# 2232
A recent article in The Lancet medical journal focuses our attention, once again, on the incredibly high fatality rate among H5N1 patients in Indonesia. As followers of the bird flu story are well aware, more than 80% of Indonesian's known to have contracted the virus, have died.
In Egypt, where 50 people have been identified as having the virus, the fatality rate is a far lower (but still dismally high) 44%. Whether this is due to there being different strains of the virus circulating in Egypt, or victims getting quicker, or better, medical care - or just of generally better health among Egyptians - is unknown.
The difference is dramatic, however.
And according to this article, a major factor in the high fatality rate in Indonesia may be that on average, it took 7 days for a bird flu patient to received antivirals.
The Lancet article, at the time of this writing, was offline (technical difficulties according to their website), but will presumably be available later today.
Human H5N1 virus: epidemiological and clinical data from case-investigation reports in Indonesia, a country which has had the most patients with H5N1 influenza and one of the highest case-fatality rates.
In the meantime we have this Reuters' article available, which ran in The Straits Times.
More than 80% of Indonesia bird flu cases die
WASHINGTON - LATE diagnosis and treatment means that more than 80 per cent of people infected with H5N1 avian influenza in Indonesia have died, researchers reported on Wednesday.
An analysis of outbreaks in Indonesia, the country hardest hit by bird flu, affirms that quick treatment with anti-viral drugs can save lives. But local health care workers are not properly trained in diagnosing bird flu and often do not have the needed drugs to treat it.
Indonesia has had one-third of the world's known cases of human infection with H5N1 avian influenza. It rarely infects people but globally has killed 243 out of 385 sickened since 2003. In Indonesia, 135 people have been infected and 110 have died, according to the World Health Organisation.
Dr Toni Wandra of the Ministry of Health in Jakarta and colleagues analysed the known cases as of February and found it took on average six days for patients to be admitted to a hospital.
By the time they were admitted, 99 per cent had a fever, 88 per cent were coughing and 84 per cent had breathing problems, they reported in the Lancet medical journal.
The lancet article goes on to say that of patients who received antivirals (generally Tamiflu) within 6 days of falling ill, more than 1/3rd survived.
While patients who did not receive antivirals for more than 7 days saw a greater than 80% mortality rate.
It is generally assumed that to be really effective, Tamiflu needs to be administered within 48 hours of infection.
It makes sense that when you use a medicine that is designed to interrupt the replication of a virus, the sooner you introduce it, the lower the viral load the patient will have to combat.
Of course we are dealing with a limited set of patients, under less than ideal conditions, and with far too few seeking early medical care to draw very many conclusions.
Early diagnosis, and antiviral treatment, does appear to increase one's survivability when infected with this virus.
Good news.
But only for those who live in countries where the drug, and prompt medical care, are readily available.
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