Readers want to know what I think about the bird flu situation in China, where four human cases have been reported in the last couple of weeks. I haven't said anything about it so far, which is normal for me. I usually like to wait for more information. There are dedicated and smart flu bloggers out there who spend more time collecting scraps of information than I do. Check out fluwiki forum and CureEvents, for the latest word, all accurately reported by top rank flu bloggers like crof and Mike and a number of others (it is dangerous to start naming people because you inevitably leave out high quality sources; the blog roll on the side bar has more). I can't improve on what these folks do and I see my role as different: taking a step back and adding some perspective. Not everyone agrees with our perspective, of course, so take it for what we are thinking at this moment. Things can change and we try to change with it when we think it's warranted. I don't know any more than anyone else outside of China, but here's my provisional take on things.
There are two issues, for me. One has to do with whether what we are seeing and hearing seems unusual or not. The other has to do with my suspicions and level of trust about what we are seeing and hearing. Regarding the first, I am not surprised to hear about a spate of new cases in endemic areas. Influenza in general and H5N1 in particular has a strong seasonal component, easily visible in the WHO Pacific Region Office's valuable bar chart showing the "epidemic curve" (cases versus time):
Source: World Health Organization, Western Pacific Regional Office
It is clear that we see peaks in this time period and that this doesn't look at all atypical. In January through March, depending on the year, we see months that can have a dozen or even two dozen cases. So what we are seeing might be "expected" on that score. What about a reported lack of nearby poultry infection? Again, this has been the pattern in China. We don't know why but we've noted it here before, the last time in November 2007.
But is that all there is or has the pattern changed? That's the second question. How much do we trust the sources of information (in this case China and Indonesia). Unfortunately, for most of us the answer is: not much. China is particularly complicated because there are, and has always been, competing factions on the bird flu front. The Health Ministry has been more concerned about health while the Agriculture Ministry has been more concerned about promoting and protecting agriculture. They battle each other in various ways, including through the press and international public opinion. Seeing the signal through the political noise becomes a problem. Indonesia is just plain untrustworthy and irresponsible. I have no confidence we know what is going on there or even if the authorities know what is going on there.
So I am left where we all are. We can speculate and fret but at the moment we don't know. If and when a significant change occurs it will declare itself. When and if that happens I fear we won't be ready for what might come. If. And if, when.
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My name is Ciprian Pater.
I was born in Romania in 1979, moved to Sweden in 1989, have been living in Norway since 1999. My parents and two brothers are alive, my only child, my daughter is full with joy and life without worries.
What does this have to do with the Bird Flu â Avian Influenza you might ask?
For you? Perhaps nothing, but perhaps, the very act you are doing now, by reading these words, may one day save your life.
How can this be possible? I can in no way or fashion tell you all that I know, I have during my past years found amazing wisdom, clear revelations, faultless understanding of many things that defines the entire reality you know of.
But I can tell you this; however you perceive your own reality, I can assure you, that your reality will one day in a not to distant future, change so drastically that all your personality will be immobilized over night. This you will remember I told you!
What I am saying to you, you can hardly yet imagine for two seconds, the reality I am talking about is an assurance of probable death, even so much greater than that one promise which we all receive in our lifeâs, that one day in the future we will surely all of us die!
Imagine you will die sooner than you wish or currently anticipate, where is your will set then unto fulfillment of whatever you wish to partake of in the reality? Your reality, a such well known constant in time. Yes, accidents and terrible Natural catastrophes happen, truly there are many constants in time that nature confronts us all with. Yet most of us cannot gather them selves to realize that whatever doomsday scenarios might be possible, indeed most of those probable events we cannot as humans do anything about. Earthquakes, volcanoes, tsunamis, solar radiation, gamma rays, tornados, hurricanes, lightning simply the will of God Almighty.
Yet, still, our modern reality is experiencing a relative calm, for this reason the chance of surviving coming a Bird Flu Pandemic is high, the day the pandemic has started the chance will slide to zero by every hour passing! It all comes down to money, either you act to survive before the entire world wakes up to the same need, or you risk of being without essential survival necessities. But once the pandemic has started money, currencies will soon loose their value! Mind you not, you cannot imagine the fullness of my words!
To stay healthy, donât get sick, to do this you must have: Respirators - Disinfectants - Gloves - Coveralls - Glasses etc
If you get sick, treat yourself, to do this you must have; medicines, herbs, vitamins, minerals etc
To survive, isolate yourself, to do this you must have, food, water, and heat for many months.
What about me? Well lets just say that no one needs to worry for me in light of this issue, so I would wholeheartedly recommend you all to try to understand why I am telling you these things.
I am normally a very carrying man, I have great empathy for people, even those whom are not suffering and strangers, yet I can tell you this honestly, that day, when I know the pandemic has started, I will suddenly care for very few people, whatever my needs, desires, wishes and hopes might have been before that day, will as I imagine now, disappear as if I never existed.
Good Luck unto you all.
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Revere, like folk at Recombinomics, I consider the future likelihood of Tamiflu resistance in H5N1 to be an issue. It's not at all difficult to picture an impoverished Indonesian, Chinese or Indian family co-infected with H5N1 and seasonal H1N1 containing the antiviral resistant mutation H274, which could lead to the evolutionary emergence of H5N1 with H274Y.
I'm deeply concerned people entrusted with our health, gov employees such as Australian Health Minister Nicola Roxon, remain silent on this issue...
What (((DO))) we do if Tamiflu becomes an ineffective treatment for avian flu!?! This is why I'm pushing the vaccine cart -- I don't see any other option:
It's dreadful, this slow "dripping tap" of avian flu infections and deaths currently taking place in different regional areas of Mainland China. It's dreadful, but predictable. I'm sorry for these people. I'm sorry for their families... I'm sorry, but hardly shocked -- indeed, I feel like I felt back in 2003... Resigned to the inevitable script: drip, drip, (regional H5N1 clade evolution) drip, drip, (governments fail to take a military approach to pandemic prevention), drip, drip, (evolution of antiviral resistance develops as a significant issue), drip, drip, (governments in financial crisis fail to invest in alternative modes of public avian flu treatments), drip, drip...
Re: prepandemic H5N1 vaccination as an early public health intervention -- especially, in light of recent global H1N1 tamiflu resistance protein mutation (H274Y) which could recombine with current or future H5N1 strains, causing these antivirals to be ineffective as an avian flu treatment.
I've repeatedly written to Nicola Roxon, Federal Australian Minister for Health and Ageing regarding this subject but to no avail. As an informed adult who has spent, over the last 8 to 9 years, thousands of hours educating myself on the intricacies of H5N1 evolution and pandemic prevention, I reasonably expect a degree of control over my own health choices -- the freedom to arrange with my GP, Dr Ric Chaney, to be vaccinated with Australia's CSL Panvax®, Avian Flu Vaccine.
Each of us are "stakeholders", attempting to keep both ourselves and our families safe...
CIDRAP News (Jun 17, 2008 ) -- "Australia approves CSL's H5N1 vaccine" by Robert Roos @ http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/jun1708v…
Excerpt: "Panvax can be used only when the Australian government officially declares that a flu pandemic is under way, CSL said in a news release. "In the event of a pandemic, CSL will rapidly gear up to manufacturing levels that will ensure all Australians have access to safe, effective coverage against avian flu," said Mary Sontrop, general manager of CSL Biotherapies, in the news release. The release quoted Australian Health Minister Nicola Roxon as saying, 'This places Australia in an excellent position in terms of its preparedness to manage an avian flu pandemic should one arise and should reassure all Australians...'"
I'm an Australian and believe me, I aint "reassured" -- how can intelligent people like Mary Sontrop and Nicola Roxon be so utterly complacent and shortsighted!?!
I want control over my body and be free to contact my GP and arrange to be vaccinated with Panvax®, Avian Flu Vaccine. This won't happen unless folk continue reminding our federal government to act now -- right now, while there's still time to calmly and efficiently utilize available public and private resources...
Jonathon, we have got a Buckley's Chance of getting any vaccine.
It will take months to produce a vaccine, and many more months to manufacture and distribute the vaccine. Who will get the vaccine first? For those of us that are not connected to the government infrastructure in some way, how will we survive long enough to receive the vaccine in time?
For all our technological advancement, and our advances in the medical sciences, I fear that should the next pandemic break, it will be like stepping back in time to 1918.
Preparation is the key.
Yeah, well, revere "doesn't know", "I don't know", so we'll just go to the other flu watch sites and forget that an epidemiologist "just doesn't know".
Let's just "speculate and fret but at the moment we don't know".
Well, something has changed in the last two years - there aren't the same number of commenters on a revere bird flu posting. I know there's not much change to speak about, but there used to be too much to read through in one sitting. Just an observation.... (where's Randy?)
On a happier note, the vacuum left with the realisation that Tamiflu was always one of many well documented mutations away from being useless, has accelerated trials of other antivirals. (At least it happened with seasonal flu and not during a bird flu pandemic.)
"Daiichi Sankyo Co, Japan's third-largest drugmaker, said it plans to apply by March 2010 for marketing approval in Japan of an influenza drug candidate, and seek approval in Taiwan, Hong Kong and South Korea soon afterwards."
""Prompted by rapidly increasingly needs for new influenza treatment, we have sped up the development of the drug and are now set to complete all our six lines of clinical tests, three for use in adults and three for children, by March," said Daiichi Sankyo director Daisuke Hiro."
http://www.reuters.com/article/rbssHealthcareNews/idUST18357620090123
CS-8958 is a long-acting neuraminidase inhibitor that is expected to be used as
single administration for treatment and once a week for prophylaxis. The compound
is under development as an inhalant that will act directly on the pulmonary and
tracheal sites of infection.
http://www.daiichisankyo.com/4less/cgi-bin/cs4view_obj.php/b_newsreleas…
Our concerns aren't only exacerbated by bureaucratic behaviour in China and Indonesia; a false faith in Tamiflu was America's contribution.
Steph: .... (where's Randy?)
I roared in laughter when I read this. MRK is in Afghanistan and will be back in a couple of weeks.
I'm surprised he still comments here as so many have been undeservedly cruel and nasty to him.
I will second that Sandra. This site is quite boring without Randy's comments. Love him or hate him, Randy is never boring, he makes us think, and we certainly get a different perspective on the topic at hand. Hey Randy - your the best!
MRK is in Afghanistan? Is he in the Army?
This constant "slow dripping faucet" of cases is cause for concern but may serve to keep the subject on the radar.
And given Obama's ties to Indonesia, he could potentially exercise some influence there. Seems to me that, regardless of who one voted for, it's important for anyone concerned with public health to start writing "Dear Mr. President" emails to encourage him to get fully informed on this issue and start talking to Indonesia's government ASAP.