H5N1

The Onion saw us coming

Thanks to the reader who pointed me to a story from last February in The Onion: Nation's Leading Alarmists Excited About Bird Flu.

I will resume my alarmist posts as soon as I can remove the skewer from my navel.

How many dead?

ABC News seems to have acquired an interest in H5N1. Now it's asking: How Many People Could Bird Flu Kill?

While mentioning David Nabarro's 150 million, it also says:

A draft report of the federal government's emergency plan predicts that as many as 200 million Americans could be infected and 200,000 could die within a few months if the bird flu came to the United States.

That seems really strange: A 66% attack rate, putting two-thirds of all Americans in bed, but killing only one in a thousand? In a routine year, the US loses 65,000 a year to flu and pneumonia combined. If two-thirds of the US workforce were suddenly sick, that would include two-thirds of the doctors, nurses, lab techs, cops, firefighters...and people would be dying from all kinds of other causes.

I can't think of anyone who's publicly argued for such a high attack rate, or such a low mortality rate. I've already published my own ill-informed speculations, but I'd be grateful for estimates from people who know what they're talking about.

"We are in real trouble."

A must-read: Newsweek interviews Laurie Garrett, who says: "We Are in Real Trouble."

Scramble the commando docs!

I don't know why this story on Times Online is headlined as "Junk medicine," when the article itself is sensible and farsighted:

By providing the funds and technical support needed to track bird flu in Asia, the developed world will in the long run be protecting itself.

This is the only way in which a pandemic might potentially be prevented: everything else is damage limitation.

An antiviral stockpile is necessary but there is a danger that it could encourage a false sense of security, much as the Maginot Line did for the French in 1939. The flu virus will always get through, unless it is tackled at source. Helping the countries in the line of fire to do just that should now be an urgent priority, for the sake of public health at home as well as abroad.

Considering the western world's long experience in putting hundreds of thousands of trained soldiers and support personnel into all kinds of unhappy places, you'd think they'd be parachuting doctors and lab technicians into Indonesia and Vietnam in battalion-size units. And for once they might even be welcomed.

I'm not entirely kidding. We already have highly trained emergency teams that can move around the planet on short notice to rescue earthquake victims and look after tsunami survivors. Get a few such teams ready to put a hospital and lab in place anywhere in the world in 36 hours, and Ferguson's plan to smother the pandemic in its cradle might have a chance of working.

"Very conscious" about influenza

A reader in Finland wrote to me yesterday, and kindly allowed me to reproduce her note:
Until yesterday Finland was supposed to purchase about 1 million vaccines. Late last night we heard from the news that Finland will purchase vaccines against the H5N1 virus for the whole population. A good news indeed but there was nothing said about from where we're going to get these vaccines. I haven't even heard any success stories yet about vaccines that are proven to work against H5N1. Unfortunately the common attitude towards bird flu is still quite arrogant in Finland and people worried about it are usually considered to be overestimating fools.

My husband also got a very strange reaction from his doctor when he asked about the vaccines against the normal flu and pneumonia which were recommended by Dr. Grattan Woodson in his pandemic preparation handbook. The good old doctor was clearly amused and called me - the wife - "very conscious". So no help from there expected in the case of an outbreak. Therefore if possible I'd like to get more information about the benefits from those two vaccines so I can personally talk to this doctor.

WHO's afraid of the big bad flu?

Well, David Nabarro's "150 million dead" warning certainly scared WHO, which itself is now warning against "scaremongering." Dr. Nabarro is probably pleased with the flap he's created: His forecast has gone around the world, picked up by all kinds of media. Now the rebuttal is doing the same thing (this version comes from Baku Today.Net), adding the fun of controversy.

Maclean's on avian flu

Maclean's, a Canadian newsweekly, has published a story on anxieties about a pandemic: Forget SARS, West Nile, Ebola and avian flu. The real epidemic is fear. It quotes Melanie Mattson and me as flu bloggers.

Indonesia making progress, according to WHO

According to a story in the Jakarta Post, the World Health Organization has given the country a stroke: Indonesia making progress in bird flu fight: WHO. The compliments came from WHO official Gina Samaan. But Samaan was tactful as well as kind:

Samaan declined to comment on whether Indonesia should immediately carry out a mass cull but said the method "seems to have worked in other countries."

Some of those infected have shown no symptoms and others have made a full recovery. The sixth fatality has not been fully confirmed to have died from bird flu.

The second paragraph is a little mystifying: I presume the asymptomatic persons are relatives of infected persons, or closely associated with them. Otherwise, why test them? And if they're showing H5N1 antibodies, are these cases where everyone shared the same sick chicken? (And if so, why did some people get sick and others not?) Or are they cases of human-to-human transmission? And how full a recovery is a "full recovery"?

NEJM article on avian influenza in humans

Via Declan at Connotea, an article just published in the New England Journal of Medicine: Avian Influenza A (H5N1) Infection in Humans.

WHO's news release on Nabarro appointment

David Nabarro's "150 million dead" forecast has spread rapidly through the media, as no doubt intended. Here's the WHO news release announcing Nabarro's appointment: WHO expert to work with the UN system on avian and human influenza.