It is only in the last few days, btw, that WHO is acknowledging that other cases of H2H have occurred:
Until now there have been only a couple of isolated incidents where one person is believed to have infected another. One of those was a woman from Bangkok, who returned to her village to nurse her child who was sick with avian flu. Although the mother had not had any contact with chickens, both died.
Samples of the virus in the bloodstream of the Sumatran victims have not so far shown any mutation of the H5N1 virus which would have to happen for it to become easily transmissible between humans. But the scale of this cluster, and the possibility of further cases, has raised serious concerns. "We are alarmed by this cluster," said Maria Cheng of the WHO. "It is the largest cluster we have had that has been identified for possible human to human transmission. The hypothesis is that these people were at very close quarters and were taking care of each other and falling ill."
It is the fourth - and largest - family cluster of bird flu cases likely transmitted from human to human since the start of the outbreak in Hong Kong in 2003, said Gregory Hartl, a spokesman for the Geneva-based WHO.So, in the midst of other reassuring findings, such as no subsequent illnesses in health care workers, and no evidence of new cases beyond the cluster, it is now established that H2H cases of H5N1 exist. The cluster in Indonesia is remarkable because it represents at least 3 and perhaps 4 generations of spread (H2H2H2H), and other, smaller clusters in Indonesia likely represent similar H2H findings, albeit fewer generations.
This likely won't change the stage of pandemic alert from 3 to 4; casual contact has not been demonstrated, major mutations have not been documented and changing the pandemic alert level has economic implications for U.N. member countries (border closings and restrictions, e.g.). The cluster has sparked WHO containment efforts, however, even without raising the pandemic level.
The World Health Organization might soon convene an expert panel to decide whether an unprecedented human outbreak of bird flu in Indonesia requires the world to go on higher alert for a possible pandemic, health officials said Wednesday.
If the global alert status were increased, international stockpiles of antiviral drugs would probably be shipped to Indonesia and travel from the country would be monitored in an attempt to contain the outbreak.
As noted, those stockpiles are already on the way. And the risks from H5N1 are not over. As this WaPo story notes:
Most of the H5N1 samples [Robert Webster's] lab analyzes are provided by Asian scientists. Occasionally, they are given secretly if they come from a place where the virus has not been publicly reported.So what else don't we know?
Now, in the postings yesterday, we had some interesting reactions from readers and posters amidst the terrific discussion about the science, the facts and the politics. More on the flip.
Nine Reasons Why the Flu Doubters Have It WrongThe letter is worth reading and rereading in full. I loved, for example, the Rumsfeld reference #7, which is as much a part of bird flu lore now as the high case fatality rate currently seen (and look at those numbers from 2006). You can't have a flu diary without someone posting about Rummy.
We've often wondered why so many people (including friends) who are otherwise perceptive and progressive have such a hard time getting their arms around the genuine threat posed by avian flu and revert instead to denial and charges that the issue is "fear mongering at its worst."
We think there are nine main reasons:
1) The range of possibilities is stupefying - anything from no pandemic at all ever to the worst plague in the history of the human race. This is more paralyzing to folks than a simple statement that a billion will die. Faced with this surreal range of possibility, people prefer to dwell on something seemingly more concrete, like the chance Karl Rove will be indicted or the possibility of an asteroid hitting us from outer space.
2) It has been our common experience during the past 40 years that these various apocalyptic threats have never panned out: swine flu, SARS, monkey pox, Y2K, a second major US terrorist strike, every Homeland Security Dept. orange alert, nuclear war with the Soviet Union - every one of these has been a dud as Armageddon.
3) This administration has used Goebbels-style misinformation more aggressively, consistently, continuously and shamefully than any in our history. You really have to look at foreign fascist regimes to see dishonesty practiced with such perversion. Otherwise incompetent, perfect only at lying, Bush and his minions have now convinced most of the country they are not to be trusted on anything, avian flu included.
4) The most quoted advice coming from US Health and Human Services Secretary Michael Levitt has been bizarre and off-putting. Levitt deserves credit for touring the country to spotlight the threat. But telling people to put canned milk and tuna "under your bed" sounds like crap. "How can that help if I have to stay at home for months?" folks rightly wonder. It sounds totally facetious, even if he was just being metaphorical. Moreover, the advice being offered on official flu sites is often next to useless for many families. Stock up on three months of your medication in case supplies are cut? Tough if you take expensive drugs. Impossible if you're one of 44 million Americans with no health insurance at all.
5) If this is the worst disease threat in decades, our administration doesn't seem overly concerned. There has been no special presidential address or high profile presidential conference. The few billions proposed to stave off the potential end of the world as we know it are a tiny fraction of the Iraqi spend. And Levitt's oddly honest über-message doesn't ring alarm bells either. He's basically saying: "We know we've been sharply criticized for our handling of Katrina and not helping as promised. So this time, we're telling you up front: we're not helping. You're on your own." Huh?
6) A handful of scientists and doctors have publicly poo-pooed the possibility of pandemic. One or two are actual experts in virology. Most are bogus boobs with expertise in unrelated medical fields. One fellow, for example, has been particularly damaging by writing that the H5N1 pandemic chances are super tiny (wrong), that there are vast numbers of hidden asymptomatic cases of H5N1 (wrong wrong) and that we are protected by some kind of "species barrier" (wrong wrong wrong). That he has done so to shill for his totally irresponsible book arguing (essentially) for non-action is nothing short of disgusting. In truth, the actual number of these professional bird flu debunkers relative to real experts in the field is about the same as the number of real experts who doubt global warming or evolution. But laymen don't understand this. The see a few docs calling bullshit and conclude: "Oh, OK then. Skip the tuna. We can relax."
7) The fact that Rumsfeld was chairman and a major shareholder of osteltamivir patent-holder Gilead is in itself proof positive of conspiracy for the many conspiracists on our side of the fence. And it does look pretty damning at first glance: the man who helped secretly plot a way to get us into a war with hype and fear is now using hype and fear so his firm can sell vast amounts of unneeded flu drugs. Sure sounds convincing unless you know that our administration has been singularly late and unhurried in its response to H5N1, and that they have shamefully failed to purchase adequate stocks of antivirals, especially Gilead/Roche's Tamiflu. But the conspiracy theorists don't understand that part.
8) Flu diaries attract an odd lot of characters. Some real experts come to comment, but there are a lot more flat-earthers, end-daysers, apocalyptarians, vaccine haters and even outright anti-science types. If you visit one these sites, you may to be impressed by the main articles, but scared off by the comment trail in some cases. Small wonder Jon Stewart has a regular bird flu: threat-or-menace parody.
9) Finally, the science here is very confusing for non-experts. It's in birds now, but only in 214 people. More people are hit by lightning each year. There are complex genetic changes occurring in the virus that even experts don't fully understand. These changes may allow the bug to infect us all, and pretty easily too. Or maybe not. We're talking about a future mutation - or maybe a "reassortment" or a "recombination." This is meaningless to most of us. The normal chaos of reporting breaking news doesn't help either. Outbreaks and clusters come and go. The threat seems to wax and wane. Last week, stories said things were better because new cases are down in China, Thailand and Vietnam. This week, WHO has been considering raising the alert level because of the worrisome Indonesian cluster. Even after Oprah's public-spirited effort at bird flu education and especially after the ABC-deathathon flu-scare movie, it's hard to explain to people what's occurring and why it's real and concrete. It just sounds like, well, science fiction.
So when the CDC warns that this could (could, not will) be the perfect biological storm, folks reasonably react with disbelief. Been there, done that, you won't fool me again with naturally occurring viral WMDs. And in that context, it's easy for people to defend their denial and inaction. And, in that context, it's not unreasonable for them to do so.
The problem is that as a result we are prepared about as well for bird flu as we were for Katrina. To push the metaphor: The medical levees are in dangerous disrepair. The disaster and evacuation plans are incomplete and incoherent. And the public - even otherwise honest, ethical and progressive people - are ill-equipped and unaware that a Category 5 organism really is bearing down on them.
Regina Dwyer, MD
But the point of it all is that there are always reasons why this isn't what it is - except that it is. H5N1 and the Indonesian cluster was the lead story in each of the network news broadcasts tonight, and with good reason. It's a major story, worth telling (even if they didn't tell you that there's unreported H5N1 somewhere we don't know).
Now, here's another interesting angle. It's a letter from the medical journals (no data, just opinion) about risk communication about pandemics from the mass media in Greece. the obervation was that oversaturation of H5N1 news was followed by a silence in mass media broadcasting on the story just as profound, a similar picture as we've seen in the US. The end result was an assumption on the part of the public that the crisis was over. The authors concluded that, among other findings, a poorly educated public was not in a position to adequately evaluate news that they were not prepared to interpret.
Effective risk communication is a priority early in an outbreak. Both the mass media and public health authorities have the responsibility to deliver correct information to the public. The fear-based approach and over-reaction towards a potential influenza pandemic may be hazardous to the general public, because it encourages solutions that inhibit the ability to properly respond to a potential pandemic.That's not likely to happen with this audience. Daily Kos readers are media savvy, critical thinkers, and well educated (by now) on the H5N1 issue, the purpose of these posts. You know where and how to get information from the Internets and it needn't be spoon-fed.
That skill is needed in politics; it's going to be a valuable and necessary skill as well should the virus continue to lurch its way toward more efficient spread. And if not this virus, some other flu virus is bound to cause a pandemic. Pandemics happen whether we want them to, or not.
Stay informed, watch the news, and learn more when you're ready. An all-hazard approach to pandemics and other natural threats is simply the prudent thing to do, whether you're inclined to shoot the messenger or not.
Oh, yeah, I almost forgot. There are things you can do to prepare your family. And there are things you can do to prepare your business. The idea that you can do nothing besides sitting passively and reading the news is hogwash. But then again, you are activists. You already know that. Don't you?