Situation in Ukraine – November 13, 2009

It is now two weeks since the crisis in the Ukraine began. Although only a small number of deaths were reported at the time, the government of that country took extraordinary steps to contain outbreaks in the western part of the country including: closing all schools for 3 weeks, banning public gatherings and restricting movements between the affected region and the rest of the country. What prompted these draconian actions?

We still do not have a complete picture, but we do know more. The most recent report suggests that there about 265 dead of flu-like symptoms. Assuming that these are mostly due to H1N1, the incidence of death for Ukraine would be about 0.6 per 100,000. This is about the same as the United States. Given that the virus has only recently started to cause deaths in the Ukraine, this would suggest a very rapid increase in the number of victims. Thus, the strong measures taken by the Ukraine government would appear justified. Had they not acted as forcefully, the death toll might be much greater.

The question now is: why has the pandemic flu caused such a rapid increase in the number of deaths? One possibility is that a poor public health care system in Ukraine and initial dithering by government officials allowed the virus to spread and kill without the benefit of modern medical countermeasures such as Tamiflu. There is significant evidence that these factors contributed to the crisis. However, reports have come from multiple sources within Ukraine suggesting that not all of the deaths are due to H1N1.

From Earth Times, November 13, 2009

Doctors in Ukraine’s western Chernovetsky region, near the centre of the flu outbreak, said lab tests showed at least some of the fatalties appeared to be caused by a flu dissimilar to both common flu, and swine flu.

“The virus causing the deaths is extremely aggressive, it doesn’t first infect the throat (as is common in flu), but strikes the lungs directly,” said Dr. Viktor Bachinsky, according to a ZIK news agency web report.

It is not clear how reliable these reports are. Is this a matter of insufficient clinical experience with a pandemic strain and inadequate equipment for proper testing? Or is there truly a new and more lethal virus circulating in Ukraine? Although samples were sent to the National Institute for Medical Research (Mill Hill) in the United Kingdom weeks ago, no sequences have been deposited in GenBank. Given the urgent nature of determining whether a new virus or strain is in play, the delay in making results public is puzzling.

Although we know more than we did two weeks ago, we still don’t know if all of the deaths associated with influenza-like symptoms are caused by the new H1N1 virus or whether it has become more virulent. The researchers at Mill Hill in England have the answer. But they aren’t talking. I can’t help but wonder why.

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