Friday, September 23, 2005

. . . and still no plan

Reports on the evolving H5N1 story out of Indonesia are confused and colored by a combination of wishful thinking and deliberate obfuscation by Indonesian authorities and WHO, whose main objectives seem to be preventing the spread of public concern. Unfortunately the virus doesn't care much whether the public is concerned or not. But attempts to calm people by downplaying the seriousness of the situation dampens enthusiasm for what needs to be done, some of it expensive and unpalatable.

Indonesia's health ministry is reporting either 16 or 17 people under observation with possible bird flu. They are also saying the 5 year old girl who died last week didn't have bird flu on the basis of tests they did, but they have elected not to send blood samples to the WHO reference lab in Hong Kong. Whether this is a true negative or a false negative we will probably never know. Niman at Recombinomics has discussed the false negative problem in this case and in the many others from Vietnam. In the Vietnamese cases, so-called negative tests later turned out to be positive when adequate procedures were used.

The UN continues to say there is no evidence that the virus is spreading person to person, on the one hand, but admits there is good evidence of transmission within families when contact is close. Unless these families are duck or chicken families, it is hard to see how this isn't evidence of person-to-person transmission. If they are talking about some measure of ease or efficiency, they should say so.

Speaking of ease of transmission, visitors to the zoo closed on Sunday after almost two dozen exotic birds were found to be infected continue to come under scrutiny. Nine of the 17 that Reuters reports to be under observation in a government hospital in Jakarta designated to receive suspect bird flu cases are zoo visitors. Three other zoo-exposed cases were earlier identified, all with non-occupational exposures to the birds. Hence the virus seems to be passing from birds to humans with greater ease than previously, although neither WHO nor the Indonesian authorities have observed this publicly.

Nor is it clear how vigorously the Indonesian government is moving to kill infected birds:
Joko Dwihartato, a driver who rears chickens in his backyard in Indonesia's capital, Jakarta, won't let the government cull his flock of seven birds without paying sufficient compensation as avian flu spreads in the nation.

"If they give me enough money, I don't mind,'' said Dwihartato, 40, who sells eggs to supplement his income. "Otherwise, why should I kill the chickens? They are perfectly healthy.''

President Susilo Bambang Yudhoyono's government, which is struggling to find ways to close a $2.5 billion budget deficit, isn't paying enough to compensate poultry owners for culling fowl infected with avian influenza, or spending the money to stem the spread of the virus in villages, UN agencies and health experts said. Culls are needed to curb a growing outbreak of a disease that's killed at least 59 people in Asia since 2003.

If the compensation "is perceived as not just by farmers,'' culling won't happen, said Juan Lubroth, senior officer at the animal health division at the Food & Agriculture Organization in Rome. ``I don't think the veterinary services have enough support to be able to do what I think the national strategy should be doing at the commune level.''


There are about 30 million village households in Indonesia that have about 200 million chickens in their backyards, the FAO said in a statement yesterday.

"The problem is with funding and not having enough resources,'' said Marthen Malole, former head of virology at Indonesia's Bogor Institute of Agriculture, who in January 2004 said the government was covering up the spread of the virus.

"The government needs to deploy officials, vaccinate, and then monitor the result of the vaccines,'' he said. "The inability to do this has helped the virus become endemic.'' (Bloomberg)
Not so, good, huh? But you wouldn't know it if you just listened to either the Indonesian government or the US government, whose ambassador, Lynn Pascoe had arranged a meeting with a "fact-finding" mission of US and Japanese scientists and experts from CDC and Japan on Friday. Pascoe reportedly praised the Indonesian efforts "to move very quickly" stood out (AFP via ChannelNewsAsia). Since the Indonesian's have been widely criticized for their slow response, it seems like this is just a case of liars covering for each other.

Meanwhile the New Zealanders are now talking openly about closing their borders:
New Zealand may lock down all air and sea ports if a lethal bird flu epidemic takes hold internationally, potentially turning planes around and putting all arrivals into quarantine.


In late October, New Zealand border agencies would look at the logistics of stopping all people and imports, such as food and medicine, from entering the country in the event of a pandemic, Customs business development unit manager John Ladd said yesterday.

Enormous problems would accompany such a move, he said.

"What do you do when you have got a whole lot of people in quarantine? Are there legislative processes available to stop New Zealanders coming into the country?"

The agencies would have to consider whether it was reasonable to direct planes in mid-air not to land in New Zealand.

People may need to be quarantined for as long as eight days if New Zealand hoped to stop the outbreak spreading while keeping its borders open, Ladd said. "How do we feed all these people?"


Customs officials will visit Christchurch next Wednesday to discuss a plan of action with airport staff.


"To do that, all those people overseas on holiday would not be allowed in either. It sounds a good idea, but I would find it interesting to see whether it could ever be done," he said.
Probably it couldn't be done, and even if it could it wouldn't keep the virus out. But this kind of talk is just a taste of what's to come if this beast really is loose. The effect on trade and travel will have enormous economic and material consequences, even for those who stay put. The lack of planning for this foreseeable eventuality on the part of national authorities, especially the United States, is nothing short of stunning.

Like generals fighting the last battle, they are currently engaged in getting hurricane preparation right. The global hurricane is brewing and still no plan.