A Journey Through The World of Pandemic Influenza

Indonesians test negative

 

The test results from the 13 Indonesians came back negative. This from Singapore's The Straights Times:

 

Indonesian villagers test negative for bird flu: health ministry

JAKARTA - THIRTEEN people in Indonesia suspected of having bird flu have tested negative for the feared disease, the country's health ministry said on Saturday.

Experts from the World Health Organisation (WHO) arrived Friday in the affected village in North Sumatra to help investigate a possible outbreak after three people died and the 13 were admitted to hospital.

'All specimens collected from suspect cases have given negative results'.

'They are all recovered', I Nyoman Kandun, director general of the ministry's communicable diseases department said on a text message.

Officials and residents in Asahan district in North Sumatra province said villagers began showing symptoms of avian flu after a large number of chickens died suddenly last week in Air Batu village.

The local husbandry office took preventive action this week by slaughtering and burning some 400 chickens and ducks.

The ministry, which has stopped giving regular bird flu updates, announced earlier this week that the human toll from avian influenza in Indonesia had risen to 112 following the recent death of a 19-year-old man.

 

 

I will not belabor the issues of accuracy of the tests. We all know they are fraught with false negatives. However, if all thirteen villagers have indeed already recovered then it is highly unlikely that they were suffering an H5N1 infection. Unlikely though it is, it is not guaranteed, however at this point in time, it's a good enough assumption.

 

It's "good enough" because the Indonesian government has proven to be less than fully transparent with the rest of the world, we have a test that is officially only presumptive at best, but mostly because there isn't a thing any of us can do about what is or isn't happening in the village of Air Batu and to its residents.

 

Can we take comfort in the fact that WHO arrived on the scene and if there were a genuine cause for greater concern we would be well served by their presence and actions? Maybe. Maybe not.

 

As I typed that sentence it came as something of a surprise to me that I actually do take comfort in the WHO's presence. Perhaps a sign I have not lost all of my naïveté, or perhaps my expectations have eroded so severely that the World Health Organization represents, at least to me, our Last Best Hope for anonymous Indonesian villagers and their 6.x billion neighbors.

 

Then again, perhaps it's a combination of being naïve with very low expectations. Hey, isn't there a term for that? Yeah, I think there is, and I think it's something along the lines of "clueless".

 

SZ

H5N1 assumptions, the good, the bad, and the who knows

 

Today Crof and Fla_Medic each covered an editorial from The Australian, Australia unprepared for epidemic, their excellent offerings notwithstanding, I would also like to comment.

 

[snip]

Given the magnitude of international air travel and the likely length of the asymptomatic incubation period of any new influenza virus, which would certainly exceed the time taken to fly between any two points on the earth's surface, it is highly likely that the entry of a new virus into Australia is almost unstoppable.

Professor Peter Curson of the Centre for International Security Studies at the University of Sydney has recently highlighted the difficulties facing traditional quarantine measures in an age of mass air travel.

If, however, the first case arriving in Australia is detected and isolated in time, there is still a chance that an epidemic on our continent can be prevented.

The current H5N1 virus has been known so far to have infected at least 385 people around the world, mostly in Asia, and the death rate — despite all modern available treatment, including all the currently available vaccines and antivirals — is approximately 63 per cent.

If and when a pandemic next occurs, if the new virus retains the same pathogenicity of the current avian influenza virus, we can expect about 4 billion people to die in the world over a six-month period. And that is how long it will take for a truly protective new vaccine to be developed and produced.

And the virus will be no respecter of wealth or class or education or intellect. In fact, if it behaves like past influenza viruses, it will not spare any age group. Even physical fitness will provide little or no protection.

 

I have frequently bemoaned the inability of many to understand and admit, or just to understand, that a pandemic from an genetically avian A/H5N1, but adapted to enable sustained human-to-human transmission, does not have to behave as 1918's H1N1 pandemic strain.  I have bemoaned it so often that recently I created a brand new category, [ Poverty of aspect], to tuck these frequent moans into.

 

They lay out some of why I believe Dr. John Graham, the Australian editorialist, might be closer to a correct assumption than those who believe 1918's pandemic is as bad as it could possibly ever be.  Please note: "Closer to correct" doesn't mean I'm saying he IS correct, only possibly closer to the measure.

 

Vindication-of sorts, and Vindication-of sorts II.

 

No one knows what the next pandemic will offer humanity, whether it will be a relatively "non-event" such as 1968's or whether it will be a beast beyond our current imagination, we just don't know.  Dr. Graham doesn't know, our officials don't know, our most renowned and well-respected virologists don't know, and I certainly don't know.

 

We can only attempt to understand the future by what we DO know, even though that is pitifully lacking.  And, what we DO know at this point in time, and A/H5N1's epidemiological profile, is that it is a DIFFERENT beast, the likes of which we have never seen before.

 

Interestingly, at least to me, is our collective willingness to believe, without question, assumptions based on a past event, an event that is for the most part only understood via assumptions and empirical data, over data coming out of our current labs underpinned with our greater scientific and continually evolving understanding.

 

If we heard about the full range of potentials for an H5N1 pandemic Dr. Graham's editorial wouldn't be so shocking to our sense of reality, instead, we could judge his words and opinions on what he bases them on, the science as we know it at this moment in time.  That "science" says it may, just may, be possible that billions would die.

 

SZ

It may or may not be H5N1

 

 

Wouldn't you know, I am swimming against the tide of "month end" and Indonesia becomes a news item.

 

Reuters UK is running the story of 13 people who have fallen ill and suspected as being infected with H5N1:

[Excerpt]

JAKARTA (Reuters) - Thirteen people from a village in Indonesia's North Sumatra province have been hospitalized after suffering symptoms of bird flu, a media report said on Wednesday.

Sinar Ginting, a spokesman for the Adam Malik hospital in North Sumatra's capital Medan, was quoted by Kompas.com as saying that two patients from the group had been transferred to the hospital early on Wednesday morning.

The other 11 from Air Batu village were being treated in a local hospital, he said.

"They have bird flu symptoms such as fever and breathing difficulties," Ginting was quoted as saying.

Not all the patients were believed to have had contact with fowl, which is the most common way of contracting the virus, but Ginting said some chickens in the area had died suddenly and were found to have had the deadly H5N1 virus.

Indonesian health ministry officials could not immediately be reached for comment.

 

 

This early in a situation half a world away it is impossible to know if this is something to be concerned about or just another "something" from a long list of potential "somethings" that are of no concern beyond those connected to the situation. I would be less than honest if I said that this story didn't cause me at least a modicum of concern. Three dead of an unidentified illness in a short span of time, along with somewhere around a dozen others ill would always cause me to watch a situation. But, this is after all, Indonesia, and we are painfully aware of some rather glaring shortcomings when it comes to efficient and proactive actions in the face of H5N1.

 

I would like to say this however, it is not at all likely that all of these cases are H5N1, even allowing that a few might be. For the answer to that we may have to wait weeks or months if this is an isolated outbreak that will settle right down as they have in the past. If, however, and is emphasis if, this is a significant cluster with human transmission involved, we will not have to wait very long at all. With that many cases of a transmissible virus and the cases begin to mount rather rapidly, even if only locally.

 

Finally, it has been my long held belief that it is not so much a single person infecting another person or two, or even three that we have to worry about, it is when we see transmission onto a third and fourth generation. And it is that that I, and others, will be watching for, the third and fourth generation in a connected chain of transmission.

 

Unfortunately, it is only a few watching. Indonesia's problems with H5N1 have become such a common story that it is no longer even much of a story. Tomorrow is the eve of the Olympics' opening ceremony and the world's attention will be riveted to the happenings in China, not unwarranted mind you, but the Olympics will drown out much of any other international news.

 

Added to the natural draw of the Olympics is the "side story" of the media and the Chinese government. Nothing captivates the media's attention more than stories about the media being victims of censorship or ill treatment. China appears to be willing to weather their wrath with all the contempt of outsider's opinions that China has shown historically. I suspect a few anonymous villagers ill and dying in Sumatra Indonesia cannot compete for journalistic attention when said journalists will be a "news item" themselves.

 

And so the "few" watch.

 

SZ

Insuring the business of HC against Pandemic Influenza

 

Although it's true you can insure just about anything against just about anything, today's news item came as a bit of a surprise:

 

From Marketwatch.com

Lexington Insurance Company Introduces Pandemic Rx

Endorsement to Lexington's Commercial Property Insurance Covers Financial Risks Faced by Healthcare Providers in the Event of a Pandemic Flu

NEW YORK, Jul 31, 2008 (BUSINESS WIRE) -- Lexington Insurance Company, a unit of AIG Commercial Insurance, today announced Pandemic Rx, an endorsement to Lexington's commercial property policy for acute care medical facilities to cover business income loss and extra expenses incurred during a declared pandemic influenza public health emergency (as defined in the policy).

"Because of the complex nature of healthcare economics, a pandemic flu would put tremendous financial strain on healthcare providers. An increase in hospital admissions, expected during a pandemic flu event, could actually result in reduced revenues and business income loss," said Kevin Kelley, Chairman and CEO, Lexington Insurance Company. "In an environment of resource scarcity, elective procedures may be canceled which may then lead to a lower average reimbursement rate for care provided during the pandemic event."

Continues….

 

Back in December of 07 I did a post, Pandemic Accounting, and it addresses why this insurance was brought to market. It is still relevant to the issue and if you haven't read it I [modestly] suggest you do so.

 

I close out that previous post with these words:

 

Even though this article addresses the financial burdens a pandemic will place upon most hospitals the supporting underpinnings are some of the best I have seen outside of dense scientific papers. Admitting it's crass and insensitive to lean on financial concerns to support PanFlu concerns in general when I refer to what will be human lives and miseries, it's as the saying goes—money talks.

The question is—is anyone listening?

 

The insurance industry is listening.

 

SZ

Japan’s H5N1 PanFlu estimates

Many days I am reduced to the briefest peek in on the world of H5N1 and Fla_Medic, along with Crof, are where I usually peek for the news. One of FM's offerings today was a post on Japan's estimates of the possible effects on the business sector should a severe pandemic occur. I would not be exaggerating to say that I was momentarily stunned, in fact stunned incredulity about sums up my reaction.

From the Daily Yomiuri Online:

40% of workers might have to stay home in pandemic

[Excerpt]

Estimates were based on the human suffering figures in government's pandemic relief action plan--revised in October. The plan estimates 25 percent of people would suffer from a new influenza pandemic, with a fatality rate of 2 percent.

I was stunned because I have long admired Japan's approach to the seriousness of the threat posed by a pandemic from H5N1, treating it more as a threat to their nation than a public health issue. As such, they have spent a great deal of energy and funds preparing Japan for the potentials. A few examples are their purchases of Tamiflu, pre-pandemic vaccines, and plans for containment on a national level. Japan has backed up words on paper with concrete actions and embraced some rather radical measures as necessary to their survival.

Given their demonstrated willingness to accept the more severe, but [some would say] less likely, severity assumptions reading 25% ill with a 2% case fatality ratio was counter to everything I had read from their planning assumptions previously.

Several hours passed as I mentally chewed on what could be driving their numbers and then it hit me:

Instead of using ill-informed and wishful thinking figures [as 25% CAR /2% CFR suggest] they quite well may be correct for Japan experiencing a severe pandemic. Japan, having done much already, and plans in place to do much more proactively, will experience a mitigated pandemic while most of the rest of the world will suffer an unmitigated pandemic.

A graphic of a community disease profile between a mitigated vs. unmitigated pandemic [FluWiki]

That graphic, though unproved for a future severe pandemic, speaks volumes in support of Japan's estimates. Doing the "tough stuff" pays off in numbers, both in CAR and CFR.

Lest we forget, those numbers represent people – many in the prime of their lives – which is exactly why Japan takes the threat so seriously, and exactly why they may just hold their numbers down to these percentages that, on their face, seem so unrealistic [and uncharacteristic for Japan].

SZ

H5N1 and Nigeria

 

I've said before that H5N1 does not exist in a vacuum, separate from all the other troubling and worrisome things and that occasional large scale disaster.  H5N1 in Nigeria is yet another example.  A country that has more than its fair share of corruption and greed, it is also struggling with being rich in oil.

 

Nigeria Reports New Outbreaks of Bird Flu at Farms in North [excerpt]

By Dulue Mbachu

July 28 (Bloomberg) -- Nigeria, Africa's most-populous nation, reported new outbreaks of bird flu in two of its northern states, the World Organization for Animal Health said.

Both cases, confirmed to be the H5N1 strain of avian influenza, occurred in ``backyard poultry'' in Kano and Katsina states, the organization said a statement posted on its Web site on July 25. 

 

Elusive peace in Nigeria's oil Delta

By Andrew Walker
BBC News, Port Harcourt

An effort by the Nigerian government to bring peace to the oil-rich Niger Delta region hangs in the balance before it has even begun.

[snip]

Corrupt politicians and military officers use armed militants to steal oil and protect their lucrative positions in government.

"Most of what is going on here is sheer criminality," says Anyakwee Nsirimovu, a human rights activist based in Port Harcourt.

"Maybe one day there will be a line drawn between who is a real fighter for the Niger Delta cause and who is not, but what we see on a daily basis is people killing civilians and pocketing money."

Without things like reliable power supplies, transport infrastructure and employment, people will remain dependent on the patronage of corrupt leaders and will be unable to speak out against them, he says.

"Not many people can speak the way I do, because they are afraid. Plenty of people spoke out in the day and were killed at night."

He says the government's intention to get militants to put their arms out of use is "absolute nonsense".

 

An interesting post on the "Nigerian background noise" from Greg Laden's Blog

The shit is hitting the fan in Nigeria 

[Excerpt]

At this point, in Nigeria, we may be at a tipping point of sorts. With increased international attention focused on oil exploitation, and a long period of time over which the same disgustingly corrupt system has been in place, the Nigerian situation appears to be heating up.

Over the last few days, there have been a number of incidents (see below) indicating a notable escalation. Militant leaders are now vowing that a major action will take place soon, possibly this weekend. Security warnings are going out to ex-patriots in the region. Expect the ongoing, in the background events that never boil to the top of the US news ticker to emerge on the front page any time over the next few days.

 

Although H5N1 in domestic poultry is old news and news we tend to not treat as news any longer, when you tack it onto corruption and chaos it might just be newsworthy.  If not newsworthy, at least a brief pause for that "oh crap" moment, in homage to the potential danger from stuff we have become inured to reading.

 

SZ

Influenza, a promiscuous virus

 

Today we have a brief announcement that two dead birds were found in Hong Kong at the location of the upcoming Olympic equestrian events (Aug 9 – 21).

 

The Associated Press (via USAToday)

2 dead birds found at Hong Kong equestrian site

HONG KONG (AP) — Two dead birds were discovered at an Olympic equestrian venue in Hong Kong, and authorities were testing whether they were infected with the bird flu virus.

The birds were found last week, equestrian competition official Mark Pinkstone said Monday.

The H5N1 bird flu doesn't pose a threat to horses, but can be lethal to humans. Hong Kong has struggled with the bird flu for years and six people died during the biggest outbreak in 1997.

The Olympic equestrian events, to be held between Aug. 9 and 21, were moved from Beijing to the former British colony because of a rash of equine diseases and substandard quarantine procedures on the mainland.

 

Even though the piece is small, it contains a great deal of information. The item most noteworthy to me is the fact that the finding was announced. Without diving too deep into The Waters-of-Conspiracy, some in the cyber flu community believe that the upcoming Olympic Games are directly driving our dry spell of news. I, myself, ascribe a certain amount of the silence to this. Nevertheless, I also believe that if something is of genuine concern we will hear about it – one way or another.

 

The second thing that I found noteworthy was the blithe assurance that H5N1 doesn't pose a threat to horses, and by extension, to people in contact with horses. On the 12^th I referenced a study where bovine (cows) calves were deliberately infected with H5N1 to study if they would become ill and if they would/could transmit the virus to other calves [here].

 

We continually learn more about the wide range of species susceptible to H5N1 infection, sometimes by surprise as was the case with cats, and sometimes like the calf experiment, deliberately. Unless someone, somewhere has scientifically validated the assumption then it is only an assumption at this point. An assumption that seems to be rather flimsy – at best – since there are strains of influenza that horses are known to be susceptible to, H7N7, H3N8, and H3N2.

 

A horse "snuffling" around in grass that has been coated with bird droppings from an infected bird seems (to this layman at least) a possible route of infection. Infected birds excrete large amounts of virus and that virus can live for quite some time in the environment.

 

The final thing I found noteworthy also bears repeating:

The Olympic equestrian events, to be held between Aug. 9 and 21, were moved from Beijing to the former British colony because of a rash of equine diseases and substandard quarantine procedures on the mainland.

 

It seems even with Olympic-sized reasons to control endemic zoonoses China has difficulty doing so. With August 8^th only days away, and several "mystery diseases" rumored to be within the region. For a great rundown of the China rumors please see Fla_Medic's post, and his follow-up if you have not already read them.

 

Finally, it is important to keep things in perspective. Two dead birds, even if they died of HP H5N1, are not a grand threat to anything, but they could be a symptom of a larger problem and as such, it is important that we know one way or another – especially when we have the (perhaps) ill-informed issuing ill-informed statements meant to placate and pacify.

 

SZ

 

H5N1 and routes of infection

Two new papers have become available:

Experimental Infection of Cattle with Highly Pathogenic Avian Influenza Virus (H5N1) [link] Donata Kalthoff, et al.

 

Abstract [snip]
Four calves were experimentally inoculated with highly pathogenic avian influenza virus A/cat/Germany/R606/2006 (H5N1) isolated from a cat in 2006. All calves remained healthy, […] All calves seroconverted.

 

Since 1997, an epidemic of highly pathogenic avian influenza virus (HPAIV) subtype H5N1 has spread in Asia, causing fatal infections in poultry, wild birds, and mammals, including humans (1). Knowing the susceptibility to HPAIV (H5N1) of mammalian species living in close proximity to humans and poultry, such as members of the family Bovidae (e.g., cattle or water buffalo), would be helpful to those developing surveillance plans or determining risk areas.

 

And…

Domestic Pigs Have Low Susceptibility to H5N1 Highly Pathogenic Avian Influenza Viruses Aleksandr S. Lipatov, et al. [link]

 

Abstract [snip]

Genetic reassortment of H5N1 highly pathogenic avian influenza viruses (HPAI) with currently circulating human influenza A strains is one possibility that could lead to efficient human-to-human transmissibility. Domestic pigs which are susceptible to infection with both human and avian influenza A viruses are one of the natural hosts where such reassortment events could occur. Virological, histological and serological features of H5N1 virus infection in pigs were characterized in this study.

 

Those who are interested, and have not done so yet, can read the papers in their entirety at the links, both are public access.

 

I found the two papers coming out at roughly the same time to be helpful in pointing out the differences in experimental infection routes (cows – intranasal and pigs –infected food). Infection doesn't just happen by airborne transmission, H5N1 can, and does, seem to take advantage of any route into a host, whether that's through inhalation or ingestion, with hints that open cuts and abrasions may offer an entrance because H5N1 can and does survive in the blood, as well as via the eye.

 

It is also logical that not all routes of infection pose the same level of risk, nor pathological profile. For instance, digestive tracks have evolved to handle many pathogens from less than sanitary food. Obviously, it's not 100% effective, but generally it's a very inhospitable environment. Eyes, although exposed to the air are a more "isolated system", independent of most of the rest of the body. Though ocular epithelial cell infection is suspected in the one fatal case of H7N7 in the Netherlands in 2003. It seems the nasolacrimal duct drains into the nasal cavity, so in the case of influenza "more isolated" doesn't translate 100% to no infection risk.

 

It's possibly worth noting that many of the nurses infected during Canada's SARS outbreak were infected during intubation of SARS patients without wearing eye protection to guard against aerosolized virus. Eventually this practice was recognized as a huge gaping hole of risk, and the nurses wore goggles and their infection rates plummeted. Of course, that may be coincidental since stringent bio-security was implemented across all possible routes of infection. That said and acknowledged however, prior to the goggles, other PPE (personal protective equipment) such as gloves, masks/respirators, and hand washing were in place.

 

It was the recognition of the extra risk the aerosolized virus posed and utilization of eye protection that would support the goggles making a statistically significant difference in new infections.

 

So much to learn, so much we don't know, which is why funding and performing these experiments are vitally important.

 

I wonder if anyone has thought to perform an experiment of ocular infection with H5N1 of piglets. Hint – hint if not.

 

SZ

Rules

Life has rules. They are everywhere and cover pretty much everything. Some rules are loosely defined and others immanent (Natural law), the nuances of Hobbs and Locke aside. International Treaties fall closer to the Natural Law side of the sliding scale, if not solidly upon it.

International Treaties generally fall into two categories, those that agree to perform a specific action and those that agree to refrain from a specific action. Countries can adopt a mutual defense treaty with others [action] and countries can adopt a treaty banning above ground testing of nuclear bombs [refrain from action]. The Kyoto Treaty [alternately known as The Kyoto Protocol] is an example of a treaty that parties agree to both action and inaction with its ratification.

Historically it has been the treaties of restraint that carried the greatest probability of international penalties or sanctions. These certainly have not been evenly and consistently enforced, and often countries gamble as to what the international community's reaction will or will not likely be. A few examples of reaction testing can be found in the nuclear development programs of some countries, and not one suffered (Iraq was a broader issue).

In fact, it has been demonstrated several times in our recent past that flaunting a treaty produces positive outcomes for countries as the international community resorts to what amounts to bribing a country to cease offending actions. There are few enforcement options and pretty much zero will to enact those few. Either countries live up to their treaties or they don't and the rest of the world pretty much has to accept it.

 

This week Indonesia caused yet another stir with Health Minister Siti Fadilah Supari's interview statement that her country will no longer announce H5N1 deaths as they occur, but rather on some yet to be officially determined schedule, from a month to upwards of six—or so. Here is a representative story of the many that covered the incident, but since I am late to the table I suspect I don't need to post on yet again.

 

Supari's gamble may pay off, literally as well as figuratively, and hey, more power to her. I hope she is successful in whatever it is that is driving her actions. The world moves on, and it's time that it move on without Indonesia. But I can't help wonder what Hobbs and Locke would think of these developments.

At one time a person's word was nothing short of a sacred bond, broken only by the lowest of scoundrels and a country's word was pretty much a bankable asset. Yes, the world moves on, and not always in the right direction.

 

SZ

Mixed Messages: Thermometers and Mass Graves

There are times when I find it difficult to remain gracefully dispassionate, especially when I come across something that I believe to be not only egregiously ignorant, but also a danger to the public. What makes today's topic so angering is the latest on the Influenza Pandemic front out of Ireland.

From IrishMedicalNews.com:

Flu medication stock-up advise

For all Ireland's high profile stocking up on antiretrovirals, each household will be urged to have the humble thermometer and paracetamol or ibuprofen in the event of a flu pandemic, according to a new Government handbook.

An introductory handbook on the Government's emergency planning plan, distributed recently to households across the country, says that while there will be more worldwide flu pandemics, the time and severity of their occurrence and the age groups on which their impact will be most severe cannot be predicted.

However, every household in the country will receive a leaflet before the pandemic reaches Ireland advising the measures including stocking up on a thermometer, paracetamol/ibuprofen, that should be taken. The Government will advise citizens to begin these preparations if and when the WHO confirms that a pandemic is imminent.

The guide also advises buying enough food and other supplies in advance of the pandemic to last "you and your household for at least one week", and advises awareness of hygiene measures to prevent infection.

Under the plan, the handbook says it is essential that people with flu symptoms stay at home while the indications persist, unless they receive other advice from a telephone hotline, which will be set up to provide advice and support, or from official Government announcements through the media.

The PDF of the handbook may be found here for those who wish to verify, as I did, that this is not a misquote but what is really being said.

 

Advising action only after the WHO declares an Alert Level Four pandemic threat will no doubt ensure that just about every household in Ireland will be out trying to purchase supplies at exactly the same time. As someone who is threatened with hurricanes on a regular basis I can attest to what it is like when many people attempt to buy the exact same supplies at exactly the same time. There just isn't enough supply to meet demand.

However, the entire timing strategy could prove to be naively misguided as publicly Ireland's Office of Emergency Planning is telling everyone that there will be time for everyone to become prepared (buy that thermometer and fever reducer). What if there's not?

What if an influenza pandemic bursts upon the world much as SARS did in 2003? Not an unreasonable question as influenza spreads much easier from person to person than SARS did, and we could find ourselves in the grips of said pandemic even before WHO has time to verify and announce its arrival.

Well actually, Ireland does have plans in place to deal with an unprepared public should a severe pandemic befall the world. This from NewsLetter.co.uk February 9, 2007:

Straw poll on grave crisis

A straw poll among district councils across Northern Ireland
yesterday revealed they are planning for at least 20,000 extra
graves to cope with a possible flu pandemic. Ian Starrett, Johnny Caldwell, Laura Murphy and Philip Bradfield report on how different councils are managing.

Continues….

 

Since the advice given to the Irish people, diligently mailed to every household, is so meager, and by any logic ridiculously inadequate, it's a good thing the district councils have planned to bury so many.

But it begs the question: Why is the official assumption that they will need those mass graves and yet the only advice they are giving their citizens is to purchase a thermometer and fever reducer? Would it not be wiser to advise people to stock up on a few more weeks of food so they don't have to be out and about possibly becoming infected, and a few more medical home treatment items?

Could it be that Ireland's Office of Emergency Planning has decided that the only effective action any citizen can effect is to depend on the Office of Emergency Planning? And that when they are exhausted and depleted it's just easier to toss the flu victims into those well thought out mass graves? Do the planners in the Office of Emergency Planning think their constituents are that stupid and personally incapable as to have no need of genuine guidance and advice? It certainly appears that way to me.

 

Officials are preparing for the range of severity of a potential pandemic, from mild-to-severe; meanwhile they are telling the public it will be little more than an inconvenient case of "the flu". Well, OK, they are not saying that explicitly, but it is what their message implies.

 

I would suggest that the citizens of Ireland politely suggest where the Office of Emergency Planning can stuff those thermometers.

 

SZ