Monday, June 25, 2007

June 25 Flu Update

CIDRAP reports on new cases in Egypt and Indonesia.

Usual excellent, high quality Revere post. Many people say that the current case fatality rate is to high--that mild cases are never counted. Revere says he agrees, but then notes that no study has actually found evidence that these mild cases exist. Read on to see what disease he compares H5N1 to, based on lethality.

As reported earlier, six wild birds in Germany are H5N1.

ProMed also on Germany.

Poultry in four Malaysian villages now are infected with H5N1.

Excellent Boston Globe story on the "silencing" of a songbird market in Hong Kong due to bird flu concerns.

The GAO says the USDA is not prepared for bird flu.

Still, GAO investigators said there is uncertainty between USDA and the Department of Homeland Security as to what role each would take during an emergency. The lack of coordination between the two departments would slow initial responses as they work to figure out their jobs.

Hawaii, on the other hand, says it is ready to go.

Scotland is hosting an International Flu Summit, under the auspices (oh, it has been so long since I have typed "auspices") of the UN.

Bangladesh discusses the need for a pandemic flu strategy.

New Zealand says major culls are unlikely during bird flu pandemic.


At 6:11 PM, Blogger Wulfgang said...


Quite an intriguing article Revere came up with today. My bottom line reaction is about the same as his – pessimism – but my observations and general conclusions vary a little.

First, the entire extent of undiscovered mild infections (asymptomatic) in humans is absolutely unknown, suspected to be much higher, and being masked by the following:

• Numerous H5N1 virus strains evolving in diverse isolated geographical locations.

• Lack of standard world wide measures and testing, resulting in: large numbers of unidentified “positives” and numerous “false negatives”. A good example of this is Europe – the H5 and H7 is apparently circulating unfettered within wild migratory bird populations and becoming endemic – defective testing indicates no prevalence of the virus.

• Lack of medical expertise, proper test equipment, manpower to conduct adequate and timely blood surveys.

• Use of extensive blanketing amounts of Tamiflu throughout regions of the world, which probably masks or diminishes symptoms, and skews test results.

• Refusal by some critical nations (China, Indonesia, etc) to supply viral isolates and critical disease information, due to perceived strategic economical, political, religious and medical advantages.

So far, we’ve managed to keep the playing field level, even though the bird flu viruses continue to spread unabated throughout countries of the world. We have averted a pandemic catastrophe – only by culling and vaccinating billions of birds, and blanketing human populations with millions of Tamiflu tablets. And the virus is responding by showing 10-30 times resistance to Tamiflu.

I contend when the virus starts demonstrating further resistance, say up to the 50% level, and it is documented – it will then be time for all of us to start doing some very serious final stockpiling. That’s my arbitrary tipping point. I’m simply not waiting around until the first Chinaman or Indonesian tourist flops on the tarmac in Newark Airport with a 108 degree temperature, pneumonia and all kinds of other organic bird flu symptoms.

Revere’s article reveals to me that when it really comes down to it - scant scrutiny of viruses, limited knowledge of extraordinarily high CFR’s, wildly variable predictions of attack rates, and incomplete blood samples, are not nearly enough information necessary to process national or personal strategic approaches. Scientists have made very little advances in understanding the evolutionary pathways of the avian viruses. He also (really) is highlighting our failures to contain the virus, along with the inadequacies of preventative and surveillance management approaches to identify the magnitude and severity of the problem. The world, and in particular nearly everyone, is wholly not prepared for the next “mother of all health crises”. This is all becoming very clear (at least to me).

When “show time” begins, it would be wise not to be caught in the play when the curtain rises, and certainly you don’t want to be even caught in the theatre. (just my opinion of course).



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