 Even with some suppression strategies in place, millions around the world are expected to die in the COVID-19 pandemic. In the United States, a best-guess estimate presented to the American Hospital Association was about a half million American deaths, with sufficient social distancing that may be reduced to around 100,000. Even at a half million, though it's still unbelievably, could be much, much worse. With thousands already dead, millions projected to perish, billions in lockdown, and trillions lost as markets tumble, COVID-19 is still only shaping up to be a category 2 or 3 pandemic. This is from the CDC's Pandemic Planning Guidelines. The Pandemic Severity Index is fashioned after the Hurricane Severity Index to define the destructive capacity of a storm. Well, this is the CDC's attempt at classifying the destructive capacity of a pandemic. It is based on case fatality ratio, also known as the case fatality rate. The percentage of those who fall ill, who eventually succumb to the infection. In the 1918 flu pandemic, about 1 in 3 fell ill, and of those about 2% died. That made the 1918 pandemic a category 5 analogous to a super typhoon with sustained winds exceeding 150 miles per hour. The rate of those dying from COVID-19 infection is much lower. If you include those who tested positive that were asymptomatic, it's looking like around the mortality of the last two flu pandemics or a bad seasonal flu season. If you're talking about true cases that people will actually get sick, we're talking closer to the 0.5% cutoff between category 2 and category 3 pandemic, meaning about 1 in 200 cases die. As you can see, the 2% case fatality like the 1918 pandemic is just where category 5 starts. COVID-19 shows that SARS-like coronaviruses can escape our grasp and spark a full-blown pandemic. SARS was rapidly stamped out by fever-monitoring travelers, but by the time it was all over, there were about 800 deaths out of 8,000 cases. That's a case fatality ratio of 10%. Thank heavens we're dealing with a pandemic from SARS-CoV-2 and not the original SARS coronavirus. Even more lethal, MERS killed more like 850 out of 2,500, which is a 34% case fatality rate, 1 in 3 chance of dying if you come down with it. Since 2002 with SARS and then 2012 with MERS, we've learned that coronaviruses could become deadly. They're not just the common cold viruses we thought they were. Now with COVID-19, we realize this family of viruses can also explode unfettered onto the global stage. So coronaviruses have already shown us they can do both. It's not hard to imagine a combination of transmissibility and lethality that makes the next coronavirus pandemic worse by an order of magnitude or more. But there's an even greater cautionary tale to be told, which is the primary subject of my new book. We've long known about the pandemic potential of the flu virus, but the deadliest it ever appeared to get was the 2% fatality of the 1918 influenza. Now, 2% was enough to kill up to 100 million people, making it the single deadliest event in human history, but an even greater threat may be wading in the wings of a chicken. In 1997, a flu virus was discovered in chickens that would forever change our understanding of how bad pandemics could get. So far, it's remained a disease of poultry, not people, but of the hundreds of rare individuals it has infected, more than half have died. A flu virus with a case fatality rate exceeding 50%. What if a virus like that were to mutate to acquire easy human transmissibility? The last time a bird flu virus jumped directly to humans and caused a pandemic, it triggered the deadliest plague in human history. But what if instead of a 2% death rate, it was more like a flip of the coin? The COVID-19 pandemic is devastating, but food is still being restocked in our grocery stores. The internet may be slow, but it's still up. The lights are still on and safe drinking water is still flowing from the tap. Doctors and nurses are still showing up to work. If the predictions are correct and only about 100,000 Americans die, that's less than 1 in 3,000. In the pandemic of 1918, in which 2% of the cases succumbed, 1 in 150 Americans died. Imagine if it were 10 times as bad as 2% with 1 in 15 dying, or 25 times as bad, killing 1 in 6 of us. The good news is there's something we can do about it. Just as eliminating the exotic animal trade and live animal markets may go a long way towards preventing the next coronavirus pandemic, reforming the way we raise domestic animals for food may help first all the next killer flu. We got off easy in the last pandemic. Swine flu only triggered a Category 1 pandemic in 2009, but it showed a new origin point for pandemic viruses, pork production. It was like epidemiological blowback from our globalizing these intensive confinement methods. The unprecedented emergence of H5N1 and the 10 other new bird flu viruses infecting humans around the world has been blamed on industrial poultry production when we overcrowd tens of thousands of animals in these cramped, filthy football field-sized sheds to like beak-to-beak atop their own waste. It's just a breeding ground for disease. This year, numbers of animals, the overcrowding, the stress crippling their immune systems, the ammonia from the decomposing waste burning their lungs, the lack of fresh air, lack of sunlight, put all these factors together. And what you have is really kind of a perfect storm environment for the emergence and spread of these so-called super strains of influenza. That's why the United Nations has urged that governments, local authorities, and international agencies need to take a greatly increased role in combating the role of what they call factory farming, which combined with these live animal markets provide ideal conditions for the flu virus to spread and mutate into a more dangerous form. These so-called CAFOs, concentrated animal feeding operations, have vastly altered the evolution of the influenza virus. The H5N1 virus started out like all bird flu viruses as harmless, waterborne intestinal infections of waterfowl, but only gained airborne transmission in the ramping up of extreme virulence within massive intensive poultry production. Perhaps only a change in conditions as great as 10 million bird mega farms could account for the dramatic series of mutations sufficient to create such a monster. There also seems to be an acceleration of human influenza problems over the last few decades, evolving an increasing number of species and, according to the Food and Agriculture Organization of the United Nations, this is also expected to largely relate to the intensification of the poultry and possibly pig production. Big Ag may be brewing up big flu. For the underlying science, the evolutionary biological mechanisms allow me to refer you to my invited review I wrote for critical reviews in microbiology where I lay out all the evidence. It's free, no paywall. Just go to bit.ly slash flu review. Currently, the CDC considers the bird flu virus H7N9 to be our gravest threat, the virus with the highest pandemic emergence risk and the highest potential impact. An estimate was published as to what an H7N9 pandemic might look like in the United States, and they concluded millions of Americans dead. So far, H7N9 has killed about 600 of the first 1500 people that infected. That's around 40%, two in five people, thankfully. Neither H5N1 nor H7N9 have acquired the capacity for easy human-to-human transmission. But given that both H5 and H7 viruses have displayed the propensity to infect humans, there is heightened concern that they may evolve the ability to transmit between people and initiate a pandemic. They're still out there, still mutating. H7N9 may just be within three mutations away from effectively transmitting between people. Pandemics are always a matter of not if, but when. And a pandemic with more than a few percent mortality wouldn't just threaten financial markets, but civilization itself, as we know it. How can we stop the emergence of pandemic viruses in the first place? If there's one concept to draw from my work on preventing or reversing chronic diseases, it's that, whenever possible, treat the cause. What does the poultry industry have to say for itself? The executive editor of Poultry magazine put it this way, the prospect of a virulent flu to which we have absolutely no resistance is frightening. However, to me the threat is much greater to the poultry industry. I'm not as worried about the U.S. human population dying from bird flu as I am that there will be no chicken to eat. Others are more self-reflective, drawing on his 37 years of experience with the failings in the factory farming model in terms of spreading disease. One industry insider concluded his trade publication article Poultry Reality Check Needed with these prophetic words. Now is the time to decide. We can go on with business as usual, hoping for the best as we charge headlong towards lower costs, or we can begin making the prudent moves needed to restore balance between economics and long-range avian health. We can pay now or we can pay later, but it should be known, and it must be said, one way or another we will pay.