# 1410
The winter bird flu season appears to be in full swing, and for those of you who weren't actively following avian flu developments last January, or during the Spring of 2006, it seems only fair to warn you of what to expect.
The H5N1 virus, like all flu viruses, likes cooler weather. And so during the winter months we tend to see a marked upswing in cases. That didn't happen in 2007 until the second week of January, and for reasons not readily understood, 2007 was less active than 2006.
We appear to already be seeing this yearly surge, with this December being very active .
From now until probably May or early June, we can expect to follow a lot of cases. Many will be suspected, and turn out to test negative (more on that in a minute).
While individual cases are a concern, and a personal tragedy to the victim and their loved ones, the cases we really worry about are the clusters - particularly when H2H (human to human) transmission is suspected.
If the last two winters are any indication, we can expect some days to be dead quiet, and other days to be filled with breaking news reports practically every hour. Weekends are traditionally difficult newsgathering times, and often if news hasn't been released by Friday Morning, we may not get updated until Monday.
Some of our best information comes from translated local media reports. Long before AP or Reuters or Xinhua News carries a story, it will often appear in the local press. There exists a large number of dedicated newshounds, working tirelessly, posting translations and analysis to the major flu forums.
Machine translations are often difficult to decipher. The syntax is awkward, and the machine translators have limitations. While informative, these toggletexted news reports should be taken with a grain of salt. Still, they are more often right than not.
There is no doubt in my mind that certain governments try very hard to downplay avian flu cases. It is, after all, bad for tourism and trade, and cases are seen as a blemish on their reputation. There are some nations where surveillance and reporting is non-existent.
I'm certain that we miss cases. How many? There is no way to know.
Often we get a report of an individual, or even a cluster, with classic signs of bird flu. After days (sometimes weeks) we learn they `tested negative'. Their actual diagnosis is almost never revealed.
While there are a great many diseases out there that can mimic bird flu (Dengue, Malaria, Seasonal Influenza, Adenovirus) a negative test doesn't always mean the patient didn't have bird flu.
It simply means the test did not detect the virus.
H5N1 testing is complex and hinges on a number of steps being done just right. Improper sample collection, delays in testing, and contamination can all render a test unusable. Additionally, the administration of Tamiflu is thought to reduce the shedding of the virus enough to skew the test.
The number of times we've heard of patients testing negative repeatedly, only to finally test positive, is legend.
Often doctors will keep a `negative' patient in isolation, ply them with Tamiflu, and treat them as a bird flu patient - even though the tests don't support that treatment. It is because they know the tests aren't always dependable.
Officially, a patient doesn't have bird flu until they test positive (twice) for the virus. And so we probably miss a certain number of cases due to false negatives. Again, we don't know how many.
It could be just a few, or it could be a lot.
And of course, things get confused because this time of year there are a lot of other viral illnesses running about. H1N1, H3N2, Adenovirus, RSV (Respiratory syncytial virus) . . . and depending on the location, the list could also include Dengue, Chikungunya, and a host of viral fevers. Spotting bird flu cases against the background clutter of all of these illnesses is a real challenge.
Often, patients that are suspected to have H5N1 really do have something else. Not every negative test is wrong.
And most frustrating of all are the `lost cases'. Detailed reports of a case, or a cluster, that make the news and then no additional word is ever released. It happens more often than you'd expect, particularly when new cases are rapidly capturing headline space.
Occasionally I'll post a `Whatever happened to . . .' blog.
The next five months are likely to be a rollercoaster, with rapid fire reports of outbreaks in poultry and in humans, dire sounding warnings, and agonizing stretches of silence and uncertainty. There will likely be a certain amount of obfuscation and/or `spin' by governments.
And often `breaking news reports' are just plain wrong. It happens.
The newshounds and bloggers try very hard to get it right, but we are operating in a `foggy' environment, and the flow of information is often tightly controlled.
For what it's worth, unless and until we see large outbreaks (25 or more in a cluster) and hospitals overrun with bird flu cases, I tend to take a fairly laid back approach to these news reports. It is easy to get caught up in the reporting, and to start seeing a pandemic behind every tree, if you don't detach yourself just a bit.
It helps to pace yourself. This is a marathon, not a sprint.
The good news is, there is an amazing array of talent out there, watching and analyzing these reports as they come in. Crof at Crofsblog, SophiaZoe, Scott McPherson, DemFromCt on the Daily Kos, and the Reveres of Effect Measure among others. . . and they are backed up by scores of newshounds, all working to find, translate, and analyze the news.
So fasten your seatbelts. It's likely to be a bumpy ride.
