A Pandemic That Wasn’t but Might Be

Last year, for the first time since avian flu emerged as a global threat, the number of human cases was down from the year before. As the illness receded, the scary headlines — with their warnings of a pandemic that could kill 150 million people — all but vanished.

But avian flu has not gone away. Nor has it become less lethal or less widespread in birds. Experts argue that preparations against it have to continue, even if the virus’s failure to mutate into a pandemic strain has given the world more breathing room.

There were 86 confirmed human cases last year compared with 115 in 2006, according to the World Health Organization, and 59 deaths compared with 79. Experts assume that the real numbers are several times larger, because many cases are missed, but that is still a far cry from a pandemic.

Dr. David Nabarro, the senior United Nations coordinator for human and avian flu, recently conceded that he worried somewhat less than he did three years ago. “Not because I think the threat has changed,” he quickly added, but because the response to it has gotten so much better.”

The world is clearly more prepared. Vaccines have been developed. Stockpiles of Tamiflu and masks have grown. Many countries, cities, companies and schools have written pandemic plans. The European Center for Disease Prevention and Control, created in Stockholm in 2005, just estimated that the European Union needed “another two to three years of hard work and investment” to be ready for a pandemic, but that is improving because previous estimates were for five years.

In the worst-hit countries — all poor — laboratories have become faster at flu tests. Government veterinarians now move more quickly to cull chickens. Hospitals have wards for suspect patients, and epidemiologists trace contacts and treat all with Tamiflu — a tactic meant to encircle and snuff outbreaks before the virus can adapt itself to humans.

Bernard Vallat, director general of the World Organization for Animal Health, recently called the virus “extremely stable” and, thus, less likely to mutate into a pandemic form. Many prominent virologists would vehemently disagree. But others who argued three years ago that H5N1 would not “go pandemic” are feeling a bit smug.

Dr. Paul A. Offit, a vaccine specialist at Children’s Hospital in Philadelphia, was one of those who, he jokes, “dared to be stupid” by bucking the alarmist trend in 2005.

“H5 viruses have been around for 100 years and never caused a pandemic and probably never will,” he said.

But Dr. Offit said he backed all preparedness efforts because he expected another pandemic from an H1, H2 or H3, the subtypes responsible for six previous epidemics, including the catastrophic one in 1918.

“What I worry is that this has been a ‘boy who cried wolf’ phenomenon,” he said. “When the next pandemic comes, people will say, ‘Yeah, yeah, we heard that last time.’ ”

Some who were Cassandras in 2005 still are.

The fact that human cases fell slightly last year is “pretty much meaningless,” argued Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. The virus is still circulating and has evolved 10 clades and hundreds of variants.

World preparations thus far are “incremental,” he said, “like sending 10 troops to a war when you need 10,000.”

He noted that the H3N8 flu found in horses in the 1960s took 40 years to adapt to dogs, but that since 2004 it has spread to kennels all over the country.

The most worrisome aspect of H5N1, virtually all scientists agree, is that it persists in birds without becoming less lethal to them.

“This is the most serious bird flu virus that has ever been known,” Dr. Nabarro said. “By 2007, it was in 60 countries. It must be dealt with.”

Despite the culling of hundreds of millions of birds and the injection of billions of doses of poultry vaccine, the virus is out of control in some of the most populous countries — though exactly which ones are in dispute, because some are touchy about conceding that they cannot rid their flocks of it.

Dr. Vallat has named three countries where it is now endemic in local birds: Egypt, Indonesia and Nigeria.

Dr. Nabarro added Bangladesh, Vietnam and parts of China. Reports of recurrent outbreaks also persist in parts of India, Myanmar and Pakistan. Last week, villagers in India were reported to be killing and eating their flocks before government cullers, who paid less than a third of market value, could seize them.

Dr. Henry L. Niman, a biochemist in Pittsburgh whose Web site tracks mutations, argues that there is a separate reservoir in wild birds that extends across Eurasia. Late each fall, fresh outbreaks appear across Europe and down into the Middle East as geese and swans migrate from Asia toward Africa.

In December, dying birds were found in Poland and Russia, in Saudi Arabia and even in a kindergarten petting zoo in Israel.

On Jan. 8, it reached one of England’s most famous swan-breeding grounds, the Abbotsbury Swannery, which has been around since the 11th century.

The Western Hemisphere is in less danger, according to a study published in the journal PloS Pathogens, which analyzed viruses found in migratory birds sampled from 2001 to 2006 in Alberta and along the Jersey Shore. It found that none carried whole viruses from Eurasian bird pathways.

Therefore, the authors argued, it is more likely that any importation of the virus would be in “birds moved legally or illegally by humans.”

It may be even more likely that a human will be the first carrier. There was a close call in early December, when six members of one family in northern Pakistan fell ill, probably infected by a brother who had culled sick poultry.

Another brother, who lived on Long Island, went to Pakistan for the funeral and felt sick when he returned home. He turned out not to have H5N1, but it showed how easily the virus could have reached the Western Hemisphere.

Pakistan had its first human cases last year, as did Laos, Myanmar and Nigeria.

Many small mutations have been recorded that seem to make the virus more adaptable to humans and more resistant to known drugs, but no combination of those producing a superstrain has yet emerged.

Ninety percent of cluster cases have been among blood relatives, and Dr. Arnold S. Monto, an avian flu expert at the University of Michigan School of Public Health, said that suggested a genetic susceptibility that has not yet been defined.

It has long been known that the virus has difficulty attaching to receptors in human noses. A team at M.I.T. has refined that, showing that those receptors come in two shapes, cones and umbrellas, and that avian viruses attach more easily to the cones.

Rapid progress has been made in vaccines. The newest, Dr. Monto said, need just small amounts of antigen — 4 micrograms an injection instead of 90 micrograms — making them much more practical to produce.

Some scientists argue for vaccinating millions of people as a precaution. One dose, even if it is based on a three-year-old strain, might protect against death, if not infection. A second, fully protective dose could be made up from whatever strain has gone pandemic.

Right now, said Dr. Klaus Stöhr, who was chief of flu vaccines for the W.H.O. and now does the same for Novartis, it would take manufacturers about one year to produce a billion doses of any vaccine based on a new pandemic strain. But the pandemic would have circled the globe within three months.

“The peak would be over, and, principally, you’d be vaccinating survivors,” Dr. Stöhr said. Switzerland, he added, has a vaccine stockpile and plans to test it on soldiers, police officers and health care workers before deciding whether to offer it to all Swiss.

Because of the American swine flu debacle of 1976, in which a vaccine made against a pandemic that never emerged harmed more people than the flu did, experts say they think it is unlikely that many Americans would be willing to take such precautions.

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Yikes, the fanciest sushi in NY loaded with mercury.

Today, The New York Times is reporting the finding of very high levels of mercury in tuna sushi in recent lab tests commissioned by the newspaper from a sampling of 20 Manhattan restaurants and food stores. Included in the study was sushi from some of the most prestigious food palaces, including Drew Nieporent's Nobu Next Door, part of the famed Nobu restaurant chain, as well as the high-end grocer Gourmet Garage.

According to The New York Times, "Tuna samples from the Manhattan restaurants Nobu Next Door, Sushi Seki, Sushi of Gari and Blue Ribbon Sushi and the food store Gourmet Garage all had mercury above one part per million, the “action level” at which the F.D.A. can take food off the market. (The F.D.A. has rarely, if ever, taken any tuna off the market.) The highest mercury concentration, 1.4 parts per million, was found in tuna from Blue Ribbon Sushi. The lowest, 0.10, was bought at Fairway."

Other critical findings:

Higher-priced blue fin tuna sushi, such as that often served at the most prestigious restaurants, had the higher levels of mercury.

A scientist involved in the study recommended limiting the consumption of tuna sushi suspected of high mercury contamination to no more than once every three weeks.

In a separate study last fall, New Yorkers' mercury blood level was found to be three times higher than the national average, according to the New York City Department of Health and Mental Hygiene, especially among Asian-born New Yorkers and the more affluent. It is thought that both groups eat more fish than many other groups in the city.

"Many experts believe the government’s warnings on mercury in seafood do not go far enough," according to the NYT.

The disturbing bottom line of the article by noted nutrition expert Marian Burros is that the mercury levels found in NYC restaurants are likely be present in eateries in other parts of the country. And for a population told for years to eat fish for better health, that's a dangerous disappointment indeed.

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7 things to say (and 7 things not to say) to your kids

Watch What You Say

The buzzer sounded in the gym in Melbourne, Florida, and the basketball game was over. Even though 12-year-old C.J. Givens's team had lost, his aunt Melanie was ecstatic. C.J. had scored every single one of his team's 24 points -- including a couple of three-pointers. As he loped over to his family waiting in the bleachers, the hugs and compliments started flying: "You were awesome!" "Way to hustle for all those points!" Then C.J.'s aunt said, "Now, if you could just help your teammates play as well as you do, you guys would be unstoppable!"

"What do you mean?" C.J. said defensively. "I did the best I could! What didn't I do right?" His aunt couldn't understand the boy's reaction. She'd just finished showering him with praise.

"The message C.J. got was that he didn't do enough," explains child psychologist Vicki Panaccione, PhD, founder of the Better Parenting Institute in Melbourne. "His aunt was telling him he was so fabulous, he could be a mentor to his teammates. An adult would have gotten that. But that's not what he heard, because of the words she used."

A parent, or anyone else who interacts regularly with kids, knows that communicating effectively with them can be difficult. In C.J.'s case, his aunt simply explained herself and the boy calmed down. But common words and phrases, no matter how well -- intended, can do emotional and psychological harm. Young brains are still developing through the teen years, and kids can't be expected to process words, context and nuance (sarcasm, for instance) the same way that an adult's brain does.

How to Say It #1-2

If you want children to grow up into the best possible versions of themselves, it's crucial to replace damaging words in your vocabulary with alternatives that help build character. Some of the things parents say to kids seem harmless or even constructive on the surface, but, experts say, they may hurt more than help. Here are seven of these common phrases, and alternatives to get your message across in a better way.

1. What you say: "You're the best!"
What they hear: "Your job in life is to make me happy."
A better way to say it: "You should be proud of how hard you worked."

For years, we've been told that boosting a child's self-esteem is important to his or her success in life. But child experts are now learning that too much praise can backfire. Praise-aholic tykes who expect it at every turn may become teens who seek the same kind of approval from their friends when offered a joint or asked if they want to go in the backseat of the car. The implication of saying "You're the prettiest girl in class," or talking about the goals she scored but not her overall effort, is that you love her only when she looks the best, scores the highest, achieves the most. And this carries over to the classroom.

Social psychologist Carol Dweck, PhD, tested the effects of overpraise on 400 fifth graders while she was at Columbia University. She found that kids praised for "trying hard" did better on tests and were more likely to take on difficult assignments than those lauded for being "smart."

"Praising attributes or abilities makes a false promise that success will come to you because you have that trait, and it devalues effort, so children are afraid to take on challenges," says Dweck, now at Stanford University. "They figure they'd better quit while they're ahead."

2. What you say: "Watch your language!"
What they hear: "I've tuned out what you're really trying to say."
A better way to say it: "I'm so glad you came to talk to me, but I have one request for the future. I find that word offensive, so please don't use it."

You probably want to keep George Carlin's "Seven Words You Can Never Say on Television" out of the house, even though you do hear them on TV these days. But Panaccione advises a more lenient policy toward contemporary jargon like "This sucks" when it comes up during the course of a conversation. This is the way modern kids talk; they aren't trying to be disrespectful. When parents shift the focus to the words themselves, the point of the talk may be lost forever, and the kid shuts down. "This is the last thing you want," Panaccione says. "Parents are lucky if kids are actually talking to them." Just remember the time for talking about offensive language is at the end of the real discussion.

3. What you say: "We can't afford that."
What they hear: "Money is the answer to everything."
A better way to say it: "The store is filled with great things today, but we've got lots at home already and we're not going to bring home anything more."

Does your child really need one more video game or doll? Of course not. But by repeatedly saying money is the only reason he or she can't have something, the parent may be sending the message that money is the source of all things good in life. Couple that with the marketing blitz everywhere they turn, and children will never get the meaning of excess or gratitude.

"You want your children to have the sense of abundance until the age of five—not in a material way, but in the sense that what you do have brings joy," says Marcy Axness, PhD, a child development specialist and founder of quantumparenting.com.

Finances are one of the few topics parents shouldn't feel a duty to discuss or explain, especially with younger kids, Axness says. "If every request is met with a legal brief as to why they can't have it or go there, you will end up with a child who is going to outnegotiate you." Don't be afraid to say to your little one, confidently and cheerfully, "No, sorry. Case closed."

If it's your older, money-wise child who's asking? Sit down with her and work out together how she can make the purchase happen -- as a reward for improved grades, say, or by buying it with an allowance for doing extra chores. The process of talking it through matters more than how much each contributes.

4. What you say: "Don't worry -- it'll be okay."
What they hear: "You're such a drama queen!"
A better way to say it: "I totally understand what you must have gone through. Tell me about it."
When a child comes home upset about being teased by classmates or not winning a medal at the swim meet, it's only natural for parents to downplay his disappointment and offer consolation. Adults know that such setbacks are minor.

"But kids need to learn how to express feelings, work through them and move on, as opposed to trying to make them go away without expression," says Panaccione. If children feel that they shouldn't have feelings or that their feelings are bad, they'll start to lock them inside and fail to adopt healthy coping strategies, she says.

On the other hand, kids shouldn't wallow in bad feelings. A question like "Why do you think this happened?" or "Do you have any ideas about what you can do to make it better?" may give them the nudge they need to deal with situations on their own. Says Mel Levine, MD, a professor of pediatrics at the University of North Carolina at Chapel Hill: "A parent gives more comfort by listening than by talking. If you simply resonate with your child's mood, then you'll have a child who's always willing to come to you and bare her soul."

5. What you say: "Don't talk to strangers."
What they hear: "Anyone you don't know is trying to hurt you."
A better way to say it: "Don't talk to people who make you feel uncomfortable. Here's how to tell."

Kids today need to, and do, talk to strangers all the time—at the store checkout, on the bus, in the doctor's office. This antiquated catchphrase is no substitute for a serious one-on-one about the real risks.

First, parents need a reality check: Despite the sensational stories, cases of children snatched off the sidewalk by total strangers and never seen again are extremely rare. Just 1 percent or fewer of all abductions happen that way. Meanwhile, children are frequently victimized by people they know well, including authority figures. That's why it makes more sense to tell kids to be wary of anyone, stranger or acquaintance, who makes them feel at all uncomfortable.

Parents of kids who spend time on the Internet should warn them against giving information that would identify their whereabouts, such as their last name, address or school name, advises James Beasley, an expert on child predators for the FBI. And kids should always tell their parents about new online buddies, especially those who ask if the child is willing to keep a secret.

6. What you say: "Make sure you share."
What they hear: "Give away your stuff."
A better way to say it: "Jesse would like to play with your race car for a while, but it's still yours and he will give it back."

You'd never hand the keys to your sports car to the guy next door. But that's what you're asking your children to do when you tell them to share a toy. "Young kids don't distinguish clearly between themselves and the objects they own or cherish, like their teddy bear or favorite toy train," says psychologist David Elkind, PhD, a professor at Tufts University and the author of The Hurried Child. "So in effect you're asking them to give away part of themselves."

In extreme cases, if a child is forced to relinquish prized possessions over and over, the separation becomes so painful that he may avoid forming attachments to people, Elkind says. Kids don't really begin to grasp the concept of sharing until age eight or so. Before then, it's still important to begin instilling nuggets of selflessness. One solution is to put your child's name on the toy before you pry it out of his hands, so he knows you're not forcing him to relinquish ownership.

7. What you say: "Why did you (miss your curfew, hit your sister, etc.)?"
What they hear: "You messed up again."
A better way to say it: "My guess is that you missed your curfew because you were having fun and didn't want to come home, but that's still not okay."

Parents ask way too many questions, child psychologists say. Some are directives in disguise ("Don't you think you should put your coat on so you won't get drenched?"), meant to make parents seem less like dictators and more like benevolent helpmates. And then there are the ones parents already know the answer to (he hit his sister because he was mad that she took his favorite toy). The goal: Shame the child into a confession.

This approach may solve a short-term headache, but it creates a long-term problem. Parents need to tell kids when they mess up. Doing so breeds a sense of guilt, which in turn lays the foundation for a sturdy conscience. But feeling too much shame early in life can shut down the development of guilt. "Kids without consciences are kids who never developed the capacity to feel what someone else feels, which could lead them to steal, lie, start a fight or even commit violent crimes," Axness says. Children take comfort in the fact that their parents see and know all. Better just to say you're aware of what they did, or at least make a guess at it, and then explain why it was a bad idea. If you're wrong, you'll be corrected quickly. And that can be the starting point for a productive dialogue.

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