In August, Indonesia earned the dark distinction of suffering the most bird-flu fatalities in the world, 43 and counting, after a 16-year-old Indonesian boy died from avian flu two days after being admitted to the hospital. Since 2003, 232 people around the world have been struck with the virus, and 134 have died.

Because it remains difficult for the virus to migrate from birds to humans, and even more difficult to transfer from person to person, many scientists still feel a bird-flu pandemic is not imminent. Some researchers, though, are far less sanguine about the potential threat. And a few are convinced a crisis is all but upon us.

Why does a disease that can’t migrate easily to humans scare so many smart scientists? Because if it does, there’ll be hell to pay.

“Seasonal flu, the kind we see every year, causes 36,000 deaths across the country every year and hundreds of thousands of hospitalizations,” says Jo Ann Dawson M.P.H. ’88, interim director and staff physician at UCLA’s Arthur Ashe Student Health and Wellness Center, and co-chairperson of the university’s Pandemic Flu Task. “But what if we get a virus that is particularly contagious has a high attack rate and is lethal, in a population with little or no immunity to it? … This flu infecting chickens now has the potential for that kind of mutation.”

One of the front lines of a bird-flu outbreak in L.A. would be UCLA Medical Center, where David Pegues, professor of clinical medicine and an infectious diseases expert, spends his time thinking about what hospitals need to do to prepare for such an emergency. At any level — federal, state, local — “nobody is as prepared as they should be,” he warns.

It Can Happen Here

Of all the factors that make health-care professionals and researchers profoundly uneasy about this virus, whose technical name is A(H5N1), number one may be its lethality: When bird flu does infect humans, it kills half of them. Also making scientists nervous is recent research showing that the 1918 influenza pandemic, which infected 500 million people and killed 40 million to 50 million, originated as a bird flu.

“The main thing people need to know right now is we have not had any bird-flu activity in birds or people in the U.S.,” says Christine Pearson, a CDC representative. “The primary concern is people traveling to where bird flu has been found. And if they go, they should take precautions like frequently washing their hands; if they eat poultry, to make sure it is well-cooked; and to avoid live bird markets and farms.” Still, the way the disease is moving around the world is unsettling. In January, H5N1 made its malign appearance in Africa. That followed outbreaks in Asia, Indonesia, Russia, Turkey and Europe.

“Right now, avian flu is a pandemic in birds, but not in humans,” notes Scott Layne, associate professor of epidemiology at the UCLA School of Public Health. “[But] even if it comes here as bird flu, it will still overwhelm us.” Layne testified about the state’s ability to respond to a bird-flu crisis before the California Assembly’s Budget Committee on Health and Human Services in November.

What Will Happen if It Does

The Institute of Medicine, part of the National Academy of Sciences, concluded in a report released in June that the nation’s emergency health system is overburdened, underfunded, and too fragmented to communicate and cooperate effectively. It has little surge capacity to deal with a disaster (estimates put a bird-flu crisis could increase hospital capacity by 50 percent), and emergency-care staff members are not adequately trained to respond to large-scale disasters or to work with pediatric patients.

Pegues and his team are working on an emergency preparation plan that would allow a hospital like UCLA Medical Center to respond to viral epidemics, natural disasters and bioterrorism. In the event of such an emergency, all nonessential surgeries would be canceled. The hospital would make use of other places like the National Guard Armory and indoor basketball stadiums to place the overflow of patients. Health-care workers in the emergency room, intensive-care unit and on the pediatric floor would be given priority to receive a bird-flu vaccine if one exists. And patients would be screened before entering the hospital to keep people sick with bird flu separate from those who weren’t.

Having sufficient staff to care for people infected with the virus also creates challenges. It’s likely that medical and public-health students would be called into service, along with retired primary-care physicians and nurses, Pegues says. And vaccinating healthcare workers against the virus has also emerged as a critical issue.

How would UCLA itself fare if bird flu struck today? Better than yesterday, says Task Force co-leader Dawson, “but there’s quite a bit more planning and development that needs to go on.”

Searching the World for Answers

Making the task of getting ready for the worst even more difficult, it’s not easy getting information from other countries where the bird flu has already hit. Reports of disease outbreaks in the field can take days or weeks to be transmitted to public-health facilities around the world. And it can take months to develop laboratory data on flu samples. Plus, individual nations don’t have to — and don’t always — share critical information about diseases with other countries.

Layne hopes to change some of the surveillance problems with the building of a high-tech global surveillance lab on UCLA’s campus that would monitor all infectious diseases, including anthrax and bioterrorism. The lab is funded in part by a Congressional appropriation, with $6 million granted for this year. And in September, Gov. Arnold Schwarzenegger announced a $9 million grant to the School of Public Health for the expansion and enhancement of a new high-speed, high-volume laboratory network capable of quickly analyzing and processing high quantities of biological samples.

Stop It Before It Starts

Another place where UCLA is a player in avian-flu research is its Center for Vaccine Research — one of three sites in the country selected by the National Institute of Allergy and Infectious Diseases to conduct bird-flu vaccine tests. Ken Zangwill, a professor of pediatrics at the center, says progress has been made on developing a vaccine quickly, but one stumbling block has been the vaccine’s inability to develop a strong immune response against the bird-flu virus.

The Facts on Fowl

Should you be worried? And what should you do to protect yourself and your family? For more information on avian influenza, visit the Centers for Disease Control and Prevention at cdc.gov/flu/avian/ outbreaks/current.htm.

Vaccine production is another problem. The current bird-flu vaccines use techniques that grow the virus from egg cultures, which takes time. “Even if I knew tomorrow that a pandemic will happen, it will still take six months just to produce the millions of doses that are needed,” Zangwill says.

When and Where

Determining when avian flu will hit American soil is also a key part of UCLA’s research. There are 150 bird species that move between North America and Asia, with between 5 million and 10 million birds migrating every year, says Thomas Smith, professor of ecology and evolutionary biology, and director of the Center for Tropical Research at UCLA’s Institute of the Environment. By monitoring migratory birds, experts can predict how the disease will move across the country once it does hit. And by identifying strains of the virus more quickly, it’s hoped that vaccines can be more rapidly produced. As of this fall, Smith’s center will have collected 20,000 samples from North American birds, in pursuit of the goal of cutting the time between discovery of a new strain of the virus and production of a vaccine from six months to four or so.

It may seem strange, in the end, to see all this feverish activity to defend against a threat that hasn’t — and may never — strike. But then, there are all those very worried scientists.

“People really see bird flu as tangible and real, and more so than bioterrorism,” concludes Pegues. After all, he says, “bioterrorism will not sweep from China to the western U.S. in a matter of weeks.”