ON SEPTEMBER 29, David Nabarro, the newly appointed Senior United Nations System Coordinator for Avian and Human Influenza, warned the world that an outbreak of avian influenza, more commonly known as bird flu, could kill anywhere between 5 and 150 million people if it crossed the barrier to humans in a form that could be transmitted through the air.

Here in Egypt, government officials and citizens alike have been worried spectators since the outbreak of the strain, which kills 60 to 90 percent of the birds who contract it, first occurred on the Asian continent in 1997. But with cases detected last month in Romania, Turkey, Greece, Croatia and England, it seems that the virus, carried by migrating birds, could well be on its way here.

Indeed, United Nations officials have recently warned that the virus is heading toward North and East Africa. According to the same officials, in this case, “The disease could be impossible to control.”

The season of bird migration to Egypt began in September and continues until the spring, when birds head back to Europe. Bird hunting season hits its peak in October and November, making the country very susceptible to outbreaks of avian influenza carried by the incoming birds.

According to the World Health Organization (WHO), in birds the virus “causes two main forms of disease, distinguished by low and high extremes of virulence. The so-called ‘low pathogenic’ form commonly causes only mild symptoms (ruffled feathers, a drop in egg production) and may easily go undetected. The highly pathogenic form is far more dramatic. It spreads very rapidly through poultry flocks, causes disease affecting multiple internal organs, and has a mortality that can approach 100 percent, often within 48 hours.”

Government officials aren’t taking it lightly: The Nazif government has cancelled hunting season this year and banned any dealings in migratory quail and duck. Sayyed Khalil, a senior government environment official, subsequently announced that the ministry is currently taking action to monitor all borders and national waters to catch any cases of bird flu. He added that the ministry has already started collecting samples from migrating birds and had not, at press time, detected any cases of influenza.

Associated Press Workers examining carcasses of wild ducks found dead in Hungary

Abdallah El-Higgawi, director of the environment administration of North Sinai, also announced that all the nets strung up to waylay quails and wild ducks have been lifted. Similar precautions were taken by the Suez Canal administration, closely monitoring any incoming boats, officials declared.

All imports of birds have been banned and are not to enter the country through any port via any means, including EgyptAir flights.

In the meantime, independent newspapers were busy stirring up a panic last month, publishing sensationalist reports about 13,000 infected chicks coming from Germany on an EgyptAir flight, which El-Dostour newspaper claims to have been in quarantine since October 1. Officials denied the allegation.

The question is, will non-recreational hunters who rely on the income from trapping migratory birds for the rest of the year, really back down from hunting? Even more worrisome: Will peasant farmers or factory owners report cases of unexplained bird deaths?

United Nations officials are afraid that peasants in areas of North and East Africa are not prepared to deal with the situation — and that governments in the area lack the funds and scientific infrastructure to control the virus. This is why at a conference beginning November 7 in Geneva, the World Organization for Animal Health together with the World Bank, WHO and the UN Food and Agriculture Organization will prepare for outbreaks in Africa and the Middle East.

A crucial part of the preparation will be establishing a fund to help pay farmers to turn over sick poultry. Officials say the destruction of more than 1 million birds in Hong Kong in 1997 after 18 people died from an avian flu outbreak prevented a massive epidemic.

We spoke to Dr. Mostafa Orkhan, the director of the World Health organization’s Egyptian National Influenza Center (one of 112 WHO-funded influenza centers around the world) and the country’s foremost authority on influenza to find out whether it is too early to panic or not. Excerpts:

Influenza is one of the most dangerous respiratory viruses around. People with a runny nose and sore throat do not necessarily have influenza. In the case of influenza, body temperature goes up to 39 and even 40 degrees Celsius. There are three types of influenza: A, B and C. C is the least threatening of the three types, and its symptoms are similar to that of the common cold and [the virus] does not tend to mutate. Types A and B, on the other hand, do mutate [making them more virulent]. Type B affects humans only, but type A affects both humans and animals. The avian flu belongs to the A type.

If we were to look at the virus, we would see surface antigens, the hemagglutinin (H) and the neuraminidase (N). As the virus is transferred between humans and animals, it undergoes mutations and the surface antigens change. A new strain of virus infecting people can cause pandemics, killing millions of people, as our bodies are not ready with the antibodies to fight the new virus.

There have been three major outbreaks of influenza in recent history. In 1918, it was caused by the H1N1 virus [which killed 25-50 million people between 1918 and 1919]. In 1957, the H2N2 strain infected 5 to 7 million [killing 1-1.5 million], while H3N1 in 1968-69 killed between 750,000 and 1 million.

[In epidemiological terms, the 1918 “Spanish” flu was a pandemic, while the 1957-58 “Asian” and 1969 “Hong Kong” flus were epidemics.]

Influenza is very dangerous because its shape is unstable, unlike polio, for example. There are 16 types of H and 9 types of N. These keep mutating and connecting together — calculate it and think of the number of new viruses that could potentially be formed. Birds are a vessel for many of these viruses, but most of them are in the low pathogenic stage, but the H5N1 is currently in its high pathogenic stage. So is the H7N7, which caused the death of a veterinarian in Holland in 2003.

All the poultry in the area was killed, and this is the best way to control the disease. This was the only detected case, but it could resurface in the future.

No. It first appeared in 1997 in Hong Kong, when only 18 people were infected. It later appeared in 2003. So far, 65 have died of the 120 people who contracted the virus. Although more than 50 percent of the people have died, just think how many people live in South East Asia.

Of the billions that live there, only 120 caught the virus.

No. Although influenza is dangerous, it is destroyed at temperatures of 60 degrees Celsius. This is why people who live in cold areas often die of less severe strains of influenza. The virus becomes more dangerous in the cold, and also in humid, crowded areas where the sun is often absent.

Most of the people who contracted the flu were people who deal with live birds ... and often touching their feces and entrails. The first child (a 3-year-old) who died of avian influenza in 1997 lived in a crowded market in Hong Kong, surrounded by live poultry.

[Avian flu is not presently believed to be transmitted person-to-person by aerosol, but scientists worry that the ease with which it mutates could see it do just that in the future.]

True, this is the concern. This could happen inside humans, and also inside pigs, which are similar to moving mutation labs. Re-assortment could occur. A particle from one virus and a particle from another could unite, forming H3N1 or H5N3, for example.

In this case, the new strain will be transferred from humans to humans, something that has never occurred so far. Any virus entering the body messes with the cell components and changes inside the body.

This is why every year we advise people to get vaccinations against influenza. It changes shape every year. Here at the center, we collect samples of influenza, which we send to one of four collaborating centers which collect the samples from all over the world and try to think of the pattern the influenza virus will be following next season.

This is done in February, and the new vaccine is ready for use in August, but is best taken these days [in early fall].

Not at all. They are of absolutely no use against bird flu, but it is still important to take them to protect against less dangerous strains.

But labs all over the world have been working on manufacturing a vaccine against the new virus, H5N1. In 2004, they declared they had finally discovered it. Factories are waiting for the WHO’s word to start producing. This will only take place in case of a pandemic.

There are drugs available that have proven successful in containing the virus. Tamiflu and Relenza are both neuraminidase inhibitors, thus stopping the effect of the virus. But like any drug, they have adverse effects.

Neither drug is available in Egypt at the moment, but the Ministry of Health has already ordered them and they will be released only if there is an outbreak of bird flu.

We currently have amantadine and rimantadine, which are not very effective. The ministry’s point in not releasing the medication is fear that anyone with regular influenza will self medicate, especially anyone who keeps birds or poultry.

Our biggest fear at the moment is from visiting birds, not the birds we already have.

True, but the cases have been avian, not human, and were quickly contained. Migratory birds are on their way to Egypt, so we should put a ban on hunting them, especially ducks, which act as a reservoir for all kinds of viruses. Viruses live in their digestive tracts and come out with the feces. Anyone who hunts the birds and then guts them to clean the entrails is in grave danger of catching it.

The ministries of health, agriculture and environment are working together to control the situation. Any cases of dead birds or poultry must be turned over to the ministry, and will eventually come to us here at the center, where we will test for the H5N1 virus.

One thing I would really want to draw attention to is that all poultry farms that fall in the way of the migratory route must be moved. The ministries of agriculture and environment are well aware of these routes. If migratory birds were to mingle with domestic poultry, they could very well infect them.

Any suspicious cases must be turned over immediately and all birds in the neighborhood must be killed. This is the best way to contain the virus.

It is too early for panic. But we should panic if ever the virus starts spreading from humans to humans, which has not yet happened. There was a suspected case of human-to-human contraction in Vietnam, where members of a whole family fell sick one after the other. But the WHO has probably overlooked the fact that the family lived in close contact with poultry and could have been infected by the birds. When it was moved to hospital, the family did not infect other patients or staff.

Awareness remains the most important thing. People must be aware of the situation and must report anything suspicious. et