Tuesday, March 22, 2005

Quang Binh: earning trust

According to Agence France Presse, WHO's Hans Troedsson has said "[t]he (200 people) figure [for people with symptoms of bird flu in Quang Binh] seems to be very exaggerated. We have discovered very few sick people so far after examining seven families."

This should remind us that responding to news of disease outbreaks or clusters is rarely straightforward. In my experience as an epidemiologist who has looked into many cancer clusters over decades, the first step when responding to a report of a cluster is the most important: first, verify the diagnosis. That works fine for chronic diseases like cancer. It is still important but tougher to implement for an infectious disease like influenza that evolves and may spread even as verification is taking place.

AFP reports that verification is underway:
World Health Organization representative Hans Troedsson said the cases "needed to be rapidly and thoroughly investigated."

"We have asked for an urgent meeting with the Ministry of Health," he said. "We could send a team from abroad at very short notice."

Pham Sinh Quyet, an official from the provincial health department, said a local team was sent to the commune on Saturday.
How soon can we expect some information? Past experience is not encouraging. WHO's record of keeping the world informed is spotty. The result is that unverified information rushes in to fill the information vacuum reticence produces.

One of the things we hear most often from public health authorities concerning bird flu is "there is no reason to panic." This reveals a mistaken attitude toward the general public. Yes, it is true many people keeping track of this situation are extremely anxious about it. But the source of their anxiety is not hard to find: good reasons to be anxious. But the readers of this site and the other sites aren't panicked any more than public health authorities, who are also anxious about bird flu, are panicked. Those who are paying attention want and need accurate and timely information. Panic comes from uncertainty. Uncertainty is fed when trust is lost in what public health authorities are saying.

I hope we will see the results of the Quang Binh investigation made public soon. Very soon.

Correction (3/22/05, 7 pm EST): Henry Niman (via Comments) points out an error in this post. The statement that the number of symptomatic individuals was "exaggerated" was not made by WHO's Hans Troedsson but by Pham Sinh Quyet, an official from the provincial health department. We apologize for the error and thank Dr. Niman for pointing it out.