Friday, January 06, 2006

Additional (obvious) thoughts on Turkey

The events in Turkey--which we believe follow a familiar pattern--raise another question, alluded to in a previous post. One of the first consequences is a sudden increase in public awareness, sometimes bordering on panic if there is sufficient distrust of the authorities. Clinics and hospitals can be swamped with people comprising a mix of those truly ill, those ill but only mildly so and with other illnesses and the "worried well." In such a circumstance health services are spread thin and easily overwhelmed. In eastern Turkey, for example, Reuters reports today twenty three people being trated at the Van hospital for suspected bird flu, fifteen confined to bed (one critical), eight ambulatory. Most are children. A health ministry report put the number at 26, with 18 others discharged "after being cleared of having the disease."

The question: how well is the disease being ruled out in those who are not seriously ill? If there were a lot of mild disease, would it be detected under these circumstances? Even the first to die, the 14 year old in the index family, was said to be "negative" on testing by local doctors. Had he not been so ill but sent home, it is likely we would never know of the case.

Most people who have thought much about this have already concluded there is much more disease than we know about; and as a corollary, it is less virulent than current case fatality figures imply. It may also be that there is undetected human to human transmission for the same reasons.