Sleight of Hand

For the past several months, all eyes have been on Indonesia. Starting with the cluster of 8 in May, where H2H2H (Human to Human to Human) transmission of the virus was first suspected, Indonesia has held the flu community breathless. While things quieted down in June, and our attention was diverted to Thailand for a few weeks, this archipelago nation of 200+ million people once again has our rapt attention.

Up until a month ago, the total number of flu patients in Indonesia was in the 50’s. Since that time, another 60 patients suspected or confirmed to have avian flu have cropped up. As I detailed yesterday, a number of these patients have died, and some without testing. But they presented clinical symptoms consistent with bird flu, and doctors there are supposedly confident that many were indeed infected.

The WHO, meanwhile, refuses to even acknowledge any suspected infection unless tests are conducted by certified WHO laboratories. Better, I suppose, that 100 cases are missed than one falsely identified. This policy of wearing blinders does provide some benefits, however. It keeps the numbers down, and therefore the panic.

Today, the MSM (mainstream news media) isn’t even paying attention, and the only reports we are getting come from Indonesian newspapers, and they are written in Bahasa, the official language of Indonesia. Translations come to us via computer programs or volunteers, and the results are often confusing.

But despite the translation difficulties, we know that many cases of suspected bird flu in humans are occurring. That a Tamiflu blanket has been applied to affected villages (considered a drastic step by the WHO), and that some villages have been quarantined, with roads in or out blocked. There are reports that health officials have run out of disinfectant sprays. And the local news media has publicly reported that they are being denied access to the affected areas.

What we don’t know, and what keeps flu watchers up at night, is just how bad it really is?

So far, the number of reported infections is below that which we would expect if the virus were spreading easily. But are we getting the whole story? We simply don’t know. The secrecy surrounding what is going on there clouds the issue. We won’t know until they decide to let us know.

The use of a Tamiflu blanket, literally forcing all citizens within a certain distance of an outbreak to take this antiviral every day, is considered a last ditch effort by the WHO to contain an outbreak. While it might stop a potential pandemic today, the fear is it could infer Tamiflu resistance to the virus, and tomorrow, or next week, when it happens again, tamiflu may be useless.

While all of this is going on, Thailand is battling it’s own bird flu outbreak. So far, officially, they only report 2 human cases. But Thailand covered those up, along with poultry deaths, and few believe we are getting the whole story there.

Vietnam, once cursed with the worst record of human infections of bird flu, had been trumpeting their success in stopping the virus until this past month, when they admitted it was back.

And Africa remains a big question mark. I’m hearing disturbing reports, nothing I can confirm, but that do make me wonder if something isn’t going on there. Bird flu could be killing scores each day, and those victims would be lost in the clutter of 6000 routine deaths every day, many from AIDS, dysentery, or Cholera. We simply don’t know. And it’s maddening.

So while all eyes are on Indonesia, we need to be aware that the virus is now endemic in many parts of the world. Surveillance in some areas is non-existent. And flu season approaches.

If this quiet season is any indication, it's going to be a busy winter.

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