Friday, July 15, 2005

Bird flu: now only bad news is believable

The three Indonesian cases, initially downplayed as bird flu, are now looking more and more like H5N1. Moreover there is so far no history that would suggest a mode of transmission other than human to human and the spacing of cases suggests this as the most likely explanation.

Recombinomics reports the index case is a nine year old girl who became sick "last month" and that the father and one year old daughter were hospitalized on July 7 (I was not able to find the source of the time sequence Niman reports here). This strongly suggests that there is a gap between disease onset that strongly suggests person-to-person transmission (for an explanation of the underlying reasoning, see the Flu Wiki)

The Indonesian health minister initially downplayed the possibility this was a bird flu cluster. WHO sent a team there but also issued reassuring statements. Now the story has changed:
"We suspect it was caused by bird flu," [Indonesian Health Minister] Supari said. She said the first girl died several days ago and was already buried, but tests on the other girl and the father had been conducted.

"The second test showed there are signs this may be caused by avian influenza," Supari said.
She said authorities were concerned about possible human-to-human transmission as there was no evidence of contact with poultry.

"The first test showed negative for the H5N1 virus, then we conducted a second test, which showed signs of the H5N1 virus," said Supari.

She said more samples were being sent to a laboratory in Hong Kong for testing and results should be known within a week.

Authorities have taken blood samples of 315 people who had contact with the family. The mother of the two girls, aged one year and eight years old, was among those under observation, but so far she appeared healthy.
WHO is continuing to say that human-to-human spread was still not shown:
Ms Supari said she was concerned the three victims could have contracted the disease via human-to-human transmission, because they had no known contact with poultry.

But World Health Organization representative Georg Petersen said that in his experience, a more thorough investigation could turn up evidence to the contrary.

"In other countries, this is often the case," he told the Associated Press. So far humans have only contracted bird flu after coming into contact with infected animals. (BBC)
Technically, this is correct. Technically. What it reveals is WHO's unwillingness to look the facts in the face and admit the more likely possibility (and the most dire one), that this virus has finally made the long predicted transition to the ability to spread human-to-human, of unknown degree. Those are the betting odds today.

WHO has now put itself in the unfortunate position that the only news that will be generally believable from now on will be bad news (whether that news is correct or not).