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Most of the damage is actually done by one's own immune system. H5N1 seems to trigger a "cytokine storm," an overexuberant immune reaction to the virus. These cytokine chemical messengers set off such a massive inflammatory reaction that on autopsy the lungs of victims may be virus-free, meaning that your body wins, but in burning down the village in order to save it you may not live through the process. In fact the reason why young people may be so vulnerable is because they have the strongest immune systems, and it's one's immune system that may kill you.
KF: How easy is it to contract the virus once it's in full swing?
MG: Catching a pandemic flu virus is essentially as easy as catching the regular seasonal flu. During a flu pandemic about 1 in 5 people may fall ill, but there are certainly ways to minimize one's risk via hand-washing and social distancing techniques. In a really severe pandemic, though, the advice would be to "shelter-in-place," isolating oneself and one's family in one's home until the danger passes. During such a pandemic the Department of Homeland Security uses as a key planning assumption that the American population would be asked to self-quarantine for up to 90 days per wave of the pandemic.
KF: Why do we have this potential disaster on our hands?
MG: The industrialization of the chicken and pork industries is thought to have wrought these unprecedented changes in avian and swine influenza. No one even got sick from bird flu for eight decades before a new strain, H5N1, started killing children in 1997. Likewise, in pigs here in the U.S. swine flu was totally stable for 8 decades before a pig-bird-human hybrid mutant virus appeared in commercial pig populations in 1998. It was that strain that combined with a Eurasian swine flu virus ten years later to spawn the flu pandemic of 2009, sickening millions of young people around the world.
The first hybrid mutant swine flu virus discovered in the United States was at a factory farm in North Carolina in which thousands of pregnant sows were confined in "gestation crates," veal crate-like metal stalls barely larger than their bodies. These kind of stressful, filthy, overcrowded conditions can provide a breeding ground for the emergence and spread of new diseases.
So far, only thousands of people have died from swine flu. Unless we radically change the way chickens and pigs are raised for food, though, it may only be a matter of time before a catastrophic pandemic arises.
KF: If factory farms are to blame, why have there been plagues and flu's throughout time, when factory farms were not around?
MG: Before the domestication of birds about 2,500 years ago, human influenza likely didn't even exist. Similarly, before the domestication of livestock there was no measles, small pox, and many other diseases that have plagued humanity since they were born in the barnyard about 10,000 years ago. Once diseases jump the species barrier from the animal kingdom, they can spread independently throughout human populations with often tragic consequences.
The worst plague in human history was the 1918 flu pandemic triggered by a bird flu virus that went on to kill upwards of 50 million people. The crowded, stressful, unhygienic trench warfare conditions during World War I that led to the emergence of the 1918 virus are replicated today in nearly every industrial chicken shed and egg operation. Instead of millions of vulnerable hosts to evolve within back then, we now have billions of chickens intensively confined in factory farms, arguably the Perfect Storm environment for the emergence and spread of hypervirulent, so-called "predator-type" viruses like H5N1. The 1918 virus killed about 2.5% of the people it infected, 20 times deadlier than the seasonal flu. H5N1 is now killing 60% of infected people, 20 times deadlier than the 1918 virus. So if a virus like 1918 gained easy human transmissibility, it could make the 1918 pandemic--the deadliest plague ever--look like the regular flu.