# 2223
With the announcement this morning that the 13 suspect Bird flu cases in North Sumatra tested negative for the H5N1 virus, many veteran observers are left with a bit of a dilemma.
Whether or not to believe the `official story'.
I'd like to, of course.
I'd much prefer to believe that the past few days has been a false alarm. And admittedly, right now, I see no solid evidence to counter the Indonesian government's claim.
Unfortunately, Indonesia has squandered much of their credibility on the bird flu issue over the past year or so by refusing to share virus samples with the rest of the world, despite the fact that numerous strains of the H5N1 virus now appear to be circulating in that nation.
In recent months, they've even delayed (for weeks) notifying the WHO (World Health Organization) and the press when human cases have been detected.
Simply put, Indonesia is systematically - and without visible shame -suppressing bird flu news in their country.
The Health Minister, Supari, has publicly stated that it harms their nation to talk about cases.
And in fact, it probably does.
Indonesia is a poor nation, struggling with economic woes, chronic infrastructure problems, an inefficient central government, and all-to-frequent natural disasters. They desperately need to attract foreign investments, and tourist dollars.
Constant talk of bird flu outbreaks, whether it be in poultry, or in people, is like an economic death of a thousand cuts for Indonesia. It isn't hard to understand why they are trying to quash bird flu stories.
Of course understanding their reasons falls far short of approving of their methods. Indonesia is playing a very dangerous game, both for them and the rest of the world, for a potential short-term gain.
Of all of the nations in the world, Indonesia is probably the mostly likely to birth an H5N1 pandemic strain. And if that happens, it will have global ramifications.
For now we are left with a great many questions regarding the events in North Sumatra, and only one cryptic, and vaguely unsatisfying text message from a government not known for their veracity in these matters.
That these villagers didn't have the H5N1 virus.
Obviously, I have no way of knowing if it they did or they didn't.
For now, I am tentatively accepting the Indonesian government's announcement simply because I have no information with which to dispute it.
That doesn't mean that I am completely comfortable with it.
It would have been nice to get some kind of diagnosis, some indication as to what claimed 3 lives and hospitalized 13 others.
Simply saying it wasn't bird flu doesn't inspire much confidence.
And third-party laboratory confirmation of these negatives would have been nice (but unlikely, given Indonesia's insistence on protecting their `intellectual property').
Perhaps we will get more clarification on these issues over the next few days.
That there were only 3 fatalities out of 16 suspected cases, in a nation where the CFR (case fatality ratio) has been greater than 80%, tends to argue against this being H5N1.
Of course, we desperately hope that if the virus does learn to transmit from person-to-person, that it loses some of its pathogenicity. So a lesser fatality rate doesn't completely rule out bird flu.
Inaccurate test results are not uncommon, and it generally requires multiple positive tests before Indonesia will accept that a patient is, in fact, infected. The testing sensitivity is poor, and is thought to degrade further once a patient is placed on Tamiflu.
And reports of other villagers with `flu-like symptoms' aside, we've heard of no new serious cases warranting hospitalization over the past 4 days. That would seem to be a good sign.
We could, of course, simply be seeing an effective use of a Tamiflu blanket.
Point. Counter-point.
And without better `facts', we could go back and forth like this all night, to little avail.
If Indonesia were perceived as being open and transparent about their bird flu problem, and interested in protecting the world against the ravages of a pandemic, it would be far easier to accept their pronouncements.
But credibility, once lost, is most difficult to rebuild. And without credibility, even the truth becomes suspect.
If there is more to this story, it will probably become apparent over the next few weeks. It would be difficult to conceal an extended outbreak for long.
But it is a pity that we can't just automatically assume that Indonesia is telling the truth when they declare than an outbreak is something other than bird flu.
By their actions, they have earned our wariness and mistrust. And so we are left with but one option.
To wait and watch to see what happens next.
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