Not even the worst

The report of another new case of bird flu in central Vietnam underscores the point that things are still not under control there. A 27 year old woman was reported in stable condition after being admitted March 29 with high fever and shortness of breath. The family had raised ducks and she ate duck meat sometime before her illness (AFP via ChannelNews Asia). The patient tested positive for H5N1 but tests on the ducks were not yet available. There are unconfirmed reports she also drank duck blood (Reuters).

Vietnam officials now acknowledge that their ability to control the disease is limited. And that many people still don't know the risks.

But although Vietnam's government has taken the matter seriously, it has been unprepared in practical terms. In the vast country of 82 million people, many residents are beyond the authorities' easy reach.

Despite public warnings and regular media coverage, a large part of the rural population remains under-informed. Many people eat infected poultry and do not know how to cope with an epidemic.

"The awareness of the people and the poultry raising conditions are limited. In many places, the epidemic surveillance network is non-existent," said vice minister of health Tran Chi Liem, in an official daily on Thursday.

Informing central authorities of the first clinical signs of the disease is an even greater problem. In passing from the village, commune, district and province to capital Hanoi, the message can get garbled or even lost (AFP via ChannelNews Asia).

The recent reports of hundreds of flu-like illnesses amongst residents of Quang Binh Province are a pertinent case in point, with the press reporting it before provincial authorities were even aware of it. Nor had the central authorities in Hanoi been notified the poultry population had been decimated in February.

Patrice Gautier, the Vietnam representative of Agronomists and Veterinarians Without Borders (VSF) . . . said the aid strategy needed to be changed.

There is an urgent need to facilitate contacts between private and public services on the ground and to set up a system for information exchange among different levels, he said.

"It is useless having a new laboratory if nobody sends any samples there, nor is there any point inviting foreign experts if they've no idea what's happening on the ground," Gautier said.

Vietnam has now launched an intensive cleanup campaign to contain the virus's spread (AFP via ChannelNews Asia). Allegedly it will extend to every village in the country and be strictly monitored. But in Chua Hoa commune in Quang Binh where the 195 cases of flu-like illness were rumored, local officials knew nothing of the campaign.

"We have not received any information (from the district authorities) about the decision to quarantine cages and farms throughout the country," Phan Huy Hoang, the commune's deputy chairperson told AFP.

Anton Rychener, representative in Vietnam of the United nations Food and Agriculture Organization, said he had doubts about how the country could actually implement the campaign.

"They will ask provinces and districts to do it on their own without any fundings from the central level," he said.

"If the (local authorities) are competent, they'll allocate funds and do it. If not, they just won't," he added.

But here's the good news about Vietnam. It is orders of magnitude ahead of its neighbors Thailand, Cambodia and Laos.

Update, 4/5/05 (1 pm EDST): Two new cases have just been reported by Reuters (via ABCNews), a 12 year old girl in Haiphong and a woman, no residence or age given. The same article reports that a 34 year old physician has died in Quang Binh with sudden respiratory distress syndrome, cause unknown. As Niman comments at Recombinomics, SARS or H5N1 would have to be high on the differential diagnosis list.