Effect Measure

The number of deaths in Indonesia from bird flu just shot past the 100 mark without even pausing — 101 was recorded right afterward. Tibet announced an outbreak and the disease continued to march through the Indian subcontinent, although the UN flu czar, Dr. David Nabarro said he thought the Indian/West Bengal outbreak was “coming under control.” The use of the progressive tense here (“coming under control”) suggests this is a mix of hope and belief and in any case indicates the outbreak is still not under control. Which won’t come as a surprise to the residents of Kolkata (neé Calcutta):

While the state government on Wednesday claimed that the onslaught of bird flu is coming under control, there was panic at Maheshtala in Kolkata after the mysterious death of 200 chickens there. State animal husbandry minister, Anisur Rehman, however, did not confirm it.

“We are awaiting the report of the High Security Animal Disease Laboratory in Bhopal but since the Union government has permitted us to notify and start the culling, we began the process,” Mr Rehman said. Chief minister Buddhadeb Bhattacharjee will hold a video conference on Thursday with the DMs and sabhadhipatis of the 14 affected districts. (Asian Age)

Given the hundreds of thousands or millions of birds that have died you might ask why the death of 200 is causing a panic and the answer is fairly simple. Because people in India don’t believe anything their government tells them about this. Government statements say one thing (“Don’t worry. We have it under control.”) and tangible evidence (what people see, hear and feel with their own eyes and hands) tells them something else.

It reminds me of that old Groucho Marx line about the man who discovers his wife in bed with someone else. She denies it: “Who are you going to believe? Me or your lying eyes?”

Comments

#1 Albert
January 31, 2008

India is not even close to having it under control. Newsnow has many headlines on the contrary. In fact, Newsnow is also reporting many suspected human cases as well. Here are some of the current alarming headlines:

“Jump in Suspect H5N1 Patients in Murshidabad West Bengal”

“Suspect H5N1 Patients in Malda Transferred to Calcutta”

Either Newsnow is a worthless news source, or there is a serious human outbreak going on.
#2 Joe Six Pack
January 31, 2008

Hundreds of thousands of millions? = Hundreds of billions. I don’t think that many birds have died even if you include the wild ones.
#3 revere
January 31, 2008

Albert: NewsNow is just a news aggregator as you know. The situation with respect to suspect cases is the same there as in Egypt which we discussed. So it is possible/probable that most or all of the genuine suspect cases are not bird flu but the reports are still correct. We saw the same pattern in Pakistan. The only thing we can do is wait and see.
#4 revere
January 31, 2008

JSP: Whoops. Supposed to be “or” not “of”. Corrected. Thanks.
#5 Albert
January 31, 2008

There are no human cases being covered up in India. It is a simple bird outbreak that is being over-hyped. This is no different from any other bird outbreak we’ve seen in the last 3 years in which no humans were infected. Very rarely do humans catch this virus. There is no reason why we should think that this outbreak is any different.

We’re watching ai for the possibility of a new human strain to emerge, and we need to keep our eye on the ball. The India bird outbreak is being hyped exactly like the Egypt bird outbreak was a few weeks ago. Why this is now happening with typical bird outbreaks these days, I’m not sure.
#6 M. Randolph Kruger
January 31, 2008

Here is a nice little video on how to cull chickens…Indian style…

http://broadband.indiatimes.com/videoshow/2746657.cms

Note all of the PPE that is in use. I am sure they all got Tamiflu too as a prophylactic.
#7 herman
January 31, 2008

“There are no human cases being covered up in India. It is a simple bird outbreak that is being over-hyped.”
Albert,
This simple outbreak in birds caused a man in Malda India, whose income depends on his chickens, to commit suicide. 19 people from Malda have been sent to a hospital in Calcutta with bird flu symptoms. Many cullers are out sick, and do not report to work. Goats are dying in large numbers, and it is insisted it has nothing to do with bird flu. Many people will starve, because they depend on the chickens for food.
An editorial in India stated it is very possible this virus will infect humans, because there is a pandemic in birds. In Indonesia an editorial specified human bird flu infections are out of control. In many places the virus is reaching the drinking water, as dead birds are thrown into wells, rivers, and lakes. Bird smugglers are collecting the dead birds and selling them.
I live in Medellin Colombia, where there is incredble poverty and hunger. There are chickens everywhere. The people depend on the chickens for food. People in India are eating the dead birds because they are hungry, and have no other source of food.
The death of all those chickens and goats in India could cause an outbreak of violence, just as it might do the same in Colombia. Supermarkets could be invaded, meaning the invaders will probably be shot. In Colombia, life is cheap.
It is easy for people who live in the US, which has an epidemic of obesity, to laugh at those in India. But your laughter may stop if this virus adapts to humans, in for instance, Calcutta, with millions of residents.
Muchatar Ihsan, a virologist in Bali, recently stated:
“(Exterminating poultry) is not possible anymore, you can only do that when there is a small outbreak, when it first begins. It is now endemic.” “The virus is uncontrollable in Indonesia.”
When Mr. Ihsan said it was uncontrollable, he was not referring to birds. He was referring to 100 human deaths.
If he is correct, and human bird flu infections are out of control, what does that mean? Please think about it for a moment.
In the research regarding binding sugar chains, called glycans, it has been found H5N1 must pick a very specific type of lock to enter the human respiratory cells.
For H5N1 to adapt to humans, it must latch onto the umbrella shaped glycans, or sugar molecules. So far, it has great difficulty in doing that. For that reason, there is only limited human to human transmission.
It is very easy for the virus to latch onto the cone shaped glycans in birds. That is why there is a bird pandemic.
But what happened to H1N1 in 1918? It somehow mutated from a bird virus to become a human virus and kill perhaps 100 million humans. And in Indonesia the mortality rate for H5N1 is about 80%. In 1918, the mortality rate was about 2 or 3%.
Now please concentrate on the next paragraph. A virologist in Indonesia, in referring to umbrella shaped glycans, stated:
“A few mutations are able to confer the HA gene (referring to H5N1) in the virus with the geometric specificity.”
In simple words, if H5N1 mutates to reach this geometic specificity (meaning identify and latch onto the umbrella shaped glycans in humans), the game is over.
#8 carl
January 31, 2008

“There are no human cases being covered up in India. It is a simple bird outbreak that is being over-hyped.” How, precisely, would one know that no human cases were being covered up? That is silly on it’s face. I agree that a massive HtoH outbreak could not be hidden easily. I also agree that there is no particular evidence of the Indian government, AS A GOVERNMENT, trying to cover up human cases. That does not mean local official might not, nor does it mean local medical personnel might not make diagnostic errors, nor does it mean that local economic interests might not be quick to attribute deaths to other causes. I do not believe the Indians are trying to cover up flu cases but one cannot say that we “know” there are “no” human cases being covered up. We know no such thing.
#9 M. Randolph Kruger
January 31, 2008

Yeah Revere-I cant tell whether there are human cases or not in India….

Its the old dog and pony act. We aint testing so you cant call it BF. We can see pneumonia though. Are there H2H cases? Obviously not in a high path way because if it were, we would be burying people in Europe by about now.

Herman-100 human cases… I think he is referring only to the Indon stuff and its not extending in a hard way…yet. I look at the news just before I hit the rack each night because thats when the news is coming in from over there and I get the feeling we are in for it.

But, and its a big damn BUT, we havent seen any “official” confirmation of anything but pneumonia. These guys if they are hiding things are gonna be dead and I mean physically if they are sandbagging in these countries. Those people have a more direct input to their electeds and its via a rope and a tree. Every story out of there is right now that no one trusts them. Thats good on one hand and bad on the other. Good because they will call them on it instantly if it is BF and it manifests itself as such. Bad, because if it is we are screwed…All of us. They will exact their pound of flesh literally and then get it and live or get it and die. But those people who were doing the bagging are going to pay for it and hard.

We saw it in Turkey, we see it in Egypt and Pakistan. Everywhere it has gotten out the people stood and still stand in open defiance of their systems. When it gets to that all things start to spin out of control. I wouldnt want to be any elected guy there if it breaks. If they dont want to call it BF, then fine. Its not fine from a world standpoint but you have to expect these things. Their electeds are as credible as ours.

Now theres a reason to really worry.
#10 Grace RN
January 31, 2008

Common sense goes a long way here. I agree with revere-wait and see-it’s all we can really do.
#11 kimdem11
January 31, 2008

Rewind all the latest case out of India, the cluster cases. Most of the first victims were buried and never tested. It this is how they normally take care of business. We are up the creek with out a boat or paddle.
#12 flulearner
January 31, 2008

Revere: Do you think the AI virus in Indonesia has a problem in binding to human receptors (compared to those in India, Pakistan, and Egypt), cone shape or not? Do you think the AI virus in Indonesia is less virulent in human than poultry since as reported the virus has killed more chickens than humans? Do you think the AI virus in Indonesia will not migrate with birds to other countries or show up in cargo goods (not yet so far)? Do you think the AI virus in Indonesia has a missing link in human transmission and it may one day find it in a pig or a bird co-infected with human H1N1? I think your answers will help global health officials like WHO insist getting collaboration from Indonesian health officials (do they have lying eyes or denying eyes?).
#13 revere
January 31, 2008

flulearner: I assume some of your questions are rhetorical and some real. I don’t have to worry about the rhetorical ones and the real ones I don’t know the answer to. One thing this virus has taught me: to be agnostic about some of the big questions. I think many possible answers are possible and forced choice is not something that’s not my role, although it is for officials. I probably couldn’t do their job. It’s hard and I’m a scientist through and through. I always have too many questions and not enough answers. The Indon gov’t doesn’t listen to me or WHO. They don’t have to and they don’t.
#14 herman
January 31, 2008

http://www.hinduonnet.com/fline/stories/20080215250301800.htm
For those of you who would like to further explore the concept of viral geometric specificity, I invite you to review the above article.
As best as I can understand, there is a need to analyze the H5N1 strains coming out of India, to try and determine if a particular strain may be approaching the point where it can provide the key to the glycan lock, and infect humans efficiently.
I would appreciate it if others who have superior knowledge of this subject would analyze the article, to inform me if my analysis is correct or not.
#15 revere
January 31, 2008

herman: This article only repeats what was said before. It has nothing new. Determining the topology of glycans is extremely difficult and there are probably few labs in the world that can do this now, so it is not a matter of just doing it on the India isolates. It will take time to develop quicker ways to do this. It is not possible at the moment. In addition, this is a single paper. It gives us some valuable places to look but it does not yet present the whole picture. It is very dangerous to fasten on press reports as “the answer” and then ride off madly in all directions. This is fairly complicated science and the topologies referred to are not really shapes in the usual sense. They are pliable and flexible and can’t be seen with a microscope. The topologies are based on molecular structural inferences.
#16 herman
February 1, 2008

Revere,
I want to sincerely thank you for responding in such a clear and concise way to my post.
Please have a good day.
#17 Stan
February 1, 2008

“Jump in Suspect H5N1 Patients in Murshidabad West Bengal”

“Suspect H5N1 Patients in Malda Transferred to Calcutta”

Albert refers to these as “Alarming headlines”.

I don’t agree. It would be better to characterize them instead as Alarmist headlines as they were both carefully scribed by Henry Niman. It seems that Albert is doing a bit of Henry promoting as he is now being picked up by Newsnow. Is Henry paying you to direct traffic his way Albert?
#18 P.
February 1, 2008

Quick note: I think the Marx Brothers version is actually “…your own eyes”, whereas it’s Richard Pryor who elaborated it into the “…your lying eyes” version. Some sources, though, indicate that the line goes all the way back to 19th-century opera!
#19 Albert
February 1, 2008

Stan, the only “paid hype” around here is niman with h5n1.