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By DemFromCT, cross-posted from Daily Kos

The Fatal Strain: On the Trail of Avian Flu and the Coming Pandemic
Alan Sipress
Viking Adult
Hardcover, 400 pages, $27.95 list
Kindle Edition $13.49
November, 2009

Money quote: CDC and WHO epidemiologist Tim Uyeki is in Indonesia, collecting flu specimens from a very sick bird flu patient who is deeply suspicious of westerners and his own country’s doctors (he’s already fled from a local hospital because family members died there.) So suspicious, in fact, the family will not permit blood samples or protective gear other than a respirator and gloves.

Uyeki squatted beside him and leaned right in. The doctor’s eyes were just inches from those of his patient. Uyeki lifted the swab. Then, he carefully inserted it through the open mouth and down Dowes [Ginting]‘s throat.

The sensation must have tickled. For at that very moment, Dowes coughed. And when he did, it was right in Uyeki’s face.

Uyeki didn’t blanch. But inside, his stomach dropped. “Oh, this is not good,” Uyeki fretted to himself. Despite the mask, most of his face was exposed. His mind raced. He instantly thought about his unprotected eyes.

Basic Premise: The author follows the emergence of bird flu in Southeast Asia, including near miss outbreaks, the response of the local population and national governments, and WHO’s struggle to conduct surveillance against a backdrop of mistrust and lack of cooperation. All of those problems continue to exist, and the next pandemic may well be more severe than this one.

Author: Alan Sipress is a deputy business editor and former foreign correspondent at The Washington Post. In the past, he’s primarily written about national security and foreign affairs. In 2005, the Post team that he anchored was awarded the Jesse Laventhol Prize for Deadline Writing for coverage of the South Asian tsunami. This is his first book.

Readability/quality: Compelling and unnerving medical detective story. See the money quote about the epidemiologist who gets a cough in the face while sampling a bird flu victim. Full disclosure: I know Tim Uyeki, and that excerpt unnerved me.

The author brings depth to the topic (see interview) beyond just the science aspects (one example is witch doctors, live bird markets and cock fighting and their relationship to disease prevention and treatment.)

Who should read it: Anyone who wants to know what it’s like to to be a medical detective in developing countries (and learn more about how the medical system works there); anyone who wants to know why there’s an emphasis on vaccine production for pandemic planning; anyone interested in the food chain origin of human disease; anyone interested in the politics and culture of Southeast Asia, including Indonesia.

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by revere, cross-posted from Effect Measure

We are now almost through the period considered to be the traditional flu season (to the end of March in the temperate northern hemisphere) and so far the amount of documented influenza infection is at a relatively low normal level and pneumonia and influenza deaths are about usual for this time of year. Said another way, there so far has been no big “third wave” of pandemic swine flu. Most flu experts didn’t know what would happen but if they had to bet, probably would have bet on a resurgence. I suppose it could still happen, since the original transmission in the community occurred “out of season” (April to June of last year). But now the odds look to be against it. So what lesson do we draw from this? I hope it’s not the wrong one:

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by revere, cross-posted from Effect Measure

The latest study on flu vaccine effectiveness in children has been well discussed in the MSM and the flu blogs, so I’ll point you to those excellent pieces (Branswell, crof, Mike Coston at Avian Flu Diary) and just add some things not covered elsewhere. The full text of the article is available for free at JAMA and it’s a pretty good read, so if you want to see for yourself what is involved I urge you to read it, too. First, let me back up a bit and connect this to the controversy about observational and randomized clinical trials we’ve been discussing here of late (before my grant writing interfered, anyway).

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by revere, cross-posted from Effect Measure

It really gives me heartburn to see an otherwise sensible article in AOLNews by Katie Drummond with a headline: “Hyping H1N1: Did It Create a Dangerous Flu Fatigue?” I don’t know if that was her title or not. Newspapers have headline writers who often seem never to have read the piece they are headlining, but online authors often title their own pieces. In any event, the word in the headline I object to is “Hyping.” It implies deliberate exaggeration for ulterior motives.

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by revere, cross-posted from Effect Measure

We still don’t know if we are experiencing a lull in flu or the virus has burned itself out for the season, but it’s as good a time as any to reflect a bit on where we’ve been and where we still need to go. Being otherwise occupied (I’m sure you are sick of hearing about my grant writing obsession but not half as sick as I am about having it!), I’ll start with something relatively straightforward: how CDC did on the epidemiology and surveillance front. Historically this is the agency’s strong suit and so it is expected they would have acquitted themselves well. And pretty much, they did. A lot of good epidemiology got done and the surveillance system more or less worked to provide important information. But this doesn’t mean there isn’t room for improvement.

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by revere, cross-posted from Effect Measure

It was some time after the pandemics of 1957 and 1968 that we were able to judge their severity and it will likely be some time after this one has finally burned itself out, most likely to become “just another” seasonal flu, that we will be able to gauge the 2009 swine flu pandemic. A lot of data is being generated but it will take time to harvest it and send it to the scientific market for consumption. A report in today’s Lancet reminds us that we aren’t seeing all there is to see, even with unprecedentedly rapid means of communication and better surveillance than ever in the history of our long battle with the influenza virus:

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by revere, cross-posted from Effect Measure

The finger pointing and the told-you-so-ers are out in force these days and WHO seems to be one of their targets. In the face of wealthy European countries cutting their swine flu vaccine orders because of limited demand, critics are claiming that WHO exaggerated the threat in league with or under the influence of Big Pharma vaccine makers out to make a killing. This is really two issues. One, did WHO appropriately appraise the risk; and two, were they unduly influenced by greedy drug makers. I think the answer to these questions are “Yes” and “No.”

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by revere, cross-posted from Effect Measure

Swine flu started in pigs (although we don’t exactly when or where), adapted to and passed to humans who returned the favor and passed it back to pig herds. Then we heard that turkeys in Chile had contracted the virus, followed by ferrets and a house cat. We can infect animals cross species with flu in the laboratory, but all of these are cases acquired in the natural world by animals interacting with humans. Once cats were on the menu, the next question was dogs, another population “companion animal” (aka, pet) in the US and Western Europe (and literally a menu item in many parts of Asia). In recent years there have been periodic outbreaks of “dog flu,” an H3N8 subtype that didn’t seem to infect humans but produced “kennel cough” like symptoms in dogs. Now we get reports out of China that the family dog can also be infected with swine flu — by us:

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by revere, cross-posted from Effect Measure

In the US we are about to embark on the Thanksgiving holiday, a 4 day period where families get together for a celebratory meal (at least celebratory unless you are one of the original inhabitants of the continent). There is lots of intergenerational visiting (grandparents to great grandchildren and lots of mingling of people from disparate geographic areas). In the midst of a swine flu pandemic, the obvious question is the epidemiologic implications. Ordinarily there is some effect. Ordinarily.

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by revere, cross-posted from Effect Measure

The blogosphere (DemFromCT at DailyKos) and the main stream media (Alan Sipress at the Washington Post) brought us the two faces of the current flu pandemic. Like Janus, one took lessons from the present and past, the other looked worriedly to the future.

Dem’s piece on flu at DailyKos (a regular feature of the world’s biggest political blog) is superb. Most everyone who regularly reads about flu in the blogosphere (and it is a huge readership) knows that DemFromCT is the blog handle of an expert who has been writing about pandemic flu for years (as long or longer than we have and we are coming up on our 5th blogiversary), knows the landscape intimately from both the policy and scientific perspective, and is himself a practicing pediatric pulmonologist, so in his daily practice he is in the eye of the storm. With those qualifications you’d expert the best and that’s what you get. His post on Sunday, “Lessons Learned from the Pandemic” hits every nail on the head, and there are a lot of nails. He extracts 7 lessons and you should read his post in its entirety, but I’ll tease you with the first lesson:

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