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PANDEMIC ALERT LEVEL
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Tracking the next pandemic: Avian Flu Talk

Bumping Alert to 5?

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cobber View Drop Down
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    Posted: October 30 2013 at 12:59am
Hi Guys, anyone else get the feeling this MERS is going global?

Personally i think we are early stage of a pandemic. If were not yet i expect it will be there in a few days..

Any thoughts?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote lake Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 1:17am
Based on WHAT? your speculation?  no source here, just fearmongering.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rickster58 Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 1:40am
Cobber
You should have posted this to the general discussion section, it is hardly latest news. (yet)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 6:27am
Rick..Sorry i thought put it in general. My Bad

Lake. I'm not a merchant of fear.. Its based on the following (yes) speculation:
Sorry should have explained reasoning. There have been several following MERS every day since it struck. Its coming to a crunch time.

1: MERS has been identified by this site and others as spreading H2H. This is despite the WHO saying otherwise. Long story, but i'm sure others will attest to contradictory evidence. Its speculation, but its what we do here. The authorities don't exactly tell the whole truth.

2: Members of the site have been discussing the issues around Hajj for around 6 months (cheers guys). The concern was that MERS was being covered up in KSA (true) and having Hajj will give the virus an escape route. We have speculated that there will be a rash of new cases popping up all over the world from early November onwards due to Hajj travelers going home.

3: Its early but we are already seeing signs of MERS in new countries. To be honest I'm surprised its so early. I expected around November 2-5 for the first reports filtering through. This was based off the following rough time line. Initial infection to hospital 8-12 days and then allowing around a week for diagnosis and tests. 

4: We know MERS survives longer on colder surfaces. We predicted that when MERS gets to a colder climate it could takeoff. again speculation
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 6:30am
The key to the whole thing is MERS popping up in new countries. If over the next two weeks there is a flood of reports. We have a pandemic
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 6:36am
Well, if we do go to level 5, that will be your trigger sign to stock up and time is short.  We will not go to 5 unless there is a drastic change, or an imminent global spread. 

There will be a lot of uncertainty during this winter/flu season and we'll watch both pandemic threats very closely as we've all been doing here for the last 8 years.   Nobody has ever recognized the AFT members for almost a decade of tracking an avian flu pandemic, but as far as I'm concerned, without AFT putting these threats on the map, I'm not sure where all of this would be right now. 


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Newbie Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 8:45am
This comment is for the designer (?) of this site. When I view this www on my computer the rating 1-6 shows up with 4 flashing but it doesn't show on my iPhone. Also a lot of the comments are harder to read on mobile device - they get 'narrower' & narrower as the quoets go down the page.
Is there a way I can view this site easier on my mobile device (a tab where I can choose mobile etc) that I'm missing?
More importantly (esp if above is no) is there anyway site can be modified so I can see alert rating/status on the go? I'm on road alot & just don't haul along computer...
THANKS & GREAT site!!!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kyle Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 9:27am
Newbie the reason why you can't see the alert banner on your iPhone is because the iPhone doesn't support flash player and the banners run off of flash player. Also on the bottom of any page on the site there's an option to view the classic site or mobile version.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Medclinician2013 Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 11:07am
With the current data that is out there, there is little or no indication that MERS has much chance of becoming a Pandemic. Short of a mutation to make it airborne, which it is in some cases, there are other diseases, like H7N9 that are more likely to do so.

H7N9 is a probable candidate to launch a Pandemic. Some basic knowledge can go a long way in keeping a clear, level, panic free perspective.  Perhaps CDC and other reporting agencies are notorious for poor tracking and under reporting cases, but there are some hardcore medical facts about the two diseases.

I am a U.S. resident experiencing flu-like symptoms (e.g. coughing, fever, sore throat, etc.). How do I know if I have seasonal influenza, H7N9 influenza, or MERS-CoV (Middle Eastern Respiratory Syndrome Coronavirus)?

http://www.cdc.gov/flu/avianflu/h7n9-faq.htm#contracted

There are simple, no numbers, but general indications to support a level 5 alert for anything. We are not out of the woods.  This isn't going to peak in late October. As Christmas and especially the New Year arrives, given data from other years, we will probably see some solid and large flu activity.

Sometimes in the "flu reporting" groups, there are efforts to be the first to wave the red flag.  No one wants there to be a flu pandemic. Well, perhaps some do, but not the CDC or other central health agencies.  In some ways, the government has correctly estimated that the panic caused by a premature alert could kill more people than the flu.

When I see a CDC map, if they even use orange and brown anymore on them instead of pastels where you can hardly even see the difference, with a solid masses of brown and a lot of oranges of widespread and regional outbreaks  in 48 states - then we have a problem.

Medclinician

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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 3:00pm
long way to go yet , we have to have clusters in different countries, and proved H2H , even then doubt they

 will call it a pandemic till it's to late, Mer's is top with H7N9 /H5N1 next ,or hybrid of all three ,

NOW YOU TALKING...........
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Post Options Post Options   Thanks (0) Thanks(0)   Quote newbie Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 3:26pm
Originally posted by Kyle Kyle wrote:

Newbie the reason why you can't see the alert banner on your iPhone is because the iPhone doesn't support flash player and the banners run off of flash player. Also on the bottom of any page on the site there's an option to view the classic site or mobile version.
 
Thanks Kyle
I just checked it and see it is on mobile - may switch it to classic and see if that helps the longer posts.  So guess I can't see the alert level when on road then...if it does go up to level 5 - could someone start a topic with that in title so I'll catch it?!?!  I know when I saw title of this one this am my heart fluttered!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 4:30pm
Originally posted by newbie newbie wrote:

 
...if it does go up to level 5 - could someone start a topic with that in title so I'll catch it?!?!  I know when I saw title of this one this am my heart fluttered!



Newbie - I was thinking the same thing when I saw the thread title, and I'm sure we weren't alone. I added a question mark to hopefully avoid any confusion for those unable to see the alert level on their mobile devices.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 4:46pm
Hello Newbie, welcome.  We appreciate your question and concerns.  I believe on my phone when I login into the forum it asks for a classic view, or mobile view, but might not be the same for all phones.  Also,  If you register on the forum and include an email, we also do an email blast to the members to alert them of any significant event/change, which we have done 3 times prior.  Other than that, if you follow the Latest News section, it will certainly be immediately posted there, and in a big way.  Going to level 5 will be very clear.   You can also email me anytime at Albert@avianflutalk.com, along with the moderators if you have any questions or if you would like to be personally notified. 
 
Best,
 
Albert
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mahshadin Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2013 at 5:12pm
Is there an AP For That         Hug
"In a time of universal deceit, telling the truth is a revolutionary act."   G Orwell
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I spoke with WHO. They no longer categorize things in 'levels' like level 5, 4 etc. and have not done so for awhile- so some basic facts would be valuable. I also have been following MERS- since March of 2012 when the first H2H cases were reported in Amman, Jordan. That stat is usually conveniently omitted from  MSM accounts- and most medical blogs. It has been airborne for year and a half. If its a pandemic we may not know it- if its covered up or wrongly diagnosed or simply not diagnosed.
this will be a tricky issue.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: October 31 2013 at 3:21am
What I understand both MERS and H7N9 are developing. A lot of people might be infected but not showing signs of infection while spreading one of those virusses. Both China and Saudi Arabia are not "very open" over health-issues. The virus that could cause wide-spread health-problems is not likely to be the same virus that went around half a year ago. 

H1N1, H3N2 also are around, H5N1, H7N7 and even new flu-virusses (H11N18 ?) sometimes show up. There proberbly is "something" on its way, it may turn out to be something "big", but it is still in a lot of fog.

I hope there will be no pandemic, any scale can be misleading. The big worry in my eyes is that there are several dangerous virusses around. Am I wright in thinking that the number of virusses, the variation itself, is new ?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: November 04 2013 at 3:55am
We gonna bump this mofo to five? Maybe not until tests are conducted.. But keep them eyes peeled.

MERS suspected cases are turning up everywhere. I set up Google news alerts to search on MERS. Its going crazy at the moment. 

http://abc.az/engews/77103. - Azerbaijan just reported 5 possible cases
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I cant get the hyper link thing working. Here goes again
http://abc.az/engews/77103. - http://abc.az/eng/news/77103.html
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: November 04 2013 at 4:08am
I need to work on getting the links to works.  Anyway, not sure about this report of the 5 suspected cases.  Since only 4,000 pilgrims made the trip from Azerbaijan to Hajj, the odds are fairly remote that these cases will turn out positive.  On another note, if they did turn out positive, it would stand to reason that the U.S. would be seeing their first cases since 11,000 traveled from the U.S. to Hajj, over twice as many as that of Azerbaijan.

With the 12-day incubation period, if we don't see an outbreak outside the middle east somewhere by about mid week, then chances are we won't.

On another note, wonder how China is coping with their h7 outbreak that they're certainly trying to cover up.  Wouldn't doubt it if they have a lot of cases at the moment of which one could pop up outside of China very soon. 


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: November 04 2013 at 6:36am
When it comes to France reporting suspected MERS cases, although other flu sites tend to be all over it hyping bad information, here are a couple more examples of Frances false alarms with MERS.  They've had half a dozen so far from their local media - and through machine translations.  These other sites will never learn.  Our greatest education with these things comes from past experience.



June: Suspected cases in France test neg.

http://www.globalpost.com/dispatch/news/afp/130612/france-says-new-suspected-cases-mers-virus



8 false positives - France.

http://www.straitstimes.com/breaking-news/world/story/sars-tests-italy-were-false-positives-clinic-20130605


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Hi Albert
Confirmed International MERS cases should come out by around the 15th November (if at all).  I expected to see some early reporting around now. Its still early days.

One thing to consider: The Western world doesn't even know about MERS, let alone screen for it. I just spoke to a mate from a hospital who should know about MERS, he said, "no information yet". This is concerning as he's head of procurement and has  access to pretty much the whole computer system.

I expect the first confirmed cases of MERS will come from countries closest to the KSA. I assume they would be on watch for it and possibly have testing serum on hand. Thinking out loud Israel, Turkey, Egypt and Azerbijan. Anywho we will wait and see.....




Is H7N9 on the march?
I haven't heard much about it. All i keep hearing its contained and under control. The Chinese have been singing their own praises as per usual. The wet market shutdown shows very strong evidence that the virus is not jumping human to human efficiently. (yes i get that it may mutate etc etc) I really expected H7N9 to surface in the West last flu season. It had good opportunity, but it never happened. Again this backs up my belief that its not spreading H2H efficiently. 

To be honest with you, i don't follow H7N9 much as i don't consider it an immediate problem. 

Should i pay it more attention to it?
Can you elaborate your concerns and why you see it as a looming threat?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: November 04 2013 at 4:39pm
Albert 

Maybe do it on another thread, so others can search it easily
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Medclinician2013 Quote  Post ReplyReply Direct Link To This Post Posted: November 05 2013 at 10:48am
Originally posted by jones jones wrote:

I spoke with WHO. They no longer categorize things in 'levels' like level 5, 4 etc. and have not done so for awhile- so some basic facts would be valuable. I also have been following MERS- since March of 2012 when the first H2H cases were reported in Amman, Jordan. That stat is usually conveniently omitted from  MSM accounts- and most medical blogs. It has been airborne for year and a half. If its a pandemic we may not know it- if its covered up or wrongly diagnosed or simply not diagnosed.
this will be a tricky issue.


Am trying to verify this data which is very significant. The most chilling scenario is a Pandemic which neither is verified, tested for, or reported to be a Pandemic.

We will continue to get miniscule reports of ones or twos which can hardly be accurate in terms that MERS is airborne (CIDRAP) and obviously spreading with a death rate of 42%.

This is a release yesterday by WHO of a new case.

http://answers.yahoo.com/question/index?qid=20111113084138AAYfh7U


The same modus operandi  https://en.wikipedia.org/wiki/Modus_operandi was used during the Swine Flu  Pandemic   https://en.wikipedia.org/wiki/2009_flu_pandemic of refusing to test and report cases. 

As for a level 5 - even having not checked it out ... and I will - when I was cyber present live at WHO when Margaret Chan announced the Pandemic, she met with the "economic leaders and super powerful 2 hours before  to get permission to announce it.

This appears to be the new alert system in place. 

http://www.cidrap.umn.edu/news-perspective/2013/06/who-proposes-new-pandemic-flu-alert-levels


Severity assessment is a critical component for assessing pandemic flu risk, and the new guidance includes methods for measuring severity, the WHO said.

A four-phase alert system would replace the current six-phase scheme. The new phases are:

  • Interpandemic, the period between pandemics
  • Alert, when a new subtype has been identified and increased vigilance and risk assessment are warranted
  • Pandemic, a period of global spread of a new subtype as indicated by global risk assessment based on virologic, epidemiologic, and clinical data
  • Transition, global risk drops, prompting stepdowns in global actions and response activities

Presumably, the world would be at the "alert" level for H5N1 avian flu, H7N9, and Middle East respiratory syndrome coronavirus (MERS-CoV).

In a potential pandemic situation, the WHO will appoint an Emergency Committee to advise the director-general, and a pandemic declaration would signal the need for collective global action to manage the risk, according to the WHO.

Conclusion: So level 5 or not - They would announce a Pandemic.  

Pandemic, a period of global spread of a new subtype as indicated by global risk assessment based on virologic, epidemiologic, and clinical data

There then is a criteria when that threshold is crossed and a need response much be taken by WHO to continue to travel and monitor the major outbreaks and for the CDC and CIDRAP to clearly state we are at Pandemic level.

I have always believed, basically, we have a super Pandemic coming. I predicted the last Pandemic when most around me thought my statements were irresponsible and inaccurate. Then, as now, I believe there is a genuine possibility this flu season will launch a Pandemic. I may not live long enough to see it, but it is coming and people had best prepare for it.

We have the nastiest multiple mutated viruses and potential bacterial plagues as well which may make this the first time we have a multiple virus group of Pandemics hitting at the same time.

Just because Mers Cov may launch one, does not mean, and there is substantial research to support this, others may hitch a ride and spread as well.

With many "lab developed" super strains and rogue nations and groups - it may not be a simple matter of just what spreads naturally.  We are already on global alert for a Pandemic. Perhaps not this flu season - but it is not an if, it will never be an if - it is a when.

Medclinician



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Didnt WHO declare a pandemic level 5 or 6 in 2009 when it really didnt exist? Pushing their vaccines to maybe propagate one? Seems their declaration is going to be politically based, not medically based.
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MERS spreading, undiagnosed and /or misdiagnosed w/ false negatives

http://www.thestar.com/news/world/2013/11/12/most_mers_cases_going_undetected_slow_epidemic_underway_study.html
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Elver Quote  Post ReplyReply Direct Link To This Post Posted: November 13 2013 at 11:48pm
Originally posted by kevlar kevlar wrote:

Didnt WHO declare a pandemic level 5 or 6 in 2009 when it really didnt exist? Pushing their vaccines to maybe propagate one? Seems their declaration is going to be politically based, not medically based.
 
The H1N1 was declared a pandemic back then, but I knew of 1 person who had this so it wasn't much of a pandemic.
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Hi Noho, Cheers for the good find. I just read the report in another site too. I agree with this study completely and it backs up what we have been saying here for months.

We did a several studies a few months back and estimated the Reproductive number closer to 1.8-2.6. conservatively. This was based around a belief that under reporting of asymptomatic cases was common. The report you refer to is indicating even higher numbers. 

One of my own personal observation wasasymptomatic cases within the general public, weren't being detected at the same rate at which they were being found among general medical staff dealing with sick patients. At the time, there was an unusually high number of medical staff testing positive to MERS but not showing symptoms. The theory was, Medical staff had easy access to the testing serum. This meant they could test themselves frequently and across a broad group. 

The conclusion was that the same level of testing wasn't happening among the general public because the same percentage of asymptomatic cases weren't coming to the surface. 

Based on medical staff only, the figures were around R 2.0. which indicates a possible pandemic.

The WHO were at the time reporting R 0.8-1.2 from what i recall

Something didnt add up!

This was just the start: Other people were bringing forward creditable theories and observations. such as: corrupt medical system not reporting cases (due to Hajj). OR just plain laziness. There were several other theories such as serums producing false negatives and lack of testing serum. Either way we came to a similar conclusion. There were a heap of asymptomatic cases going undetected. 

This recent study has backed up some of our assumptions and also points to the conclusion of a slow moving pandemic. 

We should bump the alert to 5. 

MERS CoV is a pandemic!

PS: by the "alert" i mean the one at the top of the page. Not the WHO alert
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Here is the  conclusion from the report:

We conclude that a slowly growing epidemic is underway, but current epidemiological data do not allow us to determine whether transmission is self-sustaining in man. Our analysis demonstrates that the transmissibility of MERS-CoV in man is close to the critical threshold of R=1 required for self-sustaining transmission. If R is greater than 1, then the number of human cases we estimate to have occurred to date make it highly likely that self-sustaining transmission has already begun. If a human epidemic is underway, the low estimated value of R (<1·3—1·5) and evidence of severe infection in secondary cases from case clusters suggest that intensive public health measures around cases, coupled with improved case ascertainment, are sufficient to contain spread and reduce morbidity and mortality. However, an important caveat to this conclusion is the unknown extent of mildly symptomatic or asymptomatic infection and the role it might have in transmission. http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2813%2970304-9/fulltext#bib19 - 19 Our analysis indicates a high proportion of infections are not currently being detected. The reported case data therefore probably represent the severe end of a wider clinical spectrum of disease, though a case-fatality ratio higher than 10% cannot be ruled out from present data. Paradoxically, a low case-fatality ratio might make control more difficult, if mildly symptomatic cases prove to be responsible for most transmission.

Improved surveillance, international collaboration, and data-sharing are therefore crucial to refining our understanding of the transmission dynamics and epidemiology of this novel human virus and of the risk it poses. The time window might be short for doing so: current selection pressures on the virus to evolve increased transmissibility in man are likely to be intense.


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