Saturday, January 19, 2008

January 18 Flu Update

An eight year old boy died of the bird flu in Indonesia.

Effect Measure looks at the NEJM article, which summarizes what is known about bird flu. Pretty much assigned reading for flu junkies. Note especially that the report notes that there is no evidence that mild cases are being misdiagnosed, leaving a shockingly virulent virus.

The outbreak in India is a big deal there....minister uses the word "grave concern."

There are also some recriminations, as leaders are said to have missed "telltale" signs more than a month ago.

Internet rumors to the contrary, India says the capital is safe.

The New York Times also has a little update on the turmoil caused in India.

CIDRAP summarizes news from around the world.

So does ProMed. Note that reference in mod comment to a normal seasonal surge.

ProMed also looks at Iran...note mod comment on confusion over dates.

A bird flu summit will be held in Bali later this year.

Labs in Thailand are testing birds for the bird flu.

CIDRAP on ACLU concerns over pandemic plan.

Disaster exercise in Florida includes flu.


At 6:03 PM, Blogger Wulfgang said...


Lots of good detailed news articles today on the current bird flu dilemma in India. Couple these news updates with Revere’s EM commentary and one can really see how explosive the situation in India could become if two things were to occur: (1) if the disease spreads geographically throughout all of India unabated, it could threaten the lives of 1.136 billion people and, (2) if the virus were to successfully mutate and become highly transmissible, the fatalities would be devastating. (Side note: India is expected to overcome China by 2030, to become the most populated country in the world).

Based on the latest demographics, this is how potentially volatile the situation could become in India: 31% of the entire population is under the age of 15 yrs, or 352 million people; and approximately 52% are 40 yrs old or younger, or approximately 591 million people. The median age of the population is 24 yrs old. According to Revere’s EM commentary and the New England Journal of Medicine, human cases of H5N1 reported to date are “dramatically skewed toward the young (median age 18) and 90% of cases are below the age of 40”.

If one extrapolates this data to India, the number of human fatalities would be staggering to the imagination. For example, assuming a pandemic infection total of only 35% of the 1.136 billion people in India, this results in approximately 398 million infected people. This doesn’t seem bad on the surface. However, if the actual fatality rate is truly 62% as the NEJM report and WHO data suggests, this means 247 million people in India alone, would probably die, under current known statistics. The real eye opener is that a full one half (52%) of their current population is age 40 yrs old or younger, and they fall within this 90 percent high risk category. India would stand to lose its most productive core of citizenry.

I would also like to point out that three of the worlds largest fifteen urban population areas, are located in India: Mumbai, Delhi and Kolkata (Calcutta). And Calcutta with an urban population of 14.6 million people, is about as densely populated as Los Angeles, is located exactly in the West Bengal area where your bird flu reports are generated. When Revere says, “this remains a really, really bad disease”, we need to apply the human population numbers to see just how horrendous, alarming and devastating it really would be (assuming no mild cases).

Regarding your CIDRAP article and the ACLU – about the only thing I can see that the ACLU “three prominent attorneys” got right, is their critical comments about the federal and state government flawed use of an “all hazards approach” to pandemic planning. This is a very accurate assessment and I see Dr. Osterholm also agrees with this criticism. I have participated in this all hazards planning for several years now, and unfortunately, it results in many state and federal emergency officials planning as if a pandemic is a localized natural event of short duration, much like a hurricane, storm, earthquake, or terrorist event like 9/11. Other than medical measures and supplies, I see very little if any, provision to supply people with subsistence during a protracted pandemic.

I think the ACLU lawyers ought to reevaluate their agendas and perhaps spend less time defending Senator’s rights to use public restrooms for perverse antics, and less time defending MDR-TB infected Atlanta lawyers, and then they would be perceived as more credible and value-added, in the public eyes. And in fact, as far as enforced quarantines are concerned, the SARS model used in Canada, is probably one of the best approaches we have to operate from, in social, medical and legal terms. What’s wrong with that – it worked.



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