Scott McPherson's Web Presence

Last night, I got an email from my new blogger friend, Maryn McKenna.  When not working on her forthcoming book exposing MRSA's insidious traversing of the globe, she continues to write for CIDRAP. 

Anyway, Maryn sent Crof, FLA_MEDIC, SophiaZoe and I the same email.  FLA_MEDIC is currently unavailable, on double-secret probation assignment, SophiaZoe is still recovering from a corporate reorganization, and Crof has weighed in on the email's contents.  And now, so shall I.

Here's the skinny:  Last April, an Indonesian teenage girl contracted both H5N1 and H3N2 influenzas, according to Indonesian researchers who just reported the findings at the International Conference on Emerging Infectious Diseases.  The story can be read at: http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/mar1708coinfect.html

The story is being pooh-poohed by the Indonesian government, which would pooh-pooh an alien invasion even while Downtown Jakarta was levitated ten thousand feet into the air.  The (redesigned) Jakarta Post Website features the Indonesian rebuttal, courtesy of the capable journalist Emmy Fitri.  It can be found at: http://www.thejakartapost.com/news/2008/03/18/more-concern-over-bird-flu-virus.html

I was watching the new and incredible HBO miniseries John Adams last night as the superb actor Paul Giamatti (as John Adams) admonishes the jury during the trial of the British soldiers accused of the Boston Massacre deaths thus:  "Facts are stubborn things."

So let us look at the facts and then use some logic to pull them together.

FACT:  From January, 2007 until last month, Indonesia submitted a total of two H5N1 human samples to the WHO.  These samples were from Bali.

FACT:  In a sudden and stunning reversal, the Indonesian government last month decided to resume sending samples once again to the WHO -- even as the Health Minister and Princess of Insanity, Supari, insisted that the Americans were developing a bird flu Weapon of Mass Destruction.

FACT:  A teenage girl in April, 2007 developed a coinfection of H5N1 and H3N2, according to the research paper given at the Conference.  We do not know if a reassortant virus was formed.  And we are not sure which tests were reliable and which were not, as SophiaZoe pointed out to me today.  If coinfection happened, it means that by any statistical yardstick, it has to have happened elsewhere in Indonesia.  We're just not lucky enough (read: Surveillance is not holistic enough) to have found THE coinfection.

FACT:  The lack of virus sample sharing by the Indonesian government meant the world was unable to know precisely what had happened in the island nation, and when.

FACT:  In Rome, the FAO has publicly expressed grave concern about the emergence of new substrains of H5N1 in Indonesia.  The story can be found at: http://en.rian.ru/world/20080318/101628539.html . Please note this came from a Russian news wire service.  American wire services are still too busy attempting to find out which governor slept with whose wife's aide's Great Dane.

Now, if you will, some conclusions. Really, only one big conclusion.  I came to a similar conclusion a few weeks ago in my blog, Indonesia regains its national sanity, shares bird flu samples again.    We must assume that the Indonesians believe that statistically, coinfection has happened multiple times across the nation.  The fact this happened once --almost a year ago -- cannot be chalked up merely to dumb luck.  It probably means they realize that they cannot conduct accurate surveillance over a wide enough area to be effective.  Finally, the Indonesian government's petty footstomping regarding the sharing of virus samples -- aided by Iran and Venezuela, I might add -- means that the Indonesians themselves may be on their way to a viral WMD that will overwhelm the world.

I believe that in the realm of public health, there are no coincidences.  All the events I am about to mention below have happened in the past four weeks. 

1. The Indonesian government starts sending human H5N1 samples to the WHO again, ostensibly after receiving reassurances from the WHO that a vaccine sugar daddy has been found (bada-bing).  
2. The Indonesians reveal the first-ever recorded case of coinfection between H5N1 and H3N2 (bada-boom). 
3. The FAO announces in Rome that H5N1's eventual pandemic genesis may well be on Indonesian soil (bada-bang). 
4. And Bill Gates is set to travel to Indonesia in May, ostensibly to talk software. 

To quote the immortal Stan Lee: " 'Nuff Said!"

Coinfection has a one-year head start on the world's public health people.  If we have gone through coinfection without producing a pandemic strain, that does not mean it will not happen.  Quite possibly, the virus is still trying to reassort in such a way that it can produce virulence in humans.  Influenza is playing a Rubik's Cube game and it will surely (reas)sort itself out in due time.

Don't call me Shirley.  But let's also go the other way:  What if reassortment has already occurred, and what if H5N1 was not the immediate beneficiary?  What if it instead produced an H3N2 that was/is more powerful?  It is just conjecture, but let's follow the timeline.

And timelines here are important.  First, Teenage girl develops coinfection with H5N1 and H3N2 in April, 2007.  Next, Aussies travel to Bali in droves, as Bali is to Australians what Disney World is to people from Illinois.  Next, Australia types a new and more virulent substrain of H3N2, called Brisbane, in Summer, 2007.  Then, that same substrain moves to North America and Europe in 2007 and 2008.

Look at the quote from Emmy's article:

A virologist and microbiologist at Udayana University in Denpasar (Bali), I Gusti Ngurah Mahardhika, said the co-infection involving the girl most likely was not the first such case in Indonesia because researchers used to focus only on H5N1 and did not check for the presence of other H viruses. (bold mine)

"Global fear of a new virus from such a co-infection is well grounded, I think. The product of a reassortment between H5N1 and H3N2 can be still in the form of H5N1 but with traits of H3N2. The new H5N1 is virulent and has the capacity to transmit from human to human like H3N2, our seasonal flu virus," he said.

Only after looking at the genetic makeup of A/H3N2 Brisbane will we know if it acquired any Indonesian H5N1 human polymorphisms.  But in light of this latest peer-reviewed, scientific paper, and considering where and when H3N2 Brisbane came from -- I think it is worth a serious look.  Don't you?

Because facts are stubborn things, indeed.