H5N1

A new list of links

I've created a new list, H5N1 Special Reports, down near the bottom of the right-hand column. Some of the items have already been mentioned here, and then they've vanished in the rush of new posts. If you know of useful reports that belong on this list, please let me know. They can be government reports, business reports, technical or business reports—anything dealing with H5N1 that falls between news stories and scholarly articles.

Poverty hinders China's fight

Via Reuters, a feature article you must read: Poverty hinders China's fight against bird flu. It reminds us that H5N1 is not happening in a vacuum:

Bird flu, which has killed 11 people in China since late last year, has only added to the woes of the 700 million or so people who live in the countryside, performing often backbreaking labour and earning just a third of their urban compatriots.

More than 300 million of China's farmers lack safe water to drink, and in Ningxia the government estimates that two-thirds of the almost 6 million population is infected with hepatitis B.

A prolonged drought in the already arid region compounds the problems of Ningxia's farmers.

For them, poverty is part of everyday life, and bird flu just another challenge they have to deal with.

Health experts say people should not live with poultry, or any farm animals, to lower the risk of humans catching potentially fatal diseases, such as bird flu or swine fever.

Yet despite government warnings and education campaigns, poverty means this still happens in China.

"Are people still sleeping with their chickens? Yes, they are," said Julie Hall, who oversees the World Health Organisation's fight against bird flu in China.

"The reality is, people are poor. Chickens are incredibly valuable sources of income and source of protein. Chickens don't like being cold," Hall said. The only source of heat is the kitchen.

"These issues of poverty, of rural development, really need to be tackled if we are truly going to tackle not only H5, but many of these diseases."

That brought back memories of some wonderfully bright kids I taught in Guangzhou who suddenly disappeared from class because of hepatitis. And it's a reminder that poverty and politics are driving this disease from birds to humans, where it can exploit the weaknesses created by diseases already entrenched: hepatitis, tuberculosis, malaria, and HIV/AIDS.

Bush, Fox, and Harper agree on flu policy

Via Yahoo News: North American nations to coordinate bird flu response. Presidents Bush and Fox and Prime Minister Harper met in Cancun and among other agreements said they'd cooperate on avian flu:

The three leaders "have agreed to develop a comprehensive, science-based and coordinated approach within North America to avian influenza and human pandemic influenza management".

The plan calls for trilateral cooperation "in all stages of avian influenza and human pandemic influenza management: prevention; preparedness; response; and recovery".

US, Canadian and Mexican officials "will develop, as an immediate priority, incident management protocols to ensure that we are well prepared in advance of an outbreak in North America".

The three nations have "agreed to work together to accelerate research, development, production, and availability of human pandemic influenza vaccines, and develop a strategy to best facilitate the sharing of information to enhance the availability of vaccines to the region".

I confess my bias: I'm not a fan of any of these guys. Fox is really concerned about how Mexican emigrants (legal or otherwise) are treated in the US. Harper is really concerned about getting the US to obey its own laws about softwood-lumber imports from Canada. He's also understandably horrified about the consequences of requiring a passport or equivalent from even US citizens re-entering their own country from Canada. If I say what I think about Bush's real concerns, I'll get boring email from his dwindling hardcore supporters.

I don't expect them to follow through on these promises, but if they do, I'll be pleasantly surprised. H5N1 was a total non-issue in the recent Canadian election, and if Harper's comments spark some public debate here, that will be a good thing.

Flu racketeers

Via Canada.com: Health Canada warns consumers against products to "protect" against bird flu.

With avian flu fears taking flight, Health Canada is warning consumers not to fall for the marketing claims of products professing to fight or prevent avian influenza.

"There are currently no products authorized for sale in Canada that are indicated specifically for the treatment of avian flu," the department cautioned in a release Tuesday.

The release noted the U.S. Food and Drug Administration recently issued warning letters to nine American companies marketing products - mainly dietary supplements - with labels claiming they could treat or prevent avian flu or other types of influenza.

A spokesperson said Health Canada's warning was not triggered by proof such sales are going on in Canada, but rather that the reality of the Internet means products can be targeted at consumers everywhere.

This is why I delete comments promoting any kind of commercial sales of anti-flu items, whether pills or masks.

Re-inventing the iron curtain

A pandemic-simulation exercise did not leave participants covered in glory, according to this story in FT.com: "Every man for himself" in Europe's bird flu simulation. The Swiss announced they were sealing themselves off, and the French were considering border closures also. Such measures would leave a lot of drug and vaccine makers effectively closed off from people needing their products.

That wasn't all:

Several countries had not considered the possibility of school closures, or disruptions to public order, electricity supply and businesses.

The evaluation of the exercise, commissioned by the European Commission from the UK's Health Protection Agency, called for greater understanding by member states of the laws governing travel restrictions across Europe.

Participants, who came from all EU member countries and neighbouring states, showed reluctance to share antiviral drug stocks with other countries.

The report said there was a need for greater transparency on the location of antiviral stockpiles, and more clarity for manufacturers on how the stocks they hold should be distributed.

The drug companies for their part called for greater guidance on legal liability, and an indication of which authority would decide when they should switch from the production of seasonal flu vaccines to those that would protect people from a pandemic strain. This was most likely to take place if bird flu were to mutate into a form transmissible between humans, which has yet to happen.

In the exercise, the European Commission's Early Warning and Response System, designed to notify officials of human infections, became overloaded. The report called for back-up communications facilities and greater co-ordination between officials and the media.

Thanks to Bird Flu RSS for the link.

Is Vancouver ready for H5N1?

A lot of newspapers are asking about local readiness for a pandemic, and this week the Georgia Straight (a weekly alternative newspaper) asked about Vancouver: Are we ready for bird flu?

It's a good story by one of Vancouver's best journalists, Charlie Smith. You should be able to find some of the planning documents he mentions in the lists here of Health Agencies and H5N1 Crisis Planning and Management.

Blaming the messenger

Via Yahoo News: Israel suspects journalists of spreading bird flu.

Israel suspects journalists, particularly press photographers, of being behind the spread of deadly bird flu in the Jewish state.

"It's one of our working hypotheses," an agriculture ministry official AFP, asking not be identified.

"Bird flu can be transmitted on clothing, footwear, the wheels of cars and even on cameras," the official added Friday.

"The journalists who came to cover the outbreak then went back to homes and offices across the country.

"Even if the required protective measures were taken, it is impossible to disinfect photographic equipment without damaging it."

The idea might make sense if the media had been showing up at poultry farms free of H5N1 after visting infected farms—and the uninfected farms had then gone positive. But it seems equally likely that routine traffic might have spread H5N1.

Still, isolating infected farms from all traffic (except authorized medical and enforcement personnel) certainly makes sense.

Surge capacity: none

A discouraging story from Bloomberg: Even mild pandemic will overwhelm US hospitals. An excerpt:

Even if the flu comes in a relatively mild form, emergency rooms would be first to be flooded with pandemic flu cases, said Andrew Bern, a physician at Delray Medical Center in Delray Beach, Florida.

Health authorities will have to"close off access to care'' for patients who use emergency rooms for colds, children's ear infections, cuts and broken bones, said Bern, who founded the American College of Emergency Physicians' disaster medicine section.

Emergency care in the U.S. is "like a house of cards,'' he said, "waiting for a big wind to collapse it.''

Visits to U.S. hospital emergency rooms rose 26 percent to 114 million in the 10 years ending in 2003 as the population increased, Bern said. During the same period the number of emergency rooms fell 14 percent due to cost-cutting by medical centers, said David Seaberg, a director with the Physicians' College, in Feb. 8 testimony before the House Committee on Homeland Security.

Nabarro in Africa

Via Reuters, an excellent interview with David Nabarro. He was in Libreville, Gabon, earlier this month at a conference on dealing with H5N1, and he clearly understands the issues facing H5N1-positive nations in Africa.

B2H death confirmed in Indonesia

Via Xinhuanet: Indonesia reports 23rd confirmed bird flu fatality. Not really news, but note the last line of the story.

The World Health Organization has confirmed one more death from bird flu in Indonesia, bringing the total number of deaths in the country to 23, a health official said here Friday.

The one-year-old baby girl from Jakarta died recently at a local Hospital, I Nyoman Kandun, director-general of the disease control and environmental health under the Indonesian Health Ministry told Xinhua over phone.

He said the girl's blood sample tested positive by the WTO-sanctioned laboratory in Hong Kong.

Up to now, Indonesia has recorded 31 human cases of bird flu, he added.

Meanwhile, Kandun disclosed that local test showed that another 23-year-old man from Padang, capital of west Sumatra province, has also died of bird flu.