WHO center is on the trail of deadly bird flu

GENEVA -- In a bunker-like chamber beneath the headquarters of the World Health Organization, day blends into night as teams of virologists and epidemiologists track a killer called H5N1 across a dozen time zones.

Fingertips tip-tap on keyboards as e-mails fly to distant corners of the globe amid a constant murmur of phone conversations. A virologist urgently questions a doctor in Vietnam. On another line, a logistics specialist untangles the knots of moving a mobile lab from one remote village in Turkey to an even more remote hamlet.

The suspicious deaths of wild ducks in Romania warrant fast-track tests for pathogens. Reports of the latest human infections in Indonesia leap onto an electronic screen. Confirmation of strange mortality among chickens in Nigeria sends health teams scrambling for the next plane to Lagos.

Detection of the virus in the carcasses of wild swans in northern Germany last week signaled the swift spread of H5N1, with the virus penetrating deep into Africa and Western Europe for the first time over the past several days. In the latest alarm, the H5N1 virus was confirmed in densely populated India yesterday, less than a day after emerging in Egypt and France, among other places. A new death was reported in Indonesia, one of the epicenters of the outbreak.

The $5 million basement facility here serves as the command center in the global war against bird flu. Using information gleaned from offices in 66 countries, public health and veterinary officers in the field, and breaking health data acquired by computer programs, the war room tracks the relentless spread of the virus case by case, almost minute by minute.

''It is very intense; we are seeing 15 to 20 events every day," said Dr. Michael Ryan, head of the facility, with a staff that includes 112 epidemiologists, logistics specialists, communications technicians, and other specialists from 29 countries.

Each new human infection raises the prospect of a pandemic that could claim millions of lives and wreak economic havoc. For nearly a decade, the H5N1 virus was largely confined to poultry flocks in Southeast Asia. But six months ago the disease blazed across the Russian steppe, veering into Turkey before slicing into southern Europe and backtracking into Central and South Asia. Last week, traveling with a rapidity that has stunned medical watchers, the highly pathogenic virus appeared for the first time in Africa.

Mutations that could change the H5N1 strain into a virus able to spread from human to human could occur in hours. The only signal of the shift would come from an unusual spate of deaths.

''We're not going to have much warning," Ryan said. ''One day, two days, maybe three, if we are extremely lucky. Once contagious among humans, the virus will spread like a tsunami. There will be the flash point -- probably in Asia, perhaps somewhere else -- followed by waves of infection that would hurtle around the world."

In the era of jet travel and world commerce, where almost no place is truly isolated from the rest of the world, every country would quickly become a front line in the battle against a new form of influenza, epidemiologists say.

The facility over which Ryan presides features wall-mounted video monitors, electronic maps, sophisticated communications gear, and banks of ''James Bond" computers (whose screens disappear into desktops with a purr of hydraulics to clear space for meetings). ''This room is the eyes and ears of epidemic response," the Irish physician said. ''We're already providing immediate information to the world, assessing risk in each local outbreak, getting response teams into the field, and coordinating their work once they get there."

Satellite communications equipment is designed to circumvent normal phone systems that could become overloaded in an emergency. A strike force with about 400 public health doctors and other specialists on standby at medical centers around the world -- ranging from the US Centers for Disease Control to Israel's public health agency -- is ready to respond on six hours' notice to emergent disease hotspots.

Influenza pandemics -- a pandemic refers to the spread of deadly disease over vast areas -- have erupted about every 30 years, on average, over the past century: After the 1918 Spanish flu came less-lethal pandemics in 1957 and 1968, which killed millions.

In worst-case scenarios based on extrapolations from the 1918 outbreak, some epidemiologists predict that a pandemic spawned by bird flu could kill 140 million people in a matter of months, and sicken so many hundreds of millions that some governments and national economies would collapse. A study by the Lowy Institute for International Policy, an Australian research center, predicted that a pandemic could wipe out $4.5 trillion in global economic output.

The World Health Organization is urging countries to brace for a ''mild to moderate" pandemic likely to kill 2 million to 7.4 million people, according to Ryan.

''We need to steer away from worst-case scenarios or we'll end up like deer caught in the headlights of an oncoming truck, too terrified to move," he said. ''We need preparation, not panic."

As a sign of mounting concern, international donors led by the United States last month pledged $1.9 billion to fight bird flu worldwide, substantially more than had been expected. The figure includes more than $330 million from the United States and $250 million from the European Union. The Bush administration, meanwhile, has earmarked $7 billion to combat an influenza pandemic on the home front, although the amount will also go toward research and vaccine development expected to benefit the world.

But United Nations health specialists acknowledge that the world is ill prepared to meet a major outbreak among humans.

Although many governments are stockpiling such antiviral medicines as Tamiflu, even the best existing drugs may not necessarily help people infected with an aggressive new virus. An international rush is on to boost the world's production of antiflu vaccines -- but there is no guarantee these vaccines will prove effective because no one knows exactly what form a mutated H5N1 virus might take.

Medicine aside, the trickiest task for the WHO is to persuade countries to recognize outbreaks of the disease, report them immediately, and move swiftly to quarantine outbreak areas. China, in particular, has been accused of refusing to provide timely information on bird flu. Impoverished countries, meanwhile, simply lack the will or the resources to slaughter infected chicken flocks and conduct blood work and other tests on individuals.

Bird flu is believed to be borne by migrating birds, making it impossible to control the spread. Still, epidemiologists have been stunned by the rapid advance of the disease. ''The virus is moving quite substantially into new locations," said David Nabarro, the official responsible for coordinating the UN response to avian and human influenza. ''The truth is, this virus is undergoing changes. This warning that nature is giving us has to be heeded."

So why should a few hundred sick chickens in West Africa set off international alarm bells?

''The greater the spread of the avian disease, the greater the risk for humans," Ryan said. ''The more exposure, the more the danger that virus will mutate into deadlier forms that can be spread from human to human."

In its present form, the H5N1 virus is dangerous only to humans with intensive exposure to chickens, ducks, geese, and other barnyard fowl. Most of the more than 90 people who have died of the disease have been peasant farmers or slaughterhouse workers.

But viruses mutate, often rapidly. And bird flu has a fearsome track record: In 1918, a form of bird flu leapt directly to humans, triggering the so-called ''Spanish" influenza pandemic. In less than a year, Spanish flu killed at least 25 million people and perhaps as many as 50 million, according to medical histories.

''The danger is grave, the threat is real," said Dr. Albert Osterhaus, a virologist at the Erasmus Medical Center in Rotterdam, head of the Netherlands National Influenza Center, and one of Europe's top ''virus hunters."

''Another pandemic is probable, not just possible. It's only a matter of time," he said in a telephone interview. ''Whether [the H5N1] virus will be the basis of the next pandemic is impossible to say. But the virus is already highly pathogenic."