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Did we dodge a bullet -- or are we about to take one?

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. 

Reader Comments (9)

That is a simply brilliant tactical manuever. I hope the WHO takes your suggestion - though unlikely. They don't strike me as an organization that would play hardball. I have speculated elsewhere that this whole virus sharing concern was a strawman, that Indonesia was using that as a more "principled" appearing motive for their real calculated strategy - i.e., keeping the lid on and playing for time that possibly the pandemic might break out in a more distant future or even another country. They see their country more likely being isolated by the world based upon reports of *limited* H2H transmission that has not yet evolved into the real AI perfect storm, with all its economic consequences, as the more clear and present danger. I'm not excusing this strategy; rather hailing you suggested response as the perfect countermove. If you make them already suffer those consequences, they then are better off returning to a cooperative transparency, as there is nothing to be gained by trying to avoid what your move will have already effected.

August 11, 2008 | Unregistered CommenterPaul

Scott,

Having given your idea more thought, and seeing that my comment from yesterday drew no further comments. I share the frustration you must feel having come up with a great idea, and not seeing it picked up in other blogger threads (I presume). So I posted today, a more comprehensive reason for your idea to go somewhere to bring pressure on WHO to adopt it. One can only try. What follows is the comment I've published elsewhere, as well:

I’ve been following the daily postings at many of the flublogs for a couple years now, but still consider myself a newcomer, deferring to the far greater experience and knowledge of both the flubloggers and their readership. Only for the first time, yesterday, did I see on Scott McPherson’s site (see below), what I felt to be a brilliant suggestion for a tactical response to Indonesia’s petulant and threatening policy of withholding vital information on the progress this enemy of all mankind is making, where I posted a supportive comment.

Scott says he’s mentioned the idea before, but apparently the WHO has not acted (or perhaps has not received the suggestion to act) upon it, or perhaps has not received enough pressure to acquire the political fortitude to do so.

The situation (and the stakes) have risen significantly with these last reports of the 3 deaths and 13 illnesses, possibly related to AI. If they are indeed related to AI, then the probability is that there has occurred another episode of localized (we hope) H2H transmission (as opposed to each case resulting from individual contact with a sickened chicken – for which there has been a concurrent and sudden exacerbation and die-off). With this episode, we continue to be confounded by the Health Ministry’s (Supari’s) perversely obstinate and defiant demonstration of non-cooperation, reducing the respected scientific bodies of the rest of the world to frustratedly hope for secondary information to seep out and around this craven “iron curtain” of information black-out.

In the face of this most recent worrisome event and unanswered questions about its significance, Indonesia demonstrates that it means business in adhering to its extortionist position. It has come to the point where even Pro-Med has so discounted information coming out of Indonesia, that it will no longer carry reports of AI activity there, as it will not put its professional reputation at the mercy of this type of unreliable non-reporting. No doubt, Indonesia’s efforts to remove the U.S.’s NAMRU-2 from its borders, is one more convincing act confirming their adherence to this destructive policy.

Scott McPherson’s tactical solution is both appropriate, commensurate, and most likely will be effective. WHO should immediately raise the AI pandemic threat to Phase 4, applied only to Indonesia. This is no different from the acceptable convention for quarantining any area during an identified outbreak of communicable disease, where the locale of symptomatic patients triggers a quarantine applied to a larger area of containment in the hopes that all not-as-yet-symptomatic, but infected individuals may be isolated to prevent further spread.

In this case, we have a country which is an acknowledge hot-spot for wide-spread and sporadically recurring incidents of known (so far) localized H2H transmissibility, which is actively hiding reports of further outbreaks (as you might expect an individual family to behave out of fear of isolation, with its economic and survival challenges).

For the WHO *NOT TO* quarantine Indonesia is an act of irresponsible dereliction of its duty to the rest of the nations who rely upon it as a coordinator of tracking and maintaining our best updated defenses against this world-wide invader, with whom the Indonesians have become, in effect, its accomplice.

WHO’s continued efforts to determine the true status on the ground in Indonesia represents a capitulation to this sociopathic position, and they come off as enablers, tempting other countries fearing isolation, to adopt the same positions, some of which, already have. They’re all playing for time, hoping that the eventual pandemic strain will emanate from someone else’s country, saving them from the economic consequences of being “prematurely” stigmatize by too many localized episodes of transmission, which don’t yet accurately reflect the presence of the ultimate pandemic strain.

I am posting this comment at several blogs that I visit daily in the hope that perhaps it will be passed on (even to more influential entities, like Pro-Med) to bring some pressure on WHO to adopt Scott’s suggestion. I think such a move would effectively and quickly convince Indonesia to rejoin the international scientific community as a cooperative contributor, since being placed in a Phase 4 status would result in all the negative consequences their present information black-out is trying to avoid.
Paul.

August 12, 2008 | Unregistered CommenterPaul

For some timely humor on the Chinese Olympics and the AI visit:

http://www.theonion.com/content/video/chinese_officials_deadly_virus

August 12, 2008 | Unregistered CommenterPaul

You seem pretty ready to accept the statement that the deaths in North Sumatra were not due to H5N1. But did you read this article?

http://old.thejakartapost.com/detailheadlines.asp?fileid=20080812.A05&irec=4

It seems less than completely reassuring.

August 12, 2008 | Unregistered CommenterDon

Don, I'm not quite sure how you derived from my posting that I'm ready to accept Indonesia's attempts to whitewash this event as not being due to AI. If anything, I'm quite suspicious of their behavior and their motives, and am supporting Scott's recommendation based upon the fear that the event very likely *was* an episode of localized (at the very least) H2H transmission.

August 12, 2008 | Unregistered CommenterPaul

Actually, I was addressing Scott with that statement and it was this: "On the one hand, this is welcome news. It means we dodged a bullet again.", and this: "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." that led me there.

But I meant no criticism in any case and only wanted to point out that the initial reports of "Influenza not the cause" might not be factual at all and that after reading the article I cited that I felt a lot less assured than before.

August 12, 2008 | Unregistered CommenterDon

All,
I understood Don's comment was directed toward me. It is good to know the locals there in North Sumatra are not so ready to accept the conclusions of their central government. I agree with you, but locals who openly act to question their government are few and far between down there. Every time it happens is an event to be celebrated.

And I especially wanted to thank Paul for his kind words. Careful with the "brilliant" comment" My wife would tell you it's like throwing gasoline on a fire. I think my proposal just hasn't either reached a wide-enough audience yet, or it is considered too severe a step. But what are they going to do, kick NAMRU out of the country or something? Oh wait -- they ARE kicking NAMRU out ! So what do we have to lose? Keep moving the idea forward, all of you.
Thanks again, everyone.
Scott

August 13, 2008 | Registered CommenterScott McPherson

Thanks for the come-back, Scott. I was beginning to feel both invisible and foolish (not really) for posting my above post at three other blog sites...which received no responses at all. Following commenters simply ignored the post, along with the blog hosts. If this is an indication of a great diversity of viewpoints even within the blogosphere, I'd wish us LOL in its being adopted by WHO or other government agencies.

Just discovered Immunocompetent blog, and I guess I'm one of the Cro-mangnon xenophobics who beleives "simplistic," straightforward,and direct actions are often necessary to achieve results favorable to our citizens. It seems much of the scientific community has become infected with another pathogen already pandemic in the West and our own government, the primary symptom being all talk, no action (e.g. our betrayal of our Gerogian allies being invaded by Russia). 'Nough said. Paul

August 13, 2008 | Unregistered CommenterPaul

My name is Mike Conlin and i would like to show you my personal experience with Tamiflu.

I am 26 years old. Have been on Tamiflu for 5 days now. This stuff ROCKS. I was running a 104 Fever ... felt like I was doing to die, was snapping at everyone, etc. I got home and took my first dose along with a dose of Robotussin for my cough. I woke up 3 hours later and my fever dropped from 103.7 to 99.3. It fluctuated a little after that but remained under 100. Body Aches were gone. I was sweating like a mad man but that was probably the fever breaking.

I have experienced some of these side effects-
Mild nausea .. almost puked on first dose. Also had mental fog going on. Concentration was difficult but my doctor forwarned me it makes you 'loopy'.

I hope this information will be useful to others,
Mike Conlin

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