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 has been very difficult. Only about 120 people in the world are known to have caught it that way. It's been occurring in Asia, where many people live in close 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 highly lethal and easily passed from person to person. Avoiding the consumption of birds and their products would help only if everyone did it, and there was no longer any economic incentive for anyone, anywhere to raise birds for the 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 the supermarket. As for the poultry producers, the last thing they want is for an avian flu bug to get loose in their flocks. When that happens, as it does from time to time, birds get sick and die, and government authorities order the destruction of whole flocks. The greatest risk, perhaps, is to the people working with live poultry, who could catch the virus from infected, 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." How quickly is H5N1 mutating and can a timeline be given on when H5N1 could possibly turn into a human flu virus? And when H5N1 turns into a highly contagious, deadly flu virus and it reaches the U.S., how many people in Baltimore might die from H5N1?
Roylance: The H5N1 virus has been changing slightly -- evolving -- as it spreads through 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 to person, it will also become less lethal. It's also possible that this particular strain will never become a threat to people. The next pandemic could very well come from an entirely different virus.
But public health authorities -- particularly in the wake of bioterrorism threats in 2001 and Hurricane Katrina -- want to err on the side of caution. So they are taking unprecedented steps to strengthen the nation's public health infrastructure, stockpile antiviral drugs, develop vaccines and plan for the possibility of a pandemic.
The estimates of how many people might die in a flu pandemic vary widely. The numbers are highly dependent on how lethal the virus becomes, the availability of antiviral drugs and flu vaccines, and what measures health authorities take to minimize transmission -- steps such as closing schools and reminding people to stay home if they're sick, wash their hands and 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, but not as bad as the 1918 "Spanish flu." The estimates assume that 25 percent of the state's population will catch the flu, and that public health authorities 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 your local health department. A list of the departments and their phone numbers can 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 it increased 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 have risen steadily as companies that used to produce flu vaccine got out of the business. Passport Health, a chain of immunization clinics, paid their suppliers $2 a dose just a few years ago and now pay $12. Naturally, the company 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 plans cover the shots while others do not. One HMO serving many customers in Maryland covers flu shots fully after a $20 copay. Trouble is, the copay covers the lion's share of the cost, so consumers don't really get that much relief.