WHO has troubles with Indonesia bird flu (H2H2H?)

Long, long article with, I believe a bias, but interesting and worth reading. I took the entire article and accompanying pictures from a website called CrimeLibrary.com. Could make one want to prep for bird flu.

Deception Dominates World Health Organization's Bird Flu Releases

By Marilyn Bardsley

July 16, 2006

Culture of Deception

If ever there was a need for clear and accurate information about the spreading and rapidly mutating avian influenza, it is now as the threat of a pandemic looms increasingly large. At a time when governments and individuals around the world are making preparations to battle a potentially life-altering disaster, there is no need for a group of bureaucratic elites to decide what information people are capable of handling.

The U.N.'s World Health Organization (WHO) has published its guidelines for the communicating of information about disease outbreaks, but these guidelines have not prevented a deliberate culture of deception from dominating the statements WHO makes to the press.

It has been suggested that WHO does not want people to panic, hence they are not candid when significant events in the evolution of a pandemic are unfolding. What is wrong with this rationale?

WHO seal

On a scale of death, destruction and disaster, Hurricane Katrina would be a minor event compared to an H5N1 influenza pandemic. Would anyone suggest today that state and local governments on the Gulf Coast should have played down the potential for destruction before Katrina hit? So that people wouldn't panic? Then why deceive the world about a pandemic that would kill tens of millions? Why not be truthful so that people and governments have the maximum time available to prepare?

Human-to-Human (H2H) comes out of the closet

WHO cannot guarantee that H5N1 will turn into a pandemic strain and, if it does, when it will happen, any more than people on the Gulf Coast knew for certain where Katrina would hit and what strength it would pack when it did hit. But those uncertainties didn't stop officials and forecasters from warning the region days in advance and cable news broadcasters from almost non-stop coverage as Katrina moved closer. The rationale was that everyone should be as prepared as possible as soon as the danger was recognized.

A pandemic can emerge as quickly as a hurricane and engulf the entire world in a few weeks on the wings — not of migratory birds — of big metal "birds" with airline logos on their sides. One big difference is that one can evacuate from the path of a hurricane, but the pandemic will be global.

Chicken

Now that most people, at least in western countries, know that the deadly H5N1 strain of avian flu is the most likely candidate for the next pandemic, many are watching the news for any sign that a major evolutionary change in the virus has occurred. The change that people have been trained to look for by countless media reports is that the virus has adapted to humans and can be easily transmitted from person to person like the annual flu.

Earlier this year, WHO did not admit to any human-to-human transmission, despite a number of very suspicious family clusters in Asia, Turkey, Iraq and Azerbaijan. In every single case, WHO used some excuse or another to hide these human-to-human transmissions from the media and the public.

Maria Cheng

That is, until Indonesia made it impossible to hide — and still the WHO did its very best to deceive the media and the public. It was only on May 30 that Maria Cheng, WHO spokeswoman, finally admitted that there were "probably about half a dozen" cases of human-to-human transmission. These cases went back years and WHO knew then that they were human-to-human cases, but refused then to admit it.

And Dr. Angus Nicoll, chief of flu activities at the European Center for Disease Prevention and Control, acknowledged that "we are probably underestimating the extent of person-to-person transmission."

Indonesia, the Time Bomb

In mid-April 2006, Bernard Vallat, head of the Paris-based World Organization for Animal Health (OIE) told reporters: "Indonesia is a time-bomb for the region." Vallat was referring to Indonesia having Asia's highest number of unchecked infection sites, which he correlated to the number of bird flu cases in birds and humans. Ever mindful of its tourist revenue, the Indonesian agriculture minister rebutted Vallat's comment by announcing that Indonesia was winning its fight against bird flu and expects to be free of the killer virus by 2008.

Bernard Vallat

This Indonesian official's comment was greeted with scorn, but then reports of new cases went comparatively quiet at the end of April and into the first week in May. But the events that put Indonesia squarely into the international spotlight for two months had begun in late April and had gone virtually unnoticed even by the Indonesia media until May 9 when the local media announced that in the Karo area of North Sumatra a man had been hospitalized with suspected bird flu. The Indonesian press also took notice that his mother had died a few days earlier and that others in the family were sick.

Family cluster is near Medan, Indonesia

Indonesia and other countries had experienced a number of family clusters, which raised the specter of human-to-human transmission, but WHO maintained that in these clusters family members were all infected from exposure the same flu-infected birds, usually in the preparation or eating of them. It was difficult to prove otherwise because WHO withheld critical information about onset dates. Significant gaps between onset dates can account for transmission from one person to another.

But this time it was different: facts emerged that made it impossible for WHO to sweep things under the rug, although they did try.

WHO Saves the World: the Containment Plan

WHO kept talking about a barbeque that occurred on April 29 where all the family members ate chicken and pork, implying that they all ate the same infected meat, but then it became known that the first person to die was already sick on April 27, meaning that she had probably become infected from an unknown source some 2-5 days earlier.

Village in Indonesia

As her condition worsened, many of her relatives came into close contact with her either to nurse or comfort her. Several spent the night in her small room sitting in close proximity while she coughed violently. When she died May 4, her relatives had already been infected and started dying five days later: one on May 9, one on May 10, two on May 12 and one on May 13^th. From the onset dates it was likely that she had infected her family members, one of whom was still alive in the hospital.

By that time WHO's laboratory in Hong Kong was confirming that it was an H5N1 infection and WHO was bringing in its team and Tamiflu just like it had done in several countries a few months before. By WHO's calculations they had a maximum 3-week window to contain, or at least slow a pandemic strain after it emerged. They were late in the process since they only had one man on the ground 19 days after the first victim had become sick. The larger team of three didn't assemble in Indonesia until May 18.

Tamiflu capsules

But, late or not, the WHO team would go into the village, treat everyone with Tamiflu, test the chickens and kill them if they were infected. Everything would be okay.

But it was a long way from okay.

"Evil Spirits"

The WHO team got a nasty shock in mid-May when they tried to work their usual magic on the villagers in North Sumatra. This small village was a Christian community in the midst of a dominantly-Muslim country, but it had maintained some of the types of beliefs found in other rural communities around the world.

Testing birds in Indonesia (AP)

The villagers understood perfectly the tragedy that had befallen their neighbors: "it had been caused by evil spirits." The family had been cursed. No one would go anywhere near their three modest homes. The remaining family members had fled the village to get away from the "evil spirits" and the suspicions of their neighbors.

Declan Butler, reporter for the highly respected Nature publication, summarizes the various reports coming from Indonesian media:

"...villagers concerned that their animals would be killed became hostile to outsiders, resulting in international experts and local teams being subsequently barred from the village for a whole five days. Victims refused to take Tamiflu, fled the government hospital, while families refused protective gear when caring for their sick...the list of unanticipated confusion goes on."

The villagers did not permit the WHO team to go in and test their animals so the source of the infection of the first victim will never be known. It could have been poultry, pigs, cats or any other H5N1-susceptible animal.

As if to underscore the magnitude of the Indonesia problem, a group of protesters beheaded a chicken and drank its blood to show authorities that poultry was not the source of the problem. Later, 100 poultry dealers tore apart live chickens and ate them.

None of the villagers' behavior is necessarily WHO's fault, but it shows that the WHO containment plan won't work in much of the Third World, which represents the areas most likely to produce a pandemic strain.

On that same day, Gina Samaan, a field epidemiologist for the World Health Organization in Kubu Sembilang investigating the recent cluster told reporters that the "avian flu deaths confirmed this week on Sumatra were probably not a result of human-to-human infection and did not suggest that the virus had mutated into a more deadly form." Unfortunately, she was wrong.

Buying chickens in Jakarta (AP)

The Double Skip

Then on May 22 came the news that another cluster family member, Dowes Ginting, the father of 10-year-old Rafael who died of H5N1 on May 13, died right after they had brought him to the hospital. Dowes started coughing a couple of days after his son's death. He had close contact with his son, caring for him as he was dying.

Dowes was deeply depressed by his son's death, refused treatment for the deadly flu and escaped from the hospital, traveling through at least four villages before he found someone to take care of him. He sought out a local healer — referred to in the press as a "witch doctor " — and hid out in one of the local villages until he was near death, when his wife took him to the hospital.

This event created some very serious credibility problems for WHO. The infection onset dates strongly suggested that son Rafael had been infected by his aunt, the first victim in the family, and that Dowes was infected by his son. Not only did this cluster point to human-to-human transmission, it pointed to human-to-human-to-human transmission. Even worse, you have a man infected with a potential pandemic strain of the virus running around exposing any number of people. So much for the containment plan.

Did the WHO team know about Dowes? If they did know about it, why did they suppress that information and what is one to make of WHO field epidemiologist Gina Samaan's statement?

Damage Control

Something very frightening had happened in that North Sumatran village which was clearly different from other outbreaks. Not only was the variation of the virus a threat, the dangerous, but understandable, behavior of the terrified villagers compounded the threat. For the first time a huge global audience saw how a pandemic could emerge.

Instead of admitting the obvious, WHO went into damage control mode and issued this statement on May 23, the day after Dowes Ginting died:

"All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness. Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing."

Johannes Ginting, the only survivor of the cluster family

The exposure of the family members, at least from what was described in the Indonesian press, was probably not much different than one would get sitting next to a person for a couple of hours on an airplane or children playing in school. The first victim's family members sat in a room with her for several hours, which is similar to exposure that exists in homes, schools and businesses everywhere.

"....Priority is now being given to the search for additional cases of influenza-like illness in other family members, close contacts, and the general community. To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred."

From now on there is no talk of "no confirmed cases of human-to-human transmission" in what WHO tells the media. Now the wording has changed ever so slightly to "no evidence that efficient human-to-human transmission has occurred." Good thing that there wasn't because that is a pandemic, but WHO never explained that to reporters.

"Full genetic sequencing of two viruses isolated from cases in this cluster has been completed by WHO H5 reference laboratories in Hong Kong and the USA. Sequencing of all eight gene segments found no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations. The viruses showed no mutations associated with resistance to the neuraminidase inhibitors, including oseltamivir (Tamiflu).

"The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak."

The world was left to puzzle out how something so dangerous could occur within the context of this statement. "No significant mutations?" Obviously something significant occurred in this variation of the virus. While the most of the media latched onto this phrase and trumpeted it in the headlines, others wondered if WHO's experts understood enough about the virus to even know what mutations were significant.

More Spin

On May 24 a very nervous global audience, astonished that the Indonesians had let the infected Dowes Ginting leave the hospital, was soothed by WHO spokesman Dick Thompson: "There are 33 people identified as close contacts," he told reporters. "We've asked them to observe home quarantine. That's something they are willing to do to protect themselves and their families." The number quickly rose to 54 people as WHO realized how many people Dowes had exposed in his escape from the hospital in Medan and there was absolutely no assurance that they had identified them all.

Dick Thompson

At the same time, Maria Cheng, another WHO spokesperson, told the New York Times the villagers were quarantined. She did not mention that the quarantine was voluntary, not enforced, and villagers went about their business as usual. Furthermore she neglected to mention that many refused to have their blood tested and refused the anti-viral Tamiflu. Not exactly an ideal quarantine — not even close to ideal. Upon questioning, she admitted that the villagers "had not been as cooperative as we'd like." Quite an understatement, given the facts.

In the next few days WHO continued to downplay the events in Indonesia, telling the press "that even if human-to-human transmission did occur, it was in a very limited way and the infection has not spread beyond the family cluster. In addition, scientific evidence has shown the virus has not mutated into one that can be easily passed among people."

That statement may have been true, but WHO would have had no way of knowing it when they announced it. They had no effective means of identifying everyone that had been exposed and no effective way of monitoring those that they knew had been exposed.

Keeping WHO honest

At least one expert wasn't impressed by WHO's attempts to play down the significance of the Indonesian cluster. Dr. Henry L. Niman, founder of Pittsburgh-based recombinomix, Inc., has been promoting a theory of viral evolution called recombination, which he calls "elegant evolution." Recombination, as Niman explains it, permits researchers to predict the genetic components of a pandemic influenza virus because changes in the viruses are predictable and permit vaccines to be prepared in advance.

His daily commentary on his web site and his explanations of virus behavior on discussion forums like Flutrackers have made him a popular figure among the growing number of people who closely watch the forward march of the deadly H5N1 virus. Several of his predictions have been unnervingly accurate. Niman also brings into high relief inaccuracies and spin in the WHO press releases.

Dr. Henry L. Niman

For example, WHO's desire to pretend, while it could, that human-to-human transmission did not occur in various cluster cases around the world, led various WHO spokespeople to claim during last winter's large Turkish cluster that the H5N1 incubation period was as long as 17 days. Niman punctured the credibility of this statement by referring his audience to a New England Journal of Medicine article indicating that most H5N1 infections had an incubation period of 2-5 days.

Niman always reminds his audience that the H5N1 virus doesn't read WHO press releases.

As long as WHO could keep a lid on the virus genetic information, Niman's theories on a particular cluster could not be proven. Imagine WHO's surprise when Niman was the first to expose WHO's deceptions about the virus mutations in the large Indonesian cluster that had not yet been made public.

Withholding The Evidence

WHO has been able to get away with many of its deceptions regarding the genetic mutations in the H5N1 virus because of its increasingly controversial practice of not making the genetic information public so that the world's scientific community can study it. Hopefully, this practice is coming to an end — one way or another.

Some interesting things happened when various influenza experts met in Jakarta June 21-23. The presentations and the information about the mutations in the large Indonesian cluster discussed in this closed session were leaked. Niman received the genetic sequences from that cluster and divulged what he learned to his entire audience.

It was no surprise to Niman that the mutations were much more extensive than WHO let on to the public. Apparently, the statement that WHO released was accurate, but the wording was very carefully parsed and much information had been left out.

Subsequently, Nature published a revealing article on the full mutations in the Indonesian cluster where human-to-human transmission took place at least twice. Declan Butler commented on it in his blog:

"WHO said on 23 May that there was 'no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations.'

"The data obtained by Nature suggests that although the WHO statement was not incorrect, plenty more could have been said. Viruses from five of the cases had between one and four mutations each compared with the sequence shared by most of the strains. In the case of the father [Dowes Ginting] who is thought to have caught the virus from his son — a second-generation spread — there were twenty-one mutations across seven of the eight flu genes."

WHO has to abide by the constraints put on them by member states, who own the genetic information gathered within their countries. Countries may not permit the sharing of the influenza genetic data because they want to have an advantage in developing a vaccine faster if a pandemic strain emerges in their country — a vaccine which would find a ready market in the rest of the world. Some media reports have suggested that Indonesia is willing to share its information, but WHO has not yet formally requested it.

1918 influenza pandemic

In a world where it is increasingly difficult to get a large number of countries to agree on anything and where the levels of ignorance and poverty encourage a perfect breeding ground for the development of a pandemic strain of influenza, it is unreasonable to expect that WHO can always contain the outbreaks in time and that they can persuade corrupt and negligent governments to act responsibly.

What we can and should expect from WHO is the truth — as soon as they know it — not spin or information management that insults human intelligence. If the United Nations' World Health Organization cannot be trusted in the prelude to a pandemic, what good do they serve?