer layer of the virus. H stands for hemagglutinin, of which there are 16 types. N, on the other hand, stands for neuraminidase, of which there are nine types. Because these proteins are on the outer layer of the virus, they make first contact with the receptors that line the respiratory tracts and immune systems of both animals and people. It is this interaction that determines how infectious a virus actually is. All 16 H's and nine N's have been found in waterfowl and seabirds, but only a handful of them are found in mammals such as humans and pigs. Now, here's where it gets interesting. Mammalian virus strains can meld, or "mate," with avian strains, and in some cases these "new" strains are virulent in animals, again such as humans and pigs. Novel viruses are often a combination of two or three viruses. As you may remember from our discussion of swine flu, back in the day, it contained genes from human, swine, and avian strains. New strains are especially dicey because your body has no knowledge of them, therefore no built in immunity. And flu vaccines even less so. Thus, novel strains have the potential to rip through wide swaths of humanity during a given outbreak.
That said, H7N9 is the name/designation for one subtype of the avian flu virus that is sometimes found in birds, but that does not normally infect humans. Like all flu viruses, H7N9 itself has several different strains. At the end of March of this year, China reported human and bird infections (as seen in poultry) with a new strain of H7N9 that is very different from previously seen H7N9 viruses.
How is it different? Normally H7N9 viruses do not affect humans. In fact, before this year, H7N9 viruses had never been found in people. Not so with the new strain. To date there have been 132 documented human infections from the new strain of H7N9 with 37 deaths. Most of the reported cases of human infection have resulted in very serious illness--with mortality rates running at 28%. It should be noted that the last infection reported was May 29th,3 but public health officials warn it is not uncommon to see a decline in bird flu activity during the warm months in countries that are afflicted with avian flu, only to see cases pick up again in the fall and winter. In other words, we're likely not done with it.
The available evidence suggests that most of the 132 people in question were infected with H7N9 after having contact with infected poultry or contaminated environments, although there is "some" evidence that people may be subject to infection if they breathe in the airborne virus. It should be noted that in a closely confined poultry raising environment, birds produce a lot of virus. It's in their droppings; it's on their bodies; it's in their mucous. If a person touches an infected bird or an environment contaminated with the virus and then touches their eyes, nose, or mouth, they can become infected. On the other hand, so far hundreds of close contacts have been checked and there has not been any evidence of ongoing spread of this virus from person-to-person.
Incidentally, symptoms in the people that have been infected with H7N9 start with high fever and cough. In a sizeable percentage of those, symptoms then progress to things like severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock, and, in about 30%, multi-organ failure leading to death.
As we have discussed before in previous newsletters, in order for there to be any concern about a global pandemic, with people dropping in the streets, a virus must be able to not only spread from person to person but do so readily. The operative word here is "readily." It's also been one of the primary components missing in every "black plague," pandemic scenario proposed since SARS was first billed as a possible suspect. "Sustainable" human to human spread is needed for a pandemic to occur. Health officials are watching the situation with H7N9 closely for this--to see if a mutation suddenly appears that crosses this threshold.
In the meantime, health authorities, including the CDC, recommend treatment with Tamiflu® (oseltamivir) and Relenza® (zanamivir) for anyone infected with H7N9. And therein lies the rub.
Resistance to H7N9 Is Futile
According to a new study published in The Lancet, resistance to both Tamiflu and Relenza seems to develop with some ease in infections caused by the new H7N9 bird flu.4 In fact, in one patient, the gene mutation responsible for resistance actually appears to have arisen after infection took hold, probably as a result of treatment with Tamiflu, leading to concerns that medication may be the trigger for resistance to develop. The authors of the study suggest that if this virus were to become easily transmitted among people, there might be minimal tools with which to fight it. And this is not the only evidence to suggest that resistance to Tamiflu and Relenza may arise easily among H7N9 viruses. The genetic sequence of the first spotted H7N9 patient showed a mutation that is known to confer drug resistance in other flu viruses. In the study, the authors show that this mutation lowers the effectiveness of Tamiflu by 100-fold and the effectiveness of Relenza by 30-fold.
Even worse, H7N9 viruses are already resistant to the only other class of flu medication, the adamantane drugs. And studies of other H7 viruses suggest this flu family does not trigger development of high levels of protective antibodies from any vaccine.
According to Dr. Malik Peiris, one of the authors of The Lancet study and the chair of microbiology at the University of Hong Kong, the combination of these signs is worrying. "Obviously this is something that arises not very frequently but not infrequently. And that's enough to be quite concerning."
MERS -- Middle East Respiratory Syndrome
And as if bird flu is not enough to deal with, there appears to be an outbreak of a new coronavirus (like SARS) known as MERS, or the Middle East Respiratory Syndrome. Since it was first detected in September 2012, in Saudi Arabia, this virus appears to have infected and sickened at least 58 people and killed 33 of them--give or take--in seven countries. But unlike bird flu, which is pretty well known and understood, MERS is mostly a mystery. Health officials have no idea where it hides in nature, how it spreads, how long it incubates before sickening a person, when and for how long it is most contagious, and who is most vulnerable. According to Margaret Chan, Director-General of the WHO, the virus is "a threat to the entire world."
On Monday, the World Health Organization urged health workers around the world to be on the alert for symptoms of the virus, which they said has the potential to circle the globe and cause a pandemic. Already, according to WHO, the virus has demonstrated the ability to jump from one country to another through travelers. Countries affected include Jordan, Qatar, Tunisia, and the United Arab Emirates, as well as Britain, France, Germany, and Italy.
According to the WHO, "The overall number of cases is limited, but the virus causes death in about 60 percent of patients…So far, about 75 percent of the cases in the Kingdom of Saudi Arabia have been in men and most have occurred in people with one or more major chronic conditions."5 Based on this observation, it was initially believed that the virus favored men, but based on more recently identified cases, women who have had close contact with infected males have tested positive for MERS, dispelling the idea that women were somehow less likely to be victims or have the ability to develop infection. In any case, the source of MERS remains unknown. On the positive side, clusters of cases have occurred in families and health facilities, indicating a limited capacity to spread among people in close contact with an infected person. In other words, there is no evidence that MERS has crossed the "sustainability" threshold when it comes to human to human transmission. On the negative side, there's no vaccine that is known to be effective in preventing MERS, and antiviral drugs don't appear to be of much use against existing infections.
Patients with MERS follow much the same path as those infected with H7N9. They may develop either a mild upper respiratory illness characterized by fever with a cough or follow a more severe course, marked by respiratory failure, with pneumonia progressing to acute respiratory distress syndrome (ARDS), kidney failure, and death. Those with underlying diabetes, renal failure or coronary artery disease may be more at risk for severe illness, although there have already been a number of previously healthy patients affected as well. A number of laboratory-confirmed cases--mainly among immunocompromised patients--have presented with atypical features, including diarrhea and fever, along with mild respiratory symptoms.
As always, I will conclude as I have when discussing each "potential" epidemic so far. We are not at panic time. There are things you can do. And if the situation changes, I will keep you up-to-date on anything that might affect your health.
What Are the Odds of Either Virus Becoming a Pandemic?
Here's something to keep in mind the next time you read stories about the next pandemic that is about to rid the earth of 90% of its population and fill the streets with carts of bloated bodies and flesh eating zombies: three conditions have to be met for there to be a pandemic.
- The bacteria or virus in question must be readily able to mutate--to evolve around defenses. Thanks to the widespread and inappropriate use of antibiotics and antivirals both medically and agriculturally, that's not much of a problem for most pathogens now.
- The bacteria or virus in question must not kill too high a percentage of people too quickly. At first glance, this might seem counterintuitive. After all, you'd think that the deadlier the better…from the virus' point of view. Not so. If a pathogen kills too many of its victims too quickly, it never has a chance to spread. If the infected person dies too quickly, they never get a chance to infect anyone else before they're cremated or buried. That's why diseases such as Ebola with up to a 90% mortality rate never get a lot of traction when it comes to infecting people outside of a local village. Malaria, on the other hand, which is far less lethal, nevertheless kills approximately 1.2 million people a year because it has such low lethality that it has a chance to infect many, many, many more people than Ebola.6 (Incidentally, H7N9 and MERS both fall in the high middle range--much more lethal than malaria, but nowhere near the self-nullifying threshold seen in Ebola.)
- And the pathogen must be "easily" transmitted from human to human. This is where all the threats so far have failed the pandemic test. (Swine flu came the closest to qualifying.) There is no conclusive evidence that H7N9 transmits between humans at all, and even if they find that it can, the evidence at this point is that it certainly doesn't readily pass between people. Until such time as it mutates into a form where it can transmit sustainably from person to person, bird flu is not really a pandemic threat…among people. And as for MERS, no one knows how it transmits, although all evidence points to extended, intimate contact being required for transmission. In other words, it too fails the "sustainability" test. Again, unless the virus mutates into a form that transmits "readily," it likewise is not a pandemic threat.
What Resistance to Tamiflu and Relenza Tells Us
The fact that H7N9 and MERS are not likely pandemic threats is good news. Unfortunately, there is also disturbing news buried in these reports.
The medical community's arsenal of immune builders and antipathogens is somewhat limited. Interleukin and gamma globulin injections are possible options, but when push comes to shove, 90% of the medical arsenal, when it comes to pathogens, is comprised of antibiotics, with maybe another 5% comprised of antivirals. In truth, when it comes to pharmaceutical antivirals, there are actually very few choices--and only a handful of those have any real effect. The discovery and use of antibiotics and antivirals has represented one of the greatest achievements of medical science over the last hundred years. Unfortunately, thanks to arrogance and misuse, resistant strains of bacteria and viruses are proliferating like bedbugs in a one-star hotel. And even worse, this trend may be almost impossible to stop since it is the result of the simple rules of evolution. (For the sake of simplicity, we'll focus on bacteria in the following discussion, although the same rules apply to viruses.)
Any population of organisms, bacteria included, naturally includes variants with unusual traits -- and sometimes that variant includes the ability to withstand a particular antibiotic's attack. When this antibiotic is used, it kills the defenseless bacteria, but it leaves behind those few bacteria that can resist it. These renegade variants then multiply, increasing their numbers a million fold in a single day, instantly becoming the new dominant variant. In other words, the very act of using an antibiotic creates the opportunity for resistant strains to flourish and become dominant.
It's important to understand that antibiotics vary in the way they kill microbes. Penicillin, for example, kills bacteria by attaching to their cell walls and then breeching those walls, thus killing the bacteria. Erythromycin, tetracycline, and streptomycin, on the other hand, kill bacteria by attacking the structures inside the bacteria (ribosomes) that allow them to make proteins, thus also destroying the bacteria. Because each antibiotic is a single compound and one-dimensional in its approach, it's not that hard for microbes to "evolve" around such attacks. For example, microbes resistant to penicillin have developed cell walls that prevent the penicillin from binding. Similarly, other variants prevent antibiotics from binding to ribosomes, thus neutralizing the effect of those antibiotics. Using antibiotics in combination can help in the short term, but it also accelerates the breeding of superbugs, resistant to many types of drugs.
Where it gets really frightening, though, is that bacteria swap genes like Facebook members swap friends--which brings us to vancomycin, which was, until a few years ago, the antibiotic of last resort. When all other antibiotics failed, doctors knew they could count on vancomycin. But then vancomycin resistance was discovered in a common hospital microbe, enterococcus. By 1991, thirty-eight hospitals in the United States reported the variant. Just one year later, vancomycin-resistant staph bacteria were observed with the same gene. What this means is that not only are bacteria programmed to "evolve" defenses against antibiotics, but once they produce such a defense, they are also programmed to rapidly share that defense with other strains of bacteria, thus rapidly spreading the resistance through the entire bacterial world. That is truly scary!
And viruses work much the same way, but even more quickly since their DNA is even simpler--more primitive, more malleable as it were. Whereas bacteria can take months or even years to find a way around an antibiotic, viruses can pull off the same trick in weeks, or even days as we saw with the patient who bred a Tamiflu resistant strain of H7N9 in his body during the course of his treatment with Tamiflu for that same infection. Now that's scary!
But it gets even worse.
If all that pharmaceutical antibiotics and antivirals did was negate themselves and breed superbugs over time, that would be bad enough. Unfortunately, their effect is far more damaging. Since many pharmaceutical drugs are drawn from nature, they also undermine nature. Tamiflu is a perfect example.
The Chinese star anise plant has a long history as a healing herb--for digestive problems, women's health issues, and for treating colds and flu's. The Swiss pharmaceutical company, Roche, focused in on the cold and flu benefit and then "subtracted out" all of the "extraneous" biochemicals in the plant until they settled on one component, shikimic acid, that they said was responsible for the star anise plant's ability to help with colds and flu's. From shikimic acid, they synthesized oseltamivir (for patent purposes), and thus was born Tamiflu. This is a subtractive process. You eliminate everything "extraneous" and get down to one single active ingredient. Of course, there are major problems with the magic bullet approach--in this case, that Tamiflu doesn't really work that well to begin with, and, for all the reasons that we just discussed above, flu viruses are easily able to mutate around the single magic bullet ingredient in Tamiflu. Over the next few years, we are likely to see Tamiflu become steadily less effective as more and more new viruses arrive on the scene with a pre-built resistance to it.
So how does that undermine nature? To put it simply, Roche has managed to take a natural cold and flu remedy that viruses have not been able to evolve around since the dawn of time, and by reducing it to a single active component, managed to breed multiple strains of resistant flu viruses in short order. Astoundingly, they have managed to negate one of nature's best antivirals in less than a decade--truly an amazing achievement.
You may have noticed when reading above that the progression of illness for both H7N9 and MERS included the phrase "acute respiratory distress syndrome." That's actually code for a cytokine storm, and that's one of the key factors that makes both viruses so potentially deadly.7,8
In a cytokine storm, the immune system sees a virus that it has never seen before, and it goes nuts, whipping itself into a frenzy in response to the invading virus. A biochemical cascade of immune cells and immune system bio-chemicals such as interferon, interleukin, and monokines--collectively known as cytokines--literally pours into the lungs. The subsequent damage to the lung tissue caused by these cells and their related bio-chemicals leads to a condition called acute respiratory distress syndrome (ARDS) that literally chews up a person's lung tissue. The resultant damage stimulates fluid to pour into the lungs, ultimately causing the victim to suffocate/drown in his/her own bodily fluids as a result of their own disease-fighting chemistry. Paradoxically, the stronger the patient's immune system, the stronger the chances of their succumbing to a cytokine storm.
Most common flu's and viruses do not produce cytokine storms. Most viruses kill people who have weak immune systems by eventually opening the door for pneumonia, which is what actually kills them. That's why health authorities specify that the very old and very young and those with weak immune systems are prime candidates for annual flu vaccines (even though they don't work very well). But swine flu, avian flu, SARS, H7N9, MERS, and most notably, the great flu pandemic of 1918 are different animals. They don't kill through pneumonia. They kill you by unleashing a cytokine storm, which means that it is your own immune system that kills you. And this means that the most vulnerable, ultimately, are not the very old and the very young but healthy adults and pregnant women, people who have very strong immune systems. And that means that the stronger your immune system, the greater the danger--the exact opposite of standard flu strains.
Does that mean that you should weaken your immune system to protect against the H7N9 and MERS? Not at all! That would be silly. Strong immune systems are good for many, many reasons. However, it does mean that you want natural antipathogens on hand in your medicine cabinet to use at the first sign of a cold or flu. It will protect you against standard flu, and if you perchance catch a rogue strain of avian or swine flu. How? The antipathogens kill off enough of the virus to take your viral load down to the point that your immune system can do its job without being pushed into a cytokine storm. You get the best of all possible worlds.
What Should You Do?
If you've been paying attention, then you realize there's no emergency with H7N9 and MERS--no need for panic. Nevertheless, the time to prepare is before an emergency arrives. One of these viruses may mutate and suddenly become a threat. Or some new virus may appear in some remote backwater that fulfils all the requirements for a global pandemic. Then you'll need to act. But keep in mind that there is likely to be a run on anything that might help you at the first hint of a real pandemic. We saw just such a run on Tamiflu during the earlier avian and swine flu scares--even though it provides little protection. And we saw a similar run in countries throughout the world on iodine tablets after the meltdown at the Fukushima Daiichi nuclear plant in Japan--even though no one outside of Japan was truly threatened. With that in mind, there are several things that you'll want to keep stocked in your medicine cabinet. And don't worry about them going to waste. These are good additions to your medicine chest for multiple reasons. They'll be equally helpful for combating ordinary flus and even the common cold.
- Immune Builders. Although we talked about the dangers of cytokine storms, that doesn't mean that using immune builders is a mistake. It just means that with certain pathogens using immune builders without using pathogen destroyers to take down the viral load very well might be. So with that in mind, keep a supply of AHCC and an herbal based immune building formula on hand. Use them whenever you travel or enter an environment such as a large office as a prophylactic measure.
- Antipathogens. Keep a supply of a garlic based antipathogen formula on hand--or something like it. Other options include olive leaf extract and oil of wild mountain oregano. At the first sign of feeling unwell--that scratch in the throat, a slightly feverish feeling, a dull body ache, an unexplained headache, etc.--slam down a full bottle of the antipathogen formula and a half bottle of immune enhancing formula ASAP. Stopping the flu in the incubation phase is much, much, much easier than getting rid of it once it has established itself. If you hit it hard during incubation, you should be almost 100% effective in stopping it cold. If you allow it to incubate and fully manifest, it will take you several days to beat it back. It's true that you can significantly cut the time of your sickness, but it will still be several days, and you will need to keep taking the formulas for four to five days after you feel better to make sure you clear the virus from your body and it doesn't reassert itself. Other options include elderberry extract and a good blood cleansing formula. Blood cleansing formulations are very unfriendly to viruses and bacteria.
Bottom line: we are not at panic time. There is no emergency. And if the situation changes, I will keep you up-to-date on anything that might affect your health.
- 1. http://www.naturalnews.com/040510_H7N9_avian_flu_pandemic.html
- 2. http://www.naturalnews.com/040618_superbugs_MERS-CoV_coronavirus.html
- 3. Lisa Schnirring. "WHO, CDC issue new H7N9 assessments and guidance." CIDRAP Jun 7, 2013. (Accessed 10 June 2013.) http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun0713avian.html
- 4. Yunwen Hu, Shuihua Lu, Zhigang Song, et al. "Association between adverse clinical outcome in human disease caused by novel influenza A H7N9 virus and sustained viral shedding and emergence of antiviral resistance." www.thelancet.com Published online May 28, 2013. http://download.thelancet.com/flatcontentassets/pdfs/S0140673613611253.pdf
- 5. News Release. "Middle East respiratory syndrome coronavirus: Joint Kingdom of Saudi Arabia/WHO mission." World Health Organization. 10 June 2013 (Accessed 10 June 2013.) http://www.who.int/mediacentre/news/releases/2013/mers_cov_20130610/en/index.html
- 6. Murray, Christopher JL, Rosenfeld, Lisa C, Stephen S, Andrews, Kathryn G. "Global malaria mortality between 1980 and 2010: a systematic analysis." The Lancet - 4 February 2012 ( Vol. 379, Issue 9814, Pages 413-431 ). http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60034-8/abstract
- 7. "Major Breakthroughs in Research on H7N9 Virus." Zhejiang University News. Apr. 28, 2013. (Accessed 10 June 2013.) http://www.zju.edu.cn/c279955/content_2296867.html
- 8. Laurie Garrett. "Why a Saudi Virus Is Spreading Alarm." Council on Foreign Relations. May 29, 2013. (Accessed 10 June 2013.) http://www.cfr.org/health-and-disease/why-saudi-virus-spreading-alarm/p30799