Friday, July 22, 2005

Indonesia starts to get ready

For a country that two weeks ago was set to declare itself "bird flu free," Indonesia certainly went quickly 180 degrees in the other direction. One of the world's most populous nations (220 million people) now also has human bird flu fatalities and has admitted infection in poultry in 21 of its 30 provinces resulting in almost 10 million chicken deaths. Four of the remaining nine provinces have shown preliminary evidence of infection. Just goes to show you what you might find once you actually look for it.

In a break from past practice, Indonesia will also cull (kill) the chickens on the infected farms. Prior to this they have relied on vaccination. There is considerable controversy about which is the best strategy, with WHO opposed to vaccination but the UN's Food and Agriculture Organization favoring it. The Indonesian government chose it because it didn't wish to compensate farmers for culling but has now reversed its position and has approved a little over $13 million for the purpose. This may slow the spread and gain time, but the H5N1 influenza serotype is obviously spreading globally and there is no way to stop it.

Health officials continue to try to balance caution and optimism, repeating that so far there is no evidence of human-to-human transmission outside of intimate family contact. I guess they need to be hit over the head with a two by four. But reading between the lines isn't difficult:
"Basically, the anxiety is person-to-person transfer," Sian Griffiths, director of the School of Public Health at the Chinese University in Hong Kong, told Reuters.

"And how do you stop any potential spread before it gets into the population and becomes an epidemic."
The disease already had jumped the species barrier from birds to pigs on populous Java Island and at least one asymptomatic poultry worker had been found prior to the three fatalities of last week (which were initially denied to be from bird flu). The pig connection is especially worrisome as it has classically been the "mixing vessel" whereby bird viruses combine with human viruses to produce new pandemic strains. So Indonesia is putting its rickety public health machine into what passes for high gear by "preparing" 44 hospitals around the country for the treatment and detection of bird flu (no details given as to the nature of these preparations).
Speaking at the same news conference [as the Indonesian Health Minister], World Health Organization (WHO) representative Georg Petersen said:
"It is an alarming situation. It shows us that most countries can get this infection and we need all to be alert and prepared." (Reuters)
Well, maybe. Not everyone is so alarmed. In Australia (Bush Lite in the southern hemisphere) the Health Minister says the Indonesian situation is no big deal.
There has been no change in Australia's bird flu risk level, despite Indonesia confirming three deaths from the deadly virus.

Australia's chief medical officer says the deaths are concerning but he does not think Australia's risk level from bird flu will rise.

Professor John Horvath says it makes no difference if the deaths occur in Thailand, Vietnam or Indonesia because air travel makes everything close.

"The figures people have been talking about are that, there is a small but realistic chance sometime in the next year or two that we could have an epidemic or pandemic," he said.

"The figures that have been bandied around are 10 per cent." (OptusNet)
Oh, ten percent. No problem (except that he pulled the number out of his ass, which is apparently where his head is also located). I'll grant the dumb shit this much: not much is changed by the Indonesian discovery (which was no a surprise). But it does make a difference whether a nation's health authority gives notice and license to the medical community, the business community, the public sector and everyone else, that this is a freight train coming down the tracks.

I expect that Dr. Horvath knows this, and like the US's CDC, is scared to death of the potential. But like CDC, if he doesn't start to say it, we won't get any substantive attention or action out of local and state health departments and officials who have so many other competing needs. Unless responsible officials make the decision to ramp up the priority of a pandemic threat, we will lose further precious time to prepare.