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Tuesday, September 20, 2005

More On H5N1 Preparations

I just wanted to point out that no matter how often WHO announces that the virus has not been transmitting from one human to another, it has been. One such case is listed in this CurEvents.com thread:
The case began with an 11-year-old girl who lived with her aunt and went to the doctors with a fever, cough and sore throat in September last year.

Chickens in the household had all died from avian flu in the preceding weeks. The girl slept and played in the area under the elevated house where the chickens were also present.

The girl's mother lived in Bangkok, but went to visit her daughter when she heard she was sick, and cared for her in hospital for two days before the child died.

Three days later, she too began to experience fever and severe shortness of breath. About a week later, she also died.

The child's aunt, who also nursed her, showed symptoms of the virus, and was hospitalised. However, she survived her illness.
This case of apparent human to human transmission in Thailand is by no means the only such case. Other such cases have been reported in Vietnam. So whether anything has changed in the clusters of H5N1 infections in Indonesia depends on whether transmission there is occurring from casual contacts or just from close contact. This we will not know for a while.

I just wanted to give that information before referencing this Recombinomics commentary and this one, which describe the Indonesia outbreaks. This definitely raises red flags, but it is hard to know whether this sudden apparent jump in hospitalized cases is due to increased testing/detection or increased infection. There have been 5 deaths in this area since July due to H5N1.

I know money and budget deficits are a real concern, but detecting and isolating such clusters of human patients is, at this time, the only viable weapon we have against this virus. The southeastern countries most at risk are relatively poor and probably need significant international assistance to be able to do this. I hope they get it.

In the meantime, I hope the Armed Forces are paying attention to the situation in Iraq. We have many people exposed to danger there, and the news that a shipload of infected poultry was allowed to enter Kuwait is hardly positive, and would be an excellent reason for the Armed Forces to institute special monitoring procedures for our troops there. They will need a supply of Tamiflu (which is already being stocked for embassies), rapid detection kits, procedures to assure that infected poultry aren't being bought for food and isolation wards. It's likely that the Iraqi hospitals will need similar supplies and procedures.

It was always likely that migratory birds infected with H5N1 (which had already been reported around the Volga delta on the Caspian) would eventually end up in the wetlands of southern Iraq. However that was a less immediate threat than the news that shiploads of potentially H5N1 infected poultry are arriving in Kuwait.

Armies have historically been vulnerable to such disease outbreaks. Modern technology may have changed that or it may not have. Failing to take precautions would be a betrayal of our military personnel. They volunteered to defend our country. We owe them at least as much care as we do US Embassy staff in the region. WHO is preparing stockpiles of Tamiflu for the use of its staff and dependents.

To be clear- the numbers you quote and those that are quoted elsewhere- all presuppose a reliable reporting system. Clearly, that is not an Indonesian reality.
Well, the Indonesian authorities do seem to be making an honest attempt now to get a grip on the situation.

One of the things they did was announce that the government would pay for the treatment of those who became ill. That is likely to get the poorer people to the doctors.

But since that policy was just put in place, we can't know whether we are seeing a real change or just a change in detection rates.
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