Thursday, September 22, 2005



September 21, 2005

A five year old girl, Riska, admitted to a specialised infectious diseases hospital in Jakarta only two days ago died this morning of flu-like symptoms.

Patricia Doyle, PhD on reported the girl tested positive on her blood test for avian influenza.

The Indonesian Health Ministry denied there was any proof of human to human infection but admitted it was only a matter of time.

Symptoms are appearing in family members of some of the six people already under quarantine.

Patricia Doyle believes the 5-10 day gap between one family member showing symptoms and then another family member showing symptoms would appear to be the key to proof of human to human infection, as the 5-10 day time span acts as an incubation period for the virus in the human body.

Although there are a number of doctors and virologists on line now claiming human to human infection is happening in Indonesia, the government and the World Health Organisation have not yet made the official announcement.

If human to human infection has occurred, and is expected to continue to occur, there must be enormous pressure on the WHO to both keep it quiet and make it public.

Once such an announcement is made, however, all hell will break loose. Even if the virus was to die out, or be contained, the government of Australia, for example, would be widely expected to shut down airports and instigate quarantine procedures for all travellers returning from Indonesia.

Making such an announcement is going to cost a country like Australia millions, if not tens of millions. Nothing, of course, compared to the massive financial carnage wrought by a full blown pandemic, but if the virus is contained within Indonesia there would still be fallout. There would remain many questions like did the government go too hard, too soon? Who compensates the businesses that lost all the money?

The tipping point for an announcement of pandemic bird flu should be about the same time large numbers of people were being qaurantined in Indonesia, and arrivees into Australia were being bustled into the quarantine zones near the airport. It would be hard to keep such activity quiet, people would notice and they would talk.

In the end the internet may do the job for the WHO, where such a volume on information spreads so fast and furiously that the eventual announcement of a pandemic would be something of an encore, as important as that moment would be.

The Indonesian Health Ministry is already saying a bird flu pandemic is not just Indonesia’s problem, it’s a world problem, so the blame will be spread far and wide if a pandemic breaks out.

Patricia Doyle talks of the “virtual certainty of human-to-human transmission” in at least one third of the confirmed cases of bird flu in Indonesia as of yesterday.

The families of the infected appear to have had little or no contact with infected poultry, yet the confirmed cases come from the same area southwest of Jakarta.

Patricia Doyle sees a true horror unfolding due to the primary fact that without the early warnings being issued over human to human infection family members caring for those already infected could themselves become infected and contribute to the spread amongst humans.

The concerns troubling the medical community worldwide following the Jakarta confirmation yesterday of an epidemic is the quality of Indonesia’s identification processes for avian influenza and the accuracy of their tallies for the infected, the dying and the dead.

For example, in a remote Indonesian province where poverty is rife, any number of persons could be dying from bird flu right now, but the doctors treating them might not have the means to correctly identify the flu as avian in origin.

Dying of flu-like symptoms is not rare in a country where farming communities are usually wracked by poverty and preventable disease, where tuberculosis and other respiratory illnesses are anything but rare.

In remote areas the alarm would likely only be raised after a noticeably curious number of people, young, old, fit and infirmed, starting dying.

By then, of course, a pandemic would have already begun.

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