It's just early September and already the number of confirmed cases of bird flu in humans has equalled that of all last year. And we are just entering flu season. Since the resurgence of the disease in late 2003 (four cases that year), there has been a steady escalation, with 46 cases in 2004, doubling to 97 in 2005 and as of today already 97 this year And it's only September. WHO now has recorded 244 cases since 2003, with 143 deaths (WHO).
Newspaper editors periodically tire of reporting on bird flu, or run stories that things are looking better, or that a vaccine has been devised. Many people have the impression the threat has bated. In truth, the disease is moving steadily forward, with no let up. Each year brings a record number of cases and more and more poultry flocks infected in a wider geographic area. More animals have also been found infected and no one knows the true host range of the H5N1 subtype. Some progress has been made in planning for a possible pandemic, but not much has been put in place. If a pandemic were to begin next week (or if one has begun this week or last week but we are unaware of it) we would be in desperate circumstances. But it is important to recognize we are much better off than we would have been if something had happened two years ago. While there are no complete or even partially effective plans out there, the very act of planning has a tremendously positive effect. Eisenhower said it's not the Plan, it's the Planning. Visualizing possible consequences, networking with other sectors, doing some disaster drills have been an important investment and they will pay off.
But clearly there is much more we could do and much more could have been done. Our public health and social service infrastructures are still teetering and most communities are not as resilient to the shock a pandemic would bring as they could be. Much of this is from a lack of leadership from Congress and the Bush administration and a lack of rationally directed resources to address the purpose. Most people are at much greater risk from a pandemic than they are from a terrorist event -- probably by many orders of magnitude. Bin Laden and his henchmen are undoubtedly laughing up their sleeves when they see the effects of one of their videos or pronouncements. For example, the purported statement that Iraq is the most important front in their anti-US jihad is taken as a fact just because bin Laden said it. They cannot hurt this country militarily but they can bankrupt us and they have a willing ally in George Bush whom they lead around by the nose -- dumbest President ever.
The War on Terror, the War on Liquids, the War on Privacy all add up to a War on Public Health. The War on Public Health is the only war Bush is winning. And public health is losing.
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I have observed this strange game that newspapers and news agencies play in their reporting of bird flu. It's a constant scare and then reassure see-sawing that they do. There never seems to be a consistently realistic stance on the problem, or even a continuing focus. The game seems to be a lot about baiting and creating a psychological reliance on an information source. Scare and then reassure... then scare again.. then reassure... It's addicting.
Another annoyance is the often oversimplification of the situation, exemplified by the standard ending sentence of every article that goes something like: "The bird flu virus has yet to mutate into a form that is capable of spreading from person to person, but some scientists think that it may do so in the future, possibly sparking a pandemic that could kill millions."
They always say "some scientists", as if there were just a handful of them. And I still see statements that there is no human to human transmission yet, even though this is demonstrably false or at least misleading. Most people I speak with have in their minds a static and singular form of bird flu which hasn't mutated in any way yet. There is a total lack of understanding that H5N1 is in a constant state of evolution.
Our lack of preparedness is typically mentioned but glossed over, and the potential for economic collateral damage is usually treated in the same fashion. I even get annoyed by the term "bird flu" because it seems like a cute little euphemism some marketing firm created. I think it serves in some ways to negate the severity of the threat; remember the way Jon Stewart mocked the term a while back?
Edmund: You are right on all counts. Regarding the use of "bird flu" here, we do it for a pragmatic reason. That's the term that comes up most often in Technorati and Google searches. If we were to consistently use "avian influenza" we would be missed by a large fraction of searches.
You are also right there is essentially a template or a set of stylized sentences (of which your version is a good example). Also the incorrect statement that almost all reported cases have had close contact with poultry.
It's an uphill battle, but the importance of a possible pandemic has sunk into the public health community and there is much better public awareness in the US and Europe than several years ago, so it's not been totally hopeless. On the contrary, I think we've made a lot of progress, just too little in comparison to the distance we need to travel.
http://www.globalresearch.ca/index.php?context=viewArticle&code=CHO2006…
No doubt there has been progress in the struggle against bird flu. But there is still much to be learned about H5N1.
"More animals have also been found infected and no one knows the true host range of the H5N1 subtype." This is a most important statement. All human energy is devoted to killing sick chickens. But if we do not know the host range, how can the spread of human H5N1 infections be stopped? The only blood match is from a cat. It is negligent in the extreme for scientists to ignore the investigation of this host range.
And the above address at global research is an editorial in a Toronto newspaper, in which the author states it will be necessary to bomb Iran using tactical nuclear weapons. Please read the article in order to understand just how dangerous the Iranian situation really is.
There is a large US and European naval armada forming in
the Med near Iran. The armada includes the largest US aircraft carrier. British troops are gathering on the Iranian border with Iraq. Russia's military is involved in joint exercises with countries near the Middle East. Mexico is politically very unstable.
And WHO has announced Extreme Drug Resistant TB is now worldwide, and may be spreading. HIV positive patients are extremely vulnerable to this threat. What happens if this TB spreads simultaneously with bird flu?
http://www.globalresearch.ca/index.php?context=viewArticle&code=CHO2006…
The direct link to the Toronto Sun article is shown above.
http://www.debka.com/article.php?aid=1208
Here is the report on the biggest naval armada to form in the Med since WW2. If this turns into an attack on Iran, we will have to worry about nuclear fallout before we have to worry about the spread of bird flu.
In crofs blog today there is an article about the little girl in Indonesia that died three years ago from bird flu, but who had been originally diagnosed with dengue fever. Her mother and older sister had died shortly before she did. Crof expressed the concern that there may be lots of cases of H5N1 out there, particularly the outbreak in China, being misdiagnosed as dengue. I wrote him:
"This goes back to the crux of the problem with WHO's assumption that H5N1 is associated with sick and dying poultry. When an outbreak of disease occurs without sick or dying poultry in the vicinity, they apparently don't even check for H5N1, and therefore could misdiagnose it.... the case above, diagnosed as Dengue, [makes me wonder] if they actually do testing to confirm Dengue, or is it simply a diagnosis based on symptoms and other factors surrounding the illness? I guess I'll take this question to revere, him being an epidemiologist."
So revere, or anyone else out there familiar with this, do they run tests to confirm Dengue? Is it possible that the epidemic of dengue in China might be H5N1? If so, how could WHO overlook or ignore such an enormously important possibility? They are the experts, they are on the spot, their job is to look for any and all signs of an imminent H5N1 pandemic...so it is hard to imagine they wouldn't have already checked out this possibility. Looking for some reassurances here.
I'm Canadian, and I live within driving distance of Toronto. Take anything you read in the Toronto Sun with a grain of salt -- it's a bad, right-wing tabloid (even in tab format!), a couple of rungs up the journalism ladder from The Weekly World News and not as well fact-checked as The National Enquirer.
Revere, perhaps you could comment on something... In an article predicting China won't have a surge in bird flu this winter, there's this:
I was surprised this was reported so matter-of-factly, even if it is true. And maybe it's my browser, but I think the second paragraph is no longer part of the original article. Too close to the truth, or still officially false? Or both?
caia: WHO (and others) have been saying this for a long time and repeatedly. We have reported it here a number of times (I'm sitting in a Starbucks at the moment and it isn't convenient to find it, but I know we've posted onit on the old site). I expect China will have a surge, just as other places will. But we'll see. Unfortunately I don't believe much of what the Chinese authorties say any longer.
I knew you'd been saying we don't really know the source of infection, but the way the reporters' template seems to be "associated with outbreaks in birds", I didn't realize the WHO had been saying it too.
Which in turn makes me wonder why reporters bother writing "news" articles about bird flu at all, if they're impervious to new information.
Edmund: the mantra of journalists ("The bird flu virus has yet to mutate into a form that is capable of spreading from person to person, but some scientists...")can be seen everywhere and IMO is just some laziness in their minds.
Routine, as you might call it.
I heard in global estimates 5% of all people are prepared for about 1 month and about 1% for about 4 months in the event of a pandemic outbreak.
In my country I am sure less people are even less prepared.
I heard a joke about this mind-set in people:
A lot of rain was pouring down at the little village and people were climbing on their roofs to be rescued. But one man wouldn't come with the little boat when it was there to pick up the people in danger. "God will rescue me, so go and take some others who need it more than me."
They shrugged their shoulders and went on.
Some hours later the water had continued to rise and the rain was still coming from the air. A big boat was coming alongside the house and urged the man to come with them. "It's about your last chance, later on the roofs will disappear in the waves. It's not gonna stop raining soon" they shouted at him. But he repeated his faith that God was going to rescue him. And he declined their offer to come along with them.
One hour later a chopper was flying over his head and they discovered the only man in that region left on the roof. Water was up to his waist, as he stood there and waited for something.
They let down a rope to draw him aboard, but he refused again. Then he was taken away by the stream and drowned.
In heaven, he complained to others God hadn't rescued him.
But God was astonished and puzzled. "I sent you a little boat, a big boat and a chopper. Something must have gone wrong!"
"They are on patrol against al Qaeda (which is estimated to deploy 45 small freighters in the Mediterranean and Indian Ocean)." - the DebKA article.
Head Pop! Bwahunga?
Do they have special flags on these suicide freighters? Do they face Mecca five times a day?
http://www.promedmail.org/pls/promed/f?p=2400:1001:6396749767868668270:…
I know people do not get real excited about pigs dying, but when a disease called pig high fever has killed 40% of the pigs infected, and the number of dead pigs is in the thousands; and when the ears on the infected pigs turn blue before they die; you may want to take a second look. The Promed reference is above. This is all happening in China.
As you has probably read a thousand times, pigs can be a mixing vessel of flu viruses, including human flu viruses. If they test these pigs for H5N1, and they test positive, we could have a slight problem. Could this be a mammalian vector for human H5N1 infections?
We may never know if the Chinese decide to conceal what they know about this disease, which is what they usually do; or if they are just too dumb and lazy to test the pigs for H5N1.
Since most of the brain damaged bird flu experts insist the vector for bird flu is exclusively sick birds; and since most of the human energy is spent following the advice of the idiot bird flu experts, meaning you have to ring the necks of all the chickens you can catch; we probably have an excellent chance of dying from a bird flu pandemic, which will be coming to your local theater soon. So don't miss the fun, and be sure to buy a ticket. With a little help from retarded bird flu experts, you too can die of bird flu.
And believe me, it is a real fun way to die, drowning in your own body fluids. Or if you are real lucky, the disease will leave you an invalid the rest of your life, like it did to many in 1918 during the Spanish Flu Pandemic.
Ground Zero Homeboy -
You might want to take anything you read at the Debka site with a lump of salt as big as your paired fists. They make the Toronto Sun look like the Handbook of Chemistry and Physics.
Mary in hawaii and caia. In my opinion, you two have things exactly right and have hit the crux of two very important issues.
Good to see that someone here made mention of XDR-TB.
Revere, I'm sure you know about this one; I think it deserves serious coverage in this blog. And while it presently seems to affect only people with HIV and similar immune compromise, I'm not sure we can say with reasonable certainty that it would not also affect people whose health is compromised by something else, e.g. conventional flu, or that people in normal good health are not at risk.
g510: I have considered the MDR TB problem and even drafted a post on it. It is a serioius public health problem, no doubt, along with malaria, polio and some others. This bug is certainly a threat to more than HIV patients. On this blog, though, I wanted to put it into some kind of context, which the current stories are not doing. TB is a complicated disease.
I have been traveling almost constantly and wanted to talk to some of my colleagues who are some of the world's best TB experts before writing about it. This will be my first full week back at home base in 6 weeks, so I was planning to check in with them (among the thousand other things to do). It's on my agenda but at the moment I am pondering what to say about it besides, "Oh, shit."
Mary, dengue fever does have some overlapping symptoms with H5N1, but most of the time is sufficiently differentiating that H5N1 can be ruled out. There are no quick wham-bam tests for confirmation of dengue fever. Seropositive testing for the virus is a common confirmation. An epidemic of H5N1 would be very unlikely to be misdiagnosed as dengue in my opinion, though the odd case may be confused.
(What a coincidence; revere's first reaction to the new deadly TB strain news was the same as mine? Uh-oh. That's not good.)
I read the translation quite a while back, when Osama bin Laden said, his idea was to let the US spend itself into collapse. Certainly working so far, because of poor leadership choices.
"War on Poverty"?, "War on Drugs"?, "War on Terror"?...So?
Public and politicians are too stuck on preventing a repeat of past disasters, and aren't thinking and acting proactively about the oncoming threats, like deadly pandemic, (or, nation-busting climate changes?) because they repeat at such longer intervals.
Dr. Hideki who was on the ground for the second tsunami and the volcano belching in Indo bears out what M in H was saying. There were in his opinion cases of H5N1 that were misdiagnosed as dengue. The symptoms were close but he said way too many people were dying of "dengue." When it was brought to the attention of the local doctors who really control the districts like little fiefdoms they said no way it could be bird bug and thanked him for his concern. His message still rings out to me, "Randy, please to prepare family for pandemic (big outbreak) of bird flu."
Good story Tan06. Get with your ISP people again. Its blocking inbounds to you.
I agree that if we get a full blown pandemic with H5N1 with anything close to the current mortality rate that we'd recognize it. But I think we're likely not seeing the true nature of the smoldering problem because of the lack of widespread use of good diagnostics and lack of transparency. It seems that some of the other tropical viral diseases such as dengue, chickungunya, japanese encephalitis are also increasing in incidence and virulence and really complicating the overall picture. The diagnostics problem seems to be particularly true in India and Africa.
Kent: My guess is that this increased incidence of tropical diseases may be related in some way to global warming. Sometimes it doesn't take that much to upset the fragile balance in favor of one organism over another. I recently read that this is happening in oceans globally: more and more lower organisms - bacteria, cyanobacteria (fireweed) algae and jellyfish are blooming prodigiously as the oceans warm and the organisms competing with them weaken, although exact causes are uncertain. I am torn between hope and fear that "gaia" may be about to right herself by removing the plague called man from her hide with some of these diseases you mention.
Reading this blog is interesting. We - the micro - impact the macro - all living things. One at a time. Indeed, "Gaia" may be preparing to right herself. As a registered nurse, I draw a comparison in a recent publication about how white cells rush to the parts of our bodies that are in trouble - helping heal the body if the illness has not reached an irreversible point. Likewise it only makes common sense that such a self-supporting system is duplicated on a larger scale - the Planet. Gaia. Unlike the human body - I think the Planet is powerful enough to overcome those ills produced by her polluting inhabitants - Mankind. http://shandarrah.com/Voices%20Within/
One of the scarier moments for me last week was when I asked a friend of mine who is a nurse what her 'take' on the whole bird flu scenario was. Her eyes widened a bit, then she said she just wasn't going to think about it! That it is just too scary to worry about! Then it hit me that how skewed my interpretation of things really is. I thought most folks inside the healthcare system could be relied upon to help jump-start the rest of us to get prepared.
I now realize that not only is a small percentage of the general population trying to prepare, but also, unfortunately, it may only be a small percentage of the healthcare sector that is taking this serious.
I know most everyone here probably already knows this, and it had probably been said many times over... but I felt compelled to write it for the few who have not figured it out yet.
Time to hearken back to my days as a Boy Scout: be prepared!