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February 19, 2006

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This is the SF Chron's equivalent of the "Week in Review" section of the NY Times, and this is a story, not an op-ed. It is one of three articles, one titled "America's fleecing in the name of security", about overexpenditures on homeland "security" because it has been treated as pork barrel spending, and one titled "Risk of withering terrorist hit is overblown" and the one you mention.

That said, the criticisms of the one article are fair, as far as avian flu goes--you clipped everything he said about it. He did not acknowledge that since 1997 it has spread dramatically in birds and there have been human cases for the first time in the past 2 years, with at least suspected H2H in a few cases. Kind of alters the situation, in my view.

Another piece is the hyperbole used by those arguing against hyperbole:

We are cautioned that a pandemic on the scale of the 1918 Spanish influenza outbreak, which cost hundreds of thousands of lives, is only months away
I've never seen anyone in a public halth or official capacity write "it's months away". Straw man, I think it's called.

I'll correct the op-ed thingie, thanks.

Book Recommendation..

Just finished reading John Berry's "The Great Influenza" out in Penguine Paperback. Except for the Afterword, it deals with 1918. Absolutely fascinating read from a strong narrative writer.

I have a semi-attachment to this Influenza because my grandmother had it, and my dad, at age 11 had to nurse her in the small NW Ohio village where they then lived. It was a long family saga because my Dad was anything but a nurse, and because Grandma got it from nursing her sister who died, and because all the town doc's were down with it when she was sick. The way my Dad always put it, he brewed tea till India didn't have any more. (She Survived.)

The upshot for my Dad was that he probably got a case of silent flu -- because for the rest of his life TB X-rays showed him as having a dense spot on his lung that required additional tests. In addition, he had strange allergic reactions to anti-Biotic drugs of certain classes that I eventually learned went along with acquired immunity to 1918 flu if it had silently progressed beyond the virus stage to a bacterial Pneumonia. Yet as far as he knew, he did not actually get the 1918 flu -- he was just super exposed to it.

Anyhow, the book made a little sense of these family tales I know all about. Barry's main point is that the Doc's and the researchers who got deeply involved with the 1918 epidemic essentially were the people who defined the research for the next 50 years or so. What they learned directly lead to modern cell biology and the description of RNA and DNA and ultimately the sequencing of these. (40 years later) -- but it did not lead to better patient care or treatments. No one really defined the issue that way, and that is really what we confront now.

Barry covers the "planning" for a potential pandemic -- making the point that the Bushies have plans to put the military in change of ventelators, of which we have parhaps 10% of what we might need. (Guy with M-16 determines whether you can get air or not get air. Anyhow that is apparently the plan.) I almost think it would be worth investing in a bit of diving apparatus with oxygen tanks so as to have your own private supply that could be adapted as needed.

Anyhow, I recommend Barry's book to anyone interested in the background of the 1918 epidemic and how it played out.

Posting this here for you to read before it goes behind their "pay for it" firewall. Grounds for cautious optimism as the man says below:

http://news.independent.co.uk/world/asia/article346511.ece


From the Far East, a lesson in how to beat bird flu
With Britain braced for disease's imminent arrival, Vietnam, the world's worst-hit country, is first to defeat it
By Jeremy Laurance, Health Editor, in Hanoi
Published: 20 February 2006

As avian flu advances across Europe towards the UK, public health experts in the Far East claimed the first significant victory against the H5N1 virus since the current outbreak began two years ago.

Vietnam, the worst affected country in the world with 93 human cases and 42 deaths, has become the first to successfully contain the disease that threatens to become a global human pandemic, according to the World Health Organisation.

No new cases of avian flu have been reported in humans in Vietnam since last November and in birds since last December, Hans Troedsson, director of the WHO in Hanoi said.

Vietnam's breakthrough in containing the disease comes as the worldwide outbreak was confirmed in India, France and Iran for the first time. India said it was testing dozens of people for the lethal strain after 50,000 birds died in western Maharashtra state. In France, wild ducks found dead near Lyon were confirmed with H5N1. Authorities in Bulgaria put a man in an isolation chamber yesterday and were testing him for bird flu after two of his ducks died.

Indonesia has confirmed that a 19th person had died of bird flu, while Egypt and Nigeria were struggling to cope with the spread of new cases.

Vietnam's containment offers hope to Third World countries struggling with mass culls, and developed economies contemplating an agricultural crisis. It also holds out the prospect that a pandemic of the H5N1 strain, thought to be only a matter of time, might be averted.

In Vietnam, the relief is palpable as Pho Ga, the traditional chicken noodle soup, has reappeared on restaurant menus in Hanoi in the north and Ho Chi Minh city in the south, along with other poultry dishes banned last year. In Hanoi's crowded Hang Be market, traders were doing a brisk trade in freshly-plucked chicken and duck raised by local farmers at 5,000 dong (20p) a kilo at the weekend.

Avian flu has an incubation period of one to two days in poultry and five to seven days in humans and, under WHO guidelines, a country is designated disease-free when no new cases have been recorded for 21 days. Thailand has also recorded no new cases since last November but has been less severely affected than Vietnam with 22 human cases and 14 deaths.

The H5N1 virus first infected humans, causing 14 deaths, in an outbreak in Hong Kong in 1997, which was successfully contained after millions of birds were slaughtered. The current H5N1 outbreak began in late 2003 and has spread across Asia into Europe and to Nigeria in Africa. French scientists confirmed at the weekend that a duck found dead near Lyon had been infected, putting the billion-franc poultry industry at risk.

The success in curbing the disease in Vietnam and Thailand strengthens hope that an avian flu pandemic, which could cause a global economic and medical catastrophe, may be averted. Scientists are especially encouraged that it has been achieved in a part of the world where there are tens of thousands of peasant farmers keeping small flocks of chickens.

Dr Troedsson said that a combination of vaccination, culling and public communication had proved the disease could be halted, even in a less developed country such as Vietnam.

Almost 200 million birds have been vaccinated, and up to five million culled. The Government ordered last year that all chicken prepared for sale must be certified safe and carry an official stamp, although unstamped chicken and duck were still being sold in Hanoi last week.

Dr Troedsson said: "If you had asked me six months ago I would have said we were certain to see new cases of avian flu from December to March in Vietnam which is the cold season when we know flu viruses circulate. Also it was the Tet holiday [Chinese New Year] last month when millions of people return to their families, and chicken is eaten and we feared an outbreak."

He added that although a human flu pandemic was "inevitable", because of the nature of the flu virus and the way it mutated, it might not be caused by the current H5N1 virus.

"It is not inevitable that it has to be H5N1. I am cautiously optimistic - more than I was two years ago - that [a human pandemic] won't be caused by H5N1 because countries like Hong Kong, Vietnam and Thailand have been able to contain it." But Dr Troedsson warned that the H5N1 virus was almost certainly still in Vietnam, and vigilance was essential. Ducks can carry the virus without showing symptoms and previous research has demonstrated it can persist in the soil and water. Monitoring had " improved greatly" over the past two years as a result of action taken by the Vietnamese government but co-ordination between the ministries of health and agriculture had still to be improved, he said.

mark, that was an excellent article. see also:

Avian influenza: significance of mutations in the H5N1 virus from WHO.

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