Wednesday, May 31, 2006

Message to WHO: there is no barn door to close

I try hard to be fair to WHO. They've got an exceedingly tough job and not much to work with. Every time I write an opinion or criticize them I am conscious I could be very wrong.

But this fireblanket business just exasperates me. Let's get real.
The World Health Organization (WHO) issued a step-by-step plan on Tuesday, including the rapid mass use of the antiviral Tamiflu, for containing a bird flu outbreak if the virus starts to spread rapidly among humans.

The "rapid response and containment strategy" has a chance of quashing the deadly H5N1 virus only if people in the zone at risk receive massive doses of the drug within three weeks of a confirmed outbreak, it said.

"The success of a strategy for containing an emerging pandemic virus is strictly time dependent," the WHO said in its latest containment report, based on recommendations by 70 international experts who held closed-door talks in March.

"Mathematical models have indicated that a containment strategy, based on the mass administration of antiviral drugs, has a chance of success only when drugs are administered within 21 days following the timely detection of the first case representing improved human-to-human transmission of the virus."

Under the detailed timeline laid down, a country should notify WHO of a cluster of suspicious cases suggesting sustained human-to-human spread of the virus within 24 hours of detection.

A WHO-approved laboratory has another 24 hours to confirm that the H5N1 bird flu virus has changed, either through mutation or through reassortment with human influenza.

The strategy relies on WHO's global stockpile for rapid containment, three million treatment courses of Tamiflu, donated by Swiss drugmaker Roche. Quarantine, infection control measures and contact tracing must also be carried out.

Once the WHO officially asks Roche for Tamiflu doses to be sent, they should arrive at the international airport nearest the outbreak within 24 hours, the Geneva-based agency said. (Boston Globe)
On Saturday (May 27), The Globe goes on to report, WHO asked Roche to ready the stockpile for shipment to Sumatra in Indonesia after becoming aware of the bird flu large cluster that wiped out an entire extended family and bore unmistakable marks of human to human transmission. They did this after disease transmission had already been underway for at least four weeks and three of the patients had been released from the hospital to the general community before returning to the hospital to die. If ever there was a graphic demonstation of the futility of the fireblanket approach, this was it. It's not going to work.

This doesn't necessarily mean they shouldn't try. Maybe they'll succeed in getting a couple of days grace, although it's unlikely. What worries me more is the real possibility of self-delusion. Let me say it again, as clearly as I can: It's not going to work.

I don't know if this virus will evolve into a pandemic strain or not, and if it does, where and when it will happen (although Indonesia still tops my list of likely places). But if the biology and circumstances allow it, there is nothing we can do to prevent it. The best we can do is get ready to manage the consequences.

And there's plenty we can do along those lines, things that are more likely to save lives than elaborate and futile plans to close the barn door after the horse has bolted. Because there's no barn door to close for influenza.