Accurate and timely bird flu reporting: hope springs eternal

Table top exercises are supposed to be realistic. I've taken part in them and I can tell you they are. So it's not surprising this realism, often including simulated notices and documents, can combine with the speed of information dissemination of the internet in ways that are, well, not surprising:

UNICEF and the Maldivian government are today reassuring people that reports of a bird flu outbreak in the Maldives are untrue.

The reports were spread after documents forming part of a UNICEF simulation training exercise were doctored and leaked by a third party. A document detailing the hypothetical spread of the novel influenza virus across the Maldives was passed around as if it was real.

But the document, which began as an email but was changed and reproduced as a hard copy, was part of a simulated exercise run by UNICEF on February 14 to help prepare staff for the possibility of a hypothetical emergency. In the exercise, staff were briefed on an imaginary outbreak of bird flu, and it was hypothetically stated that novel influenza was spreading across Haa Dhaal atoll. The information was all false, and part of a simulated situation that aimed to ensure UNICEF staff preparedness in the case of any future emergency.

One of UNICEF's procedures in the event of a real emergency is to produce a "situation report" - a document that details the situation and defines the steps to be taken by UNICEF and its partners in the country. As part of the simulation exercise, a situation report was prepared and sent to UNICEF staff. This report gave fictional details of a simulated outbreak.

The situation report was sent internally to staff in UNICEF, who had been briefed on the simulated exercise both in person and via email. But one staff member was not present in the office that day and read his email from a remote location. The staff member received the email detailing the simulated outbreak and forwarded it to colleagues at 15:02 on the day of the exercise. One external email address, a hotmail account, was also on the recipient list. The subject line was: Fw: SIMULATION Fw: Situation Report - Maldives Influenza Outbreak. The headline of the document was Novel Influenza Outbreak Confirmed in Maldives.

After that, the email was apparently forwarded again by one or more of the recipients. At the second round of forwarding, changes were made to the email. "It would appear that someone edited out any reference to the simulation and then handed the email off to Haa Dhaal for unknown motives," says the head of UNICEF in the Maldives, Mr. Ken Maskall.

A hard copy of the document was sent to a chicken farmer in the atoll. Alarmed by what he read, he called UNICEF for clarification. The farmer also informed the Atoll office of the document and the reports of bird flu. Central government soon got wind of the reports and, fearing an immediate impact on the tourism industry, took quick action to inform the public that the reports were untrue. The state media was employed to let people know the situation. Ken Maskall appeared on TV Maldives last night to reassure people that bird flu had not infected anyone in the Maldives. (Minivan News [The Maldives])

As far as I am aware, the Maldives alarm didn't spread very far outside this nation of 26 atolls in the Indian Ocean. Its main industries are fishing and tourism, and it was the latter that was most endangered by the false bird flu report. This did seem to be just as described.

One wonders if the report had been real, though, whether the initial response might not have been the same. Let's hope not.

More like this

It took 2 weeks to learn from Laos that there is human H5N1 infection there, now relocated to Thailand.

Laos waited until the results were known. There was suspicion. There were tests taken on the patient who had obviously something more than a standard case of influenza (or why bother taking samples in the first place?). And for 2 weeks, Laos remained silent about the matter.

There is an influenza-like outbreak in the practically unreacheable Papua New Guinea southern highlands, right now, with a reputed 6 or 7 dead humans and 1000 dead pigs. Yet the treatment of this disease outbreak, courtesy of ProMed's contributor saying it's just anthrax and PNG government saying it must protect its tourist trade, is yet another ho hum and we'll let you know.

After 3 years of witnessing this type of response, after failures to compensate or very slow compensation for culling of poultry, after clear examples of fear of reporting until the health situation is dire due to expected reprisals to the family and the community, with governmental aggressive attempts at blame assessment including fines and loss of revenue like at Bernard Matthews in the UK and even more, prosecution, for the 2 Russian poultry wholesalers in Moscow, it is IMO inappropriate to expect any change whatsoever in the behaviors of either the populace or the governmental agencies.

It is pollyanna-ish, given this sterling track record, to expect early warning, opportunity to apply a Tamiflu blanket, and even local cooperation in both dosing the population with Tamiflu and slaughter of their very foodstocks.

Instead, why do we not recognize reality and anticipate yet more of the same, which raises the question of why do more than attempt to monitor and react when the virus has attained phase 6? And recognize also that phase 6 will be known well after it has started and the virus has spread regionally?

Of course, the consequences to those nation states attempting to "stay in touch" will be less than what are hoped at this time; but that's the way this cookie is crumbling, time after time.

Unless I'm missing something here??

By GaudiaRay (not verified) on 25 Feb 2007 #permalink

GR: No, you aren't missing anything. You always say the same thing and maybe you are right and maybe you aren't. Evidence doesn't seem to make a difference to you. Some countries have reacted swiftly, many haven't. Yawn.

If you believe in evolution, and learn the lessons to be learned therefrom, a crisis of this magnitude requires we encourage as many different responses (actions, not complaints) from as many different persons, clans, and nations, as we can.

Many will be wrong, and some will sabotage others, but we don't know, only historians and mythographers in the future can know, which responses (plural we hope) will be right, which ones will produce survivors.

Evidence doesn't seem to mean a thing to me? What tea leaves are you reading? The sequences from the UK have not been released to the public. They still have not "solved" the "mystery". The Hungarians have no idea what's happening. There's no bird flu between Egypt and Hungary other than in Azerbaijan and now in Turkey (magically flu the coop, eh?)
You see where that Hungarian outbreak is? It got there on the wings of angels and didn't land anywhere in any surrounding country save Azerbaijan. More fairy tales.

Oh, and there's China, WHO's Director's home country that is miraculously bird flu free. They get a whole year of being bird flu free (but not Hong Kong, which has bird flu courtesy of birds imported from where? Oh, China. Maybe China shipped all its infected birds to HK? Gotta get rid of those infected birds (no people of course) before the Olympics of 2008, right?

Bottomline: Non-disclosure of bird flu by individuals, local villages, and countries is the norm. It has been and there is not one reason that it will not continue to be that way. Exceptions like Indonesia plagued by hundreds of outbreaks is because they recognize they blew it and are now crying out for help. If they could get away with it, they'd not say a thing; it's not difficult to deduce that by their string of repeated denials.

Bottomline: Non-recognition that the virus has evolved and added pesky little polymorphisms like S227N, N294S, and others which either kill humans or facilitate transmission is easy. They simply hide the sequences. The latest being Weybridge / Defra / UK and Hungary. Sequences? What's a sequence? The Brits have no idea if that virus which showed up has changes which can either increase transmissibility or reduce the effectiveness of their one and only antiviral defense, Tamiflu. The governments are hiding the sequences, with the exception of Egypt. I'm not missing a thing, as you say, and neither are those who watch this disease expanding its territory and its species hosts, especially you.

Do you know why they hide their sequences? I am sure that hundreds of people would be very appreciative if this were explained to us, honestly. Is it because they want the bucks from the vax deals, like Indonesia? Is it because they want to keep the tourist money rolling in? Is it because of incompetence at the mid levels in public health in those countries, or fear by the mid level'ers? Is it because grad students need to be first to announce the sequences so they can get their PhD's?

If you'd answer this question, "Why do they hide the sequences?", you'd go a long way in lighting the dark night. This would be a universally appreciated insight. Why do thye hide the sequences?

By GaudiaRay (not verified) on 25 Feb 2007 #permalink

>Some countries have reacted swiftly, many haven't. Yawn.<
How many is "some"? One? Two? Five? (Egypt, So Korea, Japan, UK)
How many is "many"? Twenty? Thirty?
How many don't react at all? (Nothing seen, nothing here.)
And what's "reacted swiftly"? Is it "kill the birds around the house", or kill them in the neighborhood, or quarantine 1000 meters? Is that bird culling, but not cats, dogs, rats, flies? I feel like I've just been given the standard brush off; and yet I believe you're not in that camp.

<"Yawn"< If you're tired, take a nap and then explain this disparity and please define what you really mean to say.

By GaudiaRay (not verified) on 25 Feb 2007 #permalink

IMO this compensation thing is H. crap. We are subsidizing insanity. We are I think at the beginning of the storm. No one can say how bad it will be, or if it will come. The ships come in every night in the news of where it is and Greg is 100% right. Its not flamingly infectious yet, but it might be.

Its actually good that he might be right because the second that say 50 cases go ape-shit anywhere on this planet in a cluster, theres going to be a cluster bombing of the economies of the world. Tourism, travel, transportation, JIT, housing, stock markets, food, utilities and on. We can only hope that Greg might be right, Revere remains in the middle and gets his research grants because cancer is a lot like virus, and that we have time to come up with something that at least works partially.

I have a lot of hope for this, but I am not betting my life or most anyone elses that I know on it.

I also think that this isnt going to be the major problem we have in the world in six months and only one or two things could top it and they are all bad.

By M. Randolph Kruger (not verified) on 25 Feb 2007 #permalink

MRK - What two things could top it?

I am looking for clusters of pneumonia deaths in the news, because it is less likely to cause panic and is a symptom of avian flu. I do not trust any government to come right out and say they have a pandemic on their hands. Such as this report from DEMIRA - http://tinyurl.com/2qu275

Lisa: I saw this and went to the guys MySpace site but couldn't find the fake BBC post (I guess he took it down) so I didn't post on it. But he sounds like a dumb asshole.

Another: This is flu season, so there will be clusters of pneumonia (there always are). So your problem is his problem, too. How do you know when you are looking at a true signal? Someone needs to check it out, and that costs time and money. It is a genuine dilemma, but filtering the news sounds like a recipe for disaster.

"One wonders if the report had been real, though, whether the initial response might not have been the same. Let's hope not."

"Hope is not a plan"

Where are the sequences, of all the "atypical influenza" hospital cases, including (local Alabama doc: "healthy"/CDC, no; they had pre-existing conditions, sick, sick) children, in the US ?

(Why did they expect to find 20 to 100 tested wild birds with H5N1 in the 2006 surveillance programs, yet we never heard anything after that 'admonish the media of their awesome responsibility to not cause panic, and anyway, the poultry industry will be perfectly safe' press conference a year ago?)

By crfullmoon (not verified) on 26 Feb 2007 #permalink

V.-Pullout of Iraq results in Iran controlling the Hormuz, and Iraq. That would be very bad. Second would be that the Israelis are not bluffing and they get permission from Jordan and the US to cross Jordanian and Iraqi airspace to carry out what would certainly be a nuke attack on Iran's nuke facilities. It would take IMO at least three tankers, a couple of mini-AWACS, a hell of a lot of fighters in a SEAD mission capability and of course likely also IMO two or three 15 to 20 meg weapons. They are not going to wait around to see if they get one. We likely are going to take them ourselves with the accord of the Russ and Chinese.

All of this would be serious. But Pakistan is about to fall and Musharaffs rule is about to end. Then they get what they want. A nearly UAR scenario for almost 3000 miles, controlling easily 30% of the worlds oil and their economies. I doubt if even the Russians or the US will tolerate it. The Russ know a united Islamic Gulf would first be customers (the French already know it) and second a very hard threat against their country. It was a like scenario that allowed the Saracens to take S. Europe.

By M. Randolph Kruger (not verified) on 26 Feb 2007 #permalink

Lisa the GP, why do you no longer post over at FluClinic? I used to enjoy your posts.