Wednesday, March 19, 2008

March 18 Flu Update

Two very significant stories today...first, this one. An Indonesian girl was co-infected with bird and seasonal flu in 2007, the first reported occurrence. (CIDRAP)

"This is the first case-report of a human with both influenza A/H5N1 and H3N2 co-infection," the paper states. "Such infections are of great concern due to the possibility of genetic reassortment leading to the emergence of a H5N1 strain that is more easily transmitted human to human, and emphasizes the importance of advanced laboratory-based surveillance in geographic regions where both human and avian influenza viruses are co-circulating."

CIDRAP also reports that FAO says that the flu is so bad in Indonesia that it makes the conditions for mutation very good. Keyword: critical.

An International Conference urges people to look at the socioeconomic effects of bird flu...who owns those culled birds?

CIDRAP on the Indonesian boy who died (reported yesterday).

The bird flu quarantine was lifted in SW China.

Vietnam is now testing a human bird flu vaccine at their military academy.

West Bengal has put more money into flu control.

A USDA official is giving a talk in Palm Beach about bird flu.

Manitoba First Nations are meeting on flu prep.

Delaware continues bird flu surveillance.

Revere blogs on CDC pandemic guidance to states, which was here a couple days ago. Note this on the (limited) benefit of planning.....

Some of this is good and goes in the right direction. Planning, in itself, is a big step forward. But the plan on paper will go out the window in the first week (the old military saying applies: no battle plan survives the first engagement with the enemy), even while the planning is valuable by envisioning what is ahead, meeting your counterparts in other agencies, thinking it through, all tremendously valuable. States and localities need to be strongly and forcefully encouraged to do this. But most states and communities are also fully engaged in the desperate business of trying to keep people alive day to day and until they can get out from the falling debris of a system disintegrating about their ears. In those circumstances, pandemic planning is a luxury, even harmful to the extent it pulls people away from other urgent business.


At 6:35 PM, Blogger Wulfgang said...


The fact that Indonesia has known about a co-infected (H5N1 & H3N2) individual for over a year now and not said anything, probably surprises very few, as we have watched the slow-motion tragedy unfold over two years. Doesn’t surprise me: what are the odds of this individual being the only lone case in the entire world – about as close to zero as you can get. How many hundreds, or thousands of other co-infected people are there in China, Vietnam, Indonesia, Egypt, India and Bangladesh ? Probably many others that haven’t been detected. FAO’s chief veterinary officer and spokesman, Joseph’s Domenech’s pleas for stronger government commitment, coordination, surveillance, control measures – and of course, money, lots of it – to control the critical endemic situation in Indonesia, is commendable. However, the situation there is now well beyond the control and influence of external countries, the OIE, FAO and WHO. One could not only describe the situation there as “critical”… also add the words “rampant” and “unrestrained”, “approaching critical mass”.

I absolutely agree with your one CIDRAP article that quotes leading researchers at the biennial International Conference on Emerging Infectious Diseases, who say: “It is time to acknowledge that the virus has become firmly entrenched in many areas and to begin grappling with its social and economic effects”. In my view, it is also time for these countries to ‘fess up, and to acknowledge that the virus has mutated and poultry H5N1 vaccines (and most likely those used in swine also) are losing their effectiveness. This phenomenon is occurring in Vietnam, Indonesia and China, especially, and describes what the Chinese keep referring to: “the country is facing a more ‘complicated’ epidemic control situation”. We already know about H5N1 and seasonal H1N1 increasing their resistance to Tamiflu, so it now appears to me we now have a double whammy coming at us.

Time to deal with social and economic effects of H5N1 ? We should be thinking much broader than that. How about the eventual loss of poultry completely as a critical source of food in these third world countries. In fact, in my mind, we need to ask the following question: which will come first, the complete loss of poultry in these countries which will trigger mass starvation, social disruption and panic; or the human influenza pandemic. It does appear we are now on dual catastrophic tracks.

On the brighter side of things, Revere has written one of his very best articles, “Pandemic flu and the best laid plans”. He has hit the nail squarely on the head by his very last sentence: “isolating pandemic planning from the overall health of the system isn’t going to work, no matter how detailed the plan”. I agree 100% with him. I absolutely feel one of the major problems that we as a nation are facing in regards to cohesive, cooperative and comprehensive pandemic planning is that the critical infrastructure preparedness roles of DHS & FEMA, versus the HHS & CDC, are so ill defined that neither of them know exactly what the other is doing (or supposed to do) with the states. The emergency and national disaster planning activities, roles and responsibilities mandates of the DHS are treated distinctly separate from the health emergency pandemic planning of the HHS. Talk about real isolation. The two over-arching roles of both Executive Level departments should overlap and complement each other. Hence, we see further evidence of this dissonance and isolation, in the HHS requirement that the states submit their pandemic plans by June 16th so they “can identify the gaps and baseline them”. Totally confusing and what we call in the workplace a “cluster-something”. It is no wonder state emergency planners and public health departments are befuddled.

Here’s a little further evidence that there is going to be guaranteed confusion when a national health emergency is declared due to an influenza pandemic: As of January 2008, FEMA now has assumed the exclusive role from the Red Cross and sole responsibility for mass casualty care and shelters:

The real kicker is FEMA does not have the staff or resources to perform this function and I doubt the states know what the new roles of the Red Cross is supposed to be in a national emergency of any type. Here we go again, “Katrina-Scene II”.



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