Sunday, March 19, 2017

Egypt: Peering Down The Rabbit Hole


On Thursday, in Egypt: MOH Statement On Investigation of Undiagnosed Cluster Of Illness, we looked at an unusual report of 11 illnesses (and 3 deaths) among members of two related households in Shubra El Kheima, just north of Cairo.

While media reports suggested some sort of `unknown virus' was behind this outbreak, the Ministry of Health sought to downplay the story, suggesting an environmental toxin or food poisoning as a more likely cause.

Since then - despite the government's clamp down on freedom of the press (see Reporters Without Borders Report) - Egypt's normally compliant media has been unusually strident in its coverage, speculating on multiple causes (including enteroviruses, meningitis, avian flu, etc.), the growing risks to the general public, and accusing the local MOH of a coverup.

Adding to this fervor, there are reports of over 100 hospitalizations following a dust storm yesterday in Minya - which some on social media are attributing to a `virus' - persistent reports of suspected (but rarely confirmed) `bird flu' infections, and conflicting statements from the government regarding the Shubra El Kheima cluster.  
It isn't clear how much of this collective angst is due to pent up frustration over the MOH's chronic slow rolling of information (see The Silence Of The Egyptian MOH and In The Land Of Limited Press Freedom, The Internet Rumor Is King), and how much is rooted in fact.

Perhaps the wildest rumor running through social media (and on some news sites) is that yesterday's dust storm in Minya has spread `an unknown virus' across the landscape, sending scores of people to the hospital.

Ambulance Minya: There is no truth to the presence of "virus" in the air .. and the weather has caused bottlenecks parents
Mohammed Abdul Latif Bassel

18-3-2017 | 17:29420
Bad weather

Deny Dr. Ahmed Saif, Director of Ambulance Authority branch in Minia Governorate what appeared in a number of news sites about the spread of an unknown virus, into the atmosphere causing the exposure a number of citizens of the state of suffocation, stressing that the atmosphere and dust storm witnessed by the province on Saturday, is the main reason exposure specifications buzz of suffocation.

He said Saif, he was transferred 144 cases by ambulance, including 96 cases of Delta garment factory in the industrial zone, and 35 cases of Samalout secondary schools and 4 cases of the industrial zone and 7 cases of Anani joint school feeding factory Bmtaa one case of Maghagha School also the case of the Health Unit Batsa, has received treatment in knowing the ambulance team and teams hospitals in the province have had recovered and left hospital.

He appealed to the Director of Ambulance Authority Branch All journalists need to investigate the accuracy and credibility in everything published statements and data media, especially in such emergency conditions

Dust storms are often linked to increased hospitalizations - primarily due to respiratory problems from the fine particulates in the air - but they can also spread certain types of fungal, bacterial or (more rarely) viral diseases.
Haboobs, or dust storms are linked to increases in Coccidioidomycosis in Arizona, and we've seen a couple of recent high profile examples of `Thunderstorm Asthma'  in Australia and Kuwaithospitalizing thousands, and killing more than a dozen people
While infectious diseases (including FMD) can be carried by dust storms, or winds  (see 2010's Viruses Blowin’ In The Wind? and 2015's Bird Flu’s Airborne `Division), it doesn't require a new or `unknown' virus to account for this spike in hospitalizations.

Although I've yet to see an official acknowledgement from the Egyptian MOH, in late February they notified the WHO of two recent H5N1 infections (see Egypt: FAO Reports Two Human H5N1 Cases).  

Since then we've seen perhaps a half dozen additional reports of `suspected' cases in the media, but no follow up or official confirmation. Typical of these reports is the following from this morning:

"Fever Eshmoun" Menoufia holding employee suspicion of bird flu

Ashmun detained Fever Hospital, today, Menofia retired employee, on suspicion of being infected with bird flu.

And woven within a few blissful Dr. Sorour, Undersecretary of the Ministry of Health, said he was detained "MSM" retired in Ashmun Fever Hospital, suffering from a high temperature on suspicion of being infected with bird flu.

I took a sample to be analyzed and sent to the central laboratories, and notified the authorities concerned "of Veterinary Medicine, Agriculture, Local Unit", to go to his place of residence to take preventive procedures

Other, less credible reports, permeate twitter and Facebook.  While most appear either suspect, or at least exaggerated, it is being reported this morning that the Governor of Minya has ordered the opening of a 24-hour bird flu operations center.
3 hours ago | Wrote: Said Nafi , Teresa Kamal
Decided Essam Badawi, the governor of Minya, the formation of the local Chamber of units of the centers and cities of the province and units Rural affiliate operations and link them to a room key processes to maintain that working out will continue on a 24-hour, immediate reporting of any suspected case of bird flu and take the appropriate decision
This came during a meeting held in the presence of the governor of Minya services directorates and heads of local units and units of village managers at the county level to discuss and examine the procedures and precautions to be taken to cope with avian flu, and a mechanism to deal with any suspected case of the disease
(Continue . . . )

This lengthy (Arabic) report outlines additional steps being taken by agricultural, public health, and hospital authorities in Minya. 

Meanwhile, beyond the media speculation regarding the Shubra El Kheima cluster, we've heard very little from the MOH, except for the following, which indicates they've sent samples to the WHO for analysis, and that the number of fatalities has now grown to four.

Of Dr Shadia static member of the Health Committee of the House of Representatives

Shadia said Dr. Thabet, a member of the Health Committee of the House of Representatives, it will be an escalation of the issue of the unknown viruses because they represent a real danger especially with repeat cases where injured in Qaliubiya 11 people died and three of whom were wounded in Imbaba 4 cases died, one of them.

She fixed, "homeland", she approached Dr. Ahmed Emad, Minister of Health, Dr. Amr Qandil, head of Preventive Medicine, Ministry of Health, address Health Organization to detect such viruses that may be unknown to our new, as happened in the avian and swine before.

She noted that the Health Committee will hold a meeting early next week in the presence of the minister with a number of House of Representatives more than a request for information in this regard.

While none of this makes it any clearer what is going on in Egypt, it should remind us that in a world where far too many countries treat disease outbreaks like state secrets, that no news isn't necessarily good news.


Giga Gerard said...

The symptoms accelerate very quickly and they include sudden vomiting, severe diarrhoea, and intense stomach-ache.
A reader suggests typhoid.

Giga Gerard said...

Vomiting and diarrhea. Members of the House of Representatives Health Committee called for an urgent plan to fight the "mysterious virus", which led to deaths in some hospitals. They also stressed the need to cooperate with international bodies:

Giga Gerard said...

Seems there is still international cooperation going on to determine the cause of the infection, as the first victim was proposed by the army to travel abroad on instruction of the president of Egypt. Strange report this:

Giga Gerard said...

No virus or epidemic disease after all, it seems, because it did not spread in the Shubra al-Kheima neighborhood. Perhaps some poisoning? The health ministry in Egypt still does not know what caused these families to die.