The Start of Something Big?

Among Flu watchers, both amateur and professional, Indonesia is at the top of our list of hot spots right now. The news we get from this massive archipelago, home to more than 240 million people, is both confusing and universally disturbing. There are some who believe that we may be seeing Human-to-Human (H2H) transmission of the H5N1 virus there, while others are not quite ready to sound the alarm.

Sadly, the news we get is filtered, mangled, and deliberately skewed. From half a world away, all we can do is watch and worry, and hope today, or tomorrow, we may learn the truth of the situation.

The numbers of infected and dead are all over the place. Officially, the WHO states there have been 35 human infections of H5N1 virus in Indonesia, with 26 deaths. The Indonesian government, however, disputes this, and puts the number at 158 probable human infections (71 dead by my count), and hints that many others have not been detected.

The hurdles mandated by WHO to confirm infection keep the numbers of infected and/or dead from Bird Flu at artificially low levels. One can either attribute this policy to due diligence or simple politics.

Right now, we have a confirmed (local lab) cluster of 8 family members on the island of Sumatra who have tested positive for the H5N1 virus. Either six or seven are dead. News reports also indicate at least another 12 persons are in the hospital with suspected bird flu, and are aggressively being treated with Tamiflu. And 58 additional human samples are being tested.

What we don’t know is the onset dates of all of these cases. And if the second group of 12 was in close proximity to the family of 8. All we get are snippets, unorganized, and lacking in crucial details. For the most part, what little information we get is from local news reports, as the International press has gone largely dark on this story.

Even more disturbing are rumors that news stories are being `scraped’ intentionally from the Internet. Stories have appeared on the news wires, and within minutes or hours, have disappeared. Their links are dead. Coincidence? Maybe, but certainly bad timing.

We’ve also heard stories that the pig population on some islands is infected with the H5N1 virus, and pigs are considered an ideal mixing vessel for the disease. Swine can host many types of human influenza, and a pig that carries both the H5 and H3 virus could swap genetic information between them and create a new, virulent strain. But these reports are difficult to verify.

Speculation is running wild on the net right now as to whether this is `it’ or not. Dr. Henry Niman has stated he believes we are seeing efficient H2H transfer. Others are not so sure, but no one is relaxing.

The message from the US and Canadian government has changed over the past few weeks. They no longer stress that the virus might mutate. Instead, they keep reassuring us it `might not’. But that we should be prepared for it’s arrival in humans anytime.

It will take a few more days to sort out things in Indonesia. Maybe a week or more.

But whatever is going on over there bears close watching. Maybe we are seeing fecal-oral transmission, which is bad, but not a direct route to a pandemic. Maybe it is airborne, which would be very bad indeed. And the possibility (read: hope) remains that nothing has changed and this is just an anomaly in the Bird-2-Human transmission of the virus.

But if things are really going south in Indonesia in a big way, we could be looking at a very long, hot summer.

The only good news (trying to be optimistic, here) is that if the Indonesian government numbers are right, the CFR (Case fatality Rate) may be lower than we feared. They are showing 71 dead out of 158 probable infections, which is a horrific 45% fatality rate. Of course, many of these infected people have not been declared cured, and that rate could go up.

But right now, it's better than the WHO numbers which show 26 out of 35 cases as ending in the death of the patient, a rate of 74%, which makes the Indonesian numbers look a lot better in comparison. Once again, the ambiguity of the numbers makes any analysis difficult.

For now, it's a time for watchful waiting. And for preparing. While there is still time.

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