Openshaw: Sometimes it starts like ordinary flu, with a bit of a cold, but that isn't absolutely invariable, some people start off with a cough, and then become short of breath and develop muscle aches and fever. So getting a fever is a very important feature, if you haven't got a thermometer, you should get one and be able to measure your temperature and be able to note if it goes up to 38 degrees. If it's not you don't need to worry about it, it's probably a flu-like illness which is very common and which isn't necessarily due to bird flu.
RFE/RL: Since there are similarities with ordinary flu and other respiratory illnesses, when then should someone suspect it is bird flu?
Openshaw: That really is one of the difficultie; there isn't anything absolutely distinctive about bird flu except that it tends to be more of a gastric flu, with abdominal pain, vomiting, and diarrhea, which happens in about 50 percent of cases. It really presents like gastric flu, so you have to have some reason to suspect it in order to do the specific tests. The suspicion should really arise because of close contact with sick poultry. In the cases seen in southeast Asia there is a history of exposure to sick poultry in about 70-100 percent of cases, depending on which region you're looking at. So, a history of exposure to sick birds, and then developing flu-like illness should mean you have some tests performed to see if it's bird flu. But it's important to emphasize that [for] most people who develop flu-like symptoms in the winter, it's not going to be due to bird flu, it's going to be due to ordinary viruses.
RFE/RL: How quickly does someone become seriously ill?
Openshaw: Usually after exposure there's a lag of three days to a week before symptoms develop. People have often been ill for between three and eight days before they get admitted to hospital, so during that period virus levels are building in their system. By the time they're admitted, quite often it's a bit late for treatment with antiviral agents. It's quite important if it is bird flu that it's treated early, preferably within two days and ideally within eight hours of developing a fever of 38 degrees, which is why it's so important to have a proper digital thermometer.
RFE/RL: What are the severe symptoms?
Openshaw: Most people that die of it die of lung failure, their lungs are so badly affected by the storm of cytokines -- body chemicals that are released after infection with bird flu. Most people who die of it die of lung failure. About 20 percent go into kidney failure and about half or more than half develop problems with bone marrow; so the bone marrow isn't producing enough cells to deal with infection. So there's a general system shutdown that is the body's response to this overwhelming infection.
RFE/RL: What should someone do if they have reason to suspect they're infected?
Openshaw: You need to get to a medical facility that can look after you in terms of providing artificial ventilation if that's necessary, and one that can administer antiviral drugs, particularly in the early stages of the disease before the body goes into this cytokine storm phase; because it's only in that early phase that the antivirals are going to do anything. The treatment otherwise is supportive and to overcome any organ problems like lung failure and kidney failure from the virus spreading into those different parts of the system.