Dr. Woodson's latest opinon

[Guest Guest]

Here's a post that Dr. Woodson posted at fluwiki with his professional opinion and an excerpt from his upcoming manual on the bird flu:

 

The data on infection rates among healthcare professionals during pandemics does show that the clinical attack rate is twice as high as that that seen in the general population. This risk comes with the territory. There is a report that 60% of the nation’s medical staff is so afraid of Bird Flu that they will not report to work if we experience a pandemic.

 

 

This might be so if the flu that ultimately becomes pandemic with the present 50% case fatality rate reported for the hospitalized cases seen worldwide today. No prior pandemic has seen this rate of death from flu and since influenza has been a constant companion humankind for countless millennium there is no reason to expect this pandemic to act differently. If it did, the human race would have been wiped out long ago. Why should Bird Flu change its strips?

 

 

My estimate is that the case fatality rate overall for a severe Bird Flu pandemic worldwide will be 12.5%. In the US it will probably be 8% when all is said and done due to affect of our healthcare resources. For those who are fortunate enough to be treated in the hospital and have the benefit of our modern hospital-based healthcare system, the 2% case fatality rate expected by the US Department of Health and Human Services in their November 2, 2005 Pandemic Influenza Plan is likely.

 

 

Healthcare professionals are likely to have a very low rate of death from flu because of their access to healthcare resources and their own knowledge of the best way to take care of themselves. For instance, they will know that dehydration must be prevented at all costs and will force themselves to drink fluids even if they are terribly tired and prostrate.

 

 

Below you will find an excerpt from my new and yet to be published book, The Bird Flu Manual, that deals with some of the issues mention in this string. I think it will provide support for the comments made above.

 

 

Grattan Woodson, MD, FACP

 

 

An excerpt from The Bird Flu Manual

 

 

By Grattan Woodson, MD, FACP Why is the H5N1 Bird Flu so Fearsome? What makes avian influenza H5N1 so troubling to many is the stunning 50% case fatality rate reported for human cases of Bird Flu. The WHO and most national public heath authorities are keeping very close track of these cases, their location, and the deaths due to Bird Flu. By the spring of 2006 over 200 cases had met the WHO criteria for official recognition as a proven case, and among that group there were about 100 deaths. Bird Flu’s terrifying 50% calculated case fatality rate is based solely upon these two numbers.

 

 

Bird Flu lethality is overstated The 1918 flu, like most pandemics, infected 30% to 50% of the world’s population, or approximately 640 million persons at the time. If we assume that approximately 80 million people died during the 1918 influenza pandemic, this results in a case fatality rate of about 12.5% of those infected. (1) While this a terribly high figure it is only a quarter or the 50% case fatality rate currently reported for Bird Flu.

 

 

There is growing evidence that the number of cases of human Bird Flu infections has actually been much higher especially the number of infections that were not fatal.(2) The undercount is partially attributed to the conservative methods used by the WHO to confirm Bird Flu that predictably results in numerous false negative results and the lack of testing of the less severely ill cases of patients with Bird Flu. (3) It makes sense that those with less than severe cases of Bird Flu would escape detection by public health watchdogs in Vietnam, Thailand, China, Indonesia, Africa, the Middle East, and India since only those admitted to hospital are being tested routinely. In Turkey, the WHO has stated that they intend to do a more thorough investigation of the outbreak but as of the spring of 2006, the WHO has not made their findings public. (4) So Bird Flu may not be nearly as deadly as once believed, but that is not to say we have nothing to worry about. The US Government expects our way of life could be severely disrupted by a 2% case fatality rate and this may be a conservative estimate. The consequences of a pandemic become exponentially greater as the case fatality rate increases.

 

 

Tracking human Bird Flu clusters When the Bird Flu re-emerged in 2003 as a human infection, it was localized in Vietnam, Thailand and probably Southeast China. (5) In Vietnam and Thailand, it infected a couple of dozen people leading to 12 deaths, and in every case those infected had close contact with infected poultry.

 

 

In 2004 the confirmed infection rate accelerated to about 100 cases with 50 deaths in Vietnam, Thailand, and Cambodia. We have no information on human cases during that time in China although subsequent unofficial reports detail previously unknown outbreaks were occurring in poultry at that time. (6) In all of the officially confirmed cases there was close contact between the people infected with sick poultry except for one case in the summer of 2004 where the only contact the person had was with an infected family member. This became the first documented person-to-person spread of H5N1 Bird Flu. (7)

 

 

Between May 2005 and November 2005 in China alone there is evidence provided by unofficial sources that there were over 1000 human Bird Flu infections and 310 patient deaths. (8) The exact number of cases or deaths and how many of these were examples of bird-to-man or human-to-human transmission is not known due to the difficulty in obtaining samples from the right place at the right time. There also appears to be reluctance to share information about Bird Flu coming surprisingly from both national governmental and international public health communities. (9)

 

 

In late June 2005, the first of a number of human cases of H5N1 Bird Flu developed in Indonesia. (10) By the fall of 2005 it was obvious that the individual cases were due to casual transmission of the virus from infected birds to man. These initial cases were being followed several days later by 1 or 2 additional cases among the friends and family of the initial Bird Flu patients. In many cases the newly ill had little, if any, contact, with infected birds. Related cases like this are called clusters and are consistent with limited human-to-human transmission of the Bird Flu virus. The spread between people being limited means the virus is not able to get very far from the originally infected person. This is an example of inefficient transmission of the virus.

 

 

There is additional but less than perfect evidence of limited human-to-human spread of Bird Flu in the form of clusters of the disease that have occurred since 2003. (11) The best evidence for this is an epidemiologic study of flu-like symptoms occurring in people living in Vietnam for a 6-month period between 2003 and 2004 who had contact with sick poultry. This study’s principal finding was there were significantly more mild to moderate cases of a flu-like illness in people who had prior contact with sick poultry compared to those with no contact. (12) Extrapolating this data to the whole of Vietnam suggests that there may have been 700 mild to moderate cases of Bird Flu during that period that did not come to the attention of the medical authorities because they were not sick enough to warrant hospitalization. The policy followed throughout Asia has been to limit testing for the H5N1 virus to only those people ill enough to warrant hospitalization.

 

 

As detailed above, there is growing evidence that Bird Flu has nowhere near a 50% case fatality rate, a statistic that overstates the true lethality to an unknown extent. For instance, if we include the additional 700 Vietnam from 2004 cases and the unofficial reports on the human Bird Flu cases in China in 2005 to the WHO total, the case fatality rates drop into the low 20% range. A finding like this drop is exactly what we expect to see as the Bird Flu adapts itself to humans.

 

 

Woodson, G., Bird Flu Preparedness Planner, HCI Books, Deerfield, FL., 15Nov2005. 2 York G., China hiding bird flu cases Globe and Mail 9Dec2005 3 Niman H, False negatives for Bird Flu. Recombinomics Commentaries. 5Jan2006 4 UN Officials Join Turks To Investigate Bird Flu Deaths US Dept State 9Jan2006 5 Outbreaks of Avian Influenza A H5N1 in Asia MMWR 13Feb2004 6 Marshal M., Genetic analysis reveals H5N1 endemic in Southern China, NewScientist 6Feb2006 7 K Ungchusak etal., Probable person-to-person transmission of avian influenza A (H5N1) N Engl J Med 2005;352:333–40. 8 Official from Ministry of Health Reveals 2005 Human Case Figures for Avian Influenza Outbreak in China Boxun 15Nov2005 9 Branswell H., WHO says countries sharing too little bird flu data to assess pandemic risk., Canadian Press. 12May2005 10 Tjandraningsih C., Indonesia health chief says bird flu suspected in 3 deaths. Kyoto News 15Jul2005 11Olsen SJ, Ungchusak K, Sovann L, etal,. Family Clustering of Avian Influenza A (H5N1) Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 11, No. 11, November 2005 12 Thorson A, Petzold M, Thi N, etal., Is Exposure to Sick or Dead Poultry Associated With Flulike Illness Arch Intern Med 2006;166:119–123.