EOW REVIEW – January 22, 2006
It’s been a busy week for avian flu watchers.
As far as we know, Avian flu is still only transmissible from birds to humans (B2H). Human to Human (H2H) transmission, if it exists, is inefficient, and not likely to cause a pandemic at this time. The worry is that this ability to infect H2H will change. For now, the World Health Organization’s (WHO) pandemic alert level remains at level 3.
The Major Headlines for the past week are:
DIRECTOR OF WHO SAYS PANDEMIC THREAT IS `GREAT’
NATIONS PLEDGE 2 BILLION DOLLARS TO FIGHT AVIAN FLU
MUTATIONS FOUND IN AVIAN FLU MAKE HUMANS MORE VULNERABLE
TWO MORE CHILDREN IN INDONESIA DIE OF AVIAN FLU (Total dead: 14)
OUTBREAK IN TURKEY, 21 confirmed cases, up to 200 suspected cases, 4 fatalities
TURKEY ACCUSES NEIGHBORS OF HIDING FLU CASES
BIRD FECES INFECTIOUS FOR UP TO 35 DAYS
AVIAN FLU CAUSES MULTI-ORGAN FAILURE
INCUBATION TIME FOR AVIAN FLU MAY BE UP TO 17 DAYS
CALIFORNIA RELEASES PANDEMIC PLAN
OPRAH WINFREY SHOW TO COVER AVIAN FLU NEXT TUESDAY
ANALYSIS:
Watching the events unfold is like watching a slow motion train wreck. News comes out in drips and drabs, and the reporting is suspect. The WHO, which has said they could be on the scene of any outbreak in 24 hours, finally arrived on the ground in Turkey 7 days after the first deaths were reported. A week-long religious holiday in Turkey has delayed testing of many suspected cases. News out of Turkey is now filtered through a government spokesperson.
WHO has released a new fact sheet on Avian Flu, and their description of the clinical picture of Avian Flu patients is not comforting. Nearly all cases descend into pneumonia, and internal bleeding and multi-organ failure is common. The usefulness of anti-viral medications such as Tamiflu is now suspect. Among confirmed cases, the mortality rate remains at roughly 50%, Unknown is how many undiagnosed cases exist.
California, among other states, has released its pandemic plan. It calls for social isolation (closing of schools, businesses, etc.) to limit the spread, and for people to be prepared to care for flu victims at home. It recommends preparation (food, water, Rx’s), and stresses the need for good flu hygiene (hand washing).
The Insurance Industry has released a report whereby they expect up to 1.9 million fatalities in the United States if the flu turns into a pandemic. Some experts consider this a low figure.
A quick search of google news stories show roughly 80 mainstream news stories about avian flu in the last 24 hours, yet public concern appears to be minimal. Next Tuesday, Oprah will do an hour long show on Avian flu, and this is likely to raise public awareness of the situation.
For now, it is still a waiting game. H2H transmission has not been documented, and if it exists, we should be seeing more cases than we are right now. WHO admits there may have been some limited cases of H2H transmission, but is unable to document them.
If the current strain of Avian Flu mutates (and that is still an `if’), we should see a large bloom of cases over the course of a week. That will be the signal that things have gone badly. If this happens, there is still the possibility of containment, although much will depend on where it happens, and the speed and effectiveness of the local response.
Realistically, it could be months or even years before a catastrophic mutation of the virus occurs. Indeed, it might never happen. Anyone who says they know what is going to happen is just deluding themselves. Outbreaks of high pathogen diseases occur worldwide on almost a daily basis, and usually burn themselves out, rather than spread.
Still, we are probably closer to the brink of a pandemic than we have been in decades.
Expect to hear a lot of opinions over the next few weeks regarding the flu. Once the Oprah show airs, pundits will take to the airwaves. There will be those who downplay the threat, while others will see this as a coming apocalypse. The truth is probably somewhere in between.
For now, all we can do is watch the situation carefully and make prudent preparations in case the worst happens. I will address preliminary flu preps in my next post.
