The calm before the storm?
Scott McPherson
in influenza and infectious diseases
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7 Comments
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.
Reader Comments (7)
But the bird flu viruses are all around! Either FluTrackers and other blogs and sites continue to track epizootics (in poultry, wild avifauna: USA, UK, VN, CDN, Laos, Indonesia, with H5 and H7 viruses involved), and sporadic human cases (Indonesia for the most part). Further, mining for scientific papers continues to produce huge amount of studies, communications, commentaries even in Nature, Lancet, NEJM and other. I think there's probably a mainstream media fatigue but both scientific and blogosphere remain well active and commited. Latest epizootics in Nigeria, Togo and Benin testify the persistence of these viruses in the environment and in wild avifauna and possibly other species. For this purpose, independent media sources and tracking forums are so important to maintain the focus on this issue.
(On the other hand, some big corporations previosly in the light for their good will in donate drugs, seem to be now a bit disappointed by the emergence of seasonal human influenza virus strains.)
As it has been in the last few years, we know it 2 be quiet during the summer months. There is still virus activity but subdued. I agree it is smouldering(simmering). Give it another month or so and the virus activity shall begin anew.Probably gonna see alot of it in Africa this year.Just a hunch... but this virus is NOT just gonna up and dissappear. It is too hardy and very evasive so I don't think it's going anywhere(except it may be heading 2 new destinations on the map).Like U said Scott, there is always a calm before the storm. But I believe we still have some time while it ferments and mutates. In a few years or less is when I think the Pandemic will come. I am no scientist this is just my opinion.
So quickly we have forgotten about the 44 suspect cases in Bali last week who all tested negative after early treatment with Tamiflu.
Just because "they" aren't "talking" about their cases, doesn't mean there aren't any.
H5N1 continues its march in Birds... probably in humans too...
It's just that we humans are keeping it quiet.
Its kind of like being in Galveston yesterday with no news coming in about Ike... sunny skies, calm wind and seas.
wait till tomorrow.
Good thing "they" have the warning... get out now or you will die.
I did not learn a lot in college back in the 70's, However, what I did learn has carried me far in life. One of the main things was that HISTORY REPEATS ITSELF!!!!
There is ALWAYS a calm before the storm, and yes she is asmolldering!
TRAPPER
Trapper,
You are quite correct. I have no doubt that the pandemic will start with a sudden bang, so to speak. I have no doubt, also, that the effect (although amplified), will be no different to the 1918 pandemic. It will cut them down in swathes. History always repeats itself.
On another matter, Scott please don't be backward in coming forward. You have left us out to dry for weeks now. I have clicked many times on your site only to be disappointed with the lack of new postings by yourself. Hope all is well with you. Just letting you know that I am an avid fan of your postings.
I don't think it's possible to make meaningful predictions, even if we all agreed that there's been a significant decrease in cases (and keep in mind, for instance, the apparent concerns in Pakistan). I've seen no evidence to suggest that there is likely to be a "calm before the storm" in the case of pandemics; unless we know of a specific evolutionary scenario in which H5N1 could be evolving quietly into a pandemic form (I can't think of any likely ones), there's no reason to assign significance to the occasional gap in cases -- fluctuations happen. Nor do I think we're starting to "beat it back," though of course I'd love to be proven wrong.
I just don't see it as being quiet. I see a lot of tamiflu being thrown around for diagnosis of asthma, pneumonia and minor respiratory tract infections (Bali). I see DBD in Sumatra, that went from 20 cases on August 10th, to 324 cases as of September 9th, with 11 deaths. A lot of dengue. Here are some short excerpts within the past 2 weeks that can be found at this thread [http://www.flutrackers.com/forum/showthread.php?p=179253#post179253]
West Java:
Totalling 87 chickens talk to that had been found to the carcass since the end of August through to last September 9 that, spread in four villages....the bird flu Illness (avian influenza) again haunted the resident Cilegon....
East Java:
365 chickens died Suddenly in seven subdistricts...at once activated his cellular phone 24 hours as the act continued the handling of bird flu in the Malang Regency. The matter like that also was done by Section Head Peternakan and the Health of the Animal Ir. Endy Kusaeri M,Si to speed up the report on the matter community of the case of bird flu. With the cellular phone program 24 hours, the two section heads hoped the case of bird flu not until spread to humankind.....
West Sumatra:
yesterday, we found approximately 50 poultries that were maintained by five families in the Bukittinggi City terjangkit flu burung...
Central Java:
365 chickens died Suddenly in seven subdistricts
I see articles on the virus "descending" and contradicting articles on simulations being undertaken, and mass planning.
The quiet is discerning, but I'm not fooled.