|So, what "ominous developments" am I referring to?
The WHO has eviscerated in early waning pandemic alert system so don't expect a heads up from them. It has abandoned its prior 6-stage system and now plans to simply announce pandemic outbreak rather than moving the needle through phase 4, 5 and then 6, the point when pandemic has begun.
So, the new WHO alert system is going to be like this:
Oops, Pandemic ready or not!
Dr. Ninan on Recombinomics.com is very concerned about WHO's failure to report any positive cases since July 2008 even though he is pretty suspicious about 7 deaths in Indonesia that have been attributed to Dengue fever.
Speaking of Indonesia, their new policy of not announcing new cases or deaths from H5N1 is very troubling. So, besides not sharing viral samples they have stopped sharing news about the activity of H5N1.
Of course, China has been pretty obscure from the beginning of the march of H5N1 toward pandemic status. Now that the Olympics have ended maybe they will be more open but this is not likely. Remember that it was the Internet based Chinese dissident news service Boxun that first reported the SARs outbreak in China. The Chinese authorities denied the report vigorously until the facts on the ground became so bad that they simply couldn't keep the lid on it any longer. A similar delay warning of pandemic flu outbreak would be devastating.
Some countries in Africa and Asia where H5N1 has become endemic in poultry and wild waterfowl have very poor epidemiology services and it is likely that if outbreak begins in one of these countries it will be very widespread before anyone realizes what is going on.
Burma is a good example of the above, a condition made worse by their authoritarian government. It is probably that they would attempt to cover-up the outbreak until the generals could rejoin their money in Switzerland, no doubt bringing the virus posthaste with them into Europe.
Thank goodness for Vietnam. They have an excellent CDC and have worked pretty hard at being transparent and prompt in their reporting even when the news is bad. If the pandemic begins there, it is likely that they will ID quickly and get the news out ASAP.
These conditions are unfortunate because it means that when pandemic outbreak occurs, its advent could be obscured for a while depending on where it happens. No matter where it occurs, it won't be for very long before news leaks out because the impact on human health and the story is just too big to keep the lid on. It could however be suppressed for a week or two. Even then, the involved authorities might deny the story and delay it getting the credence it really deserves causing confusion and promoting hesitancy to act in the prepared and unprepared alike. The problem here is that if the news of outbreak is delayed by 2 weeks, the time to arrival of the virus in your area has been reduced by 50%.
So depending where outbreak occurs will have a big affect on when the world will find out. We all need to keep our eyes and ears open and not fall victim to complacency. If it quacks, wattles and has a beak and feathers, it is almost certainly a duck no matter what the authorities call it. Remember, what the authorities fear most is panic among the population not pandemic. This goal will cause them to be very cautious in their statements. What this means is that it will be up to each of us to remain vigilant and aware that pandemic risk has not become less but in fact has progressively increased. Lets not go to sleep at the switch and get caught unprepared for outbreak.
Grattan Woodson, MD