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Letter: Bird flu pandemic
Wed, 04/23/2008 1:07 AM | Reader's Forum
More than 60 million people or some one fourth of the Indonesian population could be infected with avian influenza if the virus H5N1 gains the ability to spread easily from human to human, Bayu Krisna Murthi said (The Jakarta Post, April 19).
This is indeed terrible news for us, Indonesia, whose people are prone to any pandemic disease due to the following reasons:
First, Indonesia is a crowded country, especially on Java Island.
As such people may get infected by the virus easily as contact or close proximity is inevitable for family members living in small houses or shanties.
Second, since Indonesia is frequently in economic crisis, it will be so hard for the patients to get money for medical check-ups or to get the right medicine to recover. Third, the low development of medical sciences here may also aggravate the matter.
Finally, the low education of the majority of people is another factor in the spread of the disease.
Still another factor is that many Indonesian laymen and farmers have their hobbies closely related to animals, such as: bird keeping, domestic animal breeding, pigeon flying, ram fighting, puppy training, even cow racing in Madura and much more. These hobbies are boosting the spread of the disease.
Rose and Nicholl, in their book The Accelerated Learning (1997), noticed that there is a direct correlation between education level and health. Unless the authorities take serious measures, a bird flu pandemic may claim one fourth of Indonesian citizens.
ODO FADLOELI
Bandung
Threat of a future influenza pandemic
Health officials, scientists and people everywhere should be heartened by the efforts of Indonesian health officials to respond to the threat of a future influenza pandemic.
However, an estimate of the number of Indonesians who might die in a pandemic should be based not on the mortality experience of 1968 but on what might be expected if the current H5N1 virus develops pandemic capabilities.
The mortality rate from H5N1 infection in Indonesia has been approximately 80 percent, and it has been 100 percent in those who have not received antiviral treatment. In the event of an H5N1 pandemic, adequate supplies of antiviral agents will not be available, with predictable consequences.
Likewise, specific vaccines will be in very short supply and will probably arrive late, if at all. However, there is reason for hope.
Several investigators have shown that widely available and inexpensive generic medications that modify the host response in patients with pneumonia and seasonal influenza might reduce pandemic mortality.
Unfortunately, influenza scientists have not paid much attention to this work. For this reason, Indonesians could help themselves and people throughout the world if they would urge scientists and health officials to focus their attention on the possibility of using one or more of these generic agents to manage what otherwise might be an unimaginable global health crisis.
DAVID S. FEDSON
Sergy Haut, France
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Lisa the GP (not verified) — Wed, 04/23/2008 - 5:03am
One of the agents which may possibly assist in the event of a highly pathogenic flu pandemic, is atorvastatin. This drug is commonly used in western countries under the brand name 'Lipitor', to control high cholesterol levels.
It has been found that people who are on this drug have about a 30% reduction in their risk of developing ARDS (acute respiratory distress syndrome) when hospitalized for any reason.
Since ARDS is the primary complication responsible for deaths during H5N1 infection, any drug which reduces the risk of ARDS may possibly be helpful in reducing deaths from H5N1 infection. However, this has not been proven in any kind of clinical situation involving H5N1.
I suggest that the medical establishment within Indonesia investigate whether this drug, in addition to the Tamiflu already given to H5N1 patients, has any effect on the mortality of the virus.
I also suggest that the medical establishment investigate the concentration of this drug which occurs naturally in the common folk-cure, red rice yeast. Long after atorvastatin was discovered synthetically, red rice yeast was discovered to be a natural source of the same compound. This may be an inexpensive way for Indonesia to provide at least some of its own medical recourse should a pandemic occur.
IF it can be shown that atorvastatin is useful in reducing deaths from H5N1, and IF the amount of atorvastatin typical of red rice yeast can be determined so that an equivalent dose in yeast can be set, then this may provide at least a small margin of hope that Indonesia can save more of its people, should a pandemic of this virus occur, and should a pandemic strain retain a high mortality rate.
At this point, this remains an educated conjecture. But, since Indonesia has cases of H5N1 upon which to test this conjecture, and since such a test is unlikely to bring further danger to the H5N1 patients, I hope that your medical people are able to try atorvastatin in this context.