Columbia University Pandemic Flu Response

What Is “Pandemic Influenza?"

Influenza – “flu” – is widely familiar, causing epidemics every year. Influenza viruses spread very well from person to person.

A pandemic is an influenza epidemic so large that the entire world is affected. Two main conditions are required for an influenza pandemic: the influenza virus strain must be novel to the human population (so that most of the population does not already have some immunity to), and it must be able to spread efficiently from person to person.

What is the “Bird Flu” I’ve heard so much about?

“Influenza pandemic” and “avian flu H5N1” (also called “bird flu”) are not the same thing. The H5N1 virus is one type of avian flu virus. While it meets the test of novelty, it hasn’t yet developed the ability to spread well among humans (and may never). If the current “bird flu” evolves to spread efficiently from person to person, it could well become the next pandemic. But so far it hasn’t done that, and we don’t know when, or if, it will. 

We hear much about it because public health authorities are concerned about this H5N1 avian flu, which currently is very rare among humans. In the past, avian influenza viruses such as H5N1 have caused serious disease in poultry around the world (farmers and veterinarians used to call it “fowl plague”), but not in humans. The first known human cases of infection with H5N1 influenza were in Hong Kong in 1997. It is believed that the original patients caught the infection through close contact with live poultry.

Since 1997, the H5N1 flu virus has undergone further evolution in wild waterfowl. In 2003, H5N1 reappeared in southeast Asia, including Thailand, Vietnam and Indonesia. The newer versions of this virus caused more severe disease than the 1997 Hong Kong virus. Over the past two years, China, Turkey, Egypt and several other countries have reported cases in both poultry and humans. The World Health Organization (WHO) has been maintaining a count of officially confirmed human H5N1 cases. Although most of these cases appear to be due to direct contact with infected poultry or eating uncooked poultry products, some human-to-human transmission within families also may have occurred. Presently, the WHO considers the status of H5N1 in humans to be “no or very limited human-to-human transmission.” Public health authorities are watching H5N1 carefully for any signs that the virus is evolving to transmit readily from person to person.  Unless that happens, H5N1 will remain a concern for agriculture and for some people who have close contact with infected poultry, but not a health threat for the general public.

How likely is a flu pandemic?

Most scientists believe that occasional influenza pandemics are inevitable, like earthquakes or hurricanes.  Influenza pandemics have been documented several times in the 20th century and earlier, including 1918-19 (the most severe on record, with an estimated 50 million deaths worldwide), 1957 and 1968.  Unfortunately, scientists cannot predict exactly when a new influenza pandemic will occur, which influenza strain will be responsible, or how severe the pandemic will be. This means that public health authorities, like the people who track earthquakes or hurricanes, must be on alert to try to spot pandemics as early as possible.

There are many possible influenza strains that are novel to the human population, especially in wild waterfowl, and influenza viruses are constantly evolving. Luckily, many of these influenza strains are not able to infect humans, and efficient person-to-person spread is difficult for novel influenza viruses to achieve. For this reason, pandemics generally occur only a few times a century, not every year.

What can I do to protect myself?

The primary defense against influenza is immunization. An influenza vaccine must be made using the actual pandemic-causing virus; therefore, there will be a delay of four to six months in developing and producing sufficient supplies. Once the new vaccine were to become available, Columbia University would make arrangements to immunize students, staff and faculty.

In the meantime, several protective measures can be taken:

• Keep informed and stay tuned. There is no need to stay awake nights worrying about H5N1 (so far, it poses a very small risk to humans) or the next pandemic. But it is important to stay informed in case the situation changes. This website will be updated whenever important changes occur.

• Wash your hands before and after preparing food, before eating, after using the bathroom, after touching your nose or eyes, or after coughing. Ordinary soap and water, or alcohol-based hand cleaners like Purell® that contain at least 60% alcohol, work well in preventing illnesses including "regular" influenza.

• Cover your coughs and sneezes. Sounds elementary but it can make a difference! And wash your hands (or use an alcohol hand cleaner) afterward!

• Take good care of yourself and your family. Stay home (or in your room). If you think you or a family member has the flu, stay home and take care of the symptoms (bed rest, lots of fluids, acetominopnen/Tylenol - not aspirin - for aches and fevers). If possible, stay home until you, and/or your family, have fully recovered.

• If there is a pandemic, or even a heavy ordinary flu season, consider avoiding large gatherings or crowds when feasible. If you think you have the flu, stay away from crowds, and stay home as much as possible.

• Do not go to the emergency room unless absolutely necessary. In a bad flu year, flu patients can flood the hospital and also spread the infection to other people.

• If you are feeling sick enough to need medical care, call your regular doctor or the University health services:

Student Health Services (Morningside): (212) 854-2284 or (212) 854-7426
Student Health (CUMC): (212) 305-3400
Occupational Health Service: (212) 305-7580

• Flu on surfaces is easily killed by detergents, disinfectants, bleach and other normal household cleansers. Since person-to-person transmission is more of a risk than that from environmental surfaces, no special precautions are needed in this regard.

• Keep an extra supply of non-perishable food, water and medications on hand, in case you have to stay inside for a while. This is a good general precaution for many other emergencies, such as severe weather or power outages. In case of a flu pandemic, people may need to stay at home (or in their dorm rooms) for several weeks.

• The annual “flu shot” won’t prevent pandemics, but it may help prevent illness associated with the "regular” flu. Even the ordinary flu causes millions of lost work days and about 35,000 deaths annually in the United States alone. Flu shots may help to reduce the chances of catching the flu, or reduce the severity of the disease if it is contracted. This precaution can also help to prevent overcrowding in hospitals, clinics and doctors’ offices so that healthcare workers are able to concentrate on those who are the sickest.

I’ve heard about Tamiflu. Should I take it?

There are antiviral medications including Tamiflu® and Relenza®, which show promise against influenza, but they are not panaceas. Experts are unsure exactly when it is best to take these medications for maximum effect. Many worry that the influenza virus could become resistant if these drugs are overused. 

What about masks?

It is tempting to consider wearing masks when going out into crowds, and wearing a mask may make you feel you’re avoiding some risk. However, at this time, there is no evidence to suggest that masks will be useful for preventing flu in the general population. (Used properly, the right kind of respiratory protection is important for trained healthcare workers to wear on the job, as part of normal infection control procedures.) Patients going to hospitals with a flu-like illness will probably be given a mask to put on, in order to help reduce spread to others. However, the kind of special masks (which are really respirators) worn by healthcare workers are not comfortable to wear for long periods and require proper adjustment and training to be effective. We are not recommending them for the general public at this time.

What if a pandemic DOES happen?

Much of the same common-sense advice will apply during a pandemic as is recommended for avoiding the seasonal flu. As always, stay well informed and look for up-to-date information from this website, the local Health Department and Health Services at Columbia. Your health and welfare are a prime concern of the University, and we are committed to keeping you up to date, providing the best available information and reducing the impact of a pandemic as much as possible. The University is also developing comprehensive and up-to-date pandemic plans to prepare for when it may happen.

Where can I get more information?

• The websites listed in the Resources section of this website are good sources of information.

• We will update this website if the pandemic influenza situation changes.

• Do you have a question not covered here? If you can't find the answer on this website or one of those mentioned in the Resources section, e-mail us at ehs-hs@columbia.edu and we’ll add your question to this website.