# 298
The roller coaster ride of news reports of the past 4 days illustrates what we are likely to see over the coming months, and as there are new flubies joining our ranks each week, I thought a moment spent on perspective would be in order.
Those that were following this story last winter know how busy the months of January thru May can be, when it comes to tracking the H5N1 virus.
Seasonal flu is raging through the northern hemisphere this time of year, and it, along with other diseases such as RSV (Respiratory Syncytial Virus), and CAP (Community Acquired Pneumonia) provides us with a huge, naturally occurring base of ILI’s, or Influenza-like-Illnesses. In many developing countries, diseases like Dengue Fever and Chikungunya may also present with flu-like symptoms.
Unless a pandemic has started (and one hasn’t), the majority of cases we hear about, even those that are suspected as being H5N1 bird flu cases, are far more likely to fall into one of these other categories. Something other than bird flu.
While it is prudent to watch for, monitor, and track these cases, we need to maintain some perspective. It is far too easy to become overwhelmed by them as they roll off the news wires, breathlessly reported as `suspected’ cases.
It doesn’t help that the tests used to determine if a patient has the H5N1 virus are notorious ineffective at picking up the virus. Most flu watchers take an initial `negative’ test as a preliminary result, not a final determination. We’ve seen, far too often, patients cleared of the virus, only to have the H5N1 virus discovered in their post mortem results.
The lack of adequate follow up of these patients, blood work done a month later to check for antibody titers, is an ongoing frustration. In many of these developing countries, their hospitals and labs are simply overwhelmed, and they are unable to afford such luxuries.
Part of the problem is, and has been, the lack of transparency by public officials in countries around the world. Frankly, we know for a fact that we’ve been misled in the past, strongly believe that it has happened on other occasions, and fear it is still happening today.
Blanket statements, such as the one made earlier this week by the Indonesian Health Minister, promising that there would be no new clusters in Indonesia, are therefore viewed as propaganda by the flu community. It was only last month that the Indonesian government, after a few weeks without publicly reporting any human cases, was optimistically pledging that 2007 would be a year without bird flu fatalities.
Officials are quick to report successes, and slow to report failures.
A few short months ago, Vietnam was being hailed as an example of how well a country could handle, and eradicate the bird flu virus. Today, the virus is popping up in livestock all over the country, and those early claims of success now appear to have been premature.
The virus has obviously increased its geographic spread in the past 12 months. More countries are affected, and therefore we should expect that more cases would be reported. Even if the rate of human infection remains unchanged, more people are in a position to be exposed, and so more cases should be expected.
I’m seeing a number of flubies speculating that the increase in cases over the past week signals an ominous change, and that we are on the cusp of a pandemic. Perhaps. As long as the virus is out there, mutating, I suppose we’re always on the cusp of a pandemic. But the increase in cases this week was fully expected, and in fact, is a little late this year.
The virus may find the right genetic combination, and become a pandemic strain, at any time. That could happen today, tomorrow, or sometime in the next few months. Or, it may never happen. We could simply see scattered and sporadic cases, with small clusters from time to time, for years to come. While that may be hard on our nerves, it would certainly be easier than enduring a pandemic.
I’ve said it before, but it bears repeating. We need to be prepared for the long haul. This could simmer away for months, or even years.
Following the outbreaks, deciphering the science, and tracking the progression of the virus are all laudable goals. Quite frankly, it consumes a good part of my life. But we risk becoming mesmerized by the sideshow, and distracted from what we really should be doing; which is preparing for a pandemic.
David Nabarro at the United Nations referred to this as `God given time’, a respite before a pandemic where we could, if sufficiently motivated, make life saving preparations before it strikes. He’s right. Once it starts, it will be too late to prepare.
So while we watch, let’s not forget to prepare. Let’s not forget that seeing it coming has no advantage if we have done nothing to prepare for it.
For the first time in human history, we may actually be able to watch the birth of a pandemic, and can avoid being blindsided.
It would be a pity to have had this much warning, and to have paid it no heed.
