Interesting dude this Kernow / American -

Thursday, May 26, 2005

Ten years later.
Nguyen Van Duc lit a solitary candle in honor of Buddha, then relaxed in his favorite armchair and raised a glass of quoc lui to his lips. He very rarely drank, but today was a special occasion, an anniversary of some proportion. As the warming liquor flowed from his mouth to his throat, he remembered the day, exactly ten years ago, when he had dragged himself, his throat burning, his lungs pleading for air, into the emergency room of Hanoi's French Hospital. He hadn't needed to be a second year medical student to know that he was suffering from avian flu. What scared him almost as much as his inability to breathe properly though, was the fact that he'd had no contact with birds, or any animal that he could think of. In less than an hour he'd been isolated and they were giving him the anti-viral drug Tamiflu. Soon after, a flood of masked health workers descended on his bed, asking questions; had he been in proximity with chickens or ducks, or with pigs - they'd been especially concerned about the contact with pigs - had he seen anyone sick near him, where had he been in the last two days, how many people had he had close contact with? After a while the guy who seemed to be in charge, an italian as far as Duc could tell, came in and repeated all the questions, not just with a tape recorder but with a sense of urgency that scared Duc.The Tamiflu had helped, but the questions proved too much, after a while the fever took hold and he passed out. By the time he awakened about twenty hours later seven more cases had been confirmed in Hanoi central. Being in good shape, Duc recovered fully within the next couple of days, and, being the only person in Hanoi to now have natural immunity against the virus, he immediately volunteered to help the international health teams in the city in any way he could. It was not just that he had immunity, but also that he had to keep himself busy, had to keep his mind off the feelings of guilt that seemed to be growing within him with each confirmed case. After a week the schools and universities in Hanoi were closed, and without classes and schoolwork, Duc now immersed himself 24/7 in his volunteer duties. He would assist in the collection, transport and, after a while, even the analysis of blood samples. He would communicate information about new cases, deaths, changes in symptoms to the relevant health workers, scientists and officials. He soon became as knowledgable about the flu virus and its spread as anyone.Yet he couldn't escape the deep, eroding sense of guilt that ate away inside him. He'd been told so many times that, because he hadn't had direct contact with animals, he almost certainly wasn't the first to be infected with the new strain. Yet they couldn't assure him with certainty that his body had not provided the host for the last step in the mutation of H5N1 into the highly infectious Hanoi strain. As far as he was concerned they might as well have called it the Duc virus. Each day he watched, with horror, the news reports of new cases in new places. He would see only the eyes of those infected and of those in fear of infection, the rest of their faces covered by masks, usually home made from whatever they could get their hands on and totally useless.Sometimes those eyes seemed to be looking at him through the camera, accusing, pleading, hating.Within a week of Duc walking into the hospital, 107 cases of flu had been confirmed in Hanoi, 12 had died. Within a month the number of cases in Vietnam and neighboring Laos, Thailand and Cambodia had risen to seven to eight thousand, it was becoming increasingly difficult to accurately gauge numbers. Over the course of the next month the pandemic gained momentum, spreading through the Asian subcontinent like a wildfire; China's previous experience with SARS proving useless in the face of the onslaught. By the end of the third month, despite the early grounding of all commercial flights out of South East Asia, flu cases had been confirmed in cities overseas; Kyoto, Cairo, San Diego, Vancouver, Buenos Aires, the number of cities the virus had hit and the distance it had travelled increased day by day. It was now officially a global pandemic and by the end of the fourth month virtually every country in the world had been stricken. Nation after nation proved unprepared for the onslaught of the pandemic.Pre-existing vaccines were no defense against the new flu strain. The United States had stockpiled enough antiviral drugs for barely 2% of its population and the distribution of these limited reserves to a select few resulted in social unrest and violence to a completely unexpected level; the world's greatest economy was brought to its knees in a matter of weeks. Western european nations had been somewhat better prepared; the United Kingdom had enough antivirals for more than 30% of its population. But it was in the developing world that the virus unleashed the full ferocity of its nature. It would not be until long after the pandemic had run its course that the world discovered the full extent of the unimaginable devastation of human life in most of Africa and parts of Asia.The first effective vaccine became available in the US six months after Duc had walked into the French hospital. By that time more half a million Americans had died. The vaccine was soon available in other countries rich enough and with the industrial base to support its production. Those countries vaccinated their own populations first; most of the world's poorer countries did not receive any vaccine until after the pandemic had run its natural course. The pandemic was declared over about ten months after it had started - the virus would of course return, but the world's population would then have natural immunity to fight it.The 1918 Spanish flu pandemic had killed about 40 million people worldwide. By the time it was over, the 2006 Hanoi flu pandemic had killed an estimated 45 million.Duc continued to work within the Vietnamese health authorities and in close liaison with the WHO to find out as much as possible about the origin and spread of the Hanoi strain. Soon he turned his attention to the prevention of the next pandemic, whenever it may come. Eight years after the Hanoi pandemic he had become South East Asia's leading expert on flu epidemiology and prevention and was highly respected throughout the world's health and medical organizations. Few knew that he was the first documented case, the index case, of the Hanoi flu. But he did and it would weigh on him for the rest of his life."Blow out the candles honey!"Molly leaned over the ten candles on the cake and drew in a big gulp of air. As she did, Dave's mind flashed back to the day she was born. He had been in Vietnam leading a multi-discipline team tracking the course of the avian flu virus H5N1. He'd desperately wanted to be back in the States for the birth of the twins, but things were getting scary and there was no way anyone on the team would be able to go home for a while. Unlike chickens and ducks, the natural hosts for H5N1, pigs could be infected with both "bird" and "human" flu viruses. Pigs provided a melting pot in which the "bird" virus, which could not be transmitted between people but which they had no immunity to, could recombine its DNA with "human" flu viruses that had already infected humans, i.e. that were capable of jumping from person to person, but which humans had immunity to. Dave's team had two major goals; 1) track the changes in the DNA and animal hosts of the virus to try and predict where and when the most likely outbreaks of human transmission might occur and 2) if a human infectious virus strain did emerge, to rapidly analyze its DNA to (a) determine if pre-existing vaccines might be useful and (b) provide a template for production of new vaccines.The phone rang, Dave quickly looked at the number - Susy was due - but it was another number he knew well."Paolo, hi.""Dave, we have a walk-in case with no animal contact, full symptoms, credible history, you need to get over to Hanoi central.""Okay we're there Paolo."Dave flew ahead to Hanoi by helicopter while the rest of the team quickly readied the level 3 mobile containment lab, one of only three in SE Asia. By the time Dave arrived in Hanoi they had another case, things were getting really bad. Fortunately Paolo was really on the ball and had blood samples ready to go, they just needed to wait for the containment vessel.Within a day they'd ascertained that pre-existing vaccines would probably be useless against the new strain. They now had one goal; determine the DNA crossovers that had occurred between viruses to provide a vaccine template. Working around the clock they got the template in four days. Breaking the unofficial world record by about a month came as no reward to anyone in the team; making the vaccine would take a lot longer.Dave had spent years arguing that vaccine production needed to be ramped up - implement reverse genetics so that vaccines could be generated only with DNA fragments, change vaccine production from chicken eggs to vats of tissue culture animal cells and, most importantly, actually get the companies that made vaccines to actually make them in sufficient quantity. The night before he'd left for SE Asia, Dave and Susy had had a few close friends over for a cook-out. Dave and Stan had gotten into the same old argument."Dave, can you give me any reason why a Pharmaceutical company should be compelled to produce sufficient drugs or vaccines to cover EVERYONE in the world? They don't possess sole pole position in the conscience race you know.""I understand that Stan, but look at it this way. If the US Government wants a bunch of stealth bombers made, they don't go to Lockheed and say 'If you build us a dozen B-2's we'll pay you for them if and when we need them.' No, they go ahead and pay them in advance to build them. So why doesn't the Government do the same with Pfizer? Why pay up front for weapons that kill people and pay in hindsight for weapons that save people?"Now all Dave's worst forebodings were coming to fruition - antivirals were inadequate in supply and efficacy, vaccines were a long way off and he was stuck in Asia in the middle of a deadly flu pandemic.He was finally able to fly back to the States once the pandemic had spread there - there was no longer any point in excluding them. Before he left Vietnam he phoned Susy;"I'll be home before you know it - can't wait to see Molly and Melanie!""We can't wait either hun."She didn't tell him the twins were coughing a little - everyone was these days, nothing to worry about.By the time Dave's plane touched down Melanie was dead. Molly would pull through, as you already know, but Dave would never see his other daughter alive.Molly leant forward and blew as hard as she could on all ten candles. They all went out! WooHoo!"What did you wish Molly?" asked Susy."That's my secret Mom!" said Molly, smiling through her tears.Susy and Dave both knew that Molly had made the same wish she'd made the year before, and the year before that, and the year before that, and.........Duc placed the empty glass back on the table. Extinguishing the candle between his thumb and forefinger, he stood up and started walking toward his study. There was work to do.Next time they would be ready.

He only posts twice a year but when he does - duck - Steve at www.scienceexplained.blogspot.com

Gord night