The following is an edited excerpt from and interview with Dr. Ron St. John, conducted in late 2005...

What is the mandate of the Centre for Emergency Preparedness and Response?

The protection of the health of all Canadians from the health impacts of disasters, whether they are natural disasters or whether they human caused disasters.

We have approximately 180 staff; they are spread across the country. It includes our quarantine service in eight major airports, regional emergency preparedness and response liaisons, and of course our major operation here in Ottawa.

Are you concerned about the flu virus in Asia right now?

The avian flu virus, the H5N1, is of some concern. It continues to change some of its characteristics in ways that are a little bit worrisome.

All organisms change their characteristics. It’s a matter of how often they do it and over what period of time. Even human beings are changing their characteristics over time. Because they multiply so rapidly in such large numbers, bacteria viruses have more opportunity to change their genetic make up more frequently.

Some people, when they hear that the flu is one of the biggest public health concerns, they say ‘the flu is just a cold, so what’s the big deal?’

Flu is traditionally thought of as just a bothersome disease; you get some aches and pains, and you have a fever and maybe some coughing a sneezing for three or four days. Then you recover and go about your business.

There are two aspects of ordinary flu that are worrisome or of some concern. One is that for people that are more advanced in age or have a chronic medical condition, the flu infections itself can aggravate those conditions and cause serious illness in an elderly person with say a heart disease or a lung disease problem.

The other aspect of flu that is of some interest is that it is hugely costly economically, because if you think of all the people that stay off of work for five days, and all the kids that get sick the amount of people that have to stay home to look after their children, the economic costs are quite large.

Why are you worried about the flu in Asia?

The flu in Asia is an influenza virus of chickens, of avian species, of fowl. It’s not a virus of people, however, it has demonstrated that it can sporadically and under special circumstances infect some people. It is like a fish out of water; it’s a flu virus, but in the wrong species, it causes a very serious disease in humans with a very high fatality rate.

Fortunately, it doesn’t transfer from person-to-person as efficiently as the regular flu does. But if it happens to recombine with a human strain of the flu and acquire the characteristics of passage from person-to-person, then it might create a huge problem for us.

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What would be the concern about passage from human-to-human?

Influenza is a disease that passes from person-to-person, usually by what we call droplets -- the sneezing and the coughing. The degree to which it can cause an outbreak or widespread illness depends on the efficiency of that transmission. If the avian flu were to acquire the efficient transmission mechanisms of the normal flu, it could cause a serious epidemic.

To give you an idea, the H5N1 strain in Asia, when it did infect people, was initially causing a mortality rate of about 70 per cent. That has since fallen to about 50 per cent, which is still very dramatic. Among infectious diseases a mortality rate of 3 to 5 per cent is significant -- 50 per cent is huge. Would a recombined strain have that kind of mortality? We really don’t know. Obviously, if it did it would be an extremely serious problem.

Who is watching the development of the avian flu right now in Asia?

Most of the world is watching it vary closely. The WHO, our own scientists have been in Vietnam collecting samples, working with the Vietnamese government on analyzing those samples, looking at the genetic makeup of the virus, watching the changes that have taken place in that virus, trying to monitor its behaviour in the populations there is a lot of work going on right now.

They are looking for a trend, or the acquisition of characteristics that might be leading this virus down a path for efficient human-to-human transmission.

If that were to occur, what would your job be?

If the virus were to pick up the characteristics for efficient person-to-person transmission, we would obviously be concerned and we would try to monitor and gather as much information as we could: how efficient was it? What was the impact of the disease? How serious was the disease? How sick did it make people? What would be the mortality rate? This is a lot of information and data that would be collected early as possible and analyzed worldwide to come up with recommendations on how to intervene to slow or stop this virus down.

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What can you do to stop it once it becomes efficient as a transmittable virus?

The most efficient way of stopping something like this is with a vaccine. We would work very hard to obtain a sample of the strain very early on. It would then be put into the laboratories that specialize in identifying it and preparing it to be a candidate for a vaccine. We would then try and produce that vaccine as early as possible and make it available to the public in order to provide the level of protection.

What would show you that the virus was beginning to transmit from human to human?

The usual indication is what we call clusters. This is where groups of people get sick. What we see with the H5N1, the avian flu, is individual cases -- somebody that has been on a chicken farm, someone that has been with chickens that have been dying, has close contact because they look after the birds or they slaughter the birds. They are just solitary cases.

When you begin to see what we call clusters in a fairly short period of time, numbers of people coming down with the same disease, then you start to look at the relationship between those people and not all of them were chicken farmers. Let’s say you have the chicken farmer and his wife, but his wife went to the city and then her sister got infected, and then her sister’s kids were infected, that’s what we call a cluster. That’s when we say uh-oh, we are having some human-to-human transmission.

How does influenza kill its victims?

Influenza is an inflammation of the lungs. It begins to block the passage of oxygen into your blood, and you begin to have difficulty breathing. Then you begin to have a lot of fluid come out of your lungs, which is a little bit like having your lungs fill up from the inside with fluid. It can be so severe, making it very difficult to breath. Of course, without oxygen you run the risk of dying.

What symptoms might be exhibited?

Just like any other flu, you would start of with some general not feeling well -- some aching in your joints, and then you get a fever of 100 to 102 degrees. You don’t feel too well, you might start to sneeze, cough, have a runny nose. The trouble is that it doesn’t sound very specific. That can be one of a number of illnesses ranging from the common cold to other viruses. Sometimes it’s difficult to tell what is the flu and what is another respiratory virus.

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If a flu pandemic started in Asia, how realistic is it that we could prevent that flu from arriving in Canada?

If there were a true pandemic of influenza, and if we truly had efficient human transmission, there is global agreement that there is no real way to stop it. The global strategy is to try to slow it. The reason why we want to slow its spread is to have as much time as possible to prepare the vaccine.

The strategy is really not to stop it. There really isn’t a way to stop it given how infectious it can be. The strategy is to slow it down.

There are three measures for slowing down flu. One is the vaccine, to give you the best protection. But it’ll to take time to get that online because you can’t make a vaccine against a virus until you have a virus. That’s why there’s a lag time.

The second is anti-viral medications that are effective for decreasing the severity of illness and decreasing the mortality from flu.

The third is what we call increasing social distance, which means a lot of different things. For example, if you are having an outbreak in your community, you don’t want to go to gathering places with other human beings. Try to avoid going to shopping malls, movie theatres. Local public health authorities may decide to close public schools for a period of time. All of this increases the distance between people and makes it harder for the virus to jump from one person to another.

How realistic is creating social distance in a major urban centre where we are so closely connected?

In a modern world it’s difficult. Yet it’s a matter of an average decrease in social connectivity, if you will. The sum total of moderate reduction will slow the virus. It won’t stop the virus, but it will slow it. If you don’t have to go to the movie, don’t go to the movie. Try to only engage in social conduct that is required. You have to go to the store to get food, but you don’t have to go to the movie.

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How do you imagine Canadians would react to the pandemic?

It’s always difficult to predict people’s behaviour in a crisis situation. One of the things in our field or emergency preparedness that we feel is exceptionally important is to maintain people’s confidence that the authorities are doing the right thing and that we are doing the best we can. If confidence is lost, things can degenerate.

The SARS situation gives us a little indication about how Canadians might behave because at any given point up to 8,000 were in a self-monitored quarantine. And from the information we have from Canadian health authorities, Canadians did follow the advice of the public health authorities and for the most part did comply to staying home if they had exposure to SARS.

How seriously do you take the 1918 pandemic as a potential model for what might happen to us?

It’s a model, and we take it seriously. We’ve just had a major meeting in London with some of the world’s best mathematical modellers looking at what might be the scenario for a pandemic strain and a lot of them have gone back to the raw data from the 1918 flu and have put that into their mathematical models, run it through their computers and analyzed that data…

One of the interesting outcomes was that the flu was perhaps not quite as infectious as we thought it once was. It’s not as infectious as let’s say the measles or the chicken pox. And that’s kind of good news based on analyses of 1918 data in a mathematical model.

In 1918, the virus spread around the world rather rapidly considering there were no airplanes for transcontinental travel. Did your model take that into account?

Yes, all the models nowadays are based on rapid air travel.

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What can I do to protect myself as an average citizen of Canada?

Two things. One is to be educated about influenza and about how virus spreads and what you can do to protect yourself, like washing your hands quite often. One of the ways the flu is spread is by hands. If somebody with flu is rubbing their nose, contaminating their hands with a virus, and then they shake hands with somebody and they then rub their eyes or their nose – that’s one way that the virus moves from person to person. The other way is caused by what we call droplets. You cough and some droplets of saliva come out with the virus and you inhale those. But hand washing is a very important method for prevention.

What about heading for the hills?

It’s one way to increase your social distance, but it’s not very practical for everyone to head for the hills.

There are stories from 1918 about towns having militias with guns blocking anybody from coming into the town, and they had no deaths from flu.

That’s not going to work too well in a modern society where we are much more connected by roads, by transportation, by other systems, compared to 1918. That was a long time ago. Just the food supply – so much of our food on our supermarket shelves is what’s called ‘just in time’ inventory. Tomorrow’s food arrives today, and if it doesn’t arrive today there won’t be any food tomorrow on the supermarket shelves. We live in that kind of a world where our commodities, our supplies, our way of living is totally dependent on transportation and interconnectivity. It’s almost impossible to visualize somehow shutting off a town so that nobody comes in or out.

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Can you talk a little bit about Tamiflu – its availability?

Tamiflu is the commercial name of a drug called Osoltamivere, which has been shown to be somewhat affective against flu viruses. It reduces the duration of your illness; it also reduces the potential mortality. But the caveat of the drug is that you have to take the drug within in 24-48 hours of the onset of your symptoms. That’s a little bit difficult because some of the flu’s symptoms are a little vague.

We have acquired a stockpile in Canada of Tamiflu, the provinces and the federal government have collaborated to build a stockpile. And this is for the nine priority groups identified in the Canadian pandemic influenza plan. And those stockpiles are in place. And then there are some additional stockpiles that are being built as we speak, so there will be some supply of Tamiflu in Canada.

Do you have a supply of Tamiflu?

Do I personally have a supply of Tamiflu? No I don’t.

Would you recommend to your loved ones that they get a supply of Tamiflu?

No I don’t recommend that at this time. First of all, if you have a supply of Tamiflu at home and you wake up a little achy, are you going to take your Tamiflu? If it’s not flu, how will you replace your supply? Are you going to take your Tamiflu today when you don’t need it and use it all up -- then when the flu virus does arrive you won’t have it?

It’s not very easy in the practical sense to figure out how useful Tamiflu will really be for you as an individual during a pandemic situation. Clearly if there is a pandemic situation arriving in the community, we would wand the healthcare workers to take Tamiflu. We want them to stay as healthy as possible so they take care of people that become ill.

Tamiflu sells for about $4 a tablet. If I buy $500 worth of tablets I could theoretically take it for three months while waiting for the vaccine to come.

You could. But there is no data on the safety and efficacy of Tamiflu for that period of time.

How much Tamiflu is there in the world? Is there enough if we could afford it?

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