From Flu Wiki 2

Forum: WHO General Director Speaks

use of polio campaign for flu surveillance

09 February 2006

BillysBlueat 14:35

http://tinyurl.com/b5wz5

Released today (February 9) WHO general director speaks on situation in Africa and issues warning to all countries to prepare for possible pandemic.

Medical Maven – at 14:39

I would say that this is a “red letter” day.

BillysBlueat 14:42

Although I agree with you, I sort of feel numb, like this really can’t be happening. Almost like all the prepping - in some way - is a means to escape the harsh reality that this thing truly could be UPON us. I feel weary. Anyone else relate?

Medical Maven – at 14:47

I can relate. This is getting so surreal that I am going to take an extended break to work on my taxes. And I am looking forward to it!

Hillbilly Bill – at 14:47

What I find scary is that WHO finally is admitting what we have all known and feared. The wolf is at the door.

BillysBlue - I was weary last night after putting away a car full of supplies. Damn glad I did it now.

Scaredy Cat – at 14:50

Surreal, yeah, that’s the best word to describe it.

Naomi – at 14:53

DemFromCT

I would like your ‘take’ on this - thanks.

DemFromCTat 15:08

It’s a serious statement in the name of the Director-General. But I can’t tell if it’s a message to African countries to cooperate, or something more.

Only the Director-General can change pandemic stages, so we’ll all be watching this very closely.

giraffe – at 15:09

However, the alert status remains at 3? My stomach is in a knot!

Cinda – at 15:36

Weary and frightened. Numb- yup- thats about right. And as ready as I’ve been to hear this- I just can’t believe it was really said by the WHO. The little voicee inside me is scraeming No No No- it can’t happen- it just can’t. I wonder if the media will jump on it- or if our government will quash it? So far I haven’t seen anything about it anywhere.

giraffe – at 15:40

I have received two breaking news bulletins through Yahoo, but that is it. Nothing on the home page though.

AnnieBat 15:40

For the Director-General to make a statement within “hours” of an outbreak (and no human cases confirmed as yet) sent chills down my spine. He has not done anything like this before. To make statements like

“This latest outbreak confirms that no country is immune to H5N1. Every country is at risk. Every country must prepare.” and “If the H5N1 virus changes to allow it to pass easily from person to person, and it goes unchecked, this could trigger an influenza pandemic. H5N1 is spreading rapidly across the world. All countries must take measures to protect human health against avian flu, and prepare for a pandemic. There is no time to waste.” (I hope these are not misconstrued as taken out of context.)

Although the message is the same about preparedness and time is of the essence, the fact that he made this statement so quickly is the chilling part.

The WHO made this statement about the situation in Africa on 28 October 2005

[http://www.who.int/csr/disease/avian_influenza/riskassessmentAfrica/en/index.html]

Their worst fears are being realised and they are well aware (as in the report above) that containing the disease in African states is going to be a nightmare.

Hillbilly Bill – at 15:47

AnnieB - “Their worst fears are being realised and they are well aware (as in the report above) that containing the disease in African states is going to be a nightmare.”

Not a nightmare, just flat out impossible.

Luke – at 15:52

There went the match in the puddle…IMHO…..

MomInBCat 16:13

Sigh…all of this is so surreal to me. I plan, I prep but somewhere deep inside I really doubt that something of this magnitude could ever happen. Then you read an article like this and get smacked with the reality check.

I can’t help but feel such tremendous sadness that the world may(maybe I should say will… I prefer to say ‘may’ as I am still having bouts of denial) be so devastated by this. Terrifying concept when you really sit down and think of the potential devastation that may lie ahead.

Sigh…

BillysBlueat 16:16

DemFromCT: I agree that it is unclear whether of not the Director-General is speaking of African countries or countries of the world in general. However, since he didn’t specifically use the words “African country” in the pasted quote below, I guess it leaves the interpretation open for discussion. (Could it just be a careful usage of semantics?) If he were only referring to the African continent, I would think he would have used the words “African country.” Of course, like you said, we’ll all just have to - once again - wait and see.

Quote from WHO statement: “This latest outbreak confirms that no country is immune to H5N1. Every country is at risk. Every country must prepare.”

Further into statement: “All countries must take measures to protect human health against avian flu, and prepare for a pandemic.”

kristy – at 16:24

I’ve definetly just entered the world of the surreal. Its only been two weeks since Oprah’s show that opened so many people’s eyes, and things are just progressing faster than I was ready to handle.

The mental preparating that this will take it almost as big of a job as the physical preparations.

I am not a religious woman, but today I will pray.

MomInBCat 16:44

I hear you Kristy..just called my husband at work and read to him the press release. As he said, okay, prepare for the worst, pray for the best and just keep doing what you are doing.

The mental prep is not nearly as easy as the physical is…

kristy – at 16:51

Its not as easy at all… =/

I also just emailed the article to my boyfriend who wrote back “Start looking into places we can rent up in the mountains.” This is the first sign of concern I’ve seen come from him. Obviously it got his attention too.

I’m not even close to being ready for this physically OR mentally.

Tommorrow night a lot of money, and time will be spent on supplies.

I feel that time is running out.

kristy – at 16:54

by the way, it appears that the WHO site is down.

giraffe – at 17:00

I am able to get on to WHO, so it might just be a regional problem.

crfullmoon – at 17:01

No matter how mentally ready humans can try and get, it is different living through an experience.

Whether it is parachuting out of an airplane, giving birth, responding to an emergency, or, losing a loved one to Death, our insides are wired up to all sorts of primitive chemicals that tip into our bloodstreams and gives us those physical reactions, and, space out our brains, while we try and adjust, especially to things we don’t really have control over.

I don’t understand the places that think their citizens will riot at the mere clear warning, and directive to prep, for pandemic. They aren’t doing themselves any favors by stalling telling the public.

At least now, the system is still functioning, and perhaps, telling people jail is the last place anyone will want to be come pandemic, would have a good effect…

The mental stages take time (even some of the officials are still in denial) and we might as well get the public thinking about it. So what it doesn’t have a time and place on its “dance card”? Neither do hurrincanes, volcanos, and earthquakes.

Prepare as best we can, including food and water for months, and nursing at home.

Watching in Texas – at 17:28

I have watched the main stream news channels on and off all day and nothing - I keep thinking maybe I am just leaving the room at the wrong time, but surely I would have seen something - a scroll across the bottom of the screen, anything. Surely this coming from WHO today is news worthy. But, I saw one story today, I don’t remember where, but one thing it said was “all the bird flu hype” over the latest reports in Nigeria. So, does the main stream news think that all this is just a bunch of hype? Or is something else stopping them from making this the “breaking news” of the day? I need to go to the store. I think I may need a teddy bear and a blankie before long.

DemFromCTat 18:49

Nabarro:

London, England (AHN) – Dr. David Nabarro of the World Health Organization says the first case of H5N1 bird flu in Africa is likely to spread and create a “very severe situation.”

Nabarro adds that the WHO is expecting more outbreaks in other parts of Africa, adding governments and their citizens would have to take “very, very strong precautions” to protect themselves and the disease from becoming widespread.

DemFromCTat 18:53

also :

Alex Thiermann, special adviser to the director general of the World Organization for Animal Health — known as OIE, the initials of its French name — said the discovery of the disease in one part of Africa does not bode well for the rest of the continent.

“We have been saying for a while that were the disease to get to Africa, it’s a continent where most countries have very weak veterinary infrastructure,” he told CNN. “And we know from our experience in Eastern Europe and in Southeast Asia that the rapidity to which the disease can be fought, and how quickly we can eliminate it … is very directly related to the quality of the veterinary infrastructures.”

It is disappointing that the virus has spread this far,” said WHO spokesman Dick Thompson.

This does not change our pandemic alert level. The virus is moving around, and it makes it more difficult to pry it out of the environment. This does not change the overall risk assessment in terms of a pandemic.”

Many Cats – at 18:56

“…This does not change the overall risk assessment in terms of a pandemic.” That’s being optimistic! :(

Many Cats – at 18:57

Optimistic, politically speaking…scarier and scarier!!!!!! :(

Janet – at 19:02

I feel like I did the day before Katrina when the Official word came out and they said “there will be a category 4–5 storm and it will hit New Orleans….please prepare”. They were telling people directly that the storm will hit and tens of thousands still chose to do absolutely nothing.

I am numb too. Can’t believe this is really a possibility. I have lived on this earth for over 50 years and every year has been better than the one before. I expect this for my sons too. I cannot conceive that everything I have come to know and love will be “changed forever”. Living outside of NYC, September 11th affected all of us deeply. It was so difficult to look at the skyline and not see the twin towers, but within a very short period of time normal activities resumed. I can’t imagine up to a year of non-ending news reports of death and despair; locked in a house with little freedom to travel or enjoy life; constant worry about your kids - so much as hearing one of your kids or loved ones even sneeze could give one a heart attack!!! Financial stress; emotional stress, physical threats.

I want the WHO to be wrong. I want this to be like the swine flu where they got us all worked up for nothing. I want this to be like Y2K with all of us left for some worthless plastic and duct tape. I want people to laugh at me for all of the preparations I have done and tell me that I worried for nothing. I want it not to be true. I want the world to be safe for my sons.

worst case – at 19:04

I am very freaked out today, after reading that letter on WHO. There is a very heavy weight on my heart, as I’m sure many of you can relate. I have a sense of depression over all of this when I look around at my life as it is today and wonder for the first time, what my life (if I even have one) will be like at this time next year or even 6 months from now.

I’m starting to question my own sanity with all these IDIOTS around here that think I’m a loon. I start to wonder, maybe I am a loon. Then I swear, I hope that I’m a loon and this is all just a figment of my imagination. I don’t want to take part in this sci-fi horror movie that is unfolding. Maybe I should pretend like everyone else — that it really isn’t happening - throw out the computer and the TV and don’t read the paper - live in total ignorance of the world around me until the world closes in on my family with it’s killer disease and we let it take us.

This is such a horror and it’s crazy that people don’t even care. When will they start to care? When will they listen?!

One thing this is all doing to me is changing my view on life. It is fragile. So much of what we care about doesn’t even matter. It doesn’t matter at all.

DemFromCTat 19:08

The message appears to be (and is always subject to interpretation) that H5N1 is on its way to spreading across parts of Africa - in birds. There’s really nothing about humans in the three linked pieces (CNN, Nabarro statement and WHO Director General) unless I’ve missed it.

The usual interp discussion will now ensue, but I want to be clear about what’s been said. Please correct or add if there’s additional information.

Africa can ill afford this, and an economic issue of major proportions is likely to develop, even if this stays just B2B.

Janet – at 19:12

If you go to Dr. Niman’s site, he gives details on a report that several children in Africa are sick with blood coming from their mouths. Yes, it could be another rumor, but these damned rumors keep coming true. I think we all agree that it will not be a shock at all when people start falling ill in Africa.

DemFromCTat 19:17

Agreed about expecting human cases, but most rumors actually don’t come true. Most are just rumors. Most suspected H5N1 cases are not confirmed.

The trouble is that all rumors are not untrue, and some suspected H5N1 cases are confirmed.

Many Cats – at 19:21

Janet: It will not be a shock, but the question is, like all that goes on over there, will we even hear about it??

Alexis – at 19:23

DemFromCT, thanks for being a voice of reason…

anon_22 – at 19:28

I wonder what the effect of HIV would be on H5N1. Notice I am not saying the effect of H5N1 on a HIV positive patient, althougth that is definitely tragic. What I want to know is the effect on the H5N1 virus as it enters hosts with HIV-weakened immune systems, especially when the index case is also surrounded by HIV +ve individuals. Would it spread more easily? What effect would the passage through such hosts be on its transmissibility and virulence?

We need quick answers to these. Anyone?

Grace RN – at 19:29

Boy, you have read my mind…..

Would it change the mutation?

Racter – at 19:31

worst case:

“I start to wonder, maybe I am a loon.”

If it helps any, it might be worth noting that wondering whether or not you are a loon is something genuine loons almost never do. And you might consider changing your screen name to “there’s always hope” or something like that.

crfullmoon – at 19:48

From looking at other people with low immune systems, one theory is that the person wouldn’t get a cytokine storm and die quickly, but neither would they be able to completely fight off the virus (nor secondary infections, for that matter). It wouldn’t clear from their sytems, but could have more time to mutate in a human…Not good.

So sad for Africa, where things are so bad already and not enough resources to test and cull safely.

DemFromCTat 19:50

We need quick answers to these. Anyone?

Speculation here by Webster and Wolinsky.

Racter – at 20:00

DR. STEVEN WOLINSKY: “And again, I would emphasize that we really do need to know what is going on at the molecular level.”

Director-General of the WHO: “We simply do not know what the impact of exposure to avian influenza will be on the many people who may be already immunocompromised and in a fragile state of health.”

The problem with quick answers is, they always seem a little fuzzy.

anon_22 – at 20:02

“Speculation here by Webster and Wolinsky.”

That basically confirmed my own speculations. We just don’t know how much faster or whether there are critical barriers to the virus becoming a pandemic strain that might be easier to overcome in Africa.

anon_22 – at 20:07

Racter, there is a lot that none of us know. However, often one still needs to take such uncertainties and speculations and act as best we can. It would be rash for anyone at this point to proclaim they know exactly what’s what. It would equally be mad to abandon the attempt at some quantification no matter how fuzzy.

I am thinking of the expression ‘flying by the seat of the pants’.

Well, I think we are getting into that phase.

Janet – at 20:12

While there was as yet no evidence the virus had mutated to the point it can spread from human to human, “it’s not far away”, said David Nabarro, who heads the UN drive to contain the pandemic in birds and prepare for its possible jump to humans. “I don’t want to scare anyone but the truth is this virus is undergoing changes slowly,” Mr Nabarro told a gathering of advocacy and humanitarian groups at U.N. headquarters.

“This warning that nature is giving us has to be heeded

Statements like this could drive you crazy! David Nabarro doesn’t want to “scare” anyone, but then he is warning us. I think they should take a strong stance one way or the other. Should we be scared or shouldn’t we be. I can understand that they don’t want to “panic” us, but they should be “scaring” all of the millions of poeple who aren’t listening. They need to raise the Phase to a 4 and put some teeth into this.

Dav-uk – at 20:15

I agree with DemFromCT. The message from WHO is that H5N1 is on its way to spreading across parts of Africa - in birds. The statement is not about H2H.

There’s no doubt they are dismayed as it got there so quickly and they know in their hearts it will become entrenched and the problem with that is it will spread across the world in a matteer of months now as Africa is the main migration hub.

A quote from an article in Reuters says it all:

As recently as last June, the disease was confined largely to birds in southern Asia, Nabarro told the U.N. gathering.

But in the seven months between June and last month, “something fairly devastating happened,” he said.

“It spread massively across the world, into Siberia and Russia, into Mongolia, up toward the Baltics, into Kazakhstan, into Turkey, into Romania, a little bit into Greece, into Iraqi Kurdistan, into northern Cyprus.”

Cases of the virus were confirmed this week in northern Nigeria, followed by bird die-offs in other parts of Nigeria as well as in neighboring countries, he said.

………….

The sad thing about the Director General’s statement is he did not mention H2H. The WHO already know this is happening. Niman posted a link to his site regarding the Turkey outbreak in another post. All infected persons in Turkey were from 2 families. One boy got sick, the 2 families had diner together and within 10 days the rest were infected. It is a must read:

http://www.recombinomics.com/News/01220601/H5N1_Kocyigit_Ozcan_Timeline.html

(scroll to the bottom of the page and read it from the bottom up.)

anon_22 – at 20:16

People don’t say “I don’t want to scare anyone” unless they think there is reason to be scared. It’s the same as someone saying “I’m trying not to laugh”, isn’t it?

How many different ways can ‘people who know’ (to mirror Niman’s ‘need to know’) say Phase 4 ahead of the DG without actually using the words ‘Phase 4′?

Monotreme – at 20:32

I see nothing of importance in the Director-General’s statements. What did he actually say: That people can get bird flu from birds? Wow, that’s a news flash. That Nigeria is a poor country and may not be able to handle the culling? Knock me over with a feather. That many Africans have poor health? Stop the presses.

He said absolutely nothing that everyone here has not known for months. The sole purpose of his statement was CYA so that he could sound like he gives a rat’s ass. Well, you know what, he doesn’t care how many people die in Africa, not one little bit. How do I know? Because he didn’t mention the many, many small clusters in Asia? and the possibly much bigger clusters in Turkey. If he really cared whether Africans lived or died he would warn them that H5N1 transmits between people who care for infected patients, not rarely, but frequently.

Why is he still hiding symptom onset dates and the relationships between the infected in Turkey, long after the outbreak was first reported? Only one reason: He doesn’t want people to know that they can get infected from other people. This is criminal.

If he allowed the data to be presented, phase 4 would have to be declared. That would decrease earnings of the plutocrats who run China. They wouldn’t make as much money selling bobbleheads to Americans. So, the Director-General has a choice,

A. Avoid pissing off plutocrats in China and let Africans die because they aren’t being told that people who are infected with H5N1 frequently infect family members.

or

B. Tell the truth about the clusters.

The Director-General chose A. African blood will be on his hands.

pogge – at 20:44

Monotreme:

I edited.

Racter – at 20:52

anon_22:

“there is a lot that none of us know. However, often one still needs to take such uncertainties and speculations and act as best we can.”

Well, if we’ve got something to act on, fine. But at this point, I don’t see the value in devoting a lot of energy to speculating about such possibilities as some exotic virological event occurring as the result of co-infection with H5N1 and HIV. We’ve got more than we can possibly hope to act on already. It looks like pretty much a slam dunk that avian flu will spread more quickly (B2H or H2H) where lots of people are immunocompromised for whatever reason. But, to the extent that my rudimentary grasp of the virolgy involved makes me a reliable source, I can report that there are some fundamental reasons why we aren’t likely to see the emergence of a H5N1/HIV hybrid, if that’s the concern. More good news: head lice won’t be sprouting wings this year, either.

007 in the USA – at 20:54

Monotreme - Sadly my friend, life is cheap when you’re the one holding to dollars. Greed is what is keeping the WHO from moving to Phase 4. It sickens me the way that we will trade human life to save a dollar at Walmart. It’s about greed. No doubt. How sad.

‘Greed’ will someday be shown to be the one thing that got in the way of mankind stopping the H5N1 pandemic.

007

Fla_Medic – at 20:58

We’ve got 24 years of HIV and seasonal flu co-infections. If it were possible (I’m not a virologist, just using common sense here) for a hybrid to emerge, I’d think we’d have seen one by now.

Many Cats – at 21:05

I don’t think an H5N1/HIV hybrid is the worry, it is that the immunocompromised might become simultaneously infected by H5N1 and a seasonal flu precisely because they are immunocompromised by HIV. It’s what could come out of a flu-flu mix that is cause for concern.

Monotreme – at 21:05

thanks pogge.

DemFromCTat 21:08

I believe the issue and the worry is that HIV infected hosts may harbor and shed flu virus or viruses for much longer periods of time, thereby increasing mutation chances. It’s not that HIV-H5N1 hybrids will happen. Webster:

My great concern I think I’m sharing with you is that if this virus and when this virus gets into Africa into the HIV-positive people, who are immunosuppressed, what happens in an immunosuppressed person we know with influenza in cancer patients, the virus is shed for an extended period of time, and it gives the virus the chance to accumulate the mutations of adaptation to humans.
And so this — you put your finger on the great worry that we all have for this virus getting into Africa along with HIV.

anon_22 – at 21:17

Monotreme, “I see nothing of importance in the Director-General’s statements.”

It would seem that I am reading this rather differently from you. What he is saying includes almost a precis of what message we should be delivering to communities. Now you and I may say that is pretty obvious, but if you read the text carefully, it IS an instruction on what message is to be delivered and the rationale for the message:

“The single most important public health priority at this stage is to warn people about the dangers of close contact with sick or dead birds infected with H5N1. The vast majority of all human cases and deaths from H5N1 have occurred in previously healthy children and young adults. Experience in Asian countries and most recently in Turkey underscores the fact that immediate, clear public information is critical to help protect human health. Slaughtering, defeathering or butchering infected, sick or dead birds can put people at risk. The home slaughter and consumption of birds which appear to be sick is high-risk behaviour. Ideally, people culling and disposing of birds should have protective equipment.”

However, the revealing part comes next “WHO is offering support to the Government of Nigeria’s national public information campaign. This campaign may include delivery of messages to communities during the nationwide house-to-house polio immunization campaign beginning on Saturday.”

This refers to the ongoing attempt to eradicate polio in Nigeria. The eradication campaign suffered serious setbacks in 2004 when the governor of Kano province refused access to healthcare workers carrying out immunisations after widespread rumours by Muslim leaders that the polio vaccination campaign was an attempt by the west to make Muslim women infertile. This led to an increase in outbreaks spreading to neighbouring countries, and it was only the later part of 2005 before the efforts got going again.

To use the existing polio drive and add such messages about avian flu is probably one of the smartest things to do. However, given such history, there must be a lot of wariness about any variations to the original planned activities, which I would imagine might have been allowed to take place only after strenuous negotiations. As the ‘messages’ that will be given to villages will include culling and loss of livelihood, concerns that it would not go down well with villagers or their Muslim leaders are very real.

So a direct and clear endorsement from the DG of the WHO can serve as irrefutable endorsement of the legitimacy of any such message. This would be especially important if outbreaks are found during these visits which would necessitate official interventions such as culling or quarantine.

Many Cats – at 21:37

Wow, Monotreme: I’m more pessimistic than you today regarding this statement (although I know you are only pessimistic regarding WHO phase pronouncements). I agree with you on all but the last part of the WHO statement: “All countries must take measures…to prepare for a pandemic. There is not time to waste.” Now I find that scary!!!

gs – at 23:17

there’s not much new in this statement. It looks like a typical “give us more money” statement. Not a “we know something which you don’t and it scary, but we won’t say what exactly it is” - statement. WHO has lost some credibility the last months, we need a second opinion.

All the causes of concern,risks,warnings,coulds,calls to prepare are not new and are pretty meaningless as long as WHO doesn’t give any numbers to quantify the risks.

Does WHO consider the probability of a pandemic now larger than it did last week ? They must have known that the migratory birds were heading towards Africa. Is it worse than expected ?

IMO the reason that WHO is now more and more desparately seeking attention is in their unprecise statements in the past and lack of propability estimates. Now the economics and journalists have already come up with their own estimates and they are low.

The media and markets didn’t react very much.

anon_22 – at 23:19

gs, read my post above on the the link with the polio vaccination drive. That may explain the need to make such an apparently ‘empty’ (in our opinion) in the first place.

Monotreme – at 23:25

anon_22: I don’t know the details of the polio campaign, so may be that is a place to warn people. But, what do you tell them? Just be careful not to touch sick birds? Not enough. People are going to get infected. Then what? My complaint is that DG is hiding the fact that infected people are one of the main vectors for transmission. It also occurs to me that bird flu probably spreads the same way ebola spreads, close contact with bodily fluids. If the DG continues to hide the frequency of human to human spread of H5N1, he is setting the African people up for Ebola-like spread of H5N1 via dirty needles, ritual washing of bodies, etc.

Many Cats: I think the DG is a sociopath, so I read his pronouncements differently than do people who respect him. I think he is way over his head and doesn’t know much more than we do. His pronouncements are not due to some keen insight into H5N1 virology, they are due to fear of blame. As Dr. Niman likes to say, H5N1 doesn’t read press releases. It does what it does regardless of what the DG or anyone else says. When H5N1 is not talked about it goes about its business of infecting animals and people. It doesn’t become more or less dangerous because people talk about it. H5N1 is infecting many animals, and some people, in many countries that are not on the official list. I find this much more alarming than the DG’s pronouncements.

anon_22 – at 23:26

Also, this virus is a concern in many different ways to different people. What is important on the ground in other countries may not even be known to us sitting in front of the computer. Unless we constantly try to put ourselves into THEIR situation not ours, we will have failed to properly evaluate or reflect on this problem. Sometimes we need to sort for different things, especially things that we don’t already know, not just estimates of the same things that we already know about. This is the lesson that I keep reminding myself.

Worried Well – at 23:39

anon_22, I agree. The WHO is a health organization but it’s also a political organization, and it needs the cooperation of local officials to get the job done. That statement seems crafted for political purposes.

Also, DemfromCT is right … the statement is addressing bird infection when it states, “No country is immune to H5N1,” and the part at the end about prepping for a human pandemic is the same thing they’ve been saying for weeks now.

Infection is spreading quickly and killing birds by the thousands, but any possible H2H so far has been confined to close contact. It’s still not there yet. Perhaps soon … but perhaps not.

My 2 cents (which is about all it’s worth).

Medical Maven – at 23:41

Will the history of this hapless tale of incompetence and fence-straddling by WHO ever see the light of day? Hope I make it to the other side so I can engage in a few sardonic chuckles. I would settle for a few belly-laughs, but those may be hard to come by.

MomInBCat 23:47

[http://today.reuters.com/News/Crise…oryId=N09237223]

Nigerian cases show bird flu’s rapid spread -UN Thu 9 Feb 2006 7:02 PM ET UNITED NATIONS, Feb 9 (Reuters) - The discovery of bird flu in Nigeria caps a devastating seven months in which the H5N1 virus has spread rapidly from South Asia into Eastern Europe, the Mediterranean, the Middle East and now sub-Saharan Africa, a senior U.N. official said on Thursday.

While there is as yet no evidence the virus has mutated to the point it can spread from human to human, “it’s not far away,” said David Nabarro, who heads the U.N. drive to contain the pandemic in birds and prepare for its possible jump to humans.

“I don’t want to scare anyone but the truth is this virus is undergoing changes slowly,” Nabarro told a gathering of advocacy and humanitarian groups at U.N. headquarters. “This warning that nature is giving us has to be heeded.”

Bird flu has killed at least 88 people and infected 165 since it re-emerged in late 2003, with most of the victims in east Asia.

The World Health Organization and other experts say H5N1 is poised to mutate into a form that passes easily from person to person. If it does, it could spark a human influenza pandemic in which millions could die.

As recently as last June, the disease was confined largely to birds in southern Asia, Nabarro told the U.N. gathering.

But in the seven months between June and last month, “something fairly devastating happened,” he said.

“It spread massively across the world, into Siberia and Russia, into Mongolia, up toward the Baltics, into Kazakhstan, into Turkey, into Romania, a little bit into Greece, into Iraqi Kurdistan, into northern Cyprus.”

Cases of the virus were confirmed this week in northern Nigeria, followed by bird die-offs in other parts of Nigeria as well as in neighboring countries, he said.

“The virus now has very definitely found its way into the African subcontinent, and we have a different situation that has emerged with even more H5N1 in our world,” Nabarro said.

The good news, he said, is that the world is gearing up to deal with the crisis, strengthening veterinary health services, improving the readiness of human health systems and getting out the word on what people must do to combat the disease in birds and prepare for the possible human disease, he said

MaMaat 23:49

An opinion from some of the people living in this situation…one of the most sensible things I’ve read today…

“Poultry farmers who spoke with our correspondents on Thursday expressed concern over the outbreak of the virus in the country and called on the Federal Government to urgently quarantine the whole country.

A poultry farmer in Effurun, Delta State, Mr. Omonigho Osevwe, said the government must not treat the matter with levity.

He said, “The government should quarantine the entire country to curtail the spread of the deadly disease. We pray that this serious matter will not be politicised, otherwise the effect will be catastrophic.””

…more…http://www.punchng.com/main/article03

10 February 2006

anon_22 – at 00:08

Monotreme, I don’t disagree about the lack of opennes of the WHO.

Maybe I didn’t express myself very well. The polio campaign story is a window into the difficulties of public health initiatives. Yes, we need to tell people to not touch sick chickens. If you think this is not enough, and if you can understand that even this is a goal that is not to be taken for granted in places where communities are impoverished, illiterate, superstitious, and completely under the control of local or religious leaders, then you are halfway to understanding how much of an uphill struggle Africa is going to be.

This problem is far from unique. I remember reading about the smallpox eradication campaign by Henderson in the 60’s. Whole villages would refuse vaccination based on a rumour or the word of a witch doctor. There was a story in an area where the outbreak was particularly desperate where whole villages refused vaccination because the village chief said the vaccine would give them smallpox. After many failed attempts at negotiations, they (this was a team of nurses and technicians) decided to do it by force. They stormed the chief’s hut at night and forcibly vaccinated him. After that, they were able to vaccinate the whole village and stop the outbreak.

Now this was just the superstition of one village chief. In today’s climate of hostilities and suspicion between the Islamic world and the West, the situation has to handled with even more delicacy. If it was possible for whole regions to subscribe to the believe in the polio vaccine conspiracy, how much worse would it be now, given that the control of avian flu involves killing their chickens and taking away what may be the most important source of food and income for most people?

There are many sides than just whether the WHO is competent or whether the DG is what he is supposed to be. I owe my understanding (what little there is) to people like Henderson who was not afraid to use unorthox means to achieve a seemingly impossible goal, and to Laurie Garrett and others who wrote about this.

Monotreme – at 00:49

anon_22: I don’t dispute the difficulty of vaccination campaigns or other public health initiatives in areas where superstition conflicts with sound medical practice. However, I don’t think this is germane to my point. The DG is a sociopath, IMO, hence, he is not motivated to help other people. He is motivated to help himself and those he thinks will help him. Africans are not going to help him. The plutocrats that run China will. So, he will let the former die to help the bottom-line of the latter.

My point about the possibility of dirty needles and ritual bathing of the dead spreading H5N1 the same way Ebola spreads is in fact in agreement with your comments about the problems of public health campaigns in Africa. All the more reason that health professionals and responsible government health officials should know the truth about the clusters and the fact that H5N1 is often spread human to human by close contact with bodily fluids. Public education can be difficult, but it can work. But only if we start with the truth.

gs – at 00:56

mono, who is DG ?

anon_22 – at 01:06

gs, Director General (of the WHO)

anon_22 – at 01:18

Monotreme, I don’t know if the DG is a sociopath so I can’t comment. But if he or someone on his staff has woken up to the fact that they can use the next round of polio campaign which is happening in 2 days to put in some additional effort on the avian virus, I think we ought to give them a pat on the back. The machinery of WHO and African governments move extremely slowly as we know, for better or worse, so it must have been not easy to even get the idea accepted by the main players involved.

To quote the late chinese leader,Deng Zhao-Ping “it doesn’t matter whether it’s a black cat or white cat, if it catches mice, then it’s a good cat.”

The DG may be a sociopath and gets everything wrong and screws us all up, but if for once today he was maybe not just out there covering his backside but maybe showing some initiative, I count that a small victory. Like vaccinating the village chief.

Or I maybe wrong.

anon_22 – at 01:20

I wouldn’t be surprised if the army of HCW doing the village rounds will have a copy of today’s statement in their bags, in case they get challenged by the Islamists.

dubina – at 02:26

AnnieB – at 15:40

“For the Director-General to make a statement within “hours” of an outbreak (and no human cases confirmed as yet) sent chills down my spine.”

“Although the message is the same about preparedness and time is of the essence, the fact that he made this statement so quickly is the chilling part.”

Not so chilling in a way, but chilling in another.

It’s been reported that the initial outbreak (poultry die-off) began on January 10th. The first public announcement of H5N1 in Nigerian birds was reported on February 8th out of lab tests in Padua, Italy. The Padua lab is a facility of the OEI, joined at the hip to the WHO by earlier agreements. As we all know, transportation and lab testing takes some time, days or even weeks, so the test samples must have been collected in Kaduna sometime from mid to late January, quite possibly by OEI / WHO field personnel.

Let us then recall the welling H5N1 outbreak in Turkey and WHO’s tardy performance there in that same interval of time.

Melanie thought possibly the OEI might not have thought to inform WHO of an HPAI outbreak in Nigeria. (“The two organizations don’t have coffee”, she said, or something like that.) Furthermore, it seems the OEI didn’t issue any public reports of said Nigerian HPAI or their involvement in it.

The only obvious explanation of this timeline is that two outbreaks, including the Nigerian poultry outbreak, which may prove to be the more ominious of the two, may have been too much for the now infamous WHO clear communications policy to bear.

Monotreme – at 08:52

anon_22: I appreciate that the polio program might be a good idea given the local politics, I just don’t know enough about it, so I don’t dispute your point about this. However, I think there is virtually no chance that WHO personnel will be successful in eradicating H5N1 in birds (wild or domestic) in Africa at this point. Nor do I think they will be successful in convincing the people who depend on chickens for their protein to give them up any time soon. If the DG was serious about saving Africans, he would have started these programs months ago. The problems we see now were entirely predicatable. See this thread at the Agonist that I started on October 15 2005. The mass starvation of Africans once the pandemic starts and the food producing countries focus on keeping their own people fed is entirely predictable as well. Any planning by the WHO for this?

Again, I will repeat my other prediction. The failure of the WHO to admit that H5N1 is frequently spread via close contact with bodily fluids is setting Aficans up for many deaths via amplification at hospitals with improper use of needles and during ritual washing of bodies. I write this hoping that a member of a responsible aid group, clearly not the WHO, will read this and warn Africans to treat H5N1 infected patients as they would Ebola infected patients. Seattle Sue, I’m thinking of you.

Melanie – at 09:28

I don’t have a problem with kicking the WHO around, but lets acknowledge that they are also hobbled by the constraints of the available science. The only reliable tests for H5N1 take weeks to run and WHO can’t make declarations which have economic and political consequences without having the science to back them up.

food storage nut – at 09:32

Melanie, I asked you on a different thread a question but now it is buried and I don’t think that you will see it. You stated that the administrators of the fluwiki included two flu practitioners. What is a flu practitioner?

Melanie – at 09:35

A scientist.

food storage nut – at 09:38

What kind of scientist? Currently working with influenza strains? Am I asking too many personal questions?

Monotreme – at 10:18

Melanie: I recognize the problems with collecting samples in remote locations etc…

However, writing down when people got sick, when they died and who among the other patients they are related to is not hard. In fact, it has been done. See this page? for the results. No elaborate scientific equipment or procedures were necessary to collect this information, only a pencil and a piece of paper. Of course, we still don’t have this simple data from the Turkish clusters. Why not?

The obvious conclusion from examining the available data is that H5N1 is frequently transmitted between people in close contact with infected patients. I am quite sure the Director-General knows this. He also knows that Ebola is transmitted the same way. He knows that there are problems with reusing medical supplies, like needles, in African hosptitals. He knows that many Africans have been infected with Ebola via ritual washing of dead bodies. It is perfectly obvious that Africans are at risk of being infected with H5N1 the same they have been infected with Ebola or Marburg. Failure to warn them of this risk is tantamount to murder, IMO.

This will have consequences for the rest of us. Bird to human transmittal of H5N1 is less likely to spark a pandemic than human to human to transmission. With each passage of the virus in a human host, the virus has additional opportunities to become adapted to humans. Ebola-like outbreaks of H5N1 in Africa provide unprecedented opportunities for the serial passage of H5N1 in humans. Every virologist knows what that means.

niman – at 10:24

The is a new snow job underway on S227N

http://www.recombinomics.com/News/10220501/H5N1_H9N2_Recombination.html

See comments at

http://effectmeasure.blogspot.com/

on limits on genetic constellation

http://www.recombinomics.com/News/01190601/H5N1_Turkey_S227N_E627K.html

This is almost CERTAINLY a selection issue tied to using chicken eggs (selecting away from S227N) for the Turkey isolates.

Melanie – at 10:28

food storage nut,

If they want to tell you more, they will.

Monotreme,

The WHO teams are on the ground now. We’ll have more data by the end of the month. Remember that ordinary seasonal flu kills, too, and differentiating it from H5N1 takes testing.

Top Cat – at 10:34

Can you say “Olympics” ?

niman – at 10:55

WHO has isolates from Turkey and they have reported S227N and now are trying to say it was limited to the index case in Turkey.

WHO is abusing their “testing” procedure and focusing more on propaganda than science. First they withhold disease onset dates and relationships of victims in Turkey and Iraq.

Now they are putting out nonsense on S227N.

More science and less “management” would be useful.

crfullmoon – at 11:22

I had only hoped the DG was only putting things the way he does because if he didn’t he’d lose his job and perhaps a worse person would be put in. It does seem like he has given clear warnings about how soon and how deadly this could go pandemic, but it has to be interleaved with all the political, keep the economy going ‘til the last moment (since we can’t prevent pandemic anyway) crap.

But so much more could be being done to warn the public clearly and isn’t; it is surreal and wrong.

Too late for culling in Africa, but if paying the people to not eat the sick birds, and helping them dispose of them correctly and getting them something else to eat (were put on a war-priority footing, it could be done)-maybe using the existing campaigns to add H5N1 info will help some; every agency worldwide could be educating the public, but, they didn’t get the memos last year.

Between the pervasiveness of H5N1 and all the un-ideal situations on the ground, the world seems doomed.

April – at 11:25
  1. %@&!
April – at 11:27

Well, that did not work exactly as I typed it. It started off as a four letter word.

anon_22 – at 11:59

Monotreme, “Again, I will repeat my other prediction. The failure of the WHO to admit that H5N1 is frequently spread via close contact with bodily fluids is setting Aficans up for many deaths via amplification at hospitals with improper use of needles and during ritual washing of bodies. I write this hoping that a member of a responsible aid group, clearly not the WHO, will read this and warn Africans to treat H5N1 infected patients as they would Ebola infected patients. Seattle Sue, I’m thinking of you.”

Agreed! On this it is my turn to be pessimistic. No, fatalistic actually. These things are not going to change any time soon. The whole thing deserves a book.

But don’t let my pessimism affect your vigorous contributions. We need people like you who are willing to call things by their names and are energetic enough to take action. I am completely behind you on this, for what it’s worth.

anon_22 – at 12:07

Melanie, “I don’t have a problem with kicking the WHO around, but lets acknowledge that they are also hobbled by the constraints of the available science. “

I don’t disagree. However in the case of Africa I think the constraints (at least the immediate ones) are more political and economic.

Melanie – at 12:14

Anon,

All true, but the seroprevalence and other tests take weeks to complete and WHO has to have the science behind them before they ask governments to start taking very expensive actions.

Eccles – at 12:19

CRFullmoon - Remember, that getting the people something else to eat is not going to work. This is Africa, the continent where famines occur not because there is a shortage of food, but becuase the local Warlords and national governments either divert the food to their own followers, or else just pocket the proceeds and to hell with everyone else. Darfur is not particularly about shortage. Why would we expect anything different elsewhere?

anon_22 – at 12:25

Eccles, you are absolutely right. Untangling Africa could be the work of several generations.

kristy – at 12:27

Is anyone else concerned about the Olympics being a possible catalyst for H5N1 to fly around the globe quickly?

Medical Maven – at 12:38

Kristy: Soon, every gathering, anywhere in the world will be a “flashpoint”. I think b2h will possibly get to North America via South America and Central America and will probably get started with a single act of smuggling. The societal conditions and governmental controls in much of South America and Central America aren’t much better than Africa’s. The Third World brings down The First World, but not quite in the way that they envisioned.

Pilgrim – at 12:55

I’m continually amazed by the vituperative comments directed against WHO. John M. Barry, author of “The Great Influenza,” has praised them, especially as they have funding/personnel limitations. (Melanie above also makes this point.) Maybe they don’t have the ultimate answer about everything panflu-related, but I believe they offer some information worthy of regard. Maybe even gratitude.

Or could the feeling be related to a wide-spread (in some places) contempt for the United Nations?

Medical Maven – at 13:12

The United Nations is corrupt and ineffective. The “Oil for Food” scandal is just the latest manifestation. But beyond that extraneous aspect, you have to realize that a very large proportion of the member states are these same corrupt nationstates down in Africa that we are slamming for being ineffective and on-the-take. So understandably, the larger organization accurately represents its members. What else would you expect?

Dictators, despots, and out-and-out madmen offer up “their” men for this exalted United Nations duty. And their duty is to delay, delay, delay, and, if the opportunity arises, extort some money for their own purposes.

Pilgrim – at 13:14

Wow.

kristy – at 13:19

I was wondering if anyone can post the link to the article by the WHO Director General? The link in the original post is not working for me, and I want to print it for someone!!

DemFromCTat 13:24

It’s on the mani page of Flu Wiki, upper right in the ‘tips of the week’ space.

dubina – at 13:27

Pilgrim,

Yes, the WHO has done a lot, no doubt of that, and deserves our gratitude for doing so.

On the other hand, with so many lives in the balance now,if they have “funding/personnel limitations”, we can’t rest easy. Oh, they have funding/personnel limitations so I guess it’s OK. No, it’s not OK. They, more than any of us, know what’s at stake and what might best be done to prevent or mitigate. They’ve know a bit of what they know now for years. If they have funding/personnel limitations. it’s their problem and their fault…for not being more forthcomomg, more solicitous, more proactive…you get the picture. In the military, there are no excuses for failure. If a particular Air Force Wing fails its ORI, the Wing Commnder and some of his staff may get desk jobs from there to retirement. Same in business to some extent, except the savvy CEO takes pains to confuse his performance with “unforeseen events” and “circumstances beyond his control”. That isn’t so hard to do, by the way.

Furthermore, you ought to consider that well-deserved public criticism levied at the WHO strenthens the hands of factions within the WHO and other organizations who might be better situated to take action fit to purpose. WHO has proactive thinkers, you may be sure of that. (Search this site for “draft protocol” (for a WHO rapid containment force). Be advised the US and France have agreed to take unified action in that area.

Why does WHO persist at Phase 3 when the DG says “H5N1 is spreading rapidly across the world. All countries must take measures to protect human health against avian flu, and prepare for a pandemic. There is no time to waste”?

What can this possibly mean? There’s no time to waste, but it’s still not time to interrupt the way we are?

Perhaps the DG’s lack of determination is colored by the fact that China has relatively few ways to prepare for pandemic beyond Phase 3. North America and Europe, on the other hand, have relatively many ways. It would be meanspirited of me to think that of his consciousness, but I will think so anayway as a trial balloon. There are plenty of trial ballonos to let go in aid of getting some prompt, convincing explanation.

Pilgrim – at 13:37

Yikes.

kristy – at 13:48

Thanks DemFromCT =]

clark – at 14:31

http://www.who.int/mediacentre/news/statements/2006/s03/en/

kristy – at 14:38

I wish I could find the other one that Dave Nabbaro of the UN made yesterday also.

anon_22 – at 14:39

It’s at the other thread now.

dubina – at 14:46

Clark,

I presume you’re putting up the link so people can message several of the WHO “Communication Officers”.

Best of Kiwi Luck. Having posted them several links to Flu Wiki threads in the past, my experience was substantially zip. I did trap a WHO lurking the forum (caught him or her on the sitemeter), but I got no personal reply and I found no WHO responding as such to our threads. I suspect their idea of good communication is a one-way street.

That said, if anybody writes to the WHO asking for clarification, please tell the Wiki in turn what, if anything, they have to say.

clark – at 14:50

Hi All For a moment, completely forget about H2H, WHO, Henry Niman and prepping. What has got me in a daze is the realization that soon, we will all be living with this virus- which we know so much about. Within 12 months, probably much sooner, birds will be dropping it from our local sky. Our lakes and ponds will be contaminated. It is because of the migratory paths of birds.

Once the virus is endemic in our local birds- it is not going to go away. There will be nothing we can really do. It will be like trying to control ants, wasps or couch grass. We will have to live with it- and it will go on for a very long time (IMO)- years and years and years.

Once the virus is endemic everywhere, there is no urgency for it. It is part of the landscape. It can do what ever it wants to whenever it wants to.

It will no longer be “Here we are prepping” and “there the virus is spreading and replicating”

Many people have a fixation that what the WHO says or doesn’t say is somehow meaningful. This virus is completely out of our control. In the medium to long term, I hope we can can advance on the vaccine developemnt front.

niman – at 14:53

H5N1 has entered the East Atlantic Flyway

http://www.recombinomics.com/News/02100602/H5N1_Lagos_EAF.html

kristy – at 14:58

Great. Now H5N1 has a direct path into our yards.

Racter – at 15:00

clark:

“Once the virus is endemic everywhere, there is no urgency for it. It is part of the landscape. It can do what ever it wants to whenever it wants to.

It will no longer be “Here we are prepping” and “there the virus is spreading and replicating”

I think you are failing to fully appreciate the significance of the H2H/B2H distinction.

clark – at 15:00

That is right, fellow pilgrims.

Racter – at 15:02

When the bug makes the jump to H2H, it doesn’t matter whose yard it happens in.

kristy – at 15:08

Very true. But assuming the H2H holds off, it’ll still end up in our backyard anyway.

jack walt – at 15:08

Clark. We have to make the best of this situation. In any former time like this there were people who did it the right way as well as people who did it the wrong way. We must make the choice which way we choose to. The begining and the the end of such times is when the most important decisions are made. We all have to choose our course of action. For myself it’s easy. My view of the grand sceme of things are as follows. There is a creater of life. This is my faith. The way i express love to this creater is by my actions concerning my fellow human beings and the earth. I’m not trying to convert anyone to my views. This is simply stated how i appoach life at any time includeing now.

clark – at 15:21

Hi Racter at 15:00- I guess up until yesterday, I was spinning out about the H5N1 going effeciently H2H. I worried, that it would get into the major airports via infected, non symtomatic travelers. Before we knew it, the H5N1 virus would be everywhere. That is why we were prepping- if the unthinkable happened.

That was scary in a “what if H5N1 goes efficiently H2H” sort of way. Reading here and curevents made me think it was a possibility. We talked endlessly about probabilities (our friend GS!) Some at fluwikie thought that H2H was highly likely. Some here thought that it was highly unlikely.

None of my realworld friends even think about the H5N1, let alone worry about it. It has been reassuring in some ways to be such an odd person out.

My epiphony was yesterdays, DG WHO’s statement, basically saying that we will all, soon, be in the same situation as the people of Africa, China, Iraq- SE Asia. I somehow, erroneously, imagined that the H5N1 was going to have to go H2H in order to reach me in New Zealand.

It is not. It is coming via birds. And it is on its way this minute as I type. A viral special delivery. Racter, you are absolutely correct about the distinction between B2B, B2H and H2H.

In a nut shell. This virus scares me. Having it in Turkey scared me. Having it on my front lawn scares me even more.

Racter – at 15:24

Whether an H2H form of the virus arrives in my backyard anytime in the near future or not, I regard the arrival of an avian form capable of infecting the birds in my backyard as a forgone conclusion. I’ll be very surprised if that hasn’t happened by this time next year. At the rate things are going, I’ll be almost as surprised if that isn’t among the least of my worries. Pleasantly surprised.

anon_22 – at 16:42

This is what I was talking about in my earlier post.

http://tinyurl.com/bkcmm

Nigerian state cancels Danish contract -

Lawmakers at Kano, one of the Nigerian states hit by avian flu, burned Danish and Norwegian flags and canceled contracts worth $27M in protest against the publication of cartoons depicting the prophet Mohammed. This is the context within which surveillance and culling is going to be carried out.

Even though most poultry are raised in backyard farms, the bigger commercial farms are likely to be controlled by local power figures, who are probably hand-in-glove if not the same as the politicians. I anticipate fierce resistance against culling and the fanning of accusations of anti-Islamic conspiracies as excuses to block health authorities’ actions.

The juxtaposition of world events, though tragic, is not entirely unexpected.

I wonder how much $$$$ is pouring in to buy them off? Ethical or not, the window of opportunity for even that may be closing fast.

dubina – at 17:18

Clark,

“My epiphony was yesterdays, DG WHO’s statement, basically saying that we will all, soon, be in the same situation as the people of Africa, China, Iraq- SE Asia.”

You’re right in a way, and wrong in a way. I’ve been to Lagos, Warri, Port Harcourt, and believe you me, you’re in nowhere near the same situation, really. Your means of social distancing, your infrastructure, your political organization…are light years away from Nigeria. Some of your opportunities lie in making the most of your advantages.

clark – at 17:43

Jack Walt at 15:08 said”- We have to make the best of this situation.” Everything he says is correct in my view. I imagine that the coming months and years may put us all to the test. This could be the defining event of our generation. chin up

clark – at 17:43

Jack Walt at 15:08 said”- We have to make the best of this situation.” Everything he says is correct in my view. I imagine that the coming months and years may put us all to the test. This could be the defining event of our generation. chin up

007 in the USA – at 18:13

anon_22… I’ve decided that after the next beheading of some innocent at the hands of Muslims in the name of Allah, I’m going to sit down with a pencil and draw some really, really, mean cartoons.

Insanity. Pure and simple insanity. The crap that you pointed out in Nigeria (cancelling of the Danish contract) is a prime example of what we are up against in Nigeria. Eeeks.

anon_22 – at 18:30

Eeeks, indeed…

worst case – at 19:21

My husband has heard me complaining about the ^&*&^(_( Nigerians for a couple years now. I can’t tell you how many orders I get for my products from Nigerians using stolen American credit cards. In fact, every fraud order that I’ve ever received was from a Nigerian. There’s always something in their order that tips me off.

09 March 2006

MaMaat 12:14

Mbagathi District Hospital, Nairobi 9 March 2006

Statement to press conference- WHO Director General

http://www.who.int/dg/lee/speeches/2006/mbagathi_hospital/en/index.html

Lily – at 12:18

Yes indeed worse case. Read of a lot of scams of every sort from Nigeria. Big time stuff.

liza – at 12:56

Is WHO really so naive, or they are pouring money into Africa purely for political reasons? Isn’t it obvious that 99.9% of money that goes to Africa for any cause gets stolen?

It’s about time the world gets real.

27 May 2006

BroncoBillat 00:29

Older thread, closing for speed purposes.

check dates

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