Scott McPherson's Web Presence

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. 

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 .

The wires and blogs are atwitter this morning with news of a suspected human outbreak of H5N1 in North Sumatra, Indonesia.  The hospital in Medan, according to first reports (and let me stress first reports), includes three dead and thirteen hospitalized.

The deaths and hospitalizations were preceded by a mass die-off of poultry and pigeons.  That pigeons would die of H5N1 is not new but also not common. 

But the sheer volume of people suspected of infection -- at least sixteen -- simply cannot be simple bird-to-human infection.  If any of these cases turns out to be H5N1, the inference is that we have some serious H2H going on here.

A cluster of sixteen sick and dead/dying in one village reminds one of the largest suspected H2H H5N1 cluster of all time, back in early 2006 in Turkey.  As many as two dozen were suspected of having contracted the H5N1 virus.  However, that cluster's scope was not totally determined, nor was H5N1 proven to be the culprit in all the cases.  Insufficient testing, coupled with considerable government anxiety, hampered the overall search for truth.

Now, in 2008, we have to contend with a bipolar Indonesian government, on top of sketchy media reports.  We may never know the truth about this suspected cluster unless we get some Boots on the Ground, and quickly.  Here is the AFP wire story: