Making Sense of the Last 24 Hours
The news of the past 24 hours has not been particularly good, and this is probably a good point in time to take stock of what we know, what we think we know, and where things stand right now.
The World Health Organization has all but admitted that there is likely H2H (Human to Human) transmission going on in Indonesia. Today, they issued this statement regarding the family cluster that has claimed 7 lives so far.
All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness. Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing.
Both the Ministry of Health and WHO are concerned about the situation in Kubu Sembelang and have intensified investigation and response activities. Priority is now being given to the search for additional cases of influenza-like illness in other family members, close contacts, and the general community. To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred.
Yesterday in Geneva, the WHO admitted that in nearly all of the Chinese cases, and roughly 1/3rd of the human cases in Indonesia and Vietnam, they could find no evidence of contact with infected poultry. Given that one of the `facts’ we have heard again and again is that the major route to infection is thru sick birds, you can bet that was a difficult admission to make.
The movement of a portion of our Tamiflu stockpile to Asia indicates additional deep concerns on the part of the U.S. government. While little hope is held that a Tamiflu blanket would stop an outbreak, there is some hope it might slow it down, buying us a few weeks of preparation. There are some doctors who question this use, and view it as throwing a limited supply of vital medication at a losing proposition. This was obviously not an easy decision to reach.
So right now, the situation in Indonesia is obviously serious, although we don’t know exactly how bad it really is. Perhaps this cluster will burn itself out like others have before it. We should know in the next week or so, but for now, it is the number one hotspot in the world.
As for Romania, there are politics in play, as well as public health issues. The quarantining of 13,000 people, and the institution of what amounts to martial law, seems more than a little excessive if all they are experiencing is an outbreak in poultry. We have reports of a handful of suspected human cases, but no confirmation yet. Until we know more, I’m erring on the side of an over reaction by the government.
The bottom line is, we may simply have to get used to these types of reports, and expect them more frequently. H5N1 may erupt at any time into a pandemic, or it could slowly bubble and simmer in various hot spots for months, perhaps years. Predictions, one way or the other, are simply exercises in futility.
H5N1 is exceedingly deadly. It seems to be capable of being transmitted H2H, at least in a limited fashion. And the reservoir of the virus has spread rapidly across the globe in recent months. The more hosts infected, the greater the chances that a pandemic will erupt.
The pot is boiling.
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