Tuesday, March 01, 2005

The New Yorker article

The New Yorker is running a long article on bird flu by Michael Spector in the issue of 2005-02-28. In the last week the topic has also been featured in Time, NPR, the wireservices and numerous other Main Stream Media sources. The MSM is finally awakening. Maybe they will even turn the US government from their preoccupation with phantom risks to a recognition of a real and likely one. Probably the best we can hope for is the second part of that. If that.

Anyway, The New Yorker article. It is long, interesting and reasonably informative if you haven't been following the story, although readers of this blog probably won't learn that much. However there was one new, and slightly disconcerting, piece of information I didn't know concerning the Thai person-to-person case reported in The New England Journal last month. Spector went to Thailand and interviewed many of the people involved in that case. Here is his account:
Two weeks after the girl died in Kamphaeng Phet [this is the girl whose mother would contract the disease after caring for her], Thai epidemiologists were asked to visit a hospital near Bangkok, where a woman had symptoms that matched those caused by the virus. It turned out to be a false alarm, but while the investigators were there a nurse took one of the doctors aside and mentioned that another woman had just died of similar flu symptoms. The death hadn't been reported, but the victim's last name sounded familiar, and so did the name of her village.

"It was just a fluke," Scott Dowell told me not long ago over tea in his office, on the sprawling campus of the Thai Ministry of Public Health, in the suburbs north of Bangkok. "Sure enough, the woman was the mother of that eleven-year-old girl. We would never have known if that nurse didn't happen to mention it." Dowell is the director of the Thailand office of the International Emerging Infections Program, which was established by the Centers for Disease Control in 2001.
Spector describes a helter-skelter dash to the village in an effort to secure some tissue before the mother's body was cremated. Using a mobile phone to call ahead they were successful, but the story makes clear how close we came to not detecting the only documented case of person-to-person transmission to date. Without it, there would be those who would still say that such transmission has never happened and maybe that it couldn't happen.

If you want to read the whole article you'll have to buy the magazine (worth it even if you know the subject), but there is also a short Q&A with Spector online, here. Although much shorter than his print piece, it is also informative. Here are a few of the more interesting responses:
The way that animal and human populations coexist also seems to be a major factor. How can that be controlled? Do we have to rethink such things as large-scale poultry farming?

Well, I can’t imagine a better prescription for killing large numbers of animals with a single disease than packing tens of thousands of them into factory farms where they are lucky if they have fifteen inches of personal space. Still, the economic incentives toward factory production of food are huge—we want cheap meat. So it’s going to be very difficult to change.


You spoke to dedicated health officials, but some of them told you that they were disappointed by the way in which some governments have responded to reports of disease. How much does politics affect the spread of a disease?

Well, if you are a government official in charge of exporting food, then it’s easy to say, “Gee, there are always viruses. If we say that this is a problem before we know whether or not it is serious we are going to lose market share. And our neighbor—who almost certainly has the same problem—doesn’t seem to be doing anything.” Still, in the case of Thailand, the government has now put a great deal of money and energy into stamping out the avian flu—or, at least, into controlling its spread. But it is never easy to do, because it scares your citizens, potential tourists, and trade partners.

Is anyone in charge of global health? Are there treaties, for instance, that can force a government to take action regarding the health of its citizens?

Nobody is in charge—and, in an age of global illness, we desperately need that to change. The World Health Organization is filled with dedicated officials and smart scientists. But they are not a police agency, and they have very few powers to enforce their edicts or to convince political leaders to follow their suggestions. As a result, politics often enters into decisions that should be based solely on trying to decide what is best for the public health.
The question I have is, who is in charge of US health? You could change "global health" to US public health and WHO to CDC in the last response above and not have to change anything else.