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AVIAN INFLUENZA, HUMAN (63): INDONESIA, REPORTING
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon 11 Aug 2008
From: Randolph Kruger <memphisservices@bellsouth.net>
A comment
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The new policy of ProMED-mail not to report cases of suspected H5N1
without Indonesian confirmation [see Avian influenza, human (62):
Indonesia, NOT 20080810.2465] plays into the hands of their Health
Ministry and its director, Dr Siti Supari. While others and I
understand the desire of ProMED-mail to be accurate, it should also
be accurate in reporting suspected cases in the interest of world
health.
Suspected cases in countries that don't acknowledge malaria, dengue
or other diseases don't face being ostracized by the world community,
but those diseases generally would not kill the population of a
planet.
Indeed the suggestion that ProMED-mail will only report Indonesian and
then WHO confirmed H5N1 is a dangerous move. It places the
responsibility for information on the individual rather than the
medical community, and in this case it is fraught with politics. It
goes without saying that if a pandemic comes with high CFR [case
fatality rate] numbers that there won't be enough labs, nor will there
be the people to conduct the testing for it, to confirm more than a
few thousand cases before the system collapses.
Will ProMED-mail not report those cases as confirmed even though there
were no PCR [polymerase chain reaction] tests, but thousands of bodies
will be laying about? 56 000 in my home state of Tennessee is the
projection. What number would it take to get ProMED-mail to change its
mind?
It is the testing that produces the results. If you have no testing,
you have no bird flu -- or any other disease for that matter. If
ProMED-mail is concerned about accuracy, then *report the cases as
suspect*. This should be done so that all might know that if and when
the bug breaks out into the population of the world, ProMED-mail will
still be a source for information that is as *accurate as possible*.
If the CDC [US Centers for Disease Control and Prevention] suggested
"50" cases that are uncontained and are spreading in Indonesia, or
another country, are reported as suspect, it would give the world just
a bit more time to prepare. Incrementally, if 1 percent of the
population of the earth at 6.5 billion survived because they were able
to prepare just enough to make it to the end, then ProMED-mail will
have saved enough [people] to fill the city of New York, London, or
Caracas.
The WHO (World Health Organization) has asked Indonesia to act
responsibly under the IHR's (International Health Regulations) rather
than trying to link the demand that a vaccine plant be built there at
someone else's cost, but to no avail. [But note that the IHR mandate
outbreak reporting of international health threats, but say nothing
about pathogen sharing. - Mod.JW]
Even the Jakarta Post has called the Ministry's and Minister's actions
deplorable. If all cases have to be confirmed by WHO and the
Indonesian government or any other government, then we will simply
have a pandemic without them, even though 100 million [Indonesians]
could die in a 30 percent event. The only thing that is known to
prevent bird flu at this time is preparation. Preparations are made
via information. Are we to be held hostage for that information even
though the local media is reporting it and not the Ministry?
Please post this and ask for comments. The community and ProMED-mail
readers would be much better served if the cases were reported as
suspect rather than not at all. As an organization that is tasked with
the feeding, care, and transport of the sick, I believe we would be
much better off knowing that the storm is coming rather than when it
has already arrived.
--
Communicated by:
M. Randolph Kruger
Memphis Aviation Services
Tennessee, USA
<memphisservices@bellsouth.net>[
[ProMED-mail welcomes comments on Randolph Kruger's letter, and will
reconsider the decision to cease posting information on suspected
cases that are unsupported by diagnostic evidence, in the light of
readers' responses.
This moderator's motivation in seeking to screen out unsubstantiated
reports of suspected human cases of avian H5N1 influenza has been
simply to avoid committing the old Scottish legal offense of
unnecessarily 'creating alarm and despondency among the lieges.' -
Mod.CP]
[see also:
Avian influenza, human (62): Indonesia, NOT 20080810.2465
Avian influenza, human (61): Indonesia 20080806.2417]
........................................cp/mj/jw
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