Archive for March 20, 2008

“Why You Should Care About Indonesia”

Scott McPherson wrote an excellent article, and I highly recommend that you read it in its entirety.  Here’s just one excerpt:

Bottom line: Learn to perform your own surveillance and prepare to make good decisions about what is going on. No one is going to snap his/her fingers and begin the pandemic. There will be an interlude before all Hell breaks loose. Learn how to recognize when that interlude starts and the orchestra is warming up, about to play the overture to the first act.

Look at where your organization’s planning effort fails: usually, in terms of the event’s duration. Most disaster recovery and continuity of ops plans have an event window of 72 hours to one week. Pandemics come in waves, and each wave can last up to three months. If your BCP/DR plans do not have at least a one-month event horizon, they will fail.

Pull your old Y2K supply-chain failure tab out and update it. Then put it into your pandemic plan binder. Y2K was a superb exercise for events such as a pandemic. Just think of a pandemic as Y2K where the people fail, not the computers.

Forget vaccines and antivirals during a pandemic. Focus on the Things Momma Taught Us instead. They are:

  1. Wash your hands! Especially when you go to the potty.
  2. Cough or sneeze into your sleeve, not your hands or into the air.
  3. Keep a respectable distance from strangers.

These three basic steps, coupled with prodigious use of hand sanitizer and vinyl gloves, will save more lives in a pandemic than vaccine and antivirals combined. And these rules hold true for regular flu season, too. Enforce them.

Guess I’m not the only one that is very alarmed at what has been happening in Indonesia and the ramifications for the rest of us.  


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Bird Flu in Indonesia Could Mutate into Human Form–UN Agency

ROME (AFP) – The bird flu situation is “critical” in Indonesia, where the virus could mutate and cause a human pandemic, the UN food agency warned on Tuesday.

“The prevalence of avian influenza in Indonesia remains serious despite (national and international) containment efforts,” the Rome-based Food and Agriculture Organisation said in a statement.

The FAO’s chief veterinary officer, Joseph Domenech, said he was “deeply concerned that the high level of virus circulation in birds in the country could create conditions for the virus to mutate and to finally cause a human influenza pandemic.”

H5N1 is endemic across nearly all of the sprawling archipelago nation, and of the total 105 human deaths reported there, 11 have occurred this year alone.

“The human mortality rate from bird flu in Indonesia is the highest in the world, and there will be more human cases if we do not focus more on containing the disease at source in animals,” Domenech said.

“Indonesia is facing an uphill battle against a virus that is difficult to contain,” the statement said, urging improved surveillance and control measures.

“We have also observed that new H5N1 avian influenza virus strains have recently emerged, creating the possibility that vaccines currently in use may not be fully protecting poultry against the disease,” Domenech warned.

Source:  AFP

Hmmmm.  “Indonesia is facing an uphill battle against a virus that is difficult to contain” must be UN speak for “the Indonesian government has obstructed efforts to study and contain the virus at every opportunity, and hasn’t really done sh** to eradicate it from the poultry.”

Unless demanding baksheesh for cooperation somehow counts as an effort to fight the virus.

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Indonesia Dismisses Fears over Reassortment of Human/Avian Flu Viruses

 JAKARTA, March 20 (Xinhua) — Indonesia dismissed fears of a virus re-assortment between avian and human seasonal influenza strains in a 2007 human death involving bird flu infection, the country’s health ministry senior official said here.    Director General of Communicable Diseases I Nyoman Kandun said the possibility of re-assortment between the avian influenza virus and other flu viruses was always possible, but had not yet happened.

    “When and where it will happen, nobody knows. Risk assessment therefore is very important,” Kandun was quoted by the Jakarta Post as saying Thursday.

    Re-assortment of the highly pathogenic avian influenza and seasonal flu virus would give birth to a “new” virus that could be easily transmitted from human to human, resulting in a pandemic.

    Scientific journal Cidrap has quoted researcher Vivi Setiawaty of the Center for Biomedical and Pharmaceutical Research and Development as saying a 16-year-old Indonesian girl died of co-infection between seasonal and avian strains of influenza in April 2007.

    The girl tested positive for flu under the Health Ministry’s flu-surveillance system, which was established in 2005 shortly after the country reported its first bird flu infection in a human.

    The girl had shown flu symptoms for several days before she was treated for an infectious disease in East Jakarta. She was reported to have mild symptoms, including sore throat, cough and body aches, but displayed neither respiratory problems nor signs of pneumonia.

    Cidrap said the girl’s case occurred within the period when the Indonesian government ceased sharing flu isolates with the international laboratory overseen by the World Health Organization.

    “Such infections are of great concern due to the possibility of genetic re-assortment leading to the emergence of a H5N1 strain that is more easily transmitted human to human, and emphasizes the importance of advanced laboratory-based surveillance in geographic regions where both human and avian influenza viruses are co-circulating,” Cidrap reported.

    Asked about the finding, Kandun said Indonesia needed to strengthen its surveillance system, including laboratory capacity.

    I Gusti Ngurah Mahardhika, a virologist and microbiologist at Udayana University in Denpasar, 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. 

Source:  Xinhua

They can dismiss fears all they want, but this should be (and likely is) sounding off alarms throughout the medical community.  Coinfection in patients with human influenza has taken place and are likely continuing to take place unnoticed.

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Hospital Resources for Pandemic Influenza

To the Editor: In their November 2007 article, Pandemic Influenza and Hospital Resources, Nap et al. evaluated hospital resources for pandemic influenza in the northern part of the Netherlands. Their results can be compared with those that I have described for the combined suburban communities of Roswell and Alpharetta, Georgia, USA. The Netherlands evaluation assumed that antiviral drugs will be available and will reduce hospitalizations by 50% and deaths by 30%. In view of the uncertainty of effective antiviral drugs and timeliness of vaccines, I did not estimate their effects. Nevertheless, several issues warrant comparison.

The plan for the Netherlands has no provisions for urgent care, i.e., parenteral fluids or antimicrobial drugs that are administered to ambulatory patients who are not hospitalized. Nap et al. may not perceive a need for enough beds to handle surge capacity. Allowing for 30% of beds to be used for patients with conditions other than influenza, they report a maximum availability of 232 beds per 100,000 population for pandemic influenza patients, and they estimate use of 72 beds per 100,000 in the pandemic model. In contrast, a maximum of 47 beds per 100,000 are available in Roswell/Alpharetta. Availability of beds in intensive care units, however, is identical for both regions, at 8 beds per 100,000 population.

The Netherlands plan calls for intensified treatment evaluation in 48 hours to withdraw care from patients who have little chance for recovery. Because most patients can be expected to have pneumonia and 2-organ failure (on average), a 50% mortality rate can be expected. In US hospitals, withdrawing care is difficult, even if mortality rates are expected to be 75% or 90% during acute illness with organ failure.

The pandemic influenza resource evaluation from the northern part of the Netherlands provides a useful contrast with at least 1 US hospital. The dramatic difference in bed availability highlights the potential challenges involved in local planning. The surge capacity limits in Roswell/Alpharetta led us to consider an alternative infusion center to provide care during an influenza pandemic.

Source:  CDC, Emerging Infectious Diseases Journal

See also You’re on Your Own.

The most effective treatment against an outbreak of H5N1 flu here in the United States would be vaccination; however, if there is not enough vaccine to protect the population or it hasn’t been tested for efficacy and safety, the next best thing has already been discussed extensively and will be either child or community sequestering for various lengths of time.

On the other hand, here is some happier news reported in Reuters:

WASHINGTON, March 20 (Reuters) – A skin patch helped boost a bird flu vaccine so well that people appear to be protected by a single dose, researchers at biotechnolgy firm Iomai said on Thursday.

The so-called adjuvant patch, designed to be used with an injected vaccine, could help stretch the supply during a pandemic, the Maryland-based company said.

Current approved vaccines against the H5N1 avian influenza virus require two doses to be fully effective.

Iomai is testing its adjuvant patch on 500 volunteers in a phase 1/2 trial looking at the safety and efficacy of the patch. The patch, which is applied after gently scraping the skin with a light, sandpaper-like device, is being used to boost an H5N1 vaccine made by the Belgian drug company Solvay SOLV.BR.

When used with a single dose of the 45-microgram H5N1 vaccine, 73 percent of those tested had what is considered a protective immune response. About 49 percent of those who got the vaccine alone, without a patch, had an immune response considered protective after the first dose.

“We are thrilled,” Iomai’s chief scientific officer Gregory Glenn said in a telephone interview.

“The prospect of being able to immunize during a pandemic with a single dose is very attractive,” said Glenn, whose company got a $128 million grant from the National Institutes of Health to test the patch.

The H5N1 avian flu virus is sweeping through flocks of poultry in Asia and sometimes in Africa and Europe. It has infected 373 people in 14 countries and killed 236 of them since 2003.

The fear is that the virus might change just enough to pass easily from one person to another, sparking a deadly pandemic.

At least 16 companies are testing H5N1 vaccines but no one knows precisely what a pandemic strain of the virus would look like or how to formulate the best vaccine. Tests on the current vaccines suggest that people need bigger doses than with seasonal influenza.

Global flu vaccine production capabilities are limited and if bigger doses are needed, that means fewer people could be vaccinated in a pandemic.

“A one-dose pandemic flu vaccine is a very important advance,” Glenn said. “There is just almost no way to immunize twice in the face of a pandemic.” Keeping the right records and counting people to show up twice are both barriers, he said.

Adjuvants are frequently used to boost vaccines and some of the experimental H5N1 vaccines include adjuvants in the formulation.

Iomai is working to use its needle-free technology to make vaccines against seasonal influenza and traveler’s diarrhea. (Reporting by Maggie Fox, Editing by Michael Kahn and Bill Trott)

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Indonesia Accuses U.S. of “Abusing” Bird Flu Virus

JAKARTA, March 20 (Xinhua) — Indonesian Health Minister Siti Fadhilah Supari has accused the United States of abusing Indonesian bird flu virus for commercial purposes, Antara news agency reported on Thursday.    “We sent the virus (to them) for the sake of humanity but they have turned it into vaccines sold everywhere on the pretext of keeping watch for pandemic,” Antara news agency Thursday quoted the minister as saying at a discussion on her book titled “It’s Time for the World to Change. Devine Hands behind Bird Flu” in Surabaya, the second largest city in the country.

    On the pretext of keeping watch for pandemic, she said the U.S. and WHO had produced vaccines and sold them to third world countries for millions of dollars.

    “They made third world nations laboratories. They want us to be ill while at the same time selling the vaccines. Don’t let this continue,” she said.

    The minister said she had fought against the injustice. However, her struggle received no attention from the Indonesian media.

    “My book tells about my struggle against the injustice. The injustice happens to appear in the mechanism of sharing bird flu virus samples,” she said.

    “If we die, they will benefit from the sale of the vaccines. I want the younger generation not to “sell their heads” although they are assisted (by developed nations),” she said.

    She called for continued efforts to fight bird flu at home.

    “Although we have no technology, those who have it and with much money, do not have the right to steal our rights,” she said.

    At a meeting hosted by the WHO in Geneva last year, Supari insisted on equitable sharing of benefits arising from the use of bird flu virus.

    She said sharing bird flu virus samples was imperative to see if the virus had mutated, become drug resistant or grown more transmissible.

Source: Xinhua

Well, y’all just keep on dying there of bird flu.  Keep it all to yourselves.  Revel in it.  Sheesh. 

What is sad is when a country considers a potentially deadly disease to be their greatest treasure and attempts to extort money out of scientists desperately searching for a vaccine that would keep their citizens from dying.

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Keys Tourist Dies in Encounter with Eagle Ray

Dressed in a bathing suit, Judy Kay Zagorski was looking forward to the day’s fishing trip in the Keys with her sister and elderly parents. But she never got to cast a line.Just 10 minutes after they left the dock about 10 a.m. Thursday, the Michigan tourist’s life ended with a freak encounter with a 75-pound spotted eagle ray.

The large, flat fish jumped into the air and struck the sisters who were sitting together in front of the console of a 25-foot fishing boat going about 25 mph. The rented boat was headed out Key Colony Beach Channel to the Atlantic Ocean.

Zagorski’s sister survived, suffering a bad bruise. She was treated and released from Fishermen’s Hospital. But Zagorski wasn’t as fortunate.

”The officer on scene said she fell and maybe struck her head, too,” said Bobby Dube, spokesman for the Florida Fish and Wildlife Conservation Commission. “There was a lot of blood on the boat.”

Investigators say they think the force of the fish likely caused her to hit her head on a metal rail on the side of the boat.

Family members performed CPR while her father drove the boat to the dock just one block from the family’s rented house on Fifth Avenue Ocean in Marathon. Their cell phone couldn’t get service, so neighbor Jim Corcoran called 911. He said rescue emergency personnel arrived within minutes.

But it was too late. Zagorski, 55, of Pigeon, Mich., was already dead. Investigators did not find any visible signs of barb wounds. An autopsy will be performed Friday.

”Her parents would visit the Keys every year,” said neighbor Marcia Corcoran. “The girls came down to visit them. What a nice family.”

The Corcorans said a third sister was en route to join the family, not knowing about the accident.

”To lose a child just leaves the parents numb,” Marcia Corcoran said. “I can hardly believe it myself.”

Officials of the FWC say that type of accident is so rare they can’t remember a similar one dating back at least 20 years.

”It’s so unusual, so rare, so bizarre,” FWC spokesperson Jorge Pino said in front of the coral-colored vacation house the family is renting. “We see them jump out of the water all the time, but never seen them impact a human being or cause a death. She was just at the wrong place at the wrong time.”

Spotted eagle rays are capable of leaping completely out of the water when pursued. They swim by flying gracefully through the water via the undulation of the pectoral fins.

”They naturally jump out of the water, like porpoises do,” Dube said. “It’s natural to them and quite spectacular to watch.”

Marcia Corcoran said the ray was so big it took up about half of the front of the boat. The ray, which had about a 6-foot wingspan, also was dead at the scene, along with a remora (known as a suckerfish) that had attached itself to the fin of the ray.

The ray was put on a FWC boat and was taken out to sea where its body will be dumped.

A spotted eagle ray stung a Broward County man in October 2006, piercing his chest with its toxic barb.

The 30-pound stringray leapt into James Bertakis’ boat while the 81-year-old man was on the water near Lighthouse Point with his granddaughter and one of her friends. The foot-long barb stuck into Bertakis’ chest and entered his heart chamber.

Bertakis, now 83, has made an almost full recovery, according to son Jim Bertakis. After several weeks in intensive care followed by in-patient rehabilitation, the elder Bertakis is ”90 percent” better, his son said. He even has been back on the water in his 16-foot boat.

”Dad’s doing great. I just saw him three days ago,” Jim Bertakis said Thursday from Michigan. “It’s a miracle he survived. We smile every time we see him.”

Source:  Miami Herald

My greatest sympathies to the family. 

When I think of the dangers of a boating accident, I think of perhaps falling overboard, the boat sinking, getting bitten by a shark, entangled with a jellyfish….but getting killed by a suicidal eagle ray is just not a danger that I would have ever considered.

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Obama’s Church Espouses Controversial Doctrines

WASHINGTON — Jesus is black. Merging Marxism with Christian Gospel may show the way to a better tomorrow. The white church in America is the Antichrist because it supported slavery and segregation.

Those are some of the more provocative doctrines that animate the theology at the core of Trinity United Church of Christ in Chicago, Barack Obama’s church.

Obama’s speech Tuesday on race in America was hailed as a masterful handling of the controversy over divisive sermons by the longtime pastor of Trinity United, the recently retired Rev. Jeremiah A. Wright Jr.

But in repudiating and putting in context Wright’s inflammatory lines about whites and U.S. foreign policy, the Democratic presidential front-runner didn’t address other potentially controversial facts about his church and its ties.

Wright has said that a basis for Trinity’s philosophies is the work of James Cone, who founded the modern black liberation theology movement out of the civil rights struggles of the 1960s. Particularly influential was Cone’s seminal 1969 book, “Black Theology & Black Power.”

Cone wrote that the United States was a white racist nation and the white church was the Antichrist for having supported slavery and segregation.

Today, Cone, a professor at Union Theological Seminary in New York, stands by that view, but also makes clear that he doesn’t believe that whites individually are the Antichrist.

In an interview, Cone said that when he was asked which church most embodied his message, “I would point to that church (Trinity) first.” Cone also said he thought that Wright’s successor, the Rev. Otis Moss III, would continue the tradition.

Obama, 46, who’s biracial, joined Trinity in his late twenties when he worked as a community organizer. He says he’ll continue to worship there.

He and other Chicagoans have praised Trinity’s role as a melting pot that brings together blacks and some whites from all levels of wealth and education, boasts a joyous and energetic choir, and is deeply involved in community work, such as helping the homeless, the incarcerated and those touched by HIV and AIDS.

But Trinity has a history. Its affiliation with the United Church of Christ makes it part of a liberal, mostly white denomination that was the first in America to ordain gays, women and blacks as ministers.

Trinity goes further, embracing black liberation theology and its emphasis on empowering oppressed groups against establishment forces.

In that and related doctrines, the church and some of its guiding thinkers at times have been socially ahead of the curve and other times outside the mainstream of American religious and political thought.

For example, the 8,000-member congregation embraces the idea that Jesus was black. It’s historically supported left-wing social and foreign policies, from South Africa to Latin America to the Middle East.

Wright, who hasn’t been giving interviews since the controversy broke, told conservative TV talk-show host Sean Hannity last year that Trinity’s black value system also had parallels to the liberation theology of laypeople in Nicaragua three decades ago. There, liberation theology became associated with Marxist revolution and the Sandinistas, and split the Roman Catholic Church.

White America today embraces Nelson Mandela, and he won the Nobel peace prize. But in the early 1980s, when the U.S. government considered Mandela’s anti-Apartheid African National Congress a terrorist organization because of its support from communists and use of violence, Trinity became one of the first U.S. churches to support the group.

It isn’t clear where Obama’s beliefs and the church’s diverge. Through aides, Obama declined requests for an interview or to respond to written questions about his thoughts on Jesus, Cone or liberation theology. Trinity officials also didn’t respond to requests.

Obama’s Illinois state and U.S. Senate voting records and his speeches suggest that, if elected president, he’d take a liberal but mainstream line and seek partisan bridge-building rather than agitation as his style.

It’s possible that Obama joined Trinity as much because it gave him credibility as a newcomer to south side Chicago’s black community as for its particular theological teachings.

“As a community organizer, would people join Trinity? Yes!” said Dwight Hopkins, a Trinity member and liberation theology professor at the University of Chicago’s divinity school. (He said he’d contributed $25 to Obama’s campaign.)

However, “someone who wanted to run for public office would think twice about intentionally using Trinity as a leverage,” Hopkins said. “When it’s Election Day, all the politicians come to Trinity. But not every day.”

Cone, the Union professor, said he didn’t know Obama personally. He supports his candidacy and considers the senator’s worldview as set out in books and speeches “certainly not alien to black theology.

“But it doesn’t have as much of a radical edge to it,” Cone said of Obama’s view. “He couldn’t succeed with my message. He speaks less of the hurt and the pain of African-American history. I think his own life has been less of that.”

But Cone stands by his message, and sometimes Obama echoes it.

Consider this passage: “Hope is the expectation of that which is not. It is the belief that the impossible is possible, the ‘not yet’ is coming in history.”

Those words sound as if they were pulled from Obama’s latest campaign speech. Instead, they’re from a memoir Cone wrote in the 1980s. In it, Cone said blacks shouldn’t limit their hope to what the Republican and Democratic parties stand for. Then he posited a thought that voters are unlikely to hear from Obama:

“Together, black religion and Marxist philosophy may show us the way to build a completely new society.”

Asked about that, Cone said: “I’m not a Marxist. . . . I’m a theologian, and I want to change society. I was searching for my way forward. I want a society in which people have the distribution of wealth, but I don’t know how quite to do that institutionally.”

Read the rest here:

Heh.  Funny how those proponents of “change” are enamored of an old doctrine (Marxism) that never worked.

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