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H7N9 - Don't buy weapons at wartime


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Once the source of the H7N9 infection is found, how should the Chinese authorities you organize the response? Regarding that it is more than likely that animal-to-human contact could cause a human pandemic, all existing response methods are doomed to fail.

One of the remaining options is the novel Anoxia method, based on the absence of oxygen under atmospheric conditions. When the Chinese authorities able to apply this technique throughout all provinces, using well-equipped and trained firefighters, they could be able to stop the pandemic before it starts. The Anoxia method is therefore the weapon of choice.

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H7N9 - Don't buy weapons at wartime

  1. 1. Page 1 of 8 4/29/2013Safe Culling Methods in EmergencyResponse to the Current H7N9Outbreak in ChinaIntroductionThe central theme of this paper is which culling methods to choose and howtoorganize the response to deal with the current outbreak of the H7N9virus in China.Last MondayApril 22nd, 2013 the WHO announced that anumber of people who hadtested positive for a new strain ofbird flu in China had no history of getting in direct contactwith poultry. State media reported that the total number ofH7N9 bird flu cases had increased to more than 100. Thevirus that has killed over 20 people to date continues todevelop and it´s characteristics remain a mystery.In the case of this outbreak of H7N9 the source of infection is yet unknown. Itappears in animals and humans alikeandsince this is a new strain there still is novaccine available for humans or animals.We don’t know which mammals arereceptive to H7N9. There is no other option than to mass cull all diseased andsuspected animals to stop the spread of the virus. During this process the operatorswill have to make sure the culling operations themselves o not spread the virus evenfurther.How would you communicate the risks to all people whomusthandle diseased animals as part of their duties? Theirpersonal life might be at risk. The Case Fatality Ratio(CFR)calculated as of 21 April 2013amounts to 21%. Thepotential CFR, if the present number of serious cases withsevere flu symptoms is included, grows up to 78%.That is aserious risk compared to the CFR of 0,45%1for the H1N1‘Swine influenza’ virus (WHO 2009).Considering the high CFR there should be absolutely nocontact between humans and (possibly) infected animals. This makes all techniquesand methodologies to cullanimals, which have been used in the past obsolete. Thereare no proven techniques for mass culling available, other than brute force and alarge number of people to carry out the operation. This would be detrimental to thegoal of containing the virusIn this presentation I will outline the available methods for mass culling of farmedanimals and propose a novel method, which eliminates direct contact between relief1 outbreaks April 24, 2013Disinfection at checkpoint inChina
  2. 2. Page 2 of 8 4/29/2013workers and animals. Eradication of contamination does not only requireappropriate technology but also a functional organizational structure as well as well-trained staff. I shall also go into these aspects to propose a full working solution toeffectively deal with the present situation.Culling MethodsStart from scratch and virtually unpreparedChina has developeda large-scale and densely populated farming industry (in thecoastal regions); traditional small-scale based farming systems (close to towns) and alarge number of backyard farms (in the counties). In an ideal scenario every farmwould have its own depopulation plan, but obviously this is not the case. It wouldimply local workers are being aware of the principles of biosecurity and are able totransfer knowledge to the farmers in the field.This is still a bridge too far in China.This makes creating tactical plans for mass culling operations very complicatedbecause of the huge differences in tackling the problem of reducing the spread ofthe virus. When a crisis is announced, the workersare turned into culling staff andordered to eradicate the virus. Let´s have a look at the options at hand.Traditional mass killingIn times of a viral pandemic crisis, the local crisis manager isin charge. The only method he is familiar with is thetraditional method of mass culling of (potential) virus-carrying animals. He has been drilled in following ordersthat have been construed to kill suspect animals as quicklyas possible. No consideration has been given to the risk ofturning relief workers into virus carriers.Let’s assume the outcome of research on H7N9concludes thatpoultry is one of the sources of infection, what are the options?In Asia, poultry is normally culled by sending in a large army of poorly trainedlocalworkers. Usually under-equipped field workers with large bags; chasing animals,catching them and putting them in a bag. Next cause of action is to hit them as hardas they can until the animal is dead. The last phase is throwing the bags in a pit; addfuel and woodchips to the pit and burn the animals. Job finished.International standards, human safety and animal welfare are not part of theequation.Assumeanother type of mammal would be a source of infection, whichtechniques areavailable, and could they be applied?For other animals, there are no standard methods available to cull large quantities inthe field. The results of the mass culling of pigs in South Korea in 2010 shows thateven in a country with a well-developed agricultural industry, mass depopulation ofTraditional culling ofChickens in Asia
  3. 3. Page 3 of 8 4/29/2013in total 1/3 of the countries pig population. This has led to catastrophic2failure ofemergency response measures, including live burial and live incineration of pigs.Techniques instead of human powerChina haslearned from SARS response measures and is likely to be able to activateemergency response measures according to their plans much better than any of theneighboring countries. However, sending in large groups of workers, or large groupsof military personnel would increase the risk of human infections. In this case therisk is not just that people get sick, but also because there is a the risk that theycould become carriers of the virus. This time, the culling must be carried out with anabsolute minimum of workers.Using Techniques instead of a huge pool ofmanpower. That is new to China.What are the options?Modern slaughter/killing techniquesWhat slaughter/killing techniques have been developed so far that could be applied?The first methods to think of are the more traditional slaughter/killing methodsthatare in use during normal slaughter procedures.E.g:Take the methods described inthe EU Legislation EU 1099/20093.Thesecame into force January 1st, 2013.Method 1) knifes (Halal, mainly in Asia and Africa4)Method 2) electrical shock methods (poultry, sheep,pigs, sheep, goats)Method 3) gas (CO2 as gas or as dry ice)Method 4) lethal injection (killing method for all animaltypes)Method 5) shooting masks (penetrating/non-penetrating)Method 6) barbiturates (killing method)Method 7) gunsMethods 1, 2, 3, 4 and 5 are not applicable because they include Animalto Humancontact. In all of these methods, animals need to be handled by personnel in oneway or another and/or include bleeding the animals to death. Only the use of poisonsand gunsis an option amongst traditional slaughter/killing methods. Unfortunately,in practice, these methods prove to be very difficult to execute during outbreaksituations.Mass depopulation methodsSpecific methods and techniques of mass culling have been developed duringprevious outbreak situations in both Europe and North America. All of them havebeen based on the principles of Hypoxia and suffocation.Method 8) Stable gassing: drive all animals into barns and close all doors; andwindows; close all ventilation holes; cover all walls with plastic sheets and startpump in CO2 gas. This method is based on the principle of hypoxia (reducing the2
  4. 4. Page 4 of 8 4/29/2013level of oxygen) and is in use in Europe and Northern America to cull largenumbers of broilers.Method 9)water based Firefighting foam: put all animals under a blanket of verysmall foam bubbles, blocking the Trachea of the animal; a method based onsmothering animals to death. In use in the USA to cull large numbers of broilers.Method 10) Container/big bag culling: animals are collected out of their stablesand carried to closed containers or big bags filled with CO2.Method 8 and 9 are ruled out due to the absence of these techniques in Asia and thusthe absence of well-trained operators. Method 10 is ruled out because it calls forAnimal to Human contact.Brutal methodsWhat are left are the more brutal and cruel methods. These methods are obviouslynot described in national plans. Besides the absolute cruelty and total neglect of allinternational standards, brutalmethods are the “weapons of last resort”. Onlyexecuted if there are no other options left.Method 11) drive the animals to lorries and load them up; transport them to alarge burial place (a hole in the groundof at least 10 meters deep); dump theanimals into the pit and bury them alive.Method 12) drive the animals into an old shed: put the shed on fire and burn theanimals to death.Method 13) drive all animals to the river and dump themMethod 14) collect all animals and burn them alive in ovens and furnaces.Cruel methods call for Animal to Human contact.Method 11, 12and 14 demandtransportation, mostly through populated areas. If animals are buried (method 11),dogs can scavenge dead animals out of the pits and the virus can permeate into theground-and thus drinking water. If animals are burned, the heat can dispersecontaminated dust and feathers thus allowing the virus to become airborne. Method13 will increase the risks of infection for everything that lives in the water or on theriverbanks.New techniquesSick, crippled and diseased animals deserve to be treated with respectand inaccordancewith theOIE Terrestrial Animal Health Code5. Without suitabletechniques, there is no room for the OIE Code. In times of crisis everything will beallowed. It is not just an issue of how we treat animals in a humane way. Whendiseases are highly contagious, human safety is at stake as well.During the outbreak ofAvian Influenza in Holland and Belgium 20036it became clearthat the disease spreads much quicker when a lot of people are involved in bringingthe crisis under control. At the start of the outbreak, theReproduction Ratio was5
  5. 5. Page 5 of 8 4/29/20138.67. One farm leads to the infection of 8,6 other farms and the Dutch relief workersplayed a vital roll in the spread of the virus, mainly because of inadequate use ofpersonal protection equipment. As a result 50% of all extension workers werecarrying antibodies8. They played an important role inthe spread of the virusthroughout the countries.Method 14) AnoxiaEvaluating the outbreak and the methods used to contain the spread of the virus,the conclusion was that a radical different methodwas called for, in order toovercome the risk of infections related to the use of culling techniques. Newmethods, specially designed for the purpose of killing sick and crippled animals onthe farm, were required as well as culling a selection of animals on the farm or in thefield or the massindiscriminate culling of large quantities of animals. Thenew methodshould at least meet three criteria:1. Generally applicable to slaughter and kill animals outside the regularslaughter channels, regardless of the species - their size or - their age2. Excluding direct Animal to Human contact3. Maximizing animal welfare, completely in line with the OIE CodeA research project was started in 2004, following the evaluation of the stamping outprocedures (on 1.100 farms) during the H7N7 outbreak in 2003. The result was theinception of what is now called the Anoxia method9.This method is based on theprinciples of total absence of oxygen. The Anoxia method is the first technique that isbased on the on the principles of exposingconscious animals to high Nitrogen levelsresulting in death by anoxia. The principle of Anoxia is part of the New EU directiveEU 1099/200910,which is in force since January 1st, 2013.Prototypes of Anoxia equipment have been developed and the technique has beensuccessfully tested by dr. Marien Gerritzen in both 200711and 201012, carried out atWageningen University WUR (Holland) andby dr. Dorothy McKeegan at theUniversity of Glasgow in 200913.InJanuary 201314a project has been started at the Dutch PIG Innovation Center VICSterksel (part of Wageningen University WUR) to test the Anoxia under practicalconditions.Anoxia15is the medical description of a total absence of oxygen. All mammalsbreathe atmospheric air that contains 78% N2. Air contains also oxygen because itispart of the metabolic processes:oxygen is transported by bonding with hemoglobin,which is presentin red blood cells. The anoxia method results in transporting only7
  6. 6. Page 6 of 8 4/29/2013pure nitrogen to all organs. The absence of oxygen results in the stunning of theanimal after about 30 seconds. Death occurs without any notice.This is how the anoxia method is implementedProduction of large foam bubbles, filled with99% nitrogen gas;Nitrogen is produced by compressingatmospheric air;The air is split in oxygen and nitrogen (theoxygen is released in the atmosphere again)and the nitrogen is used to blow largebubbles;Animals are stunned by immersion in ablanket of bubbles;The animal stays calm, the brain does notissue an alarm as it does not detect the lowlevels of oxygen(unlike gassing with CO2 inwhich the brain will detect alack of oxygenand the animal will panic due toasphyxiation’;The animal dies within 1,5 minutes due to a lack of oxygen.Applicability in ChinaHow to organize a mass culling operation?In case of the latest H7N9 outbreak, officials on the national and regional levels areworking overtime to be able to inform the general population about the risks of thisvirus. There is a big difference in preparing a response organization on national level,on regional (inspection) level and on an operational level:National government officials are responsible for implementing(international) guidelines into legislationRegional veterinary- and human health inspections are responsible forturning these guidelines into standard proceduresLocal officials are in charge of carrying out procedures.In the case of China,Regional inspection services in 34 provinces are working withabout 300.000 veterinarians and human health specialists in order to locate the (stillunknown) source of the infection.All tasks are carried out by local teams in theprovinces, putting the totalnumber of people working on the current H7N9 outbreakon around 2.000.000 to 3.000.000. Most of them are veterinary and human healthworkers (relief workers) responsible for carrying out the procedures that are issued,by local officials. Without the basic knowledge of the source of the virus, their task isso huge and there is hardly any room for training all relief workers in time.Foam nozzle
  7. 7. Page 7 of 8 4/29/2013Thinking two steps aheadAt the moment the source of the infection is found, it is the responsibility of theregional governments to organize and execute the culling operations, leaving theexecution of guidelines in the hands of the largest group: local relief workers. Theycan only rely on what they know, and in most cases they are only familiar withtraditional methods of killing animals.In most cases, these people are only trained inthe basic response principles, which come down to following orders from higherauthorities.Considering the risks of Animal to Human infection, the culling operations should notbe carried out by large masses of unprepared and unskilled local relief workers.Instead of that, the Anoxia method, excluding Animal to Human infection should bethe preferred method of choice, carried out by specially trained staff.A well-trained force is available: the Fire BrigadeProvided the relief effort capacity is big enough the novel Anoxia method canpreventa large-scale human viral outbreak. It is safe, it functions according to the OIEguidelines, it is efficient and effective and most of the components needed arealready locally available.The applicability is amazingly easy because of it´s simplicity. What is needed is a well-trained ‘army-like’ organization, trucks carrying water, mobile powergenerators/compressors,and oxygen generators (using the compressed Nitrogeninstead of oxygen), special detergent and foam nozzles.The party that has most of these elements in house is the local fire bureau:They have the best-trained people in any community, used to work underhazardous conditionsMost hardware to engage in a mass culling operation using the Anoxiamethod is already available within the forceThey are used to improvise and similar to a fire outbreakThe foam nozzles and the special detergent are produced in China; available; andready to use. If needed, there are specialized companies, offering rental services forheavy-duty power suppliers, compressors and oxygen generators (similar to thepetrochemical- and offshore industries).Don’t buy weapons at wartimeWhen China is able to apply this technique throughout all provinces, they are able tomass culling of animals. The Anoxia method is also scalable, so no matter if you haveto kill single animals, cull a selection of animals, or mass cullmillions of animals: withenough fire brigades at hand, the Anoxia Method can be applied.The Anoxia methodis therefore the weapon of choice.About the authorHarm Kiezebrink (1958) is an international consultant on animal disease outbreakcontrol. He has hands-on experience in various mass culling operations and
  8. 8. Page 8 of 8 4/29/2013developed new technologies for optimum performance. He is a regular advisor ornational governments and international organizations.Contact detailsAddress: Chaoyang Park Westroad, Parkview Tower 3 App 11A, BeijingPhone: +86 135 201 93 755Mail: