Some Facts On Turkey And Avian Flu

As everyone keeps saying, the important thing in circumstances like these is not to panic. But the best defence against panic is information, and after that knowledge. So here goes:

1/. The flu virus was actually first detected in the laboratories of the Turkish Agriculture Ministry on December 9 2005, despite the fact that a ministry statement on the same day denied the existence of the disease in Turkey. So when I implicitly questioned the Turkish Health Ministry version in this post on 2 January it seems I was right to be sceptical.

2/. Nearly 100 people are currently receiving treatment in suspected bird flu cases across Turkey. Since there have only been 142 confirmed cases across the globe since the H5N1 strain was first identified in 2003, the New York Times is undoubtedly right to suggest that the flu is spreading faster than expected.

3/. Elizabeth Rosenthal of the NYT is however not quite right when she says that “the Ankara cases have the most alarming implications because….. it is a relatively well-off area, where it is not the norm for humans and animals to live under one roof. ” This is a misunderstanding, since on the outskirts of Istanbul there is a large Kurdish migrant population, which basically lives in shanty towns, and in shanty towns people often keep their own hens:

Five of eight chickens owned by Ramazan and Muhittin Mentes, living in a shanty house in Ikitelli, Istanbul, reportedly died one by one after the New Year. Members of the Mentes family who ate the remaining three sick birds last Tuesday were taken by ambulance to hospital after neighbors notified officials. Members of the Mentes family immigrated to Istanbul from the Baykan district of Siirt, a southeastern Turkish province, two years ago, and have been earning a living selling lemons in the street markets.

There is a blurring of boundaries here, since many of the people affected may simply live outside the formal limits of Istanbul. However, according to this article:

The Governor of Istanbul has announced quarantine measures will be applied in the areas of Istanbul within a three kilometer radius of regions where poultry samples tested positive to bird flu.

4/ The shanty-town structure is important, since it means the bird/human interface is much larger, and thus the possibility of transmission much greater. The speed of the spread may thus not be a function of virus mutation, but rather of the high ratio of birds to humans in some areas.

There is still no evidence whatever of human/human transmission, although obviously the more human cases there are, the higher the possibility of this ocurring. The most important objective, IMHO, should be to eliminate this outbreak before a more normal human flu strain arrives, since this would provide the ideal host for the kind of mutation that none of us want to see happen.

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About Edward Hugh

Edward 'the bonobo is a Catalan economist of British extraction. After being born, brought-up and educated in the United Kingdom, Edward subsequently settled in Barcelona where he has now lived for over 15 years. As a consequence Edward considers himself to be "Catalan by adoption". He has also to some extent been "adopted by Catalonia", since throughout the current economic crisis he has been a constant voice on TV, radio and in the press arguing in favor of the need for some kind of internal devaluation if Spain wants to stay inside the Euro. By inclination he is a macro economist, but his obsession with trying to understand the economic impact of demographic changes has often taken him far from home, off and away from the more tranquil and placid pastures of the dismal science, into the bracken and thicket of demography, anthropology, biology, sociology and systems theory. All of which has lead him to ask himself whether Thomas Wolfe was not in fact right when he asserted that the fact of the matter is "you can never go home again".

12 thoughts on “Some Facts On Turkey And Avian Flu

  1. What is the implication of this, if any for Turkish bid to join EU? This may bring home the fact that with this type of expansion “Europe” would strech to within a 100miles of Mosul.

  2. None. I still think it’s a bad idea, but not for this reason. If the criterion were close human animal contact, the EU might have been enlarged by two or three countries in 2001 only.

    Secondly, how many of the 100 suspected cases are real? A bad case of resparatory desease is not uncommon in january. How many real cases were not reported in Asia?

    In the mean time, the time has come to eliminate a lot of chicken.

  3. OK, birds aren’t the most dangerous thing here, at least for the richer countries where only a couple of people literally choose to get up with the roosters and go to bed with the chickens. The nightmare scenario, as I understand it, is not an H5N1 strain that is just a little more agressive and, given unusual circumstances (and likely genetic susceptibilty), crosses the species barrier from bird to human. It keeeps killing itself. The real danger would be a less fatal virus genetically altered through whichever mechanism (apparently this is still very much debated), which could lead to human hosts that aren’t known. And then some host get’s on a bus from chickentown to Saigon, and then on a plane to Beijing and on to Hong Kong and…

    Also, this is not just a health question. Imagine what a widespread outbreak would do to our globalising economies? I know that one major German company with significant activities in Asia has already stocked Tamiflu, simply to assure its employees that they can continue to go there. This is added expense, and very likely unnecessary given current risk levels, but apparently, assuring employees that they won’t be alone should they wake up with a truly bad cold after a trip to a subsidiary is already worth the costs.

  4. “What is the implication of this, if any for Turkish bid to join EU?”

    I agree with the others: none. But if you ask the question in another way, how will this recent outbreak affect Turkey’s ability to comply with EU demands, how will it affect the reform process in Turkey, I would say plenty.

    For two reasons. Firstly the Ester Boserup arrgument, if the challenge is strong enough then you respond vigourously. Secondly, recent experience in Spain with the Prestige oil spillage.

    In this latter case we had a government which was in denial, which tried to lie its way out of a problem, but which eventually had to clean up its act, as well as clean up the beaches.

    The outcry in Turkey at the moment over government obfuscation seems to be enormous. Politicians cannot simply hide from things like this, and people want solutions and they want action. All of this will help reform and improve the functioning of the political system in Turkey.

    In addition it might even lead to more pressure to clean up the shanty town problem. Barcelona, that magnificent city of the future, still had a number of shanty towns in the 70s, and the last were only really cleaned up just before the 92 Olympics. In Turkey the problem is obviously more extensive, but I expect them to go down the same road.

    “And then some host get’s on a bus from chickentown to Saigon, and then on a plane to Beijing and on to Hong Kong and…”

    Well, on of the big worries this week has been that this would happen, and that some person carrying the mutated virus would get on a plane and head for Mecca.

  5. Another example of the realities of the globalisation process that Tobias was alluding to is to be found in the ways in which knowledge and awareness spread, and people’s customs change, much more rapidly than in the past. This has implications for much more than bird flu (fertility control would be another good example).

    “People are very much more aware of H5N1 and the implications of contact with sick and dying birds,” said Dr. Nancy Cox, an influenza expert at the U.S. Centers for Disease Control and Prevention.Ali Hasan Kocyigit, the six-year-old brother of the dead children, was discharged from the hospital on Monday after being confirmed as free of the disease, Turkish television reported. “This should be a lesson to all of the Turkish nation. Everybody should take care of their children much more than before,” said Ali Hasan’s uncle Isa Kocyigit. “We didn’t know this virus before. But now, we lost three children in our family. The last one is living, thank God,” he added as they left hospital in the eastern city of Van.

    “I know that one major German company with significant activities in Asia has already stocked Tamiflu”

    And I know another one. But I’m not sure that Tamiflu will be much use, or rather I am sure that we don’t know in advance whether it will or won’t be, and it does have troublesome side effects.

  6. Outside Turkey today there is news of an interesting study conducted in Vietnam. The study, which was published in Monday’s edition of Archives of Internal Medicine, involved 45,476 randomly selected residents of a rural region where bird flu is rampant among poultry — Ha Tay province west of Hanoi. More than 80 percent lived in households that kept poultry and one-quarter lived in homes reporting sick or dead fowl.

    8,149 of those interviewed reported flu-like illness with a fever and cough, and residents who had direct contact with dead or sick poultry were 73 percent more likely to have experienced those symptoms than residents without direct contact. The researchers said between 650 and 750 flu-like cases could be attributed to direct contact with sick or dead birds. While most patients said their symptoms had kept them out of work or school, the illnesses were mostly mild, lasting about three days.

    As Dr. Anna Thorson of Karolinska University Hospital in Stockholm, who conducted the study wrote: “The results suggest that the symptoms most often are relatively mild and that close contact is needed for transmission to humans,”.

    The idea then is that exposure is much more widespread than the official data reveal, and that the majority of cases are much more benign. This is entirely plausible.

    Dr. Gregory Poland, a flu specialist at the Mayo Clinic is quoted as saying: “In the really rural areas, we know that this had to be occurring” too, and the study suggests that the prevalence “is pretty high….The data lines up biologically the way we would have expected it to.”

  7. It keeeps killing itself. The real danger would be a less fatal virus genetically altered through whichever mechanism

    It depends on infectiousness vs. infectious time. A desease may be very fatal as long as enough people are infected (HIV). In fact, killing the host doesn’t really matter that much if the cadavers remain infectious (eg. smallpox)

    Secondly, if this virus is relatively benign, why does it kill three of four children in one family? Because they genetically share an immune system that can’t handle it? Or are there several strains and we can only hope that a benign strain makes the jump?

  8. The three kids may have been weakened by other bugs etc etc.

    HIV proved to be mainly hysteria from the conservative establishment too… It wouldn’t even pay to have a cure for it so now they’re just waiting for the occurence of natural immunity – giving us hugely inflated numbers about “AIDS in Africa”, which serves as the great live laboratory.

    One ought to compare this “H5N1” to the millions who die from easily preventable conditions in the less developed countries. Polio, Measles, Malaria….

  9. Edward,

    >people are more aware /
    >AP story

    I think those two points excellently illustrate some of the more tricky points about globalisation: It’s so much more perception (and discourse management) than reality – and that’s true regardless of the factual truth of the AP story. Developing countries like Vietnam may now have centers that can participate in some kind of global intechanges, but only *now* are they (well, the WHO, and others, who are actually able to) looking at what’s actually going on in the country.

    >And I know another one. But I’m not sure that >Tamiflu will be much use, or rather I am sure that >we don’t know in advance whether it will or won’t >be, and it does have troublesome side effects.

    That was my point. They don’t do it because it’s worth it from a medical point of view. My example does it because they want to reassure their employees. Although I’m a little surprised the other German company you refer to (if it is the one based close to where I live) is doing it. My example isn’t anywhere close to their line of business, and the fact that your example apparently does it worries me a little more…

    Oliver,

    >It depends on infectiousness vs. infectious time.

    Agreed – although I suppose corpse to human infecions probably won’t be too much of an issue in “the West”.

    >Because they genetically share an immune system >that can’t handle it? Or are there several >strains and we can only hope that a benign strain >makes the jump?

    It think Edward’s story could be interpreted as an indicator of the genetically shared immune system if H5N1 infections are what occurs there. If all kinds of viruses happen to cross the threshold all the time then H5N1 infections (bird to human) are still very rare and can likely largely be prevented by culling of infected populations and generally “not living with (dead) birds.

    A,

    >HIV proved to be mainly hysteria from the >conservative establishment too…

    I don’t think HIV is a conservative hysteria. If 25 million Westerners were infected, we would have had a cure in 1996. Well, maybe not, but you get my drift, I’m sure.

    >Malaria….

    ist still not easily preventable, at least not without the possibility of severe side effects. Some kinds of Malaria are still possibly fatal, even with the best medial treatment. Molecular therapies of Malaria are only now being developed. A research center in Heidelberg, Germany just recently built a high security lab for experiments with a possible molecular Malaria cure (apparently the first such lab ever, as no pharmaceutical comapany is too interested in this market for, well, obvious reasons). I read about it last year when I did some research before deciding about the appropriate level of protection before going to Manaus, Brazil. They’re advancing, but apparently it takes time.

  10. Lovely, just lovely. And the turks like any other Muslim country sent their pilgrims to mill around the black box with 2 million muslims from other parts of the world. You got your pandemic right there.

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