Avian Flu Diary: January: In like a Lamb, Out Like a Lion

# 388

I know. Two months early, but no less appropriate. Particularly in Indonesia, January started out quietly, after an eerily calm December. Indonesian officials were optimistically telling their people that 2007 could be a year without any bird flu fatalities.

It was not to be.

One week into the New Year, a little more than three weeks ago, we saw this news story cross the wires. And then the floodgates opened.

Sun Jan 7, 12:55 AM ET
JAKARTA (AFP) - A teenager undergoing hospital treatment in Indonesia has bird flu, the country's first confirmed case of the feared disease this year and its 75th overall, a senior health official has announced.
"A 14-year-old patient, still under treatment at the Persahabatan hospital, has been confirmed as being positively infected by the bird flu," government health official I Nyoman Kandun told AFP.
He said the boy was in poor health but declined to elaborate further.
"He is the 75th case of confirmed infection, 57 of whom died," Kandun said.

Yesterday, the Indonesian media reported nine new suspected bird flu patients entering hospitals around Indonesia, and that two suspected patients had died. Test results are pending, so we really don’t know if either of these fatalities are truly victims of the virus.

The newshounds on the Wiki keep pretty good track of new patients, and patients declared negative of the virus and released, based on media reports. Each night, after combing through the, often convoluted, confusing, and contradictory reportage, they post a summary. While it may not be 100% accurate, it’s a pretty good gauge of the level of activity of what is going on in Indonesia right now.

What is striking is the number of suspected patients. In all of 2006, only 291 were reported by the media. In the first month of 2007, we have 221.

It should be noted that not all of these `suspected cases' are hospitalized. About 40 of them reportedly were treated in their homes. Still, that leaves about 80 or so in hospitals that we know of.

Indonesia is suffering from an outbreak of Dengue fever, and that coupled with a new media driven awareness of bird flu could be driving these numbers up. We can’t assume that symptomatic patients, who have yet to test positive, have the H5N1 virus. At least we can’t assume that many of them do. Some of them may.

But it is a real problem that the testing is unreliable. The debacle in Nigeria, with repeated tests reportedly either negative, or inconclusive, are only the latest example of how difficult it can be to detect the virus. Some of the patients still hospitalized with symptoms have been in isolation for two weeks and we still have no announced test results.

The picture coming out of Indonesia is therefore confused. We don’t know, for example, if the media are picking up all, or even a majority of the `suspected cases’ around the country. We hear that Tamiflu is being distributed fairly liberally, but have no idea to whom, or to how many people. And it is even possible that some of the suspected cases we still believe to be hospitalized have been quietly released, with no results announced.

Recently families of patients have taken to asking that their identities not be released, due to the stigma of having bird flu, which makes tracking cases much more difficult. The newshounds on the Wiki, CE, Flutrackers, and other sites continue the hard work of translating articles, and interpreting the results, and to them we owe great thanks.

Still, the news could be far worse out of Indonesia.

We haven’t seen any exponential increase in the number of cases, either suspected or confirmed, that would be the tip off that something had changed in the way the virus was transmitted. For now, cases appear to be sporadic, and likely to be caused by B2H (bird to human) contact. There are a couple of family clusters, which raise suspicions, but no evidence of spread beyond them, and no confirmation that they have the H5N1 virus.

So as we start a new month, I leave you with some images captured from Indonesian TV news (Liputan TV 6) over the past 24 hours, showing the news as they get it on the Flu Burung Crisis.