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Preparation and hygiene are first defenses against avian flu

WASHINGTON – There is no reason for panic at the possibility that lethal avian flu could show up in Indian country. But – especially as migratory birds head south for the winter – there is every reason to prepare defenses against it.

For Indian country is in harm’s way, along with half the nation. Migratory bird flyways cross over many Western and Southwest states and reservations. The Pacific flyway covers the Pacific islands, with their large Native populations. Alaska, home to more than 200 Native villages, is on the direct migratory bird flyway from Asia, where lethal avian flu first infected humans; Asian species on that flyway co-habitate with birds that nest or “overwinter” in Alaska’s avian breeding grounds. For that matter, they may intermingle with commercial and domesticated birds. As the one state where subsistence hunting remains a staple activity, Alaska is also a hotbed of direct contact between wild birds and people.

The worst-case scenario is that as lethal avian flu is transmitted among bird populations, then to humans who directly contact infected birds, it could mutate from there to become transmissible among people. According to the Centers for Disease Control and Prevention, natural human immunity to the virus is slight enough to offer little or no defense if avian flu were to become transmissible among humans. Existing anti-viral drugs are ineffective, and the development of an anti-viral vaccine is a slow process. The standard motherly advice against spreading germs is still worth taking: wash your hands, above all after contacting birds, bird feathers or bird parts in any form; and when you have to cough or sneeze, cover your nose and mouth. Even so, under the worst-case scenario, millions of people would likely die before a vaccine could be perfected.

So in the event of transmissibility among people, the best chance to avert an avian influenza pandemic – an epidemic that spreads worldwide – would be early warning. President Bush’s National Strategy for Pandemic Influenza has identified and funded wild bird surveillance and early detection plans that team the states with the Department of the Interior and the U.S. Department of Agriculture in testing bird samples for lethal H5N1, an influenza virus that has killed humans in a handful of Asian and Middle Eastern nations as birds have followed their global flight paths. The IHS, through its newly hatched Emergency Services office, has concentrated on getting out emergency response plans for the remote rural locales that characterize much of Indian country.

Interior has mobilized an assiduous campaign of testing priority bird species (ducks, geese, swans) and their fecal matter or droppings for the lethal strain of H5N1. As of Aug. 29, more than 13,000 samples had been tested. Not surprisingly, given that bird species altogether harbor almost 150 known avian influenza viruses – few of them harmful to humans – approximately 113 samples had tested positive for subtypes of bird flu. But none of them showed the so-called highly pathogenic avian influenza H5N1 virus – “high path H5N1” for short – that is fatal to poultry and people.

On Sept. 1, the USDA and Interior announced that fecal samples collected from wild birds in Maryland showed the low pathogenic avian influenza H5N1 virus – “low path H5N1” for short. Samples from wild mute swans in Michigan had earlier turned up low path H5N1. But low path H5N1, like most of the almost 150 other bird flu subtypes, poses no threat to human health, according to Interior and the USDA.

The news from sampling so far has to be considered good, but it’s just a start. The national strategy calls for testing between 75,000 and 100,000 wild bird samples. Interior Secretary Dirk Kempthorne recently called for continuing vigilance. While at a sampling camp near Barrow, Alaska, Kempthorne praised Alaska subsistence hunters who have brought in bird samples and reported back on bird behavior, citizens who have reported dead birds and a general public that has kept itself abreast of the threat from avian flu.

The IHS is also keeping its guard up. The new IHS Emergency Services office, operational since June of this year, has clarified channels of authority among tribes, states and federal agencies, so that no time will have to be wasted defining them if an emergency strikes, said Director Steve “Sid” Caesar.

In addition, IHS has prepared a workbook on pandemic influenza. Dean Ross, the IHS national emergency manager, said the target audience is tribes and the federal agencies that work with them, though it applies well enough to rural communities in general that one state has adopted it as a planning guide. Since becoming available eight months ago, it has been sent to tribes and will soon be available over the Internet, Ross said.

“It’s a tool to do a step-by-step analysis of who your partners are, you know, what capabilities you have to respond, and you know who you would communicate with, and basically it helps you develop a playbook so that if it does happen, you would know what the process is for contacting for assistance ... although it’s being done under the auspices of pandemic influenza, the basic or core information really applies to all different types of disasters and emergencies.”

Other practical steps include planning out effective responses to a high-casualty health disaster in rural communities, Ross said. “Where we have, you know, perhaps a system that you could be rather completely overwhelmed by the number of casualties in that area. Quite a few of the more difficult aspects we’re working through here with a lot of our clinical staff ... Some of them [mortuary services, priority care for the elderly, health measures in homes and communities] are morally and ethically difficult questions to respond to.”

Caesar added that a consistent message of IHS Emergency Services to tribal and rural communities is to prepare for self-reliance, simply because few people anywhere are qualified to respond to disasters.

The IHS workbook on pandemic influenza can be obtained by an online request to More information on avian flu can be found at