Sunday, December 4

Major outbreaks of bird flu watching and bureaucratic bungling

An eighth human death from H5N1 (after exposure to infected poultry) in Indonesia was confirmed on December 3. See Bloomberg for details. However, from my tour around the Internet last night I have not found anything to suggest that there is a highly lethal strain of avian flu transmitting H2H (human to human).

A World Net Daily article recounts medical speculation that a relatively mild strain of H5N1 could be spreading via H2H in Thailand. (H/T Riehl World View.) Yet I can't find data to rule out that the noted 'increase' in H5N1 cases in Indonesia and Thailand is due to increased awareness of the virus at hospitals and clinics.

The most striking increase is in the awareness of H5N1 in the health community worldwide. Also, there is vastly increased public awareness worldwide, which means more people are going to the hospital or clinic even for mild flu-like or cold symptoms, which makes it possible to catch more cases of H5N1 infection. From a September BBC report:
According to the BBC correspondent in Jakarta, Rachel Harvey, the increase in the number of suspected cases in Indonesia could be partly due to an increase in public awareness. There is now saturation coverage of the bird flu outbreak on television, radio and in newspapers, she says.

"With increased surveillance it's not unusual that you would pick up more cases," said Dr Margaret Chan, the WHO's representative on bird flu.
Right now it seems the greatest causes for alarm are that no country is up to speed on pandemic preparation and developing countries where bird flu has made an appearance are very uneven in their reporting and surveillance efforts.

The reasons for laxity cover the spectrum: bureaucratic bungling, interagency fights, low budget for data collection and reporting, reluctance to accept outside help, and so on. See the December 2 New York Times article Experts Doubt Bird Flu Tallies From China and Elsewhere. The problems discussed in the article are by no means limited to East Asia.

There is the added problem of corruption. Romania's health care bureaucracy might be the most corrupt on earth next to China's or at least up there in the top ten. So, if you just throw money at 'em, chances are good it won't all be spent on reporting. That means putting an additional layer of oversight into programs that earmark aid for avian flu data collection and reporting. That kind of oversight costs a lot of money, and it takes time to get the oversight bureaucracy up and running. Time is what we're short of.

That's not speaking to the Harry Lime problem. A November 15 New York Times report via the International Herald Tribune mentions that a fake vaccine was used for inoculating chickens against flu.
The official Xinhua news agency reported last week that a fake flu vaccine, possibly including active virus, may have actually spread the disease instead of preventing it.

"The harm is incalculable," said Jia Youling, chief of the veterinary department at the Agriculture Ministry."
For once I am in total agreement with a China official. However, the single biggest problem to emerge is that countries are putting too much faith in vaccine development and anti-viral drugs. There are serious questions about whether Tamiflu (or any anti-viral on the market) is effective against bird flu! See December 4 Pundita post Two health experts challenge use of Tamiflu to treat Avian Flu.

So it's time to get real. By now, every international airport in your country -- whichever country that is -- should have human temperature sensors at the exit and entry gates. Where are the sensors? They're in Hong Kong. Here, Pundita feels a Valley Girl joke coming on:

"How do you stop a killer bird flu pandemic?"

"Move to Hong Kong. Duh."

The truth is that any method of tracking bird flu in the boonies anywhere in the world is bound to have holes a mile wide. And it's foolish to bank on a magic bullet drug or vaccine to stop an epidemic in the critical early stage.

So while it's vital to improve data collection and work on magic bullets, governments must not neglect the most effective way to stop a pandemic, which is thorough preparation for quarantine measures. This preparation involves a lot of drill and the entire society.

Is that effort time consuming for the citizen? Yes. But you may trust that if quarantine preparation is ignored in favor of a magic bullet that misses the mark, there will be no one around to close the barn door after the horse is gone.

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