Wednesday, February 13, 2008

February 12 Flu Update

The biggest story today is that a young woman has bird flu in Indonesia, and her Mother was diagnosed last week. (CIDRAP reports)

There's also bird flu in Laos.

Hong Kong disinfected its markets after bird flu scare.

Bangladesh says simple rules will keep bird flu at bay.

In West Bengal, bird flu measures are being relaxed.

Interesting story about flu in Indonesia, where a patient is said to have numerous false negatives from local medical authorities.

Nasrudin was diagnosed with gastric pain at a public health center and with dengue fever at a public clinic before being diagnosed with dengue fever, typhoid fever and lung disease at Tangerang's Bhakti Asih Hospital on Jan. 24.

The following day, the 33-year-old was thought to be displaying the symptoms of bird flu. He was referred to an avian influenza ward at Persahabatan Hospital in East Jakarta.

Two hours after it was confirmed Nasrudin was suffering from bird flu, he died.

India accepts US help after three weeks.

Flu is now Tamiflu resistant in Canada.

Revere writes about a JAMA article on a key dilemma in pandemic planning.

This is the dilemma. Community resilience enhances overall outcome but social distancing is advocated for individual protection. Middaugh observes there is little scientific support for some of the recommendations, other than they seem like common sense. But might each person acting in what they think is his or her own interest actually be worse off because the community is weaker?


At 6:40 PM, Blogger Wulfgang said...


Your lead story about the infected 15 year old Indonesian teenage girl and her mother, who are apparently both in critical condition, appears to be more-of-the-same type news coming out of the Indonesian pipeline: familial connected H5N1 infections where there is poultry found in the neighborhood (there always is) and the likelihood of human-to-human infection is discounted to be “not provable”. Hence, the endless cycle seems to continue. Something is definitely not right.

Sorry to say it, but it takes a real odd mind-set to believe that no human infections whatsoever have occurred in India and Bangladesh over the past sixty days, when it is intuitively obvious that both countries have H5N1 spreading relentlessly within their poultry populations and thousands of people have been directly exposed to infected chickens in some way. Either there are a HECK OF A LOT of mild H5N1 infected human cases that have slipped unnoticeably under the radar screen and not being reported, or, both countries have mastered the fine art of optimistic acquiescence in a sinking situation. Notice that India has finally accepted the offer of assistance from the US – but only for advanced technology associate with culling containment and disinfectant equipment (dirty work) – but not for advanced human testing and lab support which is critical so that the extent of human infections could be truly ascertained.

Revere’s EM JAMA article about a hypothetical “dilemma” existing between current pandemic planning approaches which place more emphasis on personal preparation (self interest) versus community-based planning, is really a philosophical conundrum. Without adequate personal preparation and self quarantine considerations, it would be unlikely that enough people might be available to support the entire community effort during a pandemic. On the other hand, without a cohesive community planning approach, then conceivably everyone fares poorer, resulting in higher probability of disruptions, deaths and panic – kind of like the “Katrina Syndrome” (my words).

My view on the matter is pretty simple. Most of us are in some kind of mental “holding pattern”, hedging our bets by being prepared in some form, because there is a tremendous lack of information on expectations (virulence) and risk. Simple logic and human nature dictates that if an Indonesian CFR rate of 80% occurs and causes an ultra-severe novel influenza pandemic, this easily translates into an “every family for themselves” – no body goes anywhere or does anything scenario, until the threat subsides. Medical care would become a luxury. If a puny 1918, 1957 or 1968 pandemic occurs, well, no big deal, most everybody will pull their own weight and assist the entire community and little disruption results. Of that I am positive.

The real problem not being adequately addressed, is that neither individuals nor our government agencies are adequately prepared for anything near what might/could happen. The only thing I see an abundance of, is wishful thinking.

BTW, my government agency issue an internal precautionary warning today to all 18,000 employees about WIDESPREAD seasonal influenza activity in sixty per cent of the US territories, districts and surrounding states. This is due to the Type A variant and different Type B strain now circulating, which were not covered by the trivalent vaccine. Everyone is being urged not to come to work if infected and take precautions. Just thought I’d pass this along – keep it on the down-low.



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