Sunday, March 16, 2008

March 15 Flu Update

I maintain a pretty strict standard...we cover H5N1. But, this Time article on the Hong Kong scare of 08 has a lot of good info. Imagine if this was H5N1. Note the political pressure on Hong Kong. Note the strong response. Note, also, this (emphasis added):

Public health experts are still worried, however, that the current flu outbreak will lead to even greater use of the antiflu drug Tamiflu. The powerful treatment has been proven particularly effective against H5N1 and has become widely prescribed in Hong Kong — it is increasingly available illegally, without prescription, in pharmacies — so resistance to the drug is growing fast here. Doctors say the overuse of Tamiflu is creating a manifold risk, not only of weakening a weapon against a potential bird flu outbreak, but also of helping to spread a virulent strain of drug-resistant common flu in the wider population. "It's not a good thing to abuse," says Yuen.

And this....

But it's hard to keep a community still scarred by recent medical history from doing whatever it can to protect itself. Samuel Ho, a professor of psychology at Hong Kong University, says that during the SARS epidemic, Hong Kong residents were exceedingly concerned about infecting their families and loved ones with the virus. "People were worried about whether they would get the flu," says Ho, "But they worried more about their relations. ... How can I protect my wife? My kids?" He says that to help alleviate the kind of mass insecurity that recurs in Hong Kong during bad flu seasons like this one, doctors need to inform people not only of the true risks they face, but also what they can do to control them.

ProMed has extensive local information on the civet mystery, but does not seem to solve the ultimate riddle.

Things are quieting in Hong Kong, though note reports of a bird flu outbreak in China.

With a clean bill of health, the swannery in Dorset is cleared to open.

West Bengal claims no further outbreaks....says this story.

Yet, this story says otherwise.

Bird flu effects Indian grain markets.

Also, this story makes Thailand sound worse than we thought.

Vietnam is also raising the level of surveillance on bird flu.

A virtual symposium will be held in Asia on pandemic prep.

Wyoming is joining a national pandemic prep exercise.

A badminton tournament can go on, not withstanding the effect of bird flu on shuttlecock supply.

An Avian Flu manual has been produced for journalists, by UNICEF and others.

Here's a link to the manual


At 5:45 PM, Blogger Wulfgang said...


Excellent set of articles today, and you highlighted to most significant one first. Everyone should gazing at your blog should read your first link very carefully, because it points out some fairly significant real life issues that we could face in the near future. A couple of concerning things really surface quickly when you compare the authors comments to the profound complacency all across the US.

First, Hong Kong has learned the hard way that in order to stop the immediate fast spread of influenza, a timely command decision must be made promptly to close public schools and universities. Unfortunately, there is no universal standard procedure in the US, amongst all the states, to do this – in fact, it is left up to a confusing array of state and local public health departments, school district superintendents, and local governments. There are probably many more thousands of people involved in the primary decision making process, than needs to be. In fact, I do not believe there are any published federal HHS or CDC standards for closures at this time. What this terrible situation will default to, is probably unnecessary delays, confusion, panic and the federal government or President declaring a national health emergency, and issuing a directive to close all public schools and universities for a certain length of time.

Second, Hong Kong has learned the hard way, from their SARS experience, to provide social and economic support during times of medical emergencies, with paid overtime and other economic subsidies. Unfortunately in the US, neither the federal bureaucracy and only very few state governments, have really coughed up the necessary funding to set up common support structures and consistent pandemic plans for hospitals, HCW’s, emergency and social services. There is no integrated strategic pandemic plans for densely populated regions and mega-metropolises in the US, the closest one gets to it is patchwork “all hazards plans” or “mass evacuation plans”, mainly intended to respond to a terrorist nuclear or biological event. As a result of this lack of strategic pandemic planning, states, municipalities and large cities that have not pre-negotiated agreements in advance with essential commercial suppliers of critical goods and services, will find themselves behind the proverbial eight-ball. They will quickly run out of necessities.

Embedded in the Hong Kong article are two additional major concerns: the obvious overuse of Oseltamivir across entire regions of the world for seasonal influenza, which will most likely result in further drug resistance. This raises the terrible specter that Tamiflu may not eventually be effective at all against a virulent and pathogenic super-flu virus. The final concern raised by the article is the current H5N1 poultry outbreak in the city of Guanzhou. Guanzhou is located a mere 174 km from Hong Kong, that is only 108.1 miles, or 208K yards away. Guanzhou is also located in the Guangdong Province, where the 44-year old “migrant worker” died last month from bird flu. So we are talking a very close 108 mile distance a Hong Kong seasonal epidemic, and actual H5N1 in the Guangdong environment. That’s just a little too close for comfort.

Regarding your two diametrically opposed articles from India, I found the Indian Team of Veterinary Surgeon’s explanation for the dead poultry in West Bengal’s Malda District, rather hilarious: “After primary examination, it’s been detected that the chickens died with symptoms of diarrhea and drowsiness. The experts are closely monitoring the situation now”. What more can you can say about the sad situation there ? At least Thailand has finally admitted that their chickens died from H5N1, even though they didn’t report it in the news media.

And finally, I really shook my head in disbelief when read your article, “Wyoming Department of Health joins national exercise”. The article describes a convoy of health department vehicles near the airport transporting Tamiflu, as part of there illustrated exercise. They might as well paint “high jack me” on the side of their vehicles, if they don’t have serious protection. Heck, in the city of three million where I live, punks hold up 7-eleven stores with AK-47’s for pocket change every week. They high jack Hummers and F150’s just for practice. They also have the police scanners and are organized.

Can you imagine what these bunch of low-life degenerates would do to a convoy of health dept vehicles that were transporting the only known antiviral drug that could conceivably save them ?



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