The 100th anniversary of the flu pandemic of 1918–1919—which killed approximately 50 million people, both young and old, over a period of about nine months—looms ominously over the world.

Even with all the medical advances that have been made in the last century, it’s possible that a similar deadly pandemic could occur again, according to many infectious disease experts. To learn more about the possible risks of a modern-day pandemic and the best ways to protect ourselves, Bottom Line Health spoke with Miryam Z. Wahrman, PhD, a leading authority on communicable diseases.

We seem to hear the term “epidemic” more than “pandemic.” What’s the difference? An epidemic occurs when an infectious disease spreads rapidly to many people, exceeds what is expected based on recent experience and is typically concentrated in a particular geographic region. One example is the 2014–2016 outbreak of the Ebola virus, which was centered in West Africa and killed more than 11,000.

A pandemic is an epidemic that spreads across a large region (potentially globally), is spread from person-to-person and affects a high proportion of the population. Besides the flu pandemic of 1918, another example is the 2009–2010 H1N1 influenza pandemic that killed an estimated 200,000 people worldwide.

Do you think a new pandemic is coming? Based on the prevalence of infectious diseases in every corner of the globe, the history of past epidemics and the frequency of worldwide travel, there’s a high likelihood that new (or old) pathogens will emerge in the near future.

There are constantly outbreaks of infectious diseases all over the world, including in developed countries. Some diseases originate in animals and are passed to humans, where they become serious threats to large populations. Other disease outbreaks occur as a result of a deliberate choice of people not to vaccinate or occur when viruses, bacteria or other microbes genetically change and evolve into new forms that evade our immune systems, or resist antibiotic treatments. It is critically important to track diseases all over the world in order to document outbreaks that could lead to epidemics or pandemics.

Can anyone predict which disease may cause a pandemic? While it’s impossible to definitively predict which viruses or bacteria will spread widely, many scientists believe that the flu strain H7N9, known as the avian flu, has the greatest potential to become an epidemic—and eventually spread globally into a pandemic.

H7N9, a subtype of influenza A, has been circulating in poultry for years. In 2013, China reported the first known cases of a new strain of H7N9 in humans. The World Health Organization (WHO) reports that since 2013, 1,554 humans have been infected with H7N9 in China and roughly 40% of patients have died from the disease.

In the latest wave of H7N9, October 2016 to July 2017, the highest number of cases was reported, suggesting that according to the WHO, “the virus is spreading, and…further intensive surveillance and control measures…are crucial.” There have been no reports of H7N9 in the US yet, and it appears that the virus is transmitted from poultry to humans and seldom from human to human. However, if that transmission pattern changes, it would herald the potential for H7N9 to become an epidemic/pandemic.

Some diseases in bats are also candidates for eventual transmission to humans.

Why are we at risk for another pandemic? Our world population has more than doubled in the last 50 years, which means there are more people to infect—and to infect others. Also, more people than ever are traveling the globe. An infected person can travel to the other side of the world in as little as a day.

Global climate change is another concern. As parts of our environment become warmer, disease-carrying insects move to new areas and expose more people.

Also, while antibiotics have increased life expectancy, use and abuse of these medications lead to the development of antibiotic-resistant bacteria, or “superbugs,” that are difficult or impossible to treat. Two such superbugs, found mainly in health-care facilities, are Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA). They kill thousands in the US each year, although infections have declined due to improved medical procedures.

Can pandemics be prevented? With the development of the Internet and advances in telecommunications and air travel, scientists are better able to collaborate and share data. By sharing resources and scientific research between countries, diseases can be contained.

Also, the development of vaccines and new antibiotics against these contagious diseases is critical. Pharmaceutical companies are reluctant to spend resources developing and producing vaccines and antibiotics because it is not as profitable as selling drugs used for chronic diseases.

What can we do to protect ourselves? One of the very best ways to keep germs at bay is to practice proper handwashing. Don’t wait for a pandemic to comply.

My advice: Wash your hands with plain liquid soap and warm water, scrubbing for at least 20 seconds. Antibacterial soaps have become popular, but some studies have shown that they promote the development of drug-resistant bacteria.

Also, studies have shown that using a single-use paper towel in public restrooms is more effective at ridding bacteria from the hands than warm-air dryers or jet dryers, which have been found to spew harmful microbes into the air. When soap and water are not available, hand sanitizers, such as Purell, are a good choice, but they do not get rid of superbugs such as C. difficile.

It’s critical to wash your hands before touching your eyes, nose or mouth—the most common routes for germs to enter the body. Also, be sure to wash your hands before eating. And insist that health-care workers wash their hands before touching you or your loved ones.

Are there any other precautions that people should be taking? Phones, smartphones, keyboards and tablets have been shown to harbor bacteria and other harmful germs. It’s a good idea to clean these devices by wiping the surface down, as needed, with a microfiber cloth or tissue lightly moistened with 70% rubbing alcohol.

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