H5N1

Racaniello: Influenza H5N1 is not lethal in ferrets after airborne transmission

Somehow I missed this when Dr. Vincent Racaniello posted it on how virology blog on March 1: Influenza H5N1 is not lethal in ferrets after airborne transmission. It's a summary of Fouchier's experiments and the recent confusion over whether his mutant H5N1 is as lethal as first described. 

It's much clearer than most of the news reports I've read. Racaniello sees the contradiction between what Fouchier was reported to have said in Malta last September and what he said in Washington last month. Clearly we haven't heard the last word in this debate.

Australia: Man dies in flood as thousands remain stranded

Via ABC News: Man dies in flood as thousands remain stranded. Excerpt:

One man is dead and thousands of people are stranded from their homes as the big wet continues to affect much of New South Wales and Victoria. 

The body of a Victorian man was pulled from a swollen creek this morning after he and two friends became stuck as they tried to cross the flooded Araluen Creek near Braidwood last night. 

All three were swept away when they got out of their four-wheel drive, but a 44-year-old Arulen man was rescued as he clung to a tree and a 37-year-old from Captains Flat was found downstream. 

Both were suffering from hypothermia and other injuries. 

Police divers joined the search for the missing man at first light this morning and his body was found shortly after 7am, 700 metres from where his four-wheel-drive became stuck. 

The 43-year-old has yet to be formally identified but his relatives are on their way from Victoria. 

More than 20 people were rescued from floodwaters overnight, many around Narrandera in the Riverina. 

It has prompted more warnings for motorists to stay away from floodwaters and keep their mobile phones nearby in case they are caught in flash flooding. 

More than 70 per cent of New South Wales and large areas of northern Victoria remain flood-affected. 

Major highways and thousands of kilometres of local roads have been closed by floodwaters across New South Wales, and the SES is getting reports of 30,000 sheep stranded on one property near Ivanhoe in the state's west.

Japan: Lessons learned 1 year after March 2011 disasters

Via The Mainichi Daily News, an editorial: Lessons learned 1 year after March 2011 disasters.

We would like to take this opportunity as we approach the first anniversary of the Great East Japan Earthquake and tsunami to think about what we have lost -- and learned -- from the disasters. 

The losses are enormous: the lives of some 20,000 people, the assets and the peace of hundreds of thousands of people and numerous jobs. Residents of areas heavily affected by the ongoing crisis at the tsunami-hit Fukushima No. 1 Nuclear Power Plant have also been deprived of the freedom to live in their hometowns. 

Yet amid such hardships, Japanese people have shown to the world that they have a strong will to restore their livelihoods. Close bonds and solidarity between victims and those who have shown willingness to share their pain have shone through the disaster. 

We would like to cite two things we have learned from the March 2011 quake, tsunami and ensuing nuclear crisis.  

One of them is the importance of politics. The government's response to the disasters has demonstrated that politics has not functioned properly and has been in chaos since March 11, 2011. 

Even though the government set up several task forces to handle disaster countermeasures, its system of political leadership -- having politicians being responsible for decisions on policy while bureaucrats put their expertise to work to implement these measures -- has failed to function as far as the government's response to the disasters is concerned. 

The ruling and opposition parties have also failed to cooperate closely to solve problems with speed and focus. On the contrary, a conflict within the ruling bloc has contributed to confusion in the political situation, and delayed solutions to problems that require political-level decisions. 

The 4 trillion yen initial supplementary budget for fiscal 2011 -- designed to finance disaster recovery efforts -- did not become law until May 2, 2011. Furthermore, the government's compilation of the principles for disaster recovery, which provide direction during the recovery period and cover the scale and length of recovery measures, the financial resources required and the designation of special restoration zones, did not come until July 29 -- 4 1/2 months after the disasters. 

The government finally set up the Reconstruction Agency on Feb. 10 -- 11 months after the Great East Japan Earthquake. This is in stark contrast to the establishment of a similar body only four weeks after the 1923 Great Kanto Earthquake that devastated Tokyo and its environs. 

Enhancing political ability to solve problems is important as a means to protect ourselves from future disasters and indispensable when the government tackles other outstanding issues. 

Our second lesson is the inevitability of a fundamental review of Japan's energy policy -- including nuclear power. We were overconfident of the safety of nuclear power plants. The ongoing crisis at the Fukushima No. 1 Nuclear Power Plant has raised such questions as how to decrease Japan's reliance on nuclear power plants, how to secure substitute energy sources and how to solve problems involving radioactive waste. 

Even though these are extremely difficult questions, Japan can make an important contribution to global society by solving them and setting an example through reduced reliance on nuclear energy.

H5N1 controversy: Another NYT editorial

Via The New York Times: The Truth About the Doomsday Virus? Excerpt:

Two months ago we warned that a new bird flu virus — modified in a laboratory to make it transmissible through the air among mammals — could kill millions of people if it escaped confinement or was stolen by terrorists. Now Ron Fouchier, the Dutch scientist who led the key research team, is saying that his findings, which remain confidential, were misconstrued by the press. 

He says that the virus did not spread easily and was not lethal when transmitted from one ferret to another by coughing or sneezing, and that it became highly lethal only when big doses were injected into the animals’ windpipes. 

That is hard to square with his original assertions. Experts who read his original manuscript say it reported that the new virus spread through the air and remained as virulent as the natural virus, which has killed 60 percent of the humans it has infected. 

Dr. Fouchier’s new claims are only the latest bizarre twist in a global health debate that badly needs an objective, independent arbiter. The public needs to know whether this virus is a potentially big killer, and if so, how it should be contained. It needs to know what details can be published without giving terrorists a recipe for a biological weapon. 

And it needs to know that a mechanism will be put in place to assess all the risks and benefits of such research before it is approved — not after a new virus has been created.

Dr. Carroll on the health disaster in Haiti

Dr. John Carroll's posts in the Peoria Journal Star are among the best reporting we're getting from Haiti. Today, a long and quietly furious article on the Ministry of Health Disaster in Haiti. Excerpt:

Early today in pediatric clinic in Cite Soleil I had a young mother bring in her 10 month old baby boy. She told me that he started having diarrhea yesterday. He had ten white watery stools yesterday and five similar stools this morning. He is drinking some and nursing some but clinically appeared lethargic and moderately dehydrated. 

It was an easy diagnosis. I thought this baby boy had cholera. 

Most of my pediatric patients in the clinic actually do have diarrhea. But this baby's diarrhea was different and his clinical presentation was consistent with cholera. 

So what should I do? 

The population of Soleil is estimated to be in the hundreds of thousands. But no one knows for sure. And before cholera struck Haiti in 2010, Soleil had the usual horrible diseases of poverty. Now it has had cholera added to its "differential diagnosis" . And the experts from around the world say that cholera will return here in a few weeks when the rainy season starts. 

Is this baby the harbinger of the next wave of cholera? 

Working in Cite Soleil as a physician is challenging. We all know that the people from the slum are suffering and dying from stupid deaths everyday. This is no secret. And intervening to help them is not always straight forward. 

Soleil should not have a monopoly on medical helplessness and hopelessness, but it sure seems to. 

I first worked at St. Catherine’s Hospital in Soleil in 1987. I had the opportunity to work with Dr. Paul Blough, a retired OB-GYN doctor from Peoria, Illinois. Dr. Paul delivered over 10,000 babies at St. Catherine’s in the 1980's and 90's. He was in his 70’s and 80’s when he worked in Soleil and he gave excellent obstetric care. And so did the Haitian midwives that worked with him. 

The Daughters of Charity, who are an order of St. Vincent de Paul Sisters in Soleil, worked at St. Catherine's during those years too. The hospital functioned and many patients were treated every day. 

Doctors Without Borders, which responds to "hot zones" around the world, has been running the hospital since shortly after the 2010 Haitian earthquake. But they left the hospital three months ago because their contract with the Haitian government expired. 

Doctors Without Borders had an army of medical people including public health experts that tracked cholera in the Soleil slum neighborhood-by-neighborhood and street-by-street. Cholera tents were erected at St. Catherine's Cholera Treatment Center (CTC). These tents were away from the other post earthquake tents that housed general medical patients. Thousands of cholera patients were treated and many lives were saved. 

And inside the hospital that was not damaged by the earthquake, Doctors Without Borders offered a small emergency room, surgery department, internal medicine and pediatric wards, and an obstetric unit.  Many patients from Soleil were operated because the surgeons, anethesiologists, and surgical nurses were on site.   

But all has changed. St. Catherine's is no longer bustling with activity like it should be in this huge destitute slum. 

Ministre de la Sante Publique et de la Population (MSPP), which is the Haitian Ministry of Health, is in charge of St. Catherine's Hospital now. MSPP has government hospitals in each of Haiti's ten departments. However, they don't function well. 

St. Catherine’s is in terrible condition now. It is staffed by a tiny handful of excellent Haitian doctors employed by MSPP, but the hospital has very few medical supplies. 

And there is a new problem. 

Patients are now charged five Haitian dollars (75 cents US) to have a check up. And if they need to be admitted to St. Catherine's they are charged two hundred Haitian dollars (25 dollars US) for a bed. Doctors Without Borders did not charge. 

Patients' families have to provide the sheets for the bed and food for the patient. And family members bathe the patient and empty the bedpan. 

Medical supplies and medication are provided by the hospital if they have them. But if they are not available, the patient's family has to try and buy them somewhere on the street which is frequently impossible to accomplish. (How would you buy 4-0 chromic sutures?) 

So lack of money stops people from coming to St. Catherine's in Soleil in the first place.

Read the whole article to find out what happened to the baby.

Haiti: 7,025 cholera deaths as of January 22

On a Saturday afternoon, the MSPP has just posted new cholera statistics on its Documentation page—just two days' worth. So we are now up to January 22, 41 days behind March 3. For what they're worth, here are the January 22 numbers:

Cases: 97

Hospitalizations: 52

Deaths: 0

Total since the outbreak began in October 2010:

Cases: 526,524

Hospitalizations: 283,925

Deaths: 7,025

So no one died of cholera in Haiti between January 20 (our last update) and January 22. But I have no idea what's been happening since. Nor can I understand why PAHO and other NGOs have put up with this recurrent delay in basic reporting.

Haiti: "Building back better" just a slogan

Via CEPR's Haiti Relief and Reconstruction Watch, a discouraging report: Evaluation of Donor Response to Haiti Earthquake Shows "Building Back Better" Nothing But a Slogan. Click through for some important links. The section on cholera:

Donors’ role in the cholera response stands as one of the biggest failures over the last two years. Introduced by MINUSTAH, the cholera epidemic has killed over 7,000 people and sickened over half-a-million. 

As CEPR argued in a research paper in the summer of 2011, funding for the cholera response was withdrawn right before the rainy season, resulting in an extreme spike in cases and mortality that could have been prevented. The HRI report echoes these concerns: 

The cholera crisis demonstrated the typical strength of donors to provide funding while the crisis was in the news, but similarly demonstrated the weakness of donors to be transparent or communicative about their proposed solutions for the transitional phases. While cholera was killing an increasing number of Haitians in the second semester of 2011, donors individually and collectively pulled back without advice other than to encourage integrated health care. 

The report concludes, while noting the difficult circumstances on the ground, that: 

Much more could have been done to coordinate their own efforts, and to be more transparent and less political about their aid allocations and decision-making processes. The fact that many of the billions of aid promised has still not been delivered and is nearly impossible to track is scandalous. 

While many mistakes have been made, there are still opportunities to set a new course for longer-term recovery and development that will take these concerns into consideration, and focus on living up to the promises made to Haiti that the international community will not abandon them, but work with them to rebuild and renew.

Pakistan: Dengue returns, 2 new cases reported in Lahore

Via The Nation: Dengue returns, 2 new cases reported in Lahore. 

Despite hectic efforts and campaign to educate the people for taking precautionary measures, dengue has returned in Punjab Capital as two more dengue patients were admitted in hospital on Saturday.  

According to sources, two more dengue patients were admitted in Mayo Hospital Lahore after they were brought to the hospital for medical check up. The patients were identified as Muhammad Farooq, 22, resident of Chonian area and Razia Bibi ,40,of Shadipura area. 

The doctors diagnosed that they were suffering from dengue fever and shifted them to dengue ward of the hospital. Their condition was said to be out of danger.

My turn in the scanner

The Tyee has published My Turn in the Scanner, an account of how the BC health system handled me after my stroke in January. Excerpt:

On Jan. 9, sitting down to lunch with my Tyee colleagues at a good Chinatown restaurant, I felt my face go numb. Not all of it -- just a small patch around the left corner of my mouth. Part of my tongue was numb too. It felt very much like dental anesthetic that hadn't quite worn off yet. 

Am I having a stroke? I wondered. As a matter of fact I was, but it would take me a week to confirm it. In the process, I renewed my respect for our healthcare system. 

For a few days I managed to ignore the numb patch. It felt funny, but it didn't hurt. I expected it would fade away. Then, on Jan. 13, I woke up with a cramp in my left leg. I rolled out of bed to walk it off, as I usually do, but this time the leg would barely support me. It was still weak when I got up to walk the dogs. 

Two alarms on the same side of my body told me that something was wrong and wasn't likely to fix itself. That morning I called my doctor; he was booked solid, so I made an appointment for the following Monday afternoon. Then I took myself to the Park & Tilford walk-in clinic. 

The doctor listened carefully and did a couple of simple tests: I bared my teeth in a big grin, and held my hands out side by side. No real problems, but the doctor wasn't persuaded. Suspecting a transient ischemic attack, he told me to go straight to Lions Gate emergency.

Fukushima: Chaos reigns

Via Salon.com, one week before the first anniversary of the disaster: Fukushima: Chaos reigns. Excerpt:

The abandonment of entire communities is troubling enough, but little can prepare you for a close-up view of Fukushima Daiichi’s damaged reactors. 

One is shrouded in a vinyl cover while another appears largely intact, its mottled turquoise and white pattern clearly visible on a cold, but brilliantly sunny winter afternoon. The Nos. 3 and 4 reactors, however, are a tangled mess of steel and debris. 

This low-lying area near the coast is by far the most hazardous part of the site. High radiation levels have hampered work to clear the wreckage and inspect the state of the melted fuel. The day before our visit, a robot sent inside reactor No. 2 reactor found 200 millisieverts per hour at one spot. 

The reactors' proximity to the ocean made them easy targets for the 14-meter (42-foot) tsunami, which effortlessly breached the plant’s protective wall. Along one side of the coastal road, mesh sacks filled with rocks provide makeshift reinforcement; on the other are the exposed innards of the reactors’ turbine buildings, crammed with twisted metal, warped shutters and trucks swept up and deposited by the waves. 

But the clutter tells only half the story. From the outside, the appearance is one of utter chaos, but inside, damaged nuclear fuel is being kept cool by vast quantities of water, which is then stored in tanks covering almost every spare patch of ground on the site, before being decontaminated and fed back into the reactors. 

Water management is critical to preventing the fuel from heating up again and setting off a potentially catastrophic nuclear chain reaction, says Katsuhiko Iwaki, deputy manager of the Fukushima Daiichi stabilization centre. 

The current capacity of 165,000 tons of water will reach its limit by April, he says, adding that Tepco is adding space for tens of thousands of tons of additional water.