Thursday, August 31, 2006

Since you Can’t Hide

(note: followup to previous article)

In my last post, I addressed the futility of hunkering down and hiding from the virus for 18 months or longer. I’m sure I’ve lost some popularity points over that, but so be it.

If you can’t hide, what then?

First, lets qualify some terms. SIP (sheltering in place) doesn’t mean total isolation. It means being prepared to survive long term in your home or residence. It means having the basics of life, food, medicine; enough to enable you to go for weeks or months without being desperate for new supplies.

It makes perfect sense to protect yourself, and loved ones, by avoiding public gathering places during a pandemic. Standing in line for food, going to grocery stores, or sitting in an emergency room for 12 hours to get a Band-Aid are bad places to be when the virus is running rampant in your area. So having the supplies at hand to SIP for 3 months, or six months, or even longer is a very good idea.

But in order to survive a pandemic, we need to be thinking in terms of community, not individuals. Yes, I know that’s a tough concept. We’ve lost our sense of community over the past few decades. We rarely know our neighbors, and trust is a scarce commodity. In that sense, we are much worse off than we were in 1918.

Neighbors need to band together, support one another, and work through this together. They can’t do that hiding behind shutters, guarding their rice and beans with a shotgun.

Is there risk? Sure there’s risk. Nothing is risk free in a pandemic. But attempting individual survival, even at a family level, is riskier. We have more to fear in a pandemic than the virus. Think about hungry, desperate, and well-armed neighbors who view your supplies as the key to their survival? Better to band together, than to have to fight them off individually.

If essential workers; doctors, nurses, hospital employees, utility workers, cops, and firefighters abandon their jobs, then the collateral damage becomes much worse. And there will be a great need for volunteers to handle everything from medical work to more mundane jobs, to take up the slack when employees are out with the flu, or are taking care of loved ones.

We have a choice. We can hunker down and hide, and make the pandemic worse than it has to be, or we can take reasonable precautions and face it head on.

If we lose our medical system, our power and water, and law and order, then the death toll rises far beyond what the virus will claim. The loss of our infrastructure could start a cascade effect, and the downward spiral it would invoke could have a very deep bottom.

In a pandemic, everyone one can be an essential worker. Sure, I understand some parents won’t want to risk exposing themselves, and possibly bringing the virus home to their kids. It’s a legitimate concern. And for those with small kids at home, some dispensation should be considered. But the ability to SIP long term doesn’t change, even if you have kids to consider.

And here is the perfect example of how a neighborhood banding together can help. Some parents could stay home and care for the kids in the neighborhood while others did the necessary jobs to keep the infrastructure alive. Home schooling is another example. Does it make sense for each family to attempt this, or does it make more sense for one house on each block to handle this task?

If you have little or no medical skills, and there is a retired nurse living in your neighborhood, wouldn’t it make sense to be able to call on him or her? Perhaps you have something they need. Barter and cooperation beats isolation any day. A cooperative neighborhood watch makes far more sense than every home for themselves.

If essential services are curtailed, then each neighborhood will have issues to deal with. Trash removal, acquisition of water and food, medical care, security, and yes, even removal of bodies. All of these tasks are better handled as a group.

I know what you are thinking. But to do this, I’ll have to risk exposure!

Absolutely true. But I doubt many of us can avoid exposure in the long run. Some of us will have a natural immunity, if 1918 is any guide. Only 30% of the human race caught the Spanish flu, despite the fact that nearly all were exposed. Others may catch avian flu, and recover. It will be, admittedly, a crap shoot. And yes, some will pay the ultimate price.

But the virus isn’t the only killer in a pandemic, and may not even turn out to be the worst. We have to accept certain risks in order to mitigate the greater danger.

A pandemic is like a war. A war we must win. We will be dealing with a foreign invader on our home soil. Running and hiding isn’t really an option.

Nonetheless, some people will attempt it. And the more that do so, the worse things will be for all of us.

You Can Run . . .

Among those who are watching the avian flu threat, a certain number have decided it is in their best interest to head for the hills when the dam busts. Sadly, some of these people are doctors, nurses, and other essential personnel. While I understand their fears, and to some extent their reasons, I believe that while you can run from this virus, you can’t hide.

I’ll present what I consider to be a more logical response in another post. But for now, let’s examine the feasibility of heading for the hills. Is it even practical?

The assumption is a pandemic would last for 18 months, as that is how long the 1918 pandemic persisted. The next pandemic could last just as long, or longer. Or it could sweep thru quickly. Nobody really knows.

To be absolutely safe from the virus, one must isolate themselves away from any possibility of infection. That means zero contact with the outside world. None. Nada. The virus could arrive piggybacked to a visitor’s immune system, or thru contaminated money, or even in an infected letter left in the curbside mailbox by your local carrier. Once you go into seclusion, you’d have to turn away friends, relatives, neighbors, and even local authorities.

There are many who are planning to do this. Some have cabins in the woods to bug out to, while others will sequester themselves in their homes, locking the doors and barring the windows for the duration. I’ve heard of elaborate plans, huge stockpiles of food, water, and medicine, and even plans to meet any visitors with firearms to turn them away. In some cases, it will be a small family, in other cases, several families have banded together, pooling their resources.

Stockpiling food, water, and medicine for 18 months for a family or group is a daunting task. It is expensive, it requires ample storage, and extreme foresight to envision everything you might need. Obviously very few people will actually be able to do this. Some are stockpiling 3 months, or six months worth of supplies, and are praying the pandemic is over, or a vaccine is developed before their food runs out.

While I understand the allure of such a plan, none of this seems terribly practical to me. Logistically it would be a nightmare to SIP (Shelter in Place) for months on end. And all it would take is an infected bird depositing droppings on your windowsill, an unplanned medical emergency, or some external event like a flood, hurricane, or fire to screw the whole deal.

Worse, assuming you could do it, knowing when to emerge would be a real problem. Yes, the pandemic in 1918 lasted 18 months, but no one knew it was over in 1919. The assumption was it could come back again. And there is evidence that the Spanish flu did persist at low levels for years afterwards. At what point to you exit your self inflicted solitary confinement and expose yourself? You, after all, would have developed no immunity to the virus while sequestered.

Hunkering down until a vaccine is developed sounds good, but experts tell us it could be 3 years or more before that happens.

I suppose if you already live on a small farm in the backwoods somewhere, and are self sufficient now, it might be worth a shot. A small family might be able to maintain bio security for a year or two, assuming no one developed appendicitis or chopped off a leg with an axe. But few of us have those skills, or the requisite farm, so the question is probably moot.

Undaunted by reality, many will try this strategy. Some will head to the hills with backpacks and tents, others will nail boards across their windows of their town homes and stand watch at the door with a shotgun.

I guess these folks are picking their poison. Better to die of domestic violence brought on by prolonged isolation, or from starvation, than from the virus.

There are reasons to stockpile food, to maintain social distancing, and to prepare for the pandemic. But there are better ways to do it. Running away is a long shot. In my next post, I’ll address what I consider to be more rational methods of enduring a pandemic.

Wednesday, August 30, 2006

Sleight of Hand

For the past several months, all eyes have been on Indonesia. Starting with the cluster of 8 in May, where H2H2H (Human to Human to Human) transmission of the virus was first suspected, Indonesia has held the flu community breathless. While things quieted down in June, and our attention was diverted to Thailand for a few weeks, this archipelago nation of 200+ million people once again has our rapt attention.

Up until a month ago, the total number of flu patients in Indonesia was in the 50’s. Since that time, another 60 patients suspected or confirmed to have avian flu have cropped up. As I detailed yesterday, a number of these patients have died, and some without testing. But they presented clinical symptoms consistent with bird flu, and doctors there are supposedly confident that many were indeed infected.

The WHO, meanwhile, refuses to even acknowledge any suspected infection unless tests are conducted by certified WHO laboratories. Better, I suppose, that 100 cases are missed than one falsely identified. This policy of wearing blinders does provide some benefits, however. It keeps the numbers down, and therefore the panic.

Today, the MSM (mainstream news media) isn’t even paying attention, and the only reports we are getting come from Indonesian newspapers, and they are written in Bahasa, the official language of Indonesia. Translations come to us via computer programs or volunteers, and the results are often confusing.

But despite the translation difficulties, we know that many cases of suspected bird flu in humans are occurring. That a Tamiflu blanket has been applied to affected villages (considered a drastic step by the WHO), and that some villages have been quarantined, with roads in or out blocked. There are reports that health officials have run out of disinfectant sprays. And the local news media has publicly reported that they are being denied access to the affected areas.

What we don’t know, and what keeps flu watchers up at night, is just how bad it really is?

So far, the number of reported infections is below that which we would expect if the virus were spreading easily. But are we getting the whole story? We simply don’t know. The secrecy surrounding what is going on there clouds the issue. We won’t know until they decide to let us know.

The use of a Tamiflu blanket, literally forcing all citizens within a certain distance of an outbreak to take this antiviral every day, is considered a last ditch effort by the WHO to contain an outbreak. While it might stop a potential pandemic today, the fear is it could infer Tamiflu resistance to the virus, and tomorrow, or next week, when it happens again, tamiflu may be useless.

While all of this is going on, Thailand is battling it’s own bird flu outbreak. So far, officially, they only report 2 human cases. But Thailand covered those up, along with poultry deaths, and few believe we are getting the whole story there.

Vietnam, once cursed with the worst record of human infections of bird flu, had been trumpeting their success in stopping the virus until this past month, when they admitted it was back.

And Africa remains a big question mark. I’m hearing disturbing reports, nothing I can confirm, but that do make me wonder if something isn’t going on there. Bird flu could be killing scores each day, and those victims would be lost in the clutter of 6000 routine deaths every day, many from AIDS, dysentery, or Cholera. We simply don’t know. And it’s maddening.

So while all eyes are on Indonesia, we need to be aware that the virus is now endemic in many parts of the world. Surveillance in some areas is non-existent. And flu season approaches.

If this quiet season is any indication, it's going to be a busy winter.

Tuesday, August 29, 2006


Yes, gentle readers, I have returned from my sojourn to my doctor in Missouri and have resumed my duties here at A Flu Diary. I’m pleased to note that I made it from point A to Point B and back again without hitting anything, which meets my definition of a successful car trip.

Of course, while I’ve been gone, the virus goes on undaunted. Thailand, presumably Africa, and most certainly Indonesia are all under the gun. As I was leaving a week ago the worry was that the clusters in Indonesia heralded something ominous. While something is definitely going on there, so far, it falls short of an outbreak of sustained H2H transmission.

Over at the wiki, members have been keeping track of the outbreak, gathering information from local Indonesian newspapers, relying on toggletext translations and the efforts of some native language speakers who have volunteered their time. This isn’t easy, and these newspaper reports are often confusing. Michelle in OK has posted this latest summary in , and it now numbers 63 cases.

Cikelet, W. Java

  1. 7/26 - Misbah (20M) symptoms, no tests died Aug-5
  2. 7/26 - Umar Aup (17M) symptoms, to hospital 8/09, left for home treatment, + , RSUD Slamet Garut
  3. 7/27 - Santi (6F) symptoms, to hospital 8/16, released, tested negative , RS Handsome Sadikin (RSHS) Bandung (sister of Ismawati, daughter of Kuraisen & Osin, neighbor & playmate of Ai)
  4. 7/31 - Sardi (4M) died no tests died
  5. 8/1 - 0 symptoms, to hospital 8/14 + WHO confirmed, died Aug-15 , RSUD Slamet Garut
  6. 8/1 - Rubiah (13F) died no tests died
  7. 8/15 - Ismawati symptoms, to hospital 8/16, released, tested negative , RS Handsome Sadikin (RSHS) Bandung
  8. 8/15 - RL (34F) symptoms, to hospital 8/25
  9. 8/16 - Dea (9) died no tests died
  10. 8/16 - Risma (4F) symptoms, to hospital 8/19, released , RSUD Slamet Garut
  11. 8/17 - Euis Lina (35F) died + WHO confirmed, died , RSUD Slamet Garut
  12. 8/17 - Eti (35F) hospital , RS Handsome Sadikin (RSHS) Bandung (may be duplicate name/report for Kuraisen)
  13. 8/18 - Kuraisen (32F) symptoms, 3 mos. pregnant, released tested negative , RS Handsome Sadikin (RSHS) Bandung
  14. 8/19 - Ayi Rohima (10F) hospital , RS Handsome Sadikin (RSHS) Bandung
  15. 8/19 - Memen (60M) hospital , RS Handsome Sadikin (RSHS) Bandung
  16. 8/19 - Risman (5M) hospital (sibling of Rubiah & Misbah)
  17. 8/19 - Yana (50) hospital tested negative , RSUD Slamet Garut
  18. 8/20 - Gilang (14) hospital tested negative , RSUD Slamet Garut
  19. 8/20 - Risma (4) hospital
  20. 8/20 - Tosim (61M) symptoms, improving tested negative , Slamet Hospital Garut / RS Handsome Sadikin (RSHS) Bandung
  21. 8/21 - Dadan symptoms (family of Euis Lina)
  22. 8/21 - Dadan Child #1 symptoms (family of Euis Lina)
  23. 8/21 - Dadan Child #2 symptoms (family of Euis Lina)
  24. 8/21 - Osin (36M) symptoms, released, tested negative , RS Handsome Sadikin (RSHS) Bandung (husband of Kuraisen)
  25. 8/23 - Herman (21M) hospital, improving tested negative
  26. 8/23 - Rangga (6 months)
  27. 8/25 - Cicadas or Dede died suddenly after showing symptoms, chickens died also died
  28. 8/27 - Aris (10)
  29. 8/27 - Pipit (6)
  30. 8/27 - Burhan (38)
  31. 8/28 - Direct (60M), wife is Walk On, hospital, chickens owned died , RSUD Slamet Garut
  32. 8/28 - Ai Siti Fatimah hospital, critical condition transferred from community center to hospital

Bandung, W. Java

  1. 8/24 - student TK Sukowiyono hospital

Bekasi, W. Java

  1. 8/13 - Meggy or Mega Saputra died no tests died (possibly Nursifah’s mother)
  2. 8/18 - Nursifah (6F) hospital, ICU + , Sulianti Saroso Infection Hospital, Jakarta North
  3. 8/25 - Nursivah (3M) hospital, tested negative , Infection Hospital (RSPI) Sulianti Saroso

Bayongbong, W. Java

  1. 8/23 - Ari Tresna Alfajar Day or AT (14) hospitalized Wednesday , RSUD Slamet Garut

Garut, W. Java

  1. 8/27 - Hendra (21) +
  2. 8/27 - Gilang (9) +

Tulungagung, E. Java

  1. 7/22 - DA (5) DA (5) no tests
  2. 7/22 - NA (.5) NA (.5) no tests
  3. 8/25 - Lasting Goddess TK Sukowiyono (6) hospital, released 8/27, tested negative , Dr Iskak Tulungagung

Madiun City, E. Java

  • 8/25 - 5 suspects in Ponorogo
  • 8/25 - 2 suspects in Magetan

Kendari, SE Sulawesi

  1. 8/23 - Siblings hospitalized: Andika (1.5) hospitalized - released Aug-25 (siblings)
  2. 8/23 - Siblings hospitalized: Daffarial hospitalized - released Aug-25 (siblings)
  3. 8/23 - Istiwati (17) symptoms (cab driver Ambu Sao’s family)
  4. 8/23 - Nurhadayani (5) symptoms (cab driver Ambu Sao’s family)
  5. 8/23 - Ahmad Djafan (1.5) symptoms, ICU , RSUD South-East Sulawesi (cab driver Ambu Sao’s family)

Palu, Central Sulawesi

  1. 8/26 - Elis(21)
  2. 8/26 - Farah (5)
  3. 8/26 - Kiki
  4. 8/26 - ? Name (from Palu, at least 4 people in hospital, possibly more)

Palembang (Lubuklinggau), S. Sumatra

  1. 8/21 - Putri Wira Maharani (8F) hospitalized (siblings)
  2. 8/21 - Putra Wira Aditya (3.5 month M) hospitalized (siblings)

Saribudolok, North Sumatra

  1. 8/23 - K boru Saragih hospitalized Wednesday, direct contact w/ poultry, , RS H Adam the Medan Owner

Simulungun, North Sumatra

  1. 8/22 - RL or Rasmita Boru Lingga (35F) pregnant and on Tamiflu, ICU , Adam Malik Hospital Medan
  2. 8/25 - Simulungun government official , RSU Pematang Siantar

Tebing Tinggi, North Sumatra

  1. 8/26 - Fatimah (78 F) symptoms, chickens owned died , Tebing Tinggi Public Hospital, North Sumatra

Other Noteworthy Dates

  2. 8/25 - 215 students the Aisyiyah Kindergarten, Palu tested after 22 birds found positive

So far, this is very worrisome. Over the past year, Indonesia had reported roughly 60 cases. In the past month, that number has doubled. A number of these cases are listed as having tested negative for avian flu. Some of them, undoubtedly, are really negative. But in a high number of cases, patients test negative repeatedly, then die, and then during the post mortem have been found to be infected.

However, if this were the start of a pandemic, the number of infected after a month would number in the thousands, and so far, it doesn’t.

But each human infection is another spin of the mutation roulette wheel, another opportunity for the virus to change into a pandemic strain. It hasn’t quite found the right combination of genetic sequences yet. We can hope and pray it never does. But the virus cares nothing about our prayers. It will do what it will do, regardless.

There are also newspaper accounts telling us that the military, and health officials, are restricting the access of the press in covering this story. Villages are quarantined. Schools are closed. And doctors who are treating these patients are under observation, and not allowed back into the general population until they have passed the incubation period without incident.

So, while a pandemic may not have sprung forth from Indonesia yet, what is happening there is ominous, and bears watching.

Saturday, August 19, 2006


For those of you of a certain age, you will remember the cliffhanger; a dramatic invention most likely to be found at the end of a multipart serial shown at the movie theater. For your 25 cents (or 10 cents if you are really old), you got a double feature, a cartoon, a newsreel, and a serial.

Flash Gordon, Gene Autry in the Phantom Empire, Superman, and even Commander Cody thrilled us with their multipart adventures, each leaving us in suspense as the hero is about to meet his doom . . .

For those slightly younger, this tradition was carried on in the mid-1960's with the Batman TV show.

Why am I waxing nostalgic, and what does this have to do with Avian flu?

Simple. I’m leaving again for a week or 10 days, once again on a cross-country trip to see my doctor in Missouri. I’ll be leaving you tomorrow, and will likely not return until near the first of the month. And as I leave, the avian flu news continues it’s ominous beat. Indonesia, Thailand, Cambodia, Vietnam, China, and virtual silence from deepest, darkest Africa.

While I don’t expect a pandemic to erupt during my absence (it would be somewhat problematic for me if it did), I would urge my regular readers to remain alert, and to follow the flu news closely. Indonesia may turn out to be another brush fire, destined to self-extinguish itself as the virus comes to a genetic dead-end. But then again, we could be seeing the beginnings of a significant outbreak.

Stay tuned. And come back for the thrilling answer to that question, and many others next week.

Same Bat-time. Same Bat Channel.

Friday, August 18, 2006

Confusion and Worry in Indonesia

Something ominous is going on in Indonesia. Again. Last May we saw limited Human to Human (H2H) transmission of the virus among 8 family members in the Karo district. Thankfully, that clustered died with the family. It did not spread. We dodged a bullet.

Now, we are hearing of a cluster of cases in the Garut Regency of Indonesia, and while details are sketchy, it appears to involve 11 patients, all sickened (some have died) in the past 10 days. Much of the information we are receiving is thru local news media, and translation difficulties (and inexact reporting) make the interpretation of these reports problematic.

The Flubie community has its ears perked up right now. Flu forums are trying to put these reports into some sort of sequence that makes sense. It’s not an easy job. For those who desire to keep up with the latest, allow me to suggest you monitor the news threads at Plan For Pandemic. If you don’t already belong to this excellent flu forum, now would be an excellent time to sign up.

As the details coming out of Indonesia are still unclear, I won’t go into details about the cases. But it does appear to be a developing, and potentially serious, situation. We will hopefully know more by the first of the week. Weekends have been historically a black hole for information.

This cluster could peter out, just like the Karo Cluster. Maybe we will get lucky again. I’ve seen too many of these flash fires burn themselves out to get too excited yet.

But it is probably inevitable that one of these days; a small brush fire outbreak will expand into a viral conflagration.

So Indonesia bears watching. And yes, worrying about.

Tuesday, August 15, 2006

Opposites Attack

This morning we are getting a glimpse of how two communities are attacking the avian flu pandemic threat. I think you will be surprised by what you read.

This article appeared in this mornings paper.

County's Pandemic flu plan kept secret

CHARLES STANLEY,, (815) 795-2023

La Salle County has a preliminary written plan for dealing with a pandemic flu outbreak that has been filed with the state. But the plan is not now -- and perhaps may never be -- available to the public.

Julie Kerestes, the county's public health administrator, said a draft of the plan had been shared with community hospitals, schools, law enforcement agencies and other "players" to see where they fit in so a more comprehensive plan could be put together.

"But I'm not sure it's a public document I want to be releasing," she said Thursday.

The secrecy is not limited to the pandemic flu plan, she pointed out.

"We have other emergency plans here, other plans of operation that I don't consider public knowledge that we wouldn't give out to the public."

County Board Member Bill Johnson, D-Peru, president of the La Salle County Board of Health, said Thursday he was puzzled to hear the plan was not public. And Marius Derango, D-Peru, chairman of the County Board's Health & Coroner Committee, said he did not recall his committee reviewing the plan before it was submitted to the state.

I guess the County Board’s Health & Coroner Committee doesn’t have a need to know. But then, neither does the public. This is a shameful way to conduct public business. I can think of two good reasons not to share this pandemic plan with the people they work for. Either they have no plan (nothing that will work, anyway), or the details are so alarming, they dare not reveal them. I’m glad I don’t live in Illinois.

Now, let’s visit Arizona, where they are talking far more openly, and realistically, about pandemic concerns. . .

Education 1st step in dealing with pandemic


Sunday, August 13, 2006 8:38 PM PDT

BULLHEAD CITY - Experts agree it's not a matter of if a flu pandemic will strike the United States but when and how the virus will spread.

Arizona has held a series of forums during the last several months in hopes of preparing communities for the devastation of a flu pandemic. Western Arizona Regional Medical Center is working to assure the highest level of preparedness, officials said.

“The first thing we need to do is educate the public prior to the onset of an emergency,” said WARMC Infection Control Practitioner Pam Nolting. “People can prepare for a disaster in their homes if they know what to expect.”

To avoid a mad rush of frenzied, worried people, storming grocery store shelves and pharmacy supplies, Nolting recommends people prepare in advance.

“Start stockpiling three months of medication and food stores,” she said. “A clean garbage can is great for storing dry food and nonperishable items.”

According to projections, the flu pandemic will kill a maximum of 40 percent of those who contract the illness, down from the 50 percent succumbing in the third world countries currently dealing with the Avian Influenza, said WARMC Director of Cardiopulmonary Services Gary Lynch, who is a member of the pandemic flu response team.

“We wont know for sure until it actually hits, but a pandemic flu is going to affect millions,” he said. “One thing that's unusual about a pandemic flu is that it will hit people in the 20- to 40-year-old range. Usually healthy people in the middle age range are not at risk for influenza. It usually strikes young children and the elderly, but a pandemic flu will most affect that middle range group.

It's very likely that a pandemic will disrupt every day routines, such as school, public gatherings, even church,” he said. “All services will be disrupted, electricity, water, police and fire. Will there be enough people well and available to continue these services?

One of the main concerns at the state level is whether local facilities will have a sufficient supply of ventilators, Lynch said.

We have received a grant from the state to purchase more ventilators,” he said. “But, everyone else is doing the same thing so there is a back log.”

This is an excellent article, and I urge my readers to read it in its entirety.

For the first time, we see public officials admitting the mortality rate here could be far higher than the laughably optimistic 2.5% we’ve been hearing for months. And of course, they recommend 3 months personal stockpiling, which far exceeds the 2 weeks suggested by most officials.

Dire predictions, even by State Officials, don't guarantee that they will occur. But at least in Arizona, they are recognizing the potential. Right or wrong, they will certainly be in better shape to deal with whatever happens, than those states that have their heads buried deep in the sand.


Monday, August 14, 2006

Monday Morning Roundup 8/14/06

It is axiomatic that in the Avian Flu world, news all but disappears on the weekend. From Thursday night, thru Monday morning, very little reporting is done. We do, however, have a few interesting tidbits to start our week off with.

Indonesia continues to lose the battle with avian flu, and more human cases are being reported. The virus is endemic in the domestic poultry population, and there is little cooperation from the inhabitants of the thousands of islands that make up this country, in culling their primary food source.

Indonesian bird flu patient refuses treatment, officials say

JAKARTA (AP): Indonesia's latest bird flu patient checked out of hospital after spending just a night there, while his cousin died last week showing symptoms of the virus but was not tested in time, health officials said Monday.

Umar Aup was admitted to a hospital in West Java province last Wednesday and left the next day on the orders of his family, who said they could treat him at home with a mixture of prayers and traditional remedies, said Dr. Eka Sony, a Health Ministry official investigating the case.

The 17-year-old remains very ill, said Sony, who visited him Sunday in his remote village.

"Our team felt very frustrated we were not able to persuade the family to let doctors take care of Umar," said Sony. "His father said he has the right to choose the treatment for his son, whatever the risk."

Villagers said Aup and his cousin collected the carcasses of around 100 chickens that died suddenly last week and fed them to dogs, said Sony.

Sony said Aup's cousin died after showing symptoms of the virus.

Health officials have said they suspect that many Indonesians have died from bird flu unreported because they no tests were performed.

Laboratory tests have confirmed Aup has the virus.

This is not the only human case in Indonesia right now. And several deaths have been reported there over the past week, attributed to the H5N1 virus. How many more have died, and simply been buried without testing, is unknown. But that number is likely to be significant.

Meanwhile, in Thailand 46 patients with suspected bird flu are in quarantine.

46 patients monitored for bird flu

A total of 46 Thai patients suspected of contracting the deadly avian influenza are under close medical supervision, while Prime Minister Thaksin Shinawatra has approved a budget to build 100 more patient rooms at hospitals nationwide, said Public Health Minister Pinij Jarusombat on Sunday.

Agriculture and Cooperatives Minister Sudarat Keyuraphan said that no victim of the deadly disease has been found in Bangkok.

Rumours of Bangkok victims had caused concern last week. The capital has suffered a spate of influenza, including many serious cases, but none has proved to be H5N1 bird flu, authorities said.

Mr Pinij said the prime minister had given the green light for a budget to build 100 more rooms for patients suspected of contracting the disease.

Most of the rooms will be built at hospitals in provinces where the situation is severe such as Phichit, Uthai Thani, Kampaengphet and Nakhon Sawan and they will be completed within three months.

Friday, August 11, 2006

Public Face, Private Advice

Once again, public health Authorities are urging residents (this time in New York) to stockpile two weeks supplies in order to weather a pandemic emergency.

Flu pandemic readiness urged

Stockpiling food, water, drugs recommended

Matthew Daneman
Staff writer

(August 10, 2006) — BRIGHTON — New Yorkers should have a two-week supply of water and food on hand, as well as a stockpile of nonprescription drugs and other health supplies, in case a feared avian flu pandemic becomes reality.

That was the message state Health Commissioner and former U.S. Surgeon General Antonia Novello brought Wednesday as she addressed the annual conference of Monroe Community College's Homeland Security Management Institute.

While 2 weeks is better than nothing, and far exceeds the traditional advice from FEMA (which everyone ignores) of having 72 hours of supplies on hand, it will be woefully inadequate during a pandemic.

But this seems to be the level of preparedness that officials are willing to recommend. At least to the general public.

If you work for the State Department, however, you probably have seen the recommendation for 8 to 12 weeks of supplies, posted on the State Departments’ website. And according to recent reports by paramedics/firefighters attending Homeland Security sponsored extended education classes, many are being told to have 3 months supplies. Minimum.

Even more telling, these first responders are being told to return to their squads and spread the word. Prepare now. Do not wait.

As a former medic, one who worked side by side with firefighters and cops, I appreciate that they are getting better advice. We are going to need these folks on the job during a pandemic. Can’t very well have them standing in line for MRE’s or rice and beans for their families for six hours a day.

And I understand the logistical and economic concerns of the authorities. If they told everyone to stockpile 3 months of supplies, then the grocery store shelves would be emptied in record time. Shortages, and panic, would begin now. And should a pandemic not develop (always a possibility), there would be a lot of angry people with rice and beans in their basements, bitching about having to put off buying the latest X-Box or IPOD.

So shouting the message from the highest hilltop, that 2 weeks of supplies will not be enough, is probably a bad idea.

For those smart enough to read between the lines, hopefully the message is getting through. We need only look at 3 statements made, ad nauseum, by the Federal government, to draw our own conclusions.

#1 . Every household should stockpile 2 weeks worth of food/water/supplies.

#2 . A pandemic wave may last 8 to 12 weeks, and social disruptions, and interruptions in the supply chain may occur.

#3 . The Federal Government, and FEMA, will be unable to help local communities during a pandemic. You will be on your own.

Following the Fed’s advice, you might survive. But those last 10 weeks of the first wave, are going to be hungry weeks.

And the 2nd wave, and possibly 3rd, 4th, an 5th waves, are going to be a real bitch.

You do the math. Even 3 months is optimistic.

Wednesday, August 09, 2006

Conventional Wisdom

We've been told, ad naseum , that pandemics are short term events. That the 1918 pandemic lasted 18 months. And that is the model for any future `worst case' pandemic. I believe this to be a faulty assumption.

What follows is speculation on my part.

Looking at the excess mortality rates for P&I (pneumonia/influenza) during the 20th century, I believe I see evidence of continuing outbreaks of Spanish Flu well into the late 1920's. There are reports of islands in the Pacific, that escaped the pandemic of 1918, being hit very hard in the early 1920's by a killer influenza, with mortality rates comparable to 1918.

The assumption is that the H1N1 virus mutated to a less lethal strain. But (and this is speculation on my part), it appears that we just gained herd immunity. Those areas that largely escaped infection during the pandemic years of 1918-1919 simply paid the price later.

The chart below shows the excess death rate for P&I in Massachussetts, from 1987 to 1956.

The 1918-1919 pandemic is clearly off the charts. But the death rate in 1920 was every bit as high, if not as long lived. And you look to the years 1921, 1923,1926, and most significantly 1929, you you find major upswings in the mortality rate.

While no serological typing was available in the 1920's, it is assumed that these all were H1N1 (Spanish flu) outbreaks. It appears that it remained endemic, and deadly , for at least a decade.

I believe the theory that H1N1 mutated away from a virulent strain in 1919 is specious. I suggest we simply gained herd immunity, but the virus remained endemic, and resurfaced repeatedly for 10 years in unexposed, susceptible populations. If it did lose it's virulence, it did so after 1929.

What then, does this mean to us?
Well, it appears you can run, but you can't hide. Short of developing, and distributing an effective vaccine, it appears that the threat of contracting and dying from a novel virus outbreak remains in play for quite some time after the `pandemic' is over.

Monday, August 07, 2006

Monday Morning Roundup

Indonesian authorities are reporting another teenager has tested positive for the avian flu virus, and that he is on a ventilator in a hospital outside of Jakarta. Meanwhile, local news reports indicate that 3 suspected bf patients have fled the hospital in Northern Sumatra.

Negative tests continue to show up, and yet, often when these `negative’ patients go on to die, further examination shows they did have H5N1. Curiously, it requires 1 local positive test, and two confirmatory tests outside of the country, before the WHO accepts any patient as being positive. Yet, only one negative test is required to rule out avian flu.

The tests used in humans are notorious for not detecting the virus. Blood tests are useless early on in the disease, and sputum tests often fail to detect the virus.

Thailand now has most of the country on `red alert’ for bird flu. They are also experiencing an unusually high mortality rate for seasonal flu, and that bears watching, too. Neighboring Vietnam and Laos are reporting outbreaks in birds.

We also have confirmation now that cats in Iraq contracted the virus. This adds to the evidence that other mammals can catch the virus, and can presumably become carriers.

The only really good news is, after more than a year of international pressure, Indonesia has released the genetic sequences they have been holding. Hopefully this data will add to our knowledge of mutations, and will help us determine how great the threat has become. I hope to have more details on this over the next few weeks.

While this is the slow season for flu in the Northern Hemisphere, Avian Flu has not gone away. It is out there; simmering, replicating, and mutating. Still looking for that magical combination that will set it free.

While we may be enjoying this respite, we are only a couple of months away from the next flu season. All eyes should remain fixed on this threat. It isn't going away.

Wednesday, August 02, 2006


The news is dribbling out, but it appears there is a new outbreak in the Karo district of Indonesia. Depending on the source, between 3 and 7 people are suspected of H5N1 infection, including 3 children. Tests are pending.

Thailand has declared all 79 provinces as under a bird flu red alert. One 17 year old boy has been confirmed as having died of avian flu, and scores of others are suspected of having the illness. We have been waiting for days for test results.

And Laos is reporting outbreaks in poultry.

This may be the slow season for the flu, but apparently, nobody has told the virus that.

Weapons of Mass Distraction

While the world watches the warfare in the Mid East, and those on this side of the pond are focused on Fidel’s castrointestinal surgery, the threat of Avian Flu remains undaunted. This is the summer slow season for the virus, and so, pending dramatic events, the news has been swept from the public view, and we’ve been treated to a series of `good news’ reports on the bird flu front, designed to set our minds at ease.

Last week, it was a new vaccine, one that reportedly could be mass produced by next year. Of course, they admit the vaccine may not work, and `mass produced’ turns out to be in the tens of millions of doses, but hey, it sounds good.

This week, we are told the virus was unable to easily transmit between ferrets after being combined with a human flu virus. The heady assumption by the media has been that the likelihood of a pandemic is therefore decreased.

Perhaps, but it’s a big assumption.

According to a study published in Proceedings of the National Academy of Sciences (PNAS), scientists working with the 1997 strain of the H5N1 virus, and a strain of seasonal flu, attempted to combine the two and come up with a hybrid to see how well it would transmit between mammals. They tested this `new’ virus on ferrets, and found it was no more easily transmissible than the H5N1 virus.

A laudable experiment, which has increased our knowledge of the H5N1 virus, but not quite what the media has portrayed. Presented here are a few of yesterday’s headlines:

New virus less than pandemic USA Today

Flu Viruses Don't Transmit Easily in Test KSL.Com

Mixed bird flu strain doesn't spread easily MSNBC

Bird Flu Pandemic May Not Develop HealthDay

I guess we can all go home now. The crisis is over. Guess we won’t need that vaccine now. After all, according to the lead paragraphs in many of these articles, a pandemic is now less likely.

Of course, read further, and Dr. Gerberding of the CDC cautions that we can’t draw that conclusion. This experiment was far from far reaching, and it used the 1997 strain of the H5N1 virus, a strain that doesn’t even exist anymore. Only one human influenza virus was used. And the technique was reassortment, where an entire segment of one virus was swapped with an entire segment of the other. This only one, of three ways that the bird flu virus might mutate to a pandemic strain.

While this experiment has value, and the knowledge we gain from this research may well help us in the fight against the pandemic strain, its importance has been overblown by the media.

No one would be happier to see some genuinely good news on the bird flu fight than myself. I’ve no desire to see a pandemic, and frankly, figure my chances of survival during one are less than comforting.

But media spin, faux good news, and apathy will not serve us during this crucial run up to a possible pandemic. We should be taking the threat seriously, and doing what we can now, while there is time, to prepare. While anything we do now will be inadequate during a pandemic, everything we can do, will help mitigate the effects.

To paraphrase an old saying: Man plans, and the virus laughs.