Dear Virginia General Assembly Pandemic Preparedness Committee
Dear Virginia General Assembly Pandemic Preparedness Committee,
Please find enclosed the final version of my essay titled “Therapeutic Strategy to Survive H5N1 Avian Influenza, Reduce Extreme HPAI Mortality Rates and Improve Pandemic Preparedness – Part 1: Early Therapy”, along with the 2-page executive summary that briefly covers all the main points without the in-depth scientific detail contained in the essay. This final version supersedes any you may have received previously. Please realize, we can defeat pandemics through science – or pandemics will defeat us – as they did with Covid-19.
On December 16th in the Guardian newspaper Professor Devi Sridhar, Chair of Global Public Health at the University of Edinburg revealed that the U.S. CDC is not producing more H5N1 vaccines until it knows which strain of the virus will become pandemic. This is a great risk because this vaccine is still produced in eggs and thus requires a six-month lead time. H5N1 is not Gerald Ford’s swine flu or even Covid-19. If H5N1 is as lethal in humans as it is in many mammals, this vaccine production delay could cause a catastrophe. That makes the importance of educating people about effective, early antiviral therapy even more critical.
The World Health Organization issued its first international pandemic warning about highly pathogenic avian influenza (HPAI) H5N1 in 2006 when migrating birds brought the disease out of Southeast Asia spreading it to the Middle East, Europe, and Africa. At the 2006 all-party meeting to discuss the threat of H5N1 Zambian Minister of Health, Sylvia Masebo, asked me to explain H5N1 to the 40 ministry officials and people representing two dozen international non-governmental organizations gathered in the ministry conference room. She knew I had great expertise about HIV/AIDS and viral disease, and I had recently brought from California the only book in Zambia that had been written about this new type of flu. Thus, my concerns about H5N1 extend back to 2006.
Although a H5N1 pandemic has been threatening humanity since 1997 when the first human was infected, no one can predict the exact moment the virus will mutate or reassort to become transmissible between humans, or what the exact mortality rate will be. However, the latest information from Science journal is that H5N1 is only one mutation away from gaining the ability for human transmission. The pandemic dam will break as soon as it does. Then the mortality rate possibly could be as low as 1% as with Covid-19, or it could range as high as 50% or more as we have seen in many mammal and bird species. Scientists recently discovered that domestic cats have receptors for both avian and human influenza. Thus, cats can be added to several other species that could reassort flu genes to create a new variant transmissible among humans. And interaction with cats could be another vector for human infection. Day-by-day, this disease seems to creep closer to potentially becoming the worse pandemic humanity as ever witnessed – or perhaps only as lethal as the 1918 Spanish flu was that today would kill over 2.2 million Americans. Viruses are unpredictable. But flu season provides the greatest opportunity for H5N1 to co-infect a cell with a seasonal flu virus, exchange genes, and become pandemic.
I am neither a virologist nor an immunologist. However, I have read approximately ten books on each subject, as well as numerous histories of medicine, science, plagues and disease. I have attended over 57 AIDS and virology conferences worldwide and have served as an unpaid consultant to both the Ministry of Health of Zambia and the Ministry of Health of Liberia. Because I had studied how selenium affects hemorrhagic fever viruses like Hantavirus and Marburg, in 2014 I was able to provide Liberia the then only effective treatment against Ebola. Today, I am probably the only Virginian who has read over 450 medical journal articles related to H5N1 and treatments for influenza. For over 35 years improving treatments for viral disease has been my focus whether I lived in Los Angeles, Lusaka, Johannesburg, Farmville, or had been summoned to Monrovia at the beginning of the Ebola epidemic. Unlike most scientists who strive to discover pieces of the scientific puzzle, I assemble those established pieces of science to understand the big picture. Although current therapies for influenza including Tamiflu (OTV) and Xofluza (BXM) are effective, they are not effective for long. They have major limitations in a deadly pandemic. Meanwhile public health officials ignore broad-spectrum antiviral drugs that are much more effective and sustainable against respiratory viral disease than BXM or OTV are. Both approaches should be used.
While over 1.2 million Americans died from Covid-19 – three times as many as would have if early therapy had been used – only 25,626 out of 2.63 million confirmed Covid cases in Virginia died. That was a case mortality rate of just under 1%. Imagine if the case mortality rate were 30% or 50% as it potentially could be with HPAI H5N1. My analysis of Covid-19 fatalities in the 5th Congressional District of VA showed deaths totaling 3,350 – 30% higher than the state average. Mortality rates were significantly higher in counties and towns that had the lowest vaccination rates like Danville/Pennsylvania versus those with the highest vaccination rates like Charlottesville/Albemarle. That proved vaccination works. That is why in California the state animal conservation board has already vaccinated 250 of the 340 surviving California Condors. I do not understand why California has not started to vaccinate dairy cows when thousands are dying. China even vaccinates its chickens. Is America prepared to vaccinate millions of people as soon as H5N1 finally becomes transmissible, or will we all be locked down as if living in a 14th Century cloister hiding from the next Black Plague? Europe is gearing up to vaccinate its farmers and the UK has reserves of 5 million doses. What about Virginia? Should VA pandemically prepare our dairy cows? Or would it be better to develop sensible recommendations and educate people about viral first aid kits to protect their lives? What are best practices in the face of a killer pandemic? Failing to educate the public about effective, affordable, scientifically proven, broad-spectrum antiviral therapies should be considered a worst practice.
Once the H5N1 dam breaks it will affect every family in Virginia. Will vaccines be ready? No. Will people know what effective therapies they can use to protect their lives? If not, why not? Will children under 5 or the elderly over 70 be most at risk? What about the obese? Will people end up on ventilators and developing sepsis, or will they have the knowledge to help prevent or slow the cytokine storm from the start? Pandemic preparedness requires pandemic thinking and questioning public health experts, not just being spoon-fed information without knowing what questions to ask or digging beneath the scientific surface. Now is the time to ask questions. Once the pandemic breaks it may be too late to get all Virginia’s ducks in a row. [Water birds are the main hosts of this disease.]
It is time to batten down the pandemic hatches. Virginia can be a leader in the fight against H5N1, or it can be a victim like we were during the Covid Crisis of 2020-21. Then, American public health officials failed to inform people about broad-spectrum antiviral medicines that should have been used as early and even late therapy because they were just not profitable enough and did not stoke anyone’s reputation for discovering new drugs for new diseases. They ignored older effective drugs that could have saved lives but were not used.
Preparedness is in the eye of the beholder. It is all about perspective. I have perspective from over 40 years with HIV, 35 years of library research studying Hantavirus, Zika, Ebola, SARS-1, MERS, SARS-2, and now H5N1 HPAI. H5N1 is lethal almost 100% in some mammal and bird colonies. How bad will it be when it hits our human colony in Virginia? The history of influenza may not be a good guide. If H5N1 highly pathogenic avian flu is as bad as H1N1 avian flu was in 1918, over half a billion people worldwide may die. Millions of Americans will too.
H5N1 is like no influenza humans have seen in modern history. It is neurotropic and infects not just the lungs but all bodily organs, especially the brain. That is clear in autopsies of mammals and birds but is not yet clear in humans with the current variant. Reassortments and mutations easily may change that.
I have been researching, working in, living with, and advised two African ministries of health about pandemic viral diseases during the last 35 years. I write to you only wishing to help prevent the tragedy that will befall the Commonwealth if you are led to falsely believe only OTV and BXM can help save lives from H5N1. Do not ignore more effective treatments that are available to all and to which the virus does not develop resistance.
I would like to offer my written and verbal testimony to your Pandemic Sub-committee or join it as a member of the public. Please read the enclosed executive summary and essay so you can cross-examine me about my research that has been done in the public interest – to save the lives of those who should not have to die in ignorance as happened to so many with Covid-19. Past mistakes that cost hundreds of thousands of lives in pandemics should be corrected – not blindly repeated. I ask the Sub-committee on Pandemic Preparedness to open a science-based discussion so avoidable tragic mistakes do not occur again. Knowing the right questions to ask those who submit testimony is essential. As General George Patton said, “If everyone is thinking the same, then no one is thinking.”
Scientifically yours,
Howard
S. Armistead
H5N1
researcher
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