Scott McPherson's Web Presence

The news coming out of Indonesia is interesting.  It appears that members of two South Sulawesi families are infected with suspected H5N1.  In both families, the father and a boy are each exhibiting bird flu symptoms.  Of course, that could be anything from bad breakfast to dengue to the Real Thing. 

But what separates this incident from the usual reports is the actions of the regional government to bring in food and supplies, so the villagers do not leave the village.  This would seem to infer that the village is in quarantine and locked down, inasmuch as you can lock down a remote village.

We will have to wait for some sort of indication that the suspected infections are or are not H5N1.  But for now, it would seem that the silence has been broken and human cases are beginning to filter out of the Jakarta news blackout and into the view of Flublogia.

Stay tuned.  Thread at http://www.flutrackers.com/forum/showthread.php?t=72002&page=6 .  Map poached from the always-reliable poster Laidback Al.

It is so easy to become complacent on the bird flu front these days.  After all, there has not been a significant flareup of human cases in weeks.  Even the cases of H5N1 in poultry are down to insignificance.  Sure, Togo, Laos and Vietnam report cases this week, and the Indonesian government has been so kind as to report on the deaths of two Tangerang patients from H5N1 in July.  It also has reported on the negative tests on five persons, leading my friend Crof to speculate on whether or not we would have heard in a timely manner if they had tested positive?

I am very concerned with this dearth of reported bird flu cases, be they (not) in poultry or (not) in people.  The best description of influenza's proclivity comes from Dr. Robert Webster, or maybe it was John Barry or someone else.  But the two words are:  Influenza smoulders. 

I can't help but feel that there's a whole lotta smoulderin' goin' on here.

Perhaps someone has the statistics immediately prior to the 1918 influenza pandemic, or better yet, the 1957 and 1968 influenza stats.  What did we see prior to the onset of these three mass epidemics?  Did we see a drop in seasonal flu, or an increase?  What did we see in poultry up to that time?  Were there mass die-offs of poultry in the years and months prior to the onset of pandemic, or did we see an unusual quieting of cases in fowl before the flu hit?

I ask all of this because I find it too quiet right now.  It is hard for me to believe that, suddenly, we would all be forced to watch old Barnaby Jones reruns rather than blog on the coming flu pandemic.  The lack of cases has already cost us one important blogger (Orange) and, quite frankly, I have been so busy dealing with the threat of multiple hurricanes that I am not really focused on pandemic preps right now. 

One thing is certain:  It is uncomfortably quiet, especially considering the widespread number and location of cases that were infecting flocks (and occasionally people) across Asia, Europe, the Middle East and Africa before suddenly H5N1 hit some sort of barrier and subsided with a thud.

What I am openly wondering is:  could the H5N1 virus be in a smouldering state, possibly back into the bellies and intestines of wild birds, constantly mutating and evolving, recombining or reassorting, perhaps currently neither capable of lethally infecting bird nor man because its genetic capability to do both/either is currently between species?  Is this the time the virus is preparing to make its biggest species jump? 

Is this how influenza makes that jump, by hibernating in different pockets all over the world, quietly and out of public view, until the time is right for it to emerge and infect something/someone new by the thousands and millions?

Or has the mixture of surveillance, culling, education and swift government action succeeded in beating back the most deadly flu ever seen by Humankind?  One can surely argue in favor of surveillance and culling.  Transparency/translucency in surveillance, transparency/translucency in reports of human infections, and transparency/opaqueness in the sharing of flu samples have all helped keep this virus at bay in the human population.  No one can dispute that.

But I am not convinved we have won any kind of lasting victory against this virus. 

So let's discuss this current situation while we have the peace and quiet.  What do you think?  Has this virus turned its tail and run, or is it simply and quietly acquiring the genetic code necessary to kill?

Informed scientificspeculation is welcomed.  So is uninformed scientific speculation.

Apparently we can all rest easy about the media reports of bird flu being detected in Rhode Island poultry.  Both FLA_MEDIC and Crof have posted on the issue, so I will just have you click on the links. 

But I decided, type-A personality that I am told I am, to personally take charrrge! (can you tell I am getting ready for football season?) and call the number listed in the WPRI-12 news story, as if I were a concerned Rhode Island poultry farmer and wanted to test my flocks.

Guess what I got?  A message!  An older woman's recorded voice proclaims that "the office hours are from 8:30 AM to 4PM, Monday through Friday."

Huh?  They knock off at four in the afternoon?  Good Lord, that is early!  And I guess no one is concerned about H whatever N whatever, since they do not refer to it on the outgoing message.

Guess we will have to wait until tomorrow to see if this is H5N2, H7N-whatever, or H9N-whatever. 

The thought of blogging on Tropical Storm Fay was as far from my mind as praising Supari, until I was reading Mike Coston's Avian Flu Diary blog.  He has been covering Fay and its potential computer-driven trajectories.  In my job as a powerful and influential State government CIO, it is my duty to watch hours and hours and hours of Weather Channel broadcasts until I can expertly predict which outfit Sharon Resultan will wear.  So I pulled myself away from watching Cheryl Lemke (nailed the blazer perfectly), and dutifully pulled up Mike's blog from the weekend, which had computer models showing Fay was headed anywhere from Tallahassee to Ft. Myers to Uzbekestan. 

I noted that the computer model AVNO was the best at predicting the actual trajectory of Fay, followed by a combination of CMC's entry point (Ft. Myers) and BAMD's exit point (Cocoa Beach).  But AVNO nailed it with entry and exit points perfectly -- and I mean perfectly. 

So now, AVNO shows the storm lolligagging (that's a meteriorlogical term, as the President would say) and crossing over (no, not the John Edward crossing over) back to the Gulf coast, and eventually headed for Pensacola.  This would give Fay the opportunity to a) water my lawn dang good without messing it up with tree limbs and such, and b) strengthen into a hurricane, since the northern Gulf waters are quite hot where Fay would go, according to AVNO.

God, where else on the Net are you going to get this kind of in-depth analysis?  Latest computer models at:

http://my.sfwmd.gov/sfwmd/common/images/weather/plots/storm_06.gif

And let's hear it for the fool who went kite surfing on Ft. Lauderdale Beach and got slammed into a) the beach and then b) a building.  There are always people who want to straddle that fine line between adrenaline and a coffin.  I know he was an experienced kite surfer, but you never, NEVER test Mother Nature's patience during such things as tropical storms. 

http://www.miamiherald.com/news/miami-dade/story/649030.html

http://www.local6.com/weather/17229517/detail.html

The Indonesian government has declared that all 13 suspected bird flu sufferers in Air Batu, North Sumatra, are clear of the virus.

Excuse me while I digest this news.  On the one hand, this is welcome news.  It means we dodged a bullet again.

On the other hand, we know that rapid and overwhelming Tamiflu administration can mask H5N1.  No one is advocating the withholding the administration of Tamiflu to sick people.  But it does beg the question as to the veracity of the tests, using a word from a blog from my friend Mike Coston.  No one connected with avian flu issues is ready to accept any Indonesian government test result as a matter of faith.  But we rationalize the result by saying that the government could not possibly be so Hell-bent for homicide that it would deliberately lie about test results, right?

The simple truth is, we have no choice but to accept the Indonesian report as factual, while questioning the veracity of the testing that found the thirteen suspected bird flu sufferers free of the virus.   But while we are told what it wasn't, namely H5N1, we are not told what it was.  Consider that the patients are allegedly all on the road to recovery.  So was it the Tamiflu that worked?  If it was, then the cause was indeed influenza.  This is their season for flu down there, and it sure would be nice to know what killed three and sent 13 to hospital with bird flu symptoms while giving villagers the Willies. 

Perhaps the Tamiflu did nothing, but bed rest and other meds did.  OK, that is quite possible.  But the bird cull and the declarations of the culling's leader that he didn't need tests to tell him the obvious is quite unsettling.

I also ask:  Are they testing for H7 down there?  H9?  A reassortant H5/H1 that would not show up on certain tests?

A casualty of this incident is surveillance.  ProMED, the invaluable reporting mechanism for doctors and researchers all over the world, has just announced it will no longer report suspected cases of Indonesian avian influenza unless/until they are confirmed by the Indonesian government.  Why should proMED put its reputation in jeopardy by reporting cases that are more likely than not to be discredited by the Indonesian government?  After all, initial reports came not from proMED but from newspaper and media accounts.  Flublogia will continue to translate and post reports of avian flu, and we will continue to speculate on their veracity until we know otherwise.  In that sense, nothing has changed.

What HAS changed is a global surveillance organization's decision to stop taking anything coming out of Indonesia seriously unless it is confirmed by the Indonesian government.  This, of course, puts both proMED and the Indonesian government in the role of Mayor Larry Vaughn waiting until the Fourth of July is a disaster to agree to hire Quint to kill the shark in Jaws.  Only this time, an abundance of proof of an avian flu outbreak will not be simply wiped out by improbably sharpshooting police chiefs.  Remember, the Boy Who Cried Wolf was ultimately proven correct. 

All this reinforces a step I have advocated for months now: simply that, like we do to different sectors of the infrastructure for homeland defense, we should bestow WHO Phase levels to individual nations.  While the rest of the world may be at Phase Three, the time has come to take Indonesia to Phase Four -- evidence of sustained H2H transmission --and warn people appropriately. 

And until the Indonesian government gives us clear and compelling evidence to the contrary, Phase Four is where it needs to stay.