Sunday, February 19, 2006

Flawed reasoning in India

The Indian government -- who seems to have learned nothing from the experience of others about the way you talk to the public about bird flu -- has told everyone not to worry. In the wake of the discovery of the disease in poultry in two regions of the country, a number of people were placed under observation as a precaution with the diagnosis of "rule out avian influenza." Blood samples from 30 people with flu-like symptoms in Nandurbar district (western Maharashtra state) were sent for testing (it isn't stated where the tests will be performed or by whom). Now one of them has died. But don't worry.

Today, in advance of reliable test results, the government said "that earlier fears of the country’s first human victim were unfounded, after 'preliminary' tests on a dead farmer showed he was not affected." (MSNBC) According to AFP,
"Ramesh Sonar died in general hospital in Surat (in western Gujarat state) on 17th February. The death has been reported as (due to) bacterial infection," senior health ministry official Vineet Chawdhry told a press conference in New Delhi.

Officials had earlier said that the man was a poultry farmer, but Chawdhry said the man had not handled poultry.

"Those reports must have been speculative. He did not have history of handling poultry." (AFP)
So a 27 year old poultry farmer dies of a disease like bird flu in a region where there is an outbreak, and bird flu is ruled out because, (a) he had a bacterial infection, and (b) he didn't have a history of handling birds. The problem with this "reasoning" should be obvious. Secondary bacterial infection is a common complication of influenza (his death occurred 10 days after onset, so this wasn't a fulminant viral pneumonia) and a history of handling poultry may have been missed or he may have contracted the disease from the environment (feces or raw poultry being prepared for a meal) or from another person, not from a bird. If we are going to be vigilant about detecting early signs of human to human spread, we can't use contact with poultry in our case definition.

I'm fully expecting this will turn out not to be avian influenza (the odds are against it -- although one of these days we'll probably get a nasty surprise). But the reasoning is deeply flawed and smacks of false reassurance.

Bad idea.