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Sunday, September 18, 2005

What Really Matters

Update: To follow developments on this story try the FluClinic at CurEvents.com.

Bird flu (H5N1) appears to be showing an unpleasant pattern in Jakarta. See Recombinomics here:
Human-to-human transmission was clear in the initial family cluster, which involved 3 members of a family of a government auditor (38M). His eight year old daughter was the index case, showing symptom on June 24. The time gap between her symptoms and her 1 year old sister who developed symptoms on June 29 is a strong signal of human-to-human transmission. Such a 5-10 day gap has been present in almost all familial clusters in Vietnam, Thailand, and Cambodia. WHO however, has refused to acknowledge the virtual certainty of human-to-human transmission in all or most of those cases, which account for more than one third of confirmed cases.
It was also investigating another suspected case, identified only as a family member of Rini Dina, the country's most recent confirmed bird flu fatality. The relative tested positive on the blood test and is currently suffering from flu-like symptoms, such as a fever and sore throat, which are also symptoms consistent with early stages of avian influenza.
Perhaps this explains why President Bush has started an international coalition to deal with bird flu and a US-led delegation is being dispatched to SE Asia. As of this time, there is little available in the way of medical treatment to deal with this problem. The only real public-health strategy that will be useful is quarantine. For treatment, it is possible that two different classes of drugs could be combined to provide a more effective treatment, but oseltamivir is in extremely short supply. Vaccines effective against this strain of the virus will not be available in quantities sufficient to make much of an impact.

One ominous development is that the latency period seems in some cases to be 8 to 10 days, which provides plenty of opportunity for spread. The virus is spreading at least through contact. I have no idea why WHO presumes that these people, none of whom come in close contact with poultry, are getting it from poultry rather than from each other. Such an idea is incredible. An environmental vector (like WNV) would not be showing this pattern of family cases. The poor testing in these countries leave open the possibility that many more cases of infection actually exist, and that the virus is not as lethal as it appears from the identified cases.

So it is of particular interest to know what public health measures might be taken in this country. I refer you to HomelandSecurity.org, and its entry regarding quarantine authority:
Civil Liberties: (42 U.S.C. § 264, called the "Federal Quarantine Law")

* Public health law is primarily a State concern.
* Judicial decisions indicate that forcible inoculation and quarantine of infected patients may be constitutional.
* SecHHS has the authority to issue regulations that authorize Federal agencies to respond to the spread of a communicable disease across State lines, likely including quarantine of patients, forcible blood draws and inoculations, disposal of bodies in ways contrary to personal beliefs, and related restrictions on liberty.
* SecHHS has not promulgated any regulations under this authority.
* DirCDC may take measures, likely including the list set forth above, to prevent the spread of a communicable disease upon determining that a State is not acting sufficiently to prevent the spread of that disease (42 C.F.R. § 70.2).
* A person who has a communicable disease "in the communicable period" shall not travel from one State or possession to another without a permit from the health officer of the State if such a permit is required under the law of the destination State (42 C.F.R. § 70.3).
Personally, I would buy a lot of bleach and soap. These are going to be our best friends in the near future. Try to get in the habit now of never touching your face unless you have just washed your hands. You also want to keep a small container of bleach handy and disinfect faucet handles, door knobs etc with it constantly. Don't assume those anti-bacterial hand rubs will do the job. They probably won't. If you get any cut on your hands, wash it with peroxide and cover it with an antibacterial ointment and a bandaid. Disinfect phones as well.

There is a nasty strain of H3N2 circulating in Nepal that is apparently killing people as well. Measures like the above have the side benefit of reducing your exposure to cold viruses and other flu strains. You might also want to consider buying gloves and beginning to stockpile staple food products. Whenever H5N1 breaks out, it will be a relatively serious event. No one can possibly predict at this time how serious it will be.

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I have a Cold Sore site/blog. It pretty much covers Cold Sore related stuff.

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