Continued from here
The issue of whether there are significant no of mild cases of H5N1 infections is unresolved, since absence of evidence is not the same as evidence of absence. However, we do know that with the Cambodian seroprevalence study, the result was zero percent in a village with massive poultry die-off’s and a human case. Also, tests on contacts of patients have so far shown extremely low positive results (unpublished results, oral communications, Indonesia and Thailand). Additional unresolved issues include the fact that tests for antibodies for H5N1 have been shown to be problematic for false negatives, incidence unknown (from tests used in vaccine trials, Treannor).
So, the answer is, we don’t know whether there are mild cases and how many there are.
OTOH, I do know that we have missed some fatal cases, whenever we have a confirmed case where a close family member has died recently of similar symptoms. None of these cases are counted, and they are the fatal ones, so one can argue that the CFR could very well be higher not lower.
My suspicion is, and I have no evidence one way or the other, that the 60% is pretty close to the real situation.
From Dr Woodson’s post There is also epidemiologic evidence of flu-like symptoms occurring in people living in Vietnam for a six-month period between 2003 and 2004 who had contact with sick poultry. This study’s principal finding was 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.
I don’t know what study this refers to but I suspect it may be this one by the Karolinska Institutet. This was a retrospective survey using questionaires asking people about flu-like symptoms, specifically fever and cough, over the preceding months and correlating that with exposure to poultry.
This is by no means a survey that can give meaningful results as retrospective recall of the frequency of fever and cough is certainly not enough to diagnose any single person as having influenza, let alone influenza caused by H5N1. Experience in Vietnam and Indonesia tells us that even in hospitalized patients, the clinical pictures of seasonal flu and H5N1 infections are indistinguishable unless and until someone starts having breathing difficulties around day 6 onwards.
In addition, because of the publicity surrounding bird flu, there could be any number of reasons why those involved in poultry farming are more likely to report symptoms, including awareness and fear.
I have read that New York city in the 1920′s put all their orphans on trains and sent them all over the country. Any one who wanted a kid just went to the train and got one.
And a century later, it will be airport terminals and bus depots.
Yes, and one of my real concerns is pedophiles. Life, not being fair, means some of the pedophiles will survive. That is one reason I would take in children even though I’ve had enough parenting experience to make me know better!
would need fuel for planes and buses -
but, communities need plans and lists of guardians from parents, now. Schools and daycare could have helped faciliate that; they already keep emergency contact numbers; they could add files, to only be used in pandemic, of 6 or more people listed who could at least temporarily take your kids if you were sick or dead. Families have to have background checks to volunteer in schools; they could be asked who has prepped, for how many kids.
Hopefully law enforcement will be proactive about some things during emergencies, too. But, hope is not a plan.