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Health reporters on the flu threat

Darlene Cook, Baltimore: If this flu is such a threat, shouldn't we avoid eating all birds and their products? How motivated are the producers to cull out their sick birds?

Roylance: So far, the transmission of the avian flu virus from birds to humans hasbeen very difficult. Only about 120 people in the world are known to havecaught it that way. It's been occurring in Asia, where many people live inclose proximity to their flocks.

The worry is that the avian virus -- in a human or some other animal -- will swap genes with an easily transmissible human flu virus, and create a "super-flu" virus that will be both highlylethal and easily passed from person to person. Avoiding the consumption ofbirds and their products would help only if everyone did it, and there wasno longer any economic incentive for anyone, anywhere to raise birds forthe food market. That would eliminate the close contact between people,poultry and their viruses. But that's not likely to happen.

In the meantime, you can't catch avian flu from the dead poultry or eggs encountered at thesupermarket. As for the poultry producers, the last thing they want is foran avian flu bug to get loose in their flocks. When that happens, as itdoes from time to time, birds get sick and die, and government authoritiesorder the destruction of whole flocks. The greatest risk, perhaps, is tothe people working with live poultry, who could catch the virus frominfected, live birds.

Kun Sun Sweeley, Baltimore: I saw a news article dated Tuesday, Nov. 1, that stated: "It [the H5N1 strain] is making steady mutations that scientists say could allow it to spread easily from person to person and cause a catastrophic global pandemic." Howquickly is H5N1 mutating and can a timeline be given on when H5N1 couldpossibly turn into a human flu virus? And when H5N1 turns into a highlycontagious, deadly flu virus and it reaches the U.S., how many people inBaltimore might die from H5N1?

Roylance: The H5N1 virus has been changing slightly -- evolving -- as it spreadsthrough animal populations. But while scientists fear it may eventually hit on a mutation that makes it both highly transmissible between people and highly lethal, there is no way to predict how those genetic dice will roll.

It's possible that, in acquiring the ability to be passed from person toperson, it will also become less lethal. It's also possible that thisparticular strain will never become a threat to people. The next pandemiccould very well come from an entirely different virus.

But public health authorities -- particularly in the wake ofbioterrorism threats in 2001 and Hurricane Katrina -- want to err on theside of caution. So they are taking unprecedented steps to strengthen thenation's public health infrastructure, stockpile antiviral drugs, developvaccines and plan for the possibility of a pandemic.

The estimates of how many people might die in a flu pandemic varywidely. The numbers are highly dependent on how lethal the virus becomes,the availability of antiviral drugs and flu vaccines, and what measureshealth authorities take to minimize transmission -- steps such as closingschools and reminding people to stay home if they're sick, wash their handsand cover their coughs and sneezes.

That said, epidemiology modeling by the Centers for Disease Control and Prevention has suggested that nearly 10,000 Marylanders could perish in a "mid-level" flu pandemic. That's one that involved a virus three times as lethal as the 1968 Hong Kong flu, butnot as bad as the 1918 "Spanish flu." The estimates assume that 25 percentof the state's population will catch the flu, and that public healthauthorities do nothing to reduce the toll.

Pete Randrup, Baltimore: Where are flu shots being offered in [Baltimore] City or [Baltimore] County?

Bor: To find out about the next flu clinic at a location near you, call yourlocal health department. A list of the departments and their phone numberscan be found at www.cha.state.md.us/html/local2.html.

Nancy Benson, Laurel: If the flu vaccine is so important for everyone to get, why has itincreased in cost and why isn't it offered through HMO copay? My doctor advertises the flu shot for $25 and won't give it during a regular appointment. This seems to be the way of everyone. Before, I had been able to get the flu shot through my doctor with the $10 copay.

Bor: You are right about the price. Over the past several years, prices haverisen steadily as companies that used to produce flu vaccine got out of thebusiness. Passport Health, a chain of immunization clinics, paid theirsuppliers $2 a dose just a few years ago and now pay $12. Naturally, thecompany has passed along the cost to consumers, who now pay an average of$25 per dose, far more than before.

As for insurance coverage, some planscover the shots while others do not. One HMO serving many customers inMaryland covers flu shots fully after a $20 copay. Trouble is, the copaycovers the lion's share of the cost, so consumers don't really get thatmuch relief.

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