Next pandemic is 'not a matter of if'

Medical expert tells Abu Dhabi conference that vigilance is needed to prevent another global pandemic.

Jude Law, right, as Alan Krumwiede in the thriller Contagion. Courtesy Warner Bros. Pictures

"Don't talk to anyone. Don't touch anyone. Stay away from other people," advises the tagline to the latest apocalyptic disaster flick, Contagion.

The blockbuster, made by Abu Dhabi production house Image Nation, presents a nightmarish, if familiar, scenario in which a killer disease sweeps through the global population, laying waste to tens of millions of lives while scientists race against time to create a vaccine.

What marks Contagion out from comparable movies - such as Andromeda Strain or Outbreak - is its rigid attention to scientific accuracy. Medical experts were consulted to provide authentic evidence on virus mutation and dispersion, while the film's protagonists work for real-life agencies, such as the World Health Organisation (WHO) and the Centers for Disease Control and Prevention.

And the premise of Contagion's plot is drawn from actual outbreaks. These include the Sars epidemic, the outbreak of severe acute respiratory syndrome that started in Hong Kong in 2003, before spreading to 37 countries and eventually killing almost 1,000 people, and the H1N1 virus, more commonly known as swine flu, that claimed about 20,000 lives in 2009.

With the threat of global pandemics being one of the most pressing issues of the 21st century, it's no surprise that the issue was the subject of a number of presentations at the recent Abu Dhabi Medical Congress at Adnec.

One of the keynote speakers was Dr Steven Gordon who, as chairman of the department of infectious diseases at the Cleveland Clinic - the healthcare provider that operates the Sheikh Khalifa Hospital in Abu Dhabi, as well as constructing its own new facility on Sowwah Island - is a respected authority in this area of research.

Dr Gordon contends that Contagion's plot is by no means far-fetched fantasy, but instead is an accurate representation of the worst-case scenario.

"More and more people are living in congested cities, people are flying all over the world for business and holidays and then you have refugee crises - all of these are increasing the possibility of a pandemic happening," he says.

"And you have precedents from history. Look at the bubonic plague, which wiped out a third of the world's population in the Middle Ages, or the influenza pandemic after World War One, which killed about 50 million people."

Not that he wants us to panic. "We have moved on from 1919," he adds, "and although they are not foolproof, there are systems in place to make sure it doesn't get to this level again."

While the WHO may coordinate the fight against virus propagation from its six worldwide offices, Dr Gordon says the real foot soldiers in the battle are hospital doctors and general practitioners.

"It's really the clinicians who are tasked with detecting unusual clusters of illness first. So, for example, there was an outbreak of a disease called the West Nile virus in 2009 in Texas, which was picked up by clinicians looking at patients and saying: 'Wow, I don't know what this is, but this is unusual'.

"The systems we have at the moment for detection involve surveying sick people who arrive in hospitals and then lab results. If we see spikes in antibiotic use, or higher death rates in certain areas, this could be a signal that an outbreak is imminent.

"In my department, it's really important we have accurate baseline data [from the hospitals] and then we analyse it correctly. Even if it's just background noise it can trigger investigations and this might allow time to intervene and to prevent morbidity."

Nevertheless, Dr Gordon claims that surveillance and detection can go only so far in preventing the spread of diseases, as other factors play a part.

"If we accept that pandemics are an inevitability of modern life, the question then arises how we're going to limit them. For example, we know the best prevention for influenza is a flu shot, but in the US just a fraction of the population actually get them. Of the 300 million population of the US, [fewer than] 50 to 60 million get their flu shots.

"Although I don't know the exact percentage of the population of the UAE who get [flu shots] I imagine it's a lot less."

But the best medical system can take a dangerously long time to spot a problem, let alone to react to it.

"Take the 2009 pandemic flu ... the first case in the United States was identified in June in San Diego, but going back there were cases in Mexico that occurred in February, but the data wasn't reported.

"The problem is that it takes several months of research to get a vaccine in production, and [in the case of H1N1 virus] by the time the vaccine was readily available, the peak of the epidemic had already passed. Had we known about this in February, that may have allowed us to save a lot of lives."

Despite all the medicines, equipment and know-how available, "in the US, we still had about 12,000 people dying of pandemic flu in 2009".

On top of this, respiratory viruses are not the only threat to the global population. The recent E.coli food-poisoning outbreak in Europe - traced to a batch of contaminated bean sprouts Germany - sickened thousands and killed at least 50, while bioterrorism, such as the 2001 anthrax attacks in the US, which killed five people, and the sarin gas attack on the Toyko underground in 1995, which claimed 13 lives, remains another menace.

But perhaps the most pressing concern to medical practitioners is hospital superbugs - germs that have genetically mutated to form resistance to antibiotics - which are now the fourth-highest cause of death in the western world. Recent scares include New Delhi metallo-beta-lactamase, or NDM-1, which was first spotted in an Indian hospital three years ago, and has since spread to the country's general population.

Another speaker at the Abu Dhabi Medical Congress was Peter Martensson, president of Bactiguard AB, a Swedish firm that markets a patented galvanising technology to coat catheters, syringes and other hypodermic equipment. He rates the chance of a contagious superbug from within a medical facility spreading to the outside population as highly probable.

"It's not a matter of if it happens, it's all a matter of how serious it is," he says. "The fact that so much antibiotics are being used in these hospitals, all it would take is one mutation and there could be something serious on the horizon. That's why it's important to keep our intake of antibiotics down to the minimum, unless in cases of emergency."

Dr Gordon agrees that the general public should play their part in disease control.

"One of my department's major functions is education of the population," he says. "Our primary goal is preparedness, in whether it's an influenza outbreak or something potentially new. But we all need to be vigilant. If you see a certain wild animal dying in great numbers, like crows, that could be the harbinger of the arrival of a new disease."

The main thing to consider, he says, is that today "we live in a global environment and none of us can be immune from what's happening on the other side of the globe. With people moving so freely around the world, what's going on in Korea, or China or Dubai can easily affect you, so make sure you're aware of the symptoms of these diseases."

And one way to do that, he says, is to go to the movies: "Although Contagion and films like it make for good entertainment, personally, I think they do some good as it does bring our line of work into the public consciousness."

On the other hand, what was that tagline again? Oh yes: "Don't talk to anyone. Don't touch anyone. Stay away from other people."

Maybe you should wait for the DVD.