Time
the enemy in bird-flu fight By
Marwaan Macan-Markaar
BANGKOK - As
Indonesia grapples with the specter of deaths from
bird flu, public health officials in the region
are racing against time to put into place a
pandemic prevention operation that comes down to
one word - speed.
The fate of millions of
lives in Asia hangs on the speed with which a
patient, infected with a human-to-human
transmission of a mutated strain of bird flu, is
diagnosed and prevention measures are implemented.
"We will only have a 21-day golden period
to stop the virus spreading and becoming a
pandemic," said Dr Kumnuan Ungchusak, director of
epidemiology at Thailand's department of
disease
control and a key player in plans being mapped out
to stall the virus ravaging Southeast Asia. "A
longer delay, even a month, can be fatal."
The new urgency follows the deaths
announced Wednesday of two young girls admitted to
Jakarta hospitals after they developed symptoms
indicating bird flu. Nine others are currently
under treatment for suspected bird flu in
Indonesia.
Indonesia confirmed its first
bird-flu deaths on July 20, after a man and his
two daughters died from the virus. A fourth
person, a 37-year-old woman, was confirmed to have
died from bird flu on September 10.
Avian
influenza has infected more than 100 people in
Asia and killed about half of them since 2004,
three health agencies, including the World Health
Organization, said last month. More than 140
million chickens have been slaughtered in Asia
because of concern that the H5N1 virus may mutate
into a form easily transmissible between humans.
On Wednesday, Indonesia's Health Minister,
Siti Fadilah Supari, told reporters in Jakarta
that she considered the outbreak the possible
start of an epidemic on the archipelago and that
"most definitely there will be others as long as
we are not able to identify positively the
sources".
The pandemic-prevention scenario
is expected to follow two broad paths, she
explained during an interview. The first is geared
toward the immediate family of the patient
diagnosed with the lethal virus. Each family
member coming in contact with an infected relative
will be given - within two days of the patient
showing symptoms - a dose of Tamiflu, the only
known drug capable of stopping the spread of a
mutated form of the H5N1 avian flu virus. This
regime of Tamiflu will be for a 10-day period,
Kumnuan said.
More challenging, though, is
to provide medication for the second part of this
preemptive initiative. "It would require giving
[medication to] around 10,000 people, 100,000
people or even one million who live within the
area where this human-to-human form of the virus
has been diagnosed,'' the Thai epidemiologist
said.
It is this phase - a novel way to
destroy a possible pandemic at its roots - that
has the 21-day window. "This is a very challenging
concept, very new and necessary if we have to save
lives," Kumnuan said. "Cooperation at every level
and speed will matter the most."
According
to public health officials, Southeast Asia needs
to stockpile antiviral drugs to treat at least 3
million people if the deadly H5N1 virus mutates to
one that could explode into a pandemic.
But meeting this demand is already proving
to be a problem due to limited stocks for the
developing world. The World Health Organization
(WHO) is due to receive 1 million doses from Swiss
pharmaceutical giant Roche, the producer of
Tamiflu, by the end of this year and another 2
million by mid-2006.
To compound that
delay, this region appears far from ready to meet
the looming global health challenge that the WHO
states could result in 2-7 million deaths around
the world.
Already, the region has had 63
fatalities from the H5N1 strain of the bird-flu
virus since January last year. Of the 63 people
who have died, Vietnam has had 43, Thailand 12 and
Cambodia and Indonesia four each. These deaths
account for more than half the number of the
estimated 119 people who have been infected with
the H5N1 strain of bird flu after having come into
contact with poultry infected with the virus.
"Asia is still the weakest link in
pandemic preparedness when compared with what is
underway in Europe," said Peter Cordingley,
spokesman for the WHO's Western Pacific regional
office (WPRO) in Manila.
Earlier in the
week, the head of WPRO said at a conference that
there were still many gaps in the health
surveillance systems, so pivotal to detecting a
new virus and mounting a response within a limited
time.
"At the national level we need to
improve further the capacity for surveillance and
virological investigation. In addition, we need
greater cooperation in sharing specimen samples,"
said Dr Shigeru Omi, WPRO's regional director in
New Caledonia, an island in the South Pacific.
"Vietnam is on par with Thailand in health
surveillance, but poorer countries like Cambodia
and Laos don't have the capacity due to the lack
of resources," Cordingley told IPS. "This is also
too big for the WHO and FAO (Food and Agriculture
Organization) to handle. We need a lot of
international help."
The rising concern
about a pandemic comes in the wake of revelations
by researchers at the Rome-based Instituto
Superiore di Santi that people can be infected
with even bird flu strains considered
low-pathogenic avian influenza. Hitherto, medical
researchers have maintained that humans were only
susceptible to the high-pathogenic strain of H5N1
influenza.
Since the winter of 2003, when
the current strain of bird flu began spreading
through Asia, more than 100 million birds have
died, either falling to the disease or being
culled. Russia became the 11th country recently to
be struck by this spreading lethal virus.
The fear of bird-flu mutating into a
virulent virus that can easily spread from person
to person has kept pace with the appearance of the
strain among Asia's poultry and duck populations.
That is because humans lack a natural response to
fight the H5N1 strain of the virus.
For
people like WHO's Omi, it appears to be a matter
of time before disaster strikes, since, in his
view, the current bird-flu virus is "resilient,
unpredictable, unstable and extremely versatile".
