After bne's initial scepticism about the severity of the flu outbreak in Ukraine, things have taken a turn for the worse.
It seems the virus that's on the loose in Ukraine has mutated into a more virulent form, says the World Heath Organisation (WHO). bne was commissioned to write a report on the bird flu virus a few years ago by the WHO and attended the scientific conferences in the Hague ahead of the political meetings to coordinate a response a few months later in Geneva.
The scientists then warned that the danger of these viruses was not the current form, which can kill though isn't particularly lethal, but the fact that this family of "animal" viruses are very unstable and can easily mutate into more contagious and deadly forms; in order to jump across the species divide, the virus has to be almost by definition unstable if it is to be able to adapt itself to attack first an avian or porcine host and then move into humans. Once in humans, the virus continues to adapt and while the avian version never changed into a form that did much damage, the porcine virus seems to have mutated into a more contagious form in Ukraine, albeit not particularly deadly yet.
The WHO said on Wednesday, November 4 that the strain of the porcine virus affecting Ukraine "has been caused by the H1N1 pandemic flu subtype."
"Laboratory testing in Ukraine has confirmed pandemic H1N1 influenza virus in samples taken from patients in two of the most affected regions," the WHO said in a statement, reported newswires. "As the pandemic virus has rapidly become the dominant influenza strain worldwide, it can be assumed that most cases of influenza in Ukraine are caused by the H1N1 virus."
Ukraine's health ministry reported on the same day that the death toll had risen to 81 as of this week and Ukrainian chief public health official Oleksandr Bilovol said up to 12m citizens could be infected with the virus by the end of next year. "Taking into account susceptibility to the pandemic flu virus, there is a general indicator of the number of patients, which we have calculated based on WHO recommendations and which could amount to 25% of the entire population," Bilovol said. "About 12m people will be down."
About 1% out of the 12m patients in Ukraine will require hospitalization, and some 18,000 people will have to be put in intensive care, Bilovol predicted.
Ukraine has already recorded more than 250,000 cases of influenza-like illness, with 235 patients requiring intensive care, the WHO said. Ukraine's authorities put the number infected at much higher, saying the number of those officially diagnosed with flu or other acute viral infections in Ukraine reached 450,000 as of November 4, Bilovol said.
"Regions in western Ukraine continue to show the highest rates of acute respiratory illness/influenza-like illness. The level of activity in the Kyiv area is also increasing rapidly," the WHO said. "As elsewhere, WHO strongly recommends early treatment with the antiviral drugs, oseltamivir or zanamivir, for patients who meet treatment criteria, even in the absence of a positive laboratory test confirming H1N1 infection."
The scientists in the Hague say that once the virus has mutated into a highly infectious form there is little a country can do to prevent the spread and there is little neighbours can do to prevent it crossing the border. Russia is already reporting an outbreak of the virus in Buratiya, in central Russia.
A computer model developed by virology experts at the University of London showed that borders were impossible to close and even countries surrounded by sea cannot prevent the virus entering the country. Even banning travel completely and closing the borders completely will only slow the entry of the virus into an unaffected country by up to one week. On Wednesday, November 4, WHO reaffirmed this point, insisting on its recommendation that no borders should be closed and no restrictions on international travel should be imposed, including in relation to Ukraine. "Experience shows that such measures will not stop further spread of the virus," it said.
Likewise, quarantine or isolating patients doesn't work either. Experience has shown that all quarantine does is increase the infection rate. Infected people are isolated, but they are usually isolated together with their family and others that they are in close contact with, many of whom have not been infected. The result of concentrating people who are both ill and healthy is that more healthy people become infected. As no quarantine is perfect, the denser infection rates leads to a more rapid transmission of the virus.
Happily, the good news is that from the appearance of a virus it usually takes up to six months to develop a vaccine and this period has already passed and a vaccine is already available. Inoculations are the most effective way to bringing a virus under control and this process has already started. Other simple hygiene precautions are also very effective in slowing the spread of the virus such as washing your hands regularly and wearing facemasks in public places.
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