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Killer Flu: A Breath Away

Aired December 11, 2005 - 22:00   ET


FREDRICKA WHITFIELD, CNN ANCHOR: Hello, I'm Fredricka Whitfield with a look at what's happening right now in the news. Death row inmate "Tookie" Williams will have to wait until tomorrow to find out if he will be executed on Tuesday. California Governor Arnold Schwarzenegger's office says there will be no decision tonight on Williams' request for clemency.
Iraq has closed its borders as it gets ready for Thursday's elections. The U.S. ambassador predicts large numbers of Sunnis will participate in the vote. He says their participation could reduce the level of insurgent violence in Iraq.

Is this a turning point in Iraq? CNN's Anderson Cooper will be there all week. His live reports begin Monday at 10:00 and 11:00 p.m. Eastern.

Straight ahead, "Killer Flu: A Breath Away". CNN's Dr. Sanjay Gupta takes you to the frontlines in the fight against bird flu. And join me in one hour at 11:00 p.m. Eastern for "CNN SUNDAY NIGHT."

I'm Fredricka Whitfield.



AGOOS DINNA, WIFE DIED FROM AVIAN FLU (through translator): She started coughing.

GUPTA: Agoos and Rinny Dinna were high school sweethearts, married 14 years. They ran a small business together, working from home. But Rinny's cough was the beginning of the end.

DINNA: On the third, I took her to an internal specialist. There wasn't any change. On the morning of the 6th, she fainted.

GUPTA: Four days later, she was dead of a killer flu known at H5N1. Normally a bird disease. Since late 2003, it's infected more than 120 people, killing about half of them. If the virus stays that deadly and starts spreading easily from person to person, we're in trouble.


GUPTA: Hello and welcome. I'm Dr. Sanjay Gupta in Indonesia. I'm standing outside the home of one of the recent victims of the bird flu and one of the luckiest. He lived.

You might be asking yourself why is there all this concern about bird flu? After all, we made it through 9/11, several years of a war in Iraq, and a season of devastating hurricanes. But the thing is, this is a different kind of flu. It has the potential to kill millions.


GUPTA: With regular flu, a single sneeze ejects millions of tiny viruses into the air. And the virus can live as long as two days, even on a cold surface like a doorknob.

LAURIE GARRETT, COUNCIL ON FOREIGN RELATIONS: The problem with flu is it is orders of magnitude more contagious than the dreaded Ebola virus, the smallpox which we have been preparing as a nation for as a possible bioterrorist weapon, than just about anything, except common cold.

GUPTA: Now imagine a new flu just as contagious, but killing half its victims. That's the nightmare scenario. Dr. Robert Webster has been studying flu viruses for more than 50 years.

ROBERT WEBSTER, ST. JUDE CHILDREN'S RESEARCH HOSPITAL: If this virus learns to transmit human to human and maintains that level of killing humans, you've got a global catastrophe.

GUPTA: So far, all the human cases are in Southeast Asia, but you can get on an airplane in Bangkok, or Hong Kong, or Jakarta and in a day be in any major city on the planet. A new virus could easily hitch a ride and spread around the world in a matter of weeks.

IRA LONGINI, WORLD HEALTH ORGANIZATION: It's a disaster waiting to happen.

GUPTA: A consultant to the World Health Organization, Dr. Ira Longini built a computer simulation, showing how quickly a killer flu might spread starting with a single patient in southeast Asia.

LONGINI: The outbreak starts here.

GUPTA: The yellow dots are new cases. The blue dots are people who are already recovered or dead. You can see how quickly the screen fills up as new patients are infected. In less than a month, it's out of control and on its way to the United States.

They say the chance of a pandemic sits at about 100 percent.


GUPTA: It's going to happen.

LONGINI: It's absolutely going happen. .

FIRDAUS BASKARA, BIRD FLU SURVIVOR: (through translator) My full name is Firdaus Baskara. I'm eight years old. GUPTA: Firdaus, known to his friends and family as Daus, is the nephew of Rinny Dinna, the 40-year-old woman who died of the H5N1 virus in early September. That same week, Daus also tested positive for bird flu.

DINNA: I picked him up at school and took him out for lunch first. And then he played here. My wife was in the bedroom.

BASKARA: On that day, I was watching TV. And then Auntie Rinna came out from her room and she sat next to me for a little while. And then she was feeling cold. And so she went back to her room.

GUPTA: When a patient gets bird flu, one of the first questions to ask is did they catch it from a bird or another person? If it's another person, we're one step closer to the nightmare scenario.

We set out to find how close the virus is to making that dangerous leap. As bird flu cases pop up, a pattern is starting to emerge.

GARRETT: If you look at the list of the cases, many of them are family clusters. You have to either say everybody shared the same common chicken source or were exposed to the same infected chicken, or somebody was exposed to the chicken and then gave it to the rest of the family.

There's just no other way to explain how these family clusters are occurring.

TIM UYEKI, DOCTOR, U.S. CENTERS OF DISEASE CONTROL & PREVENTION: Epidemiologists are disease detectives.

GUPTA: Dr. Tim Uyeki of the U.S. Centers of Disease Control, worked with Indonesian scientists to investigate the latest bird flu cases.

UYEKI: Urgent investigation of these cases must be done because the question is, is there more human to human transmission going on?

GUPTA: The home of Rinny Dinna and her husband is in a suburb on the south side of Jakarta, a crowded, sprawling city of more than 10 million people. As in any big city, hospitals see thousands of people with breathing trouble every day.

But Rinny Dinna's condition was severe. So she was tested for bird flu. She died before getting the result. She was the country's second official case.

UYEKI: Some of the issues that you really want to try to figure out are did this person have direct contact with poultry? By direct contact, we're talking about actually touching, holding the birds. The other question that's really important to ascertain is, is it possible that there might have been person to person transmission?

GUPTA: We got a first hand look at a similar investigation. A 19-year old woman dead of a sudden respiratory illness. When the test comes back, it's positive for bird flu.

The next morning, an investigation team sets out for the village. It's a two hour drive through winding, narrow streets. We have to stop and ask for directions a half a dozen times. By the time the health team arrives, the family is frightened. The victim left behind a young husband and a 10-month old daughter. Now the child is feeling sick, too. And so is a five-month old niece and the victim's eight- year old brother.

DR. ERLANG SAMOEDRO, INDONESIAN MINISTRY OF HEALTH: ..we have the symptoms -- fever and cough and runny nose.

GUPTA: Bird flu? No one is sure.

The team takes blood samples from anyone who was in contact with the dead woman during her illness, more than 20 people. They come by the house one by one.

And a team from the animal health department takes samples from song birds and of course the chickens. It's not a pleasant experience for anyone. Test results for people take three days, but for birds, a rapid test can generate results in 20 minutes.

The animal health inspectors wait an hour to be sure. The verdict? These birds are healthy.

The dead woman's aunt tells the team that in another village where the victim's mother and father live, chickens and ducks have been dying, a handful at a time for the past month.

We all go to take a look, but the birds have been burned. There's nothing left to test. The investigation is at a dead end.

Back in Jakarta, after Rinny Dinna died, the health department tested dozens of people. Only one was positive for H5N1, her nephew, Daus.

UYEKI: The nephew had a much milder illness, had fever for quite a number of days, but he did quite well and he's quite healthy.

GUPTA: Aside from the mild illness, there was another mystery. Did the little boy catch it from his aunt? Or did they both catch it somewhere else? The answer is critical. If they got it from each other, it could mean the virus is shifting in a dangerous direction.

UYEKI: The viruses just do not have this ability to go from a person to another person to another person, what we call sustained person to person transmission. But when we begin to see some human to human transmission, you have to really investigate that because that could tell us that the virus has changed. And this is what we fear.

GUPTA: While Daus waited in an isolation ward at the hospital, investigators scoured the neighborhood. Was the virus lurking in a nearby bird? A neighbor's yard? Or perhaps in the field at the end of the block?

Potential hiding places are scattered everywhere. Now investigators have to wonder how many others are at risk?


UNIDENTIFIED FEMALE: Is this the next killer flu? We'll get the answers straight ahead.


UYEKI: Limited person to person transmission is definitely a possibility here.

GARRETT: Only thing I can think of that could take a larger human death toll would be thermo nuclear war.

UNIDENTIFIED FEMALE: But next, the worst case scenario that really happened.

UNIDENTIFIED MALE: We find it kind of eerie that there are some parallels between 1918 and the current H5 viruses.

UNIDENTIFIED FEMALE: And later, cutting edge medical research that could stop the bird flu. Don't go away.



GUPTA: What would a global outbreak of killer flu look like and how would it change our daily lives? We actually have a pretty good idea because it's happened before.


GUPTA (voice-over): Medical advice was basic -- avoid crowds, wear a mask, hope for the best. The headlines screamed, "Germans Ready for Retreat." It was September 1918, the final months of World War I.

But in the shadow of that war, there was a silent, even more sinister killer.

JOHN BARRY, AUTHOR, "THE GREAT INFLUENZA": This disease killed more people in 24 weeks than AIDS has killed in 24 years.

GUPTA: Worldwide, anywhere from 20 to 100 million people perished within six months. According to John Barry, author of "The Great Influenza," the suffering was often horrific.

BARRY: Their skin could turn so dark blue from lack of oxygen that one physician reported that he had difficulty telling African- American troops from white troops.

People could bleed from not only from their mouth and nose, but even from their eyes and ears.

GUPTA: Kenneth Crotty lived in this house in Framingham, Massachusetts right outside Boston. He was 10 when his neighbors started dying.

As an altar boy at St. Stevens Church that fall, he assisted in dozens of masses for the dead and says in some families, there was no one left to go to the funerals.

KENNETH CROTTY, WITNESS TO THE FLU PANDEMIC: Sometimes the church was vacant because they had no one left in that particular family.

GUPTA: Two of his four sisters got the flu, but survived. Crotty himself stayed healthy, even as friends, neighbors, and his sixth grade teacher dropped dead.

CROTTY: Every morning, when you got up, you'd ask who died during the night. Death was there all the time.

GUPTA: Boston, September. The paper reported 63 deaths. And health officials suggested the worst was over. In fact, much worse was to come. Nearly 600 deaths in 11 days alone.

BARRY: People could see why they were being told on the one hand, that it's ordinary influenza. On the other hand, they're seeing their spouse die in 24 hours or less, bleeding from their eyes, ears, nose, and mouth.

GUPTA: As the death toll mounted, President Woodrow Wilson was silent.

BARRY: He was obsessive and focused totally on the war. One thing he did do was to make a decision to continue to send troop ships, even though many of his own senior advisers told him, I mean, you're literally a troop ship packed like sardines.

So these became almost floating coffins.

GUPTA: As it turned out, even the president was not immune. Barry says the evidence strongly suggests Wilson got the flu while negotiating the disastrous treaty that end the war.

BARRY: It's clear that Wilson was -- got totally disoriented in the middle of the negotiations over the peace treaty in Versailles. And it's also, I think, pretty clear that that was because of influenza.

GUPTA: One Army physician said lung damage reminded him of what he'd seen from poison gas on the battlefield. But nearly every internal organ was ravaged, even the brain. The virus inflamed the sack of tissue and fluid that protects the heart, seared the kidneys, liver, and adrenal glands. Muscles along the rib case were torn apart by violent coughing.

As war raged within the lungs, the immune system tried to stave off the invading virus. But the all out immune response backfired and was often the actual cause of death.

With typical flu, the old and the young are most at risk. In 1918, it was young adults, the very people with the strongest immune response.

BARRY: The immune system was basically destroying the lungs to save them. More than half of the dead were young adults. And young adults actually had the strongest immune systems.

GUPTA: Crotty, who never even fell sick himself, says that fear was in the air.

CROTTY: If you met someone in the street, you were very alert to -- that they had their mask on and you had your mask on, too. There were no antibiotics. It was just hope that you'd get through.

GUPTA: In desperation, doctors inoculated the sick with typhoid vaccine, quinine, even hydrogen peroxide.

BARRY: They were just throwing everything at it and hoping something would stick.

GUPTA: To ward off infection, some people even wore garlic necklaces. They tried just about anything. Exactly what made the 1918 flu such a virulent killer remains a mystery. The answer may lie hear at the Armed Forces Institute of Pathology, a vast warehouse containing stacks and stacks of tissue samples, some dating back to the Civil War. Others date from the fall of 1918.

Samples which have allowed molecular pathologists Jeffrey Taubenberger to take a detailed look at the 1918 flu.

JEFFREY TAUBENBERGER, DOCTOR, ARMED FORCES INSTITUTE OF PATHOLOGY: We don't know why that virus was severe. We don't know where it came from. We don't know what happened because influenza viruses weren't even known to exist in 1918. So there are no isolates. There was no way to actually study this virus.

GUPTA: But Taubenberger and his team found a way. The breakthrough was finding intact virus particles in the lungs of the death. For years, Taubenberger collected samples, stashing them in this locked freezer.

An Eskimo woman who's whole village was wiped out in 1918, buried in the Alaskan permafrost until her body was dug out eight decades later by Johann Holzen, a fellow scientist.

And these remains of a young soldier, preserved since 1918 in a tiny block of wax. In a just published paper, Taubenberger and his colleagues describe their breakthrough, the entire genetic make-up of the 1918 flu virus.

TAUBENBERGER: We find it kind of eerie that there are some parallels between 1918 and the current H5 viruses.

GUPTA: Taubenberger says the amino acids in the 1918 virus share similar traits with today's H5N1 virus. So far, H5N1 does not jump easily from person to person. What Taubenberger wants to understand, how does a virus change to make transmission easier? TAUBENBERGER: We think that using experimental models in the next year or two, we might be able to actually figure out some of these basic mechanisms. You know, what does it take for a bird virus to become a human virus? And these might be the same mechanisms that all viruses would have to take.

GUPTA: According to Taubenberger, mapping the 1918 flu gene sequence is just the beginning. This fall, he obtained new samples, infected tissue from people who died of flu in 1915. Was that flu related to the 1918 killer?

TAUBENBERGER: How does influenza virus like this happen? And since pandemics happen two or three times a century, we wanted to understand what does 1918 have to tell us about the present? How would it tell us information about what might be happening with the H5 virus in Asia right now?

GUPTA: Perhaps the last great pandemic will give up its secret, helping scientists like Taubenberger stave off the next killer flu.


UNIDENTIFIED FEMALE: Coming up next, meet the man who created the bird flu vaccine. How much will it help?

ROBERT WEBSTER, ST. JUDE CHILDREN'S RESEARCH HOSPITAL: The vaccine, even though it's not a perfect match, would probably protect you from death. And you'd probably get very sick, but not die.

UNIDENTIFIED FEMALE: Killer flu with Dr. Sanjay Gupta continues in a moment.



GUPTA: For nearly 50 years, Robert Webster has specialized in flu viruses and the simple fact that he knows more about the H5N1 virus than probably anyone else in the world has made Webster the scientific equivalent of a rock star.

This year, he created a vaccine that the U.S. government is scrambling to produce in mass quantities. And at the age of 73, he still works 10 hours a day at St. Jude's Children's Hospital in Memphis, trying to outsmart the virus that is already killing half the people it infects.

WEBSTER: I'm concerned that the first go, if you like, of H5N1, if it learns to transmit, won't be pretty. We are going to be faced with potential catastrophe.

GUPTA: To stop the virus, Webster says you've got to look at it closely, very closely.

WEBSTER: Under the electro microscope, influenza viruses are spiky creatures. Something like hedge hogs, if you like. GUPTA: Those spikes on the surface of the virus are proteins. In H5N1, the H stands for Hemaglutinen protein. That's this one. It attaches the virus to the respiratory tract. This is the N, short for Neuraminidase, a molecular scissors.

The flu virus uses its H protein to dock on the surface of a cell and invade. Then it hijacks the cell's own machinery to produce literally thousands of copies of itself.

The end spikes, the scissors, cut the new viruses free from the cell, turning them loose to infect new cells in the respiratory tract. To fight the flu, you target either the H or the N protein.

Webster's vaccine, in fact any flu vaccine, takes aim at the H spike. So the virus can't enter cells in the first place to make people sick.

Drugs like Tamiflu and Relenza work a different way, going after the N spike.

WEBSTER: These drugs essentially wreck the ability of the virus to use its molecular scissors.

GUPTA: The virus can infect a person, but can't multiple to cause severe illness. The flu virus is simple. In fact, it contains only eight genes. But the virus has a menacing trick up its sleeve, those genes constantly change more than most organisms.

WEBSTER: I compare it to a production line for an automobile. No quality control in the workers. They just threw the pieces in. And most of the time, it's disastrous. But every now and again, it can give a master strain.

GUPTA: Those master strains contain mutations that allow it to evade your immune system. Your immune system doesn't recognize it. These constant mutations are the reason we need a new flu vaccine every year.

ANTHONY FAUCI, DR., NATIONAL INSTITUTES OF HEALTH: It changes just enough that the vaccine from the previous year doesn't induce an immune response.

GUPTA: There's also another way that a super flu might be born. The flu virus can acquire genes from other viruses in the cell. It's called reassortment.

For example, a chicken farmer comes down with the regular flu, which spreads like wildfire from person to person. Then she gets infected with H5N1 from one of her chickens. Now both viruses are in her cells, where they exchange some of their eight genes.

WEBSTER: We can look upon this as two packs of cards or two hands of poker, if you wish. Eight card poker.

GUPTA: If the genes are shuffled just right, the H5N1 strain could pick up the gene that would help it pass from person to person like the winter flu. That is the biggest fear of all.

FAUCI: Of course you always think of the worst case scenario, where you have rampant highly virulent and very easily spread pandemic going throughout the world, killing, you know, hundred millions of people. Sure that can happen. Is it likely? No. Do we still need to be prepared for it? Yes.

GARRETT: The only thing I can think of that could take a larger human death toll than virulent pandemic influenza would be thermo nuclear war.

GUPTA: And here's another question. If the virus does mutate to spread easily between people, would Webster's vaccine, the one that the government is stockpiling, still work?

WEBSTER: I would argue the vaccine, even though it's not a perfect match, would probably protect you from death. If you were vaccinated, you will still get infected, you would probably get very sick, but not die.

GUPTA: This vaccine could buy us time, but a better vaccine, a perfect match can't even be started until a new virus emerges. Even then, with existing technology, it takes at least four to six months to produce a mass quantity.

Sanofi Pasteur operates one of the largest vaccine production plants in the world. Like other drug companies, it grows flu vaccine in chicken eggs.

MARIE-JOSE QUENTIN MILLETT, SANOFI PASTEUR: Eggs are sort of like a little cell factory. So you inoculate the virus. The virus takes over the machinery, the cellular machinery and replicates.

GUPTA: It's a process that currently requires millions of chicken eggs. Those eggs must be ordered more than six months before the flu hits. Now, that means scientists must predict the number of doses required even before they know just how bad the flu might be. And there is another problem: Since bird flu kills chickens, the birds required to produce those millions of eggs could be killed off in an outbreak.

TOMMY THOMPSON, FORMER U.S. HEALTH & HUMAN SERVICES SECRETARY: That's what killing chickens right now, is H5N1, and that's where we're basing our future on, to create a vaccine. I mean, it's just -- it just nuts.

GUPTA: But for now, that's the only option in the United States. The National Institutes of Health is testing Webster's vaccine against H5N1 in clinical trials. And even though trial results aren't completed, the United States government is spending more than $1 billion on the vaccine, and even that is only enough to immunize just one in 14 Americans.

ANNOUNCER: Coming up, what Hurricane Katrina can teach us about bird flu, and how you can protect yourself.

GUPTA: Your best protection probably isn't Tamiflu.

ANNOUNCER: Plus, flirting with disaster: Could we stop an outbreak before it's too late? We'll be back in a moment.


GUPTA: We all remember the horrifying images from the Gulf Coast in the aftermath of Hurricane Katrina. Thousands waited, and waited, and waited to be rescued without food, water or shelter, day after sweltering day. Many who were ill died before help ever came. It was hard to comprehend that this was even possible in the United States of America.

But some health experts say if Americans don't prepare immediately, the human suffering could be even more painful during a worst-case flu pandemic.

UNIDENTIFIED MALE: The president of the United States.

GUPTA: Under the president's national strategy for pandemic influenza, the federal government will stockpile vaccine and drugs to protect Americans.

(on camera): It's 2005 now, and the president has announced a plan to try and protect Americans against the bird flu. You heard it?


GUPTA: Will it work?

OSTERHOLM: I applaud the president for having announced. But we also have to understand it's a lot like the guy who has got his 25th class reunion tomorrow, and he's decided he wants to lose 50 pounds tonight.

GEORGE W. BUSH, PRESIDENT OF THE UNITED STATES OF AMERICA: And I'm asking that the Congress fund $1.2 billion for the Department of Health and Human Services to purchase enough doses of this vaccine from manufacturers to vaccinate 20 million people.

GUPTA (voice over): But the vaccine is still in clinical trials. It is not approved by the FDA, and you can't go to your doctor's office and get it. And the amount of vaccine the president is talking about would be enough to vaccinate only one in 14 Americans, and only if the virus doesn't change significantly. And then there is the question of whether it can be made fast enough.

FAUCI: The critical issue -- that's the sobering part of all of this -- is that we don't have the capacity to manufacture this in the right amount of doses that would be able to be available for enough people to make a difference.

GUPTA: In other words, even if every factory runs full speed, we can't make it fast enough. That's because, as the president acknowledges, the vaccine industry in the United States has dwindled away. He's trying to encourage drug companies to make vaccines again. BUSH: Today there is only one manufacturer in the United States that can produce influenza vaccine. That leaves our nation vulnerable in the event of a pandemic.

GUPTA: Because most vaccine is manufactured elsewhere, in the case of a pandemic, the countries where it's made, like France, might declare an emergency and refuse to ship it to the United States.

If a vaccine is unavailable to stop a pandemic, what else might? Like many countries', the United States government is attempting to stockpile two antiviral drugs, Tamiflu and Relenza, that might be helpful. Some Europeans countries are stockpiling enough for 25 percent of their populations. But the U.S. only has enough to treat about 2 percent. It could take two years before the goal of 25 percent can be met. Even if we did have enough Tamiflu or Relenza, are scientists sure they would even work?

FAUCI: We do not know how this drug is going to perform under the conditions of a pandemic flu.

GUPTA: None of these drugs have actually been tested against bird flu.

And what about the things most people haven't even thought about?'

OSTERHOLM: We can't assure the things like food, basic health care, the kinds of things for our own security are all there. We've got to do that now.

GUPTA: In fact, Osterholm says in the disasters of Katrina, we find lessons for the flu.

OSTERHOLM: Imagine in the hospital setting that we saw in New Orleans, seven to 10 days, but it was an absolutely horrific situation, brought these people to the very edge of their fatigue capability. Now, imagine having try to do that for 12 to 18 months.

GUPTA: And, add in the complications caused by any shutdown of trade or travel, as countries try to keep the infection out.

OSTERHOLM: If we start shutting down borders, we'll have a major reduction in transportation, whether it's fast traders or airplanes. Suddenly the products of these businesses would be selling; the services they provide would, in many cases, be seriously altered.

GUPTA: As a result, Osterholm says, hospitals need to plan now to stockpile basics, masks and supplies, for example, that are currently made overseas. And he says many of the problems we saw after Katrina would be magnified in pandemic flu. Grocery store shelves would be empty. Mail could stop. There would likely be a gasoline shortage.

But have we heard this dire predictions before?

GERALD FORD, FORMER PRESIDENT OF THE UNITED STATES OF AMERICA: I've been advised that there is a very real possibility that unless we take effective counteractions, there could be an epidemic of this dangerous disease.

GUPTA: If you were alive in 1976, all of this might sound familiar. In February of that year, an Army recruit at Fort Dix died of swine flu. Worried about a repeat of the 1918 disaster, President Ford called for mass vaccinations.

FORD: I'm asking each and every American to make certain he or she receives an inoculation this fall.

GUPTA: Millions of people got the shots, but there was no pandemic, and hundreds of people who were vaccinated developed a nervous system disorder called Guillain-Barre syndrome, although a link was never proven.

FAUCI: The bottom line is that there was no clear indication whatsoever that there was human-to-human transmissibility. Despite that, they went ahead and mass-vaccinated, you know, about 45 million people.

GUPTA: So, are we sounding the alarm prematurely on bird flu as well? Is this all hype?

OSTERHOLM: This is not hype. This is not something that is just a temporary scare and it will go away. If it doesn't happen in the next six months or two years, there will be those who will want to say, oh, why did you scare us needlessly? Again, we will never, ever not use pandemic preparedness, because one day we will have a pandemic.

GUPTA: What are you doing to prepare?

OSTERHOLM: I've bought some masks, and I've stockpiled some food, and I think at the very least I also have a plan to communicate with my family. I know what I want to do, I know where we're going to go.

GUPTA (voice over): The key, he says is to have a plan. Prepare now to be able to sustain your own family, for several months, so you don't have to wait for days for help that in the case of pandemic flu might not be coming.

(on camera): It is scary, but remember, bird flu is still a very rare disease, and it's hard to get. You have to come in close contact with an infected bird. That's why your best protection probably isn't Tamiflu, nor is it one of those special masks. It's washing your hands, and often. Soap and water will do, and if that's not available, one of these alcohol-bases sanitizers will work as well.

You may also be wondering if it's safe to eat chicken. The answer is yes, as long as you cook it. Use a meat thermometer. Even if there is virus, cooking a chicken to 158 degrees Fahrenheit is enough to get rid of all the virus.

The H5N1 virus we've been talking about is only in Asia, and in parts of Europe. It's simply not here in the United States, not in birds, not in humans. Now, if you have been in the country where the virus exists and you've had contact with birds, and within a week you develop a fever and a cough, tell your doctor about where you've been. They'll tell you if there is reason for concern.

ANNOUNCER: Just ahead, an 8-year old boy who's survived a case of bird flu, and a medical mystery that surrounds him.

UNIDENTIFIED MALE: The occurrence of clusters demands urgent investigations, because we really want to know are these viruses changing, because that could be the beginning of a pandemic.


GUPTA: Here in northeastern Thailand, more than two-thirds of families live side by side with chickens. After the initial outbreak of bird flu, Thailand went more than a year without a single human case. But in October, a 48-year old man caught the virus, got sick and died. Within a week, there were several more suspected cases. It was a reminder that Thailand remains on the frontline in the fight against bird flu.

(voice-over): In Thailand, like much of Southeast Asia, people are close to the birds. He says, "I treat them better than my own children."

But lately, the relationship has gone sour. An hour out of Bangkok, it's almost a routine: Chickens die of H5N1, and then health teams descend to spray disinfectants on everything, within a kilometer of where the infected bird was found. Nearly everyone in this neighborhood keeps chickens, but we didn't see a single one. The health teams slaughtered the healthy birds two days ago.

Where H5N1 lives in birds, epidemiologists worry that people are at risk.

This man's brother caught the virus in October, when he killed a sick chicken and then cut it up for a meal. He slaughtered the bird right here, cleaned it here, cooked it on this stove. The man died within a week.

Let's go back to that simulation by computer scientist Ira Longini. The outbreak starts with a single case. Each color dot represents a flu victim. In less than a month, it's out of control. But here, on the left, we see Longini's alternate version, where health officials quarantine the first victims and treat them with Tamiflu, and what a difference. Only a few hundred people get sick; the outbreak is contained.

(on camera): If the bird flu does start spreading easily from person to person, the only way to keep it from spreading around the world would be to catch it early. Now, if it's spreading in a city like Bangkok, with a population of 10 million people, it would probably already be too late.

(voice-over): The U.S. Centers for Disease Control and Prevention has a field station in Bangkok to be on the lookout for new emerging diseases, like H5N1.

DR. SCOTT DOWELL, CENTER FOR DISEASE CONTROL & PREVENTION: The first thing you need to do is to early detect a cluster of cases early on. That part I think is quite possible. Surprisingly so. Remember, we're not trying to detect a sporadic case here or there of H5 in a human. We're trying to detect a spreading cluster of cases, and that's much easier to detect.

GUPTA: Dr. Scott Dowell ran the CDC outpost for the past four years, including during the outbreak of the new disease, SARS, which killed nearly 800 people and shut down economies across Asia.

DOWELL: Well, we saw with SARS, for example, that once you get severe pneumonia that starts infecting doctors and nurses in a hospital and you get dying health care workers, you can't hide that for very long.

GUPTA: Dowell is back home now, but in eastern Thailand, we met Sonya Olsen (ph), who has taken over on the frontlines. She believes some of the steps taken in computer simulations might work in real life.

UNIDENTIFIED FEMALE: If the virus is not too infectious and we're able to get there quickly and use certain strategies like quarantine and antivirals, I think it may be possible for us to stop the pandemic, and we don't know, but I think certainly it behooves us to try.

GUPTA: Which brings us back to Jakarta, Indonesia, and the mysterious case of Reni Dina (ph), a 40-year-old woman who died of H5N1. And her 8-year-old nephew Daos (ph), who caught the virus, but somehow was barely sick. Investigators needed to find the source of Reni's illness, and whether Daos caught the virus from her or someplace else.

Testing in Daos' neighborhood found no sign of bird flu, but what about the home of his aunt, where he often spent time?

UYEKI: It's possible that he could have gotten infected from contact with his aunt, yes. There was household contact. It's a very suspicious cluster, and that limited person-to-person transmission is definitely a possibility here.

GUPTA: Your wife, did she have any contact at all with birds or chickens? No contact.

(voice-over): In fact, when investigators scoured the neighborhood, they saw birds everywhere. However, when they tested the birds, none had H5N1, but the virus did turn up somewhere else -- in the fertilizer Reni Dina used to tender a garden of house plants. Made from chicken waste, the fertilizer was contaminated with the deadly virus.

(on camera): Do you worry about your own safety?

UNIDENTIFIED MALE (through translator): Life is in the hands of God. I actually even want to go to the bird places. I want to know how the bird flu feels.

GUPTA: So you've gone to bird places?

UNIDENTIFIED MALE (through translator): Yes, I go to pet shops with many birds, because people say the virus is in the birds or poultry. I go there. I want to know what the bird flu is like.

GUPTA: You (INAUDIBLE) bird flu so you -- because you think you might die and then you might see your wife?


GUPTA: I hope you don't do that.

(voice-over): As for Daos, he's back at full speed. No one knows why his illness was so mild, or why a handful of other infected people have not become seriously sick. And investigators say we may never know if he caught the virus from his relative, touched some contaminated soil, or got it somewhere else entirely.

Of the first 125 human cases, more than a quarter involved members of the same family, but so far, no one believes that virus has learned that crucial trick of spreading easily from person to person.

(on camera): Is this something that is inevitable, that it's going to become more efficient at transferring itself? That's what viruses do.

UNIDENTIFIED FEMALE: I think whether it's this virus or another influenza virus, we don't really know. I think history tells us that there will be another influenza pandemic, but it's -- no one really knows whether it's going to be this H5N1 or a different virus.

UYEKI: The occurrence of clusters demands urgent investigation, and that includes both epidemiological investigations, but as well as examining the viruses, if we can isolate viruses. Because we really want to know, are these viruses changing? Because that could be the beginning of a pandemic.

GUPTA (voice-over): Viruses today have opportunities to spread quickly, not available during the 1918 pandemic. Light commercial air travel and dense concentrations of people and birds. Whether the next pandemic is relatively mild or even worse than the killer of 1918 may depend on the ability of a few scientists to find and contain the first cases.

ANNOUNCER: Coming up: the birds, like you've never seen them before. "Killer Flu" will be right back.


GUPTA: Finally tonight, the birds. The bar-headed goose is one of dozens of wild species hit with H5N1, dying by the thousands. We know more about bar-headed geese because they're in a movie, called "Winged Migration," by a bird lover named Jacques Perrin. He used balloons, hand gliders and remote-controlled cameras. When they flew north to the summer breeding grounds, he went along, and captured their majestic flight. It's a tough journey, 2,000 miles across the Himalayas. And this year, the deadly bird flu went along, spreading west, from Southeast Asia to western China, Mongolia, Kazakhstan, Turkey, Eastern Europe and beyond.

Birds who never died from bird flu before are dying. Those who live spread the illness to chicken flocks, where the virus spreads even faster.

When we fly, it's in an airplane. But just as the virus spreads, on the wings of birds, we people can carry it too. Nowhere on Earth is more than a breath away.

(on camera): Here in Indonesia, Daos continues to do well. No one knows if or when the H5N1 virus will turn into a mass killer, but every single doctor and public health expert we met said that sooner or later, one or another flu virus will start spreading. Let's hope we're ready.

I'm Dr. Sanjay Gupta. Thanks for watching.



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