The following is an edited excerpt from and interview with Dr. David Butler Jones, conducted in late 2005...

Why is the world concerned about H5N1 right now?

The main concern is that this particular avian flu has been going on, it’s not settling down. It’s spread to other bird flocks across Southeast Asia. It doesn’t seem to be slowing down. The concern is the potential for spread into humans. If that were to happen, it would be a very large concern.

Why should we be concerned about influenza?

Influenza itself, even in the in-between of pandemic years, kills thousands of people prematurely in Canada and around the world in larger numbers. It is a disease that is preventable through vaccination. It is easily spread from person to person and it is a disease that we can actually do something about.

How do you die from a type of influenza virus?

It’s a disease that starts off like a cold. You develop a cough, fever, muscle aches, etc. In some cases, that’ll go on for four five or more days and then you get better. In some cases you develop secondary pneumonias or sinus infections. Those are the secondary bacteria infections that are of concern and in those cases antibiotics can help.

How would you hear about a pandemic if it was starting to emerge in Southeast Asia?

There is surveillance going on. We are involved as public health agents working with these countries, providing technical support and being involved with them directly. We would get reports back either through WHO, through the country directly, or through the public health information network which constantly monitors media around the world looking for events of outbreaks, bio-terrorism, a whole range of things that then is that first alert. Once you get that alert, you investigate to see the extent of the problem.

We would be involved with our counterparts both at WHO and in the affected countries to verify the problem. Then we would be informing public health authorities in Canada, bringing together expertise to assess our pandemic plan.

How would we slow down the spread of a pandemic?

There are a number of ways that you can slow it down. The use of antivirals may help, but there is no guarantee of that. Secondly, assessing the situation: what kinds of issues are there around travel? How do we monitor people, or give people information at border points to make sure that if they have symptoms they get appropriate medical attention? Making sure that people understand the importance of washing their hands properly.

Staying home if you are sick, covering sneezes and coughs, using the alcohol gels, washing of hands… All of these things we know, whether during the event of a pandemic or even now, can help prevent the spread of infection.

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At what point do you recommend to the government that travel to Southeast Asia gets suspended?

It really depends on the situation. The point at which you might consider that is where the spread is increasing, it’s infecting a number of communities, it doesn’t seem to be slowing down … at the same time you recognize the impact of suspending travel, so you don’t do it lightly.

How likely is it that if a pandemic broke out in Southeast Asia that you could stop from arriving in Canada?

The likelihood of being able to completely stop the outbreak of influenza is very small. Part of the difference between SARS and influenza is that we SARS carriers weren’t actually infectious until they had symptoms. Whereas with influenza, you could be infectious before you have symptoms.

I could shake your hand today. I rub my nose, I shake your hand, and you rub your nose. I have no symptoms. Tomorrow I come down with influenza, and the next day you come down with it. The potential of it to spread without being recognized early on is much easier and its ability to infect is much easier then many other diseases. That’s why the basic precautions, the frequent washing of hands, the covering of sneezes, the staying home when you’re sick, can slow it down. But could we say we’d ever be able to stop it? That’s unlikely.

What sort of measures will Canadians see once a pandemic emerged in this country?

The expectation is that businesses are planning for influenza as a potential threat to continuity in the business. What you would see is that each business would assess, depending on the situation, perhaps asking people to work at home, rather then coming in to work. In terms of schools, again depending on how its spreading, we might need to look at limiting school and other extra-curricular activities, to limit the spread. Or you may find that in terms of controlling it, it’s more effective to have the kids in school – but you have to have hand-washing programs and other things.

It would really depend on the scenario as it’s evolving, and that’s something that we will constantly need to assess to make sure that people have the best advice possible.

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You may have a large amount of deaths - what kind of problems might that pose for medical staff?

This is where the local planning around pandemic, not that you want to think about it, are the undertakers to deal with it. Maybe you’ll need to have a cool area to store bodies for a short period of time, to commandeer ice rinks and other facilities. That’s all part of the planning. While we may not like to think about it, these are important things to have in place. Hopefully we will never need them.

What sorts of preparations have been talked about in Canada?

Planning occurs at several different levels. At the national level we have a pandemic plan. We were the first in the world to have a national plan, and many other countries have been making use of it. At each provincial and territorial level there is a plan as it’s appropriate for their needs and for their situation. Local plans are also being developed with hospitals, family doctors and other practitioners, as with the local business communities, other providers, social services/.

Who gets the vaccine first?

The protocols continue to evolve around understanding the issue and that may change based on what the appearance of the virus is and who is most affected, and who is most at risk. Clearly you want to insure that there are some minimal essential services set in place: frontline health workers are there to provide care, as well as essential services. If you need a minimum of two people to run the water works, then you want to make sure they are immunized, and other sort of important decision makers, and then those who are at greatest risk of suffering in terms of their likelihood of dying.

There is a range of priorities, they may change and they continue to be re-evaluated as our understanding of the virus continues to improve.

And family members of people who are important?

Again, that depends on the situation at the time. If you only have a limited amount of the vaccine, then you need to protect those that will protect the integrity of the society and it’s a difficult challenge in terms of family members, if they are not engaged in that work then we may need to look at, where people for a period of time are not staying together in order to protect their family. All of these things are decisions that will be based on the issues that we face through the outbreak should it occur.

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What can I do to protect myself before the vaccine arrives?

There are two things. Clearly, the basic issues that we talked about in terms of the washing of hands, staying home if we are ill, the basic kind of things that reduce the spread of a whole range of infectious diseases, that’s one.

And two, keeping ourselves in good health. The more we can do to look after ourselves: basic nutrition, physical activity, and all those things that kind of keep us in good shape, that’s also essential in advance.

Are we due for a pandemic?

Most experts would say you would see three or four pandemics in a century. The last one was in the late 60s, so we are 40 plus years since the last one. Could we see one next year? Or could it be five or ten years? Nature is quite unpredictable about these things. It could be a soon as a couple of years, it could be five, ten or 15 years.

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What is it like to die from influenza?

I haven’t done that yet. I may some day. For those who are affected, it’s a range. In most situations it’s the development of pneumonia, and the inability of the body to fight it off.

What was it like to die in 1918-19?

In 1918-19 you had the full range. You had those who died of secondary infections and you had those who died rapidly, unable to breathe. Much like SARS, much like some of the atypical pneumonias, that inability to catch a breath is kind of like drowning in the midst of air.

How seriously are politicians in Canada taking the threat of some form of pandemic?

I’ve been very impressed. They are concerned about this and we continue to develop the planning and processes that will help us as Canada to respond as effectively as one would hope in this kind of situation.

People are taking this seriously. It’s a tremendous challenge when it hasn’t happened yet, we don’t know when it’s going to happen. Some people are saying it’s imminent and then some months later WHO says that well maybe it’s not imminent once we reassess it.

There is a risk that being too negative, it sounds like the boy who cries wolf. Two or three years later, if haven’t seen it, people go away.

People shouldn’t be lying awake worrying about it, but people in public health and governments need to be worrying about it enough that we continue to plan to prepare to set ourselves in a situation where we will be able to respond as best as possible in a very difficult situation.

That’s kind of where we are at now. Nobody can predict exactly when we’ll face it, someday we will.

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