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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. 

A report from the news organization Kompas, translated by CurEvents.com poster Dutchie, gives us the slightest glimmer of an update on the situation in Air Batu.  Air Batu is part of the province in North Sumatra, Indonesia, that has snapped the world out of its collective pandemic fatigue.

First, the recap: Three people are dead, reportedly buried before samples could be taken to test for H5N1 infection.  Thirteen people are in hospital, taking Tamiflu.  Two of the thirteen were moved to a more secure isolation ward in Medan, the provincial capital.  Poultry were dying all over the village, and the Indonesian government moved in quickly, culling every bird within a kilometer of the suspected outbreak's center.

What comes next is a machine translation of the news story:

WHO is Monitoring Bird Flu in Air Batu

The Head of the Health Section of the Province North Sumatran Candra Syafii in Medan, on Friday (8/8), said a team from the Organisation of the Health of the World (WHO) descended to monitor the development of the case of bird flu in Air Batu. (bold Dutchie)

Some of the team's members saw directly the patient in RSUP Adam Malik, Medan, another part was in the Air Batu Village, Kecamatan Air Batu, Asahan.

They, said Candra, held investigation and the monitoring of the development of the illness (surveilans epidemiology). The team will be in North Sumatra until this case could be handled. (bold Dutchie)

In the meantime, the Section Head Veteriner Dinas Peternakan North Sumatra Nurdin Lubis said, the extermination of the poultry has in the location been finished.

The team destroyed the poultry, especially in the radius one kilometre from the discovery of the positive case of the virus attack H5N1 in the village. ” We also has sprayed disinfectant in the pen and the settlement of the resident that we thought as the place of the development of the virus ,” he said. (bold mine)

The official of the combination, said Nurdin, continued to give the socialisation.

Metro TV News, Indonesia, reported this (hat-tip Solitare):

In other the side, Kebun Village apparatus 39 established the command post of the bird flu complaint. Since yesterday, the command post has received the complaint 73 from 1,409 residents who admitted to suffering the sign of flu burung. (bold mine)

From AFP, this latest update:

MEDAN, Indonesia (AFP) - Hundreds of chickens and ducks have been slaughtered to contain a suspected bird flu outbreak in Indonesia as 13 people with flu-like symptoms await laboratory results, officials said Friday.

Experts from the World Health Organisation (WHO) had arrived in the affected village in North Sumatra to help investigate the possible outbreak and the sudden death of three residents last week, a provincial health official said.

"They will be in the village of Air Batu for two days to investigate the source of the suspected bird flu virus in the area and to check on the death of three people in the village," the official, Suhadi, told AFP.

Thirteen people have been hospitalised with fevers and respiratory problems, two of whom, a baby boy and a seven-year-old girl, were still in a bird flu isolation unit at a hospital in the provincial capital Medan.

Adam Malik hospital spokesman Sinar Ginting said the two children in isolation had shaken off the symptoms.

"The two patients with suspected bird flu have recovered and are in normal condition. But as we haven't received results from the laboratory they remain in the isolation room," he said.

Local officials said work was continuing to sterilise the village.

"We have taken measures since Tuesday when we found strong indications of bird flu virus in some 100 chickens and ducks in several places in Air Batu village," local husbandry office chief Oktoni Eryanto said. (bold mine)

At least 400 birds have been slaughtered and burned, and officials are continuing to spray backyard coops with disinfectant, he said.

"We don't need to send samples from the poultry to a laboratory because it's pretty clear that the cause is the bird flu virus," he said. (bold from  Kassy, CurEvents.com poster and hat-tip recipient).

So, if we are not too presumptuous, here are the latest details: 

• There is a stong belief that bird flu was/is in Air Batu; and that the Indonesian government, expert at identifying (if not reporting) bird flu, did not wait for test results before moving to kill every bird within a kilometer of the suspected epicenter of the outbreak.
• Someone has actually identified a suspected epicenter of the outbreak - and it is a home.
• Three are dead, thirteen are in hospital, and as many as 73 others are complaining of flu-like symptoms. This is out of a village of 1,900 people.
• The WHO was allowed in by the Indonesian government to find out what in the Wide Wide World of Sports is a-going on down there. Good sign.
• The WHO will be there for awhile.

When I ran Jeb Bush's statewide Y2K preparedness project, I worked closely with Craig Fugate, who at the time was Florida's #2 man for emergency management.  When his boss Joe Myers left, Craig slid into the chair and has led Florida's emergency efforts capably ever since. 

Craig is blunt and candid when he speaks, which is a rare and much-appreciated quality when it comes to public officials.  He does not mince words and his candor is welcomed.  He also does not sugar-coat things, which is why the Florida pandemic disaster drill -- the largest conducted by Florida government to date -- was designed to provoke more questions than answers.

For example:  Someone has either a) been doing his homework, or b) watching my numerous State government PowerPoints, or c) both a) and b), because the issue of 16,000 new orphans arose during the simulation.  How will Florida cope with 16,000 new orphans?  The answer was not forthcoming.  And that is fine for now:  As long as the question is asked in a public setting, the answer can come later.  Just get someone thinking about that and get back to him quickly.

Equally comforting in its bluntness was the estimate of 100,000 Floridians dead from pandemic influenza.  That is in line with HHS projections for a 2% case fatality rate.  Eighteen million Floridians, at a 30% attack rate, with a 2% CFR ..... right on line with the scenario.  There was no attempt to lower the CFR; no attempt at a happy ending. 

From my sources who attended the briefing (I was not invited, a protocol oversight because I am not in the Executive Branch anymore), the simulation was both extremely well-attended and very realistic.  My sources are informed because they understand the issue, having done their own research and having sat through my presentations. 

What was sad was the tabletop "death" of Agriculture Commissioner Charles Bronson (no, not that Bronson).  I have blogged about my friend before.  He is arguably the most informed elected official in the nation on avian flu.  And he took the step of hiring away USDA's top fowl veterinarian who helped manage the Delmarva Peninsula bird flu outbreak of a few years ago -- just for this very possibility. 

Bronson got the "death tap" during the exercise.  It is a Fugate trademark and creates the appropriate somber mood for the proceedings.  It reinforces the theme that happy endings are reserved for Disney movies.  No happy endings for Mr. Bronson.

The infection path itself was eeire, especially since the exercise was held on the very day the news broke of a possible human outbreak of H5N1 in North Sumatra:  Floridians returning from an Indonesian trip bring H5N1 with them.

Many eyes were opened during the exercise.  According to the Miami Herald, Governor Charlie Crist looked up at Fugate and asked, "Could this really happen?"

Fugate's measured response: ''Unfortunately, that's what science tells us. Do we want this to happen? Pray it never does. But we have to ask, what if it did?''

What if it did, indeed.

the Miami Herald story is at: http://www.miamiherald.com/news/miami-dade/breaking-news/story/631419.html .

One of the concluding slides in my default pandemic flu Powerpoint presentation is a reminder to get your PPV vaccine.  The PPV vaccine, or Pneumoccal Polysaccharide Vaccine, has been available for many years and helps ward off some 23 types of pneumoccal bacteria.

I mention this because the latest issue of NewScientist magazine has an excellent article about new findings from the 1918 Spanish Flu pandemic.  It is almost a matter of Scripture now that pneumonia was the real killer in 1918-19, and the flu virus paved the way for a rapid and often lethal insertion of pneumoccal bacteria into the lungs of otherwise healthy young adults the world over.

The conclusion drawn from this report, as espoused by one government expert ts to gird for the next influenza pandemic – bird flu or otherwise – and stock up on antibiotics, says John Brundage, a medical microbiologist at the Armed Forces Health Surveillance Center in Silver Spring, Maryland.

Of course, all flu pandemics will be "bird flu," so that is kinda redundant.  But the message is quite clear.

We have spent countless hours talking about magic bullets such as prepandemic vaccines (ask homeless Poles how they feel about that!), H5N1 vaccines that do not survive the inevitable antigenic drift that H5N1 is so notorious for, and quibbling over dosages of antivirals whose distribution in a pandemic will be a massive logistical cluster-you-know-what.

We have certain tools in the shed, arrows in the quiver, that we need to engage today.  And when it comes to PPV, we need to rethink the threshholds for injection.  I got my PPV prior to age 50 because I have a history of pneumonia (there -- a self-inflicted HIPAA violation!).  My nurse practitioner -- who is more pessimistic about bird flu than I! -- also gladly gave me the shot.

In light of college students dying from bacterial meningitis, and in light of the thousands who die from complications from influenza every year, shouldn't we be stressing the need for PPV vaccination at every level possible?  I believe we need to revisit those age threshholds for PPV vaccination with the intent of getting people vaccinated at the youngest age considered medically safe.

Last year, I wrote a blog titled "Influenza is baseball."   Let me continue to work that metaphor.  Influenza preparedness is also baseball.  Defense in depth is what is most important.  You do a whole lot of things well, most of which cost very, very little, and watch the cumulative result for the good.

Mike Coston yesterday posted a blog on the British claim that vaccinating all of Britain's schoolchildren would cut seasonal influenza by 97% in all populations.  Those results are supported by research done here in the American South that support the herd immunity theory.  Yet there are those new "Flat-Earthers" who believe every vaccine is deadly and every jab is a potential death sentence.  Look at the growing numbers of parents who opt out of "mandatory" vaccinations for their school-age children because they fear the Worst Case Scenario more than the most likely one.  By their actions, these new Flat-Earthers are placing all kids at greater and greater risk of disease. 

Again, homeless Poles would disagree with me today, and to them I would admonish and remind that the H5N1 vaccine that killed some of them was experimental and not an everyday, tested, certified and widely available vaccine.  And that they consented to the testing; I do not believe some kind of Polish Tuskeegee Experiment was performed upon them, right?  Someone please correct me if I am wrong.

While I agree in the strongest of terms that research is needed to find the source of autism, I am much more inclined to believe in an environmental or genetic trigger -- or both -- than to think one jab caused that terribly debilitating disorder. 

Those who are repelled by vaccines the same way Dracula is repelled by garlic and wolfbane clearly do not watch nor play baseball.  Otherwise, they would know that you take necessary risks and avoid unnecessary ones.

An unnecessary risk is not getting your PPV vaccine.  Getting that vaccine takes you further down the road of pandemic preparedness -- perhaps much further, courtesy of NewScientist.

As I write this, the Congressional majority's talking heads on CNN are apoplectic over the Bush Administration's decisions a) not to stop putting oil into the Strategic reserve, and b) not to sell oil from the reserve.  As one can imagine, the debate is shaped along mostly partisan lines.

There are worse things than price hikes on gasoline.  What could be worse than $4, or even $5 gasoline?

Try this:  No gasoline at all, for days at a time.  And that is precisely what we will have in a pandemic of any severity:  Little petroleum to go around and flashbacks to the days of 1973 and 1979.  Many of us will never forget those even/odd days when we could or could not buy gas.  After Katrina, I recall sitting in line to buy fuel for an hour, simply because supplies coming into Florida were depleted.  Or maybe it was in 2004 after the Big Four hit Florida.  What specific year is irrelevent; what matters is that I saw something this new century that I had not seen in thirty years, and I was amazed at what I beheld. 

There are many who are openly condemning of this Administration's handling of pandemic preparedness.  This, despite the knowledge that this Administration has done more to combat global infectious disease than any other presidential administration in modern history.  This is the true Bush Legacy:  Real, funded efforts to stop HIV/AIDS in Africa, and concrete moves to prepare America for an eventual flu pandemic without crying WOLF or otherwise appearing to go overboard.  Surely there have been missteps along the way, but let us recall that nothing was happening in Washington on panflu preparedness  -- nothing -- until Bush read The Great Influenza cover-to-cover. 

On the African front, Franklin Graham and Bono can share in the credit for converting Bush into a believer.  Barry himself may take credit for the Bush Administration's turnaround on pandemic flu.  Barry had been meeting with HHS Secretary Mike Leavitt and others in the Cabinet ever since his classic tome hit print.  But Barry, himself a Bush critic, said this to the Los Angeles Times in 2005:

“One lesson is to absolutely take it seriously,” Barry said. “I’m not a great fan of the Bush administration, but I think they are doing that. The Clinton administration I don’t think paid much attention to it as a threat.”  (bold mine)ttp://articles.latimes.com/2005/aug/16/nation/na-bushread16

So the Bush Administration's decision to keep the Strategic Petroleum Reserve in place represents forward-thinking of a kind not expected by his adversaries and, yes, outright enemies.  It means, folks, there are more important things than expensive gas.  The Strategic Petroleum Reserve today holds about a 55-day supply of oil.  That equates to an eight-week reserve.  That we expect pandemics to come in two-to-three-month waves and that the SPR could see America through two months of the first wave of a pandemic is not coincidental.  Those who are running for office, regardless of party and regardless of office, would do well to remember that fact.  Attacking Bush on a lack of panflu preparedness and then attacking Bush for not selling off the SPR is a train wreck and the two cannot be reconciled logically.