....Almost invariably, an activist group has two sets of constituencies. Its radical stakeholders — key volunteers, for example — are likely to take offense if the group “compromises itself” by giving courteous advice to the enemy. They want it to stay pure and embattled. But moderate stakeholders — including large numbers of small-money donors — may want to see it settle for half a loaf, accomplishing something concrete even at the expense of purity....
Talking about “high-path” and “low-path” avian flu (http://www.psandman.com/gst2006.htm#link)
...The science in a nutshell:
There are lots of different strains of bird flu, just as there are lots of different strains of human flu.
Categorized in terms of ability to inflict harm on poultry, bird flu comes in two “strengths.” “High-pathogenic avian influenza” (often abbreviated as HPAI) can be deadly to poultry. “Low-pathogenic avian influenza” (LPAI) causes very mild symptoms in poultry, or sometimes no observable symptoms at all.
Some bird flu strains — not all — have been found in both HPAI and LPAI versions. This is true of the H5N1 strain that is currently getting so much attention.
The bird flu strain that is currently devastating some bird populations, that has managed to spread to a few hundred people, and that many believe threatens a possible human pandemic is HPAI H5N1.
LPAI H5N1 occurs from time to time in North America. (In fact, it's often called “North American H5N1,” as opposed to the “Asian” HPAI H5N1.) In its current form, LPAI H5N1 is no threat at all to human health — at least to the best of scientists’ knowledge thus far.
HPAI strains differ in their ability to cause serious disease when they spread from a bird to a human. HPAI H5N1 is deadly to humans (though so far very hard for humans to catch). But a recent high-path H7N3 strain, which devastated domestic chicken flocks in Canada two years ago, caused only a mild eye infection when it spread to some poultry workers.
Laboratory tests for bird flu give you some information fairly quickly, while other information takes longer. You usually get the H before the N. You usually get both before the definitive high-path or low-path determination (though you may have a strong high-path/low-path hint from clinical observation — birds are dying or they aren't).
Some strains of bird flu can be low-path in most wild bird species and high-path in domestic poultry. Some strains can be low-path but then mutate (or not) to high-path after they spread to domestic poultry. H5N1 has both of these traits. So if H5N1 is found in wild birds that are perfectly healthy, it is still possible that it’s HPAI as far as poultry are concerned. And it’s also possible that it’s LPAI but will become HPAI later. All that is what you ideally want people to understand — though it’s a lot for laypeople (and even for many officials) to absorb. You want people to recognize that not all cases of bird flu are H5N1, and that not all cases of H5N1 are high-path....
How much should we trust what WHO says about pandemic phase? (http://www.psandman.com/gst2006.htm#phillip)
...This response was written jointly with my wife and colleague Dr. Jody Lanard. You write: “I accept that WHO internally may be using a different system (not available to the public) and probably plays down the actual risk....”
We have no reason to think that WHO is using a different system, or that WHO is playing down the risk. Everyone — including WHO officials — wishes there were certainty about the predictive value of each cluster, and of each new situation that arises with H5N1 in humans. When WHO investigates a cluster or other new development, it is looking for evidence of progress toward a possible pandemic. If it finds such evidence, it needs to decide — without anything approaching certainty — whether the evidence justifies notching up to the next pandemic phase.
The phases are merely ways of describing a progression of the H5N1 virus in the direction of more efficient human-to-human transmission. The actual cut-off points between each phase and the next were judiciously but arbitrarily defined; WHO could just as easily have divided the progression into more or fewer phases. These cut-offs are not nearly as crisp and definitive as we all wish they could be — and as we all sometimes imply they are. Even if the facts of a particular situation are known and undisputed, there may be room for debate over whether that situation does or doesn’t meet the criteria for Phase 4.
Nor can anybody predict how long H5N1 (or any flu virus) might linger in one phase before moving on to the next. We could move to Phase 4 and stay there for years — which would probably lead many people to conclude we shouldn’t have moved to 4 at all. Or we could move to Phase 4 and then move almost instantly to 5 and 6 — which would probably lead many people to conclude we should have moved to 4 earlier.
The phases are approximations that WHO experts hope will provide at least a little guidance to countries that are deciding how to respond to a changing situation.
Remember: This has never been tried before. We have no experience predicting pandemics — no experience with successful predictions, and no experience with failed predictions.
Everyone worries that some countries may try to hide what is happening, or may not be aware of what is happening in some remote areas....
whether we are closer to 3.1,3.2,...,3.8,3.9
or what they consider the likelyhood that we will be
(at least) at 4
by -say- spring or summer 2007.
But WHO is not trying to be very open and informative here.
In contrary, I get the feeling that they avoid to talk
about this. WHO doesn't say how likely they consider
a pandemic and the phases are not used to ahow this
very well. Of, course, the higher the phase, the more likely
-we would expect- they consider a pandemic.
But besides that there is little information. It could go from
3 directly to 6.
They could delay going to 4 for political
or funding reasons.
necessities alone. That further reduces credibility on WHO
and in the phases.
whether we are closer to 3.1,3.2,...,3.8,3.9
or what they consider the likelyhood that we will be
(at least) at 4
by -say- spring or summer 2007.
But WHO is not trying to be very open and informative here.
(Emphasis SO)
In contrary, I get the feeling that they avoid to talk
about this. WHO doesn't say how likely they consider
a pandemic and the phases are not used to ahow this
very well. Of, course, the higher the phase, the more likely
-we would expect- they consider a pandemic.
But besides that there is little information. It could go from
3 directly to 6.
They could delay going to 4 for political
or funding reasons.
In fact even if only Phase 4 would be declared, it would trigger National response has specified in National Pandemic Response Plan with Huge Economical damage.
If WHO would not be extremely cautious it is wasy to foresee the terrible consequences that panic could generate on an economical level, on a social level, on the Medical Instances Level and Political level could not be only Huge, but they would by themselves (with or without the omnipresence of the oandemic) generate tremendous collateral damage.
In face of such responsabilities towards our fellow human beings, extra cautiousness is at least what we should expect from such a powerfull authorative Organisation as WHO.
Therefore, I totally agree on those in the field that it is a MUST to be extremelly cautious in statements and I second them in that behavior.
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