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In Vietnam, A Dark Side To Good News On Bird Flu

Tuan started running a high fever about four days later, his wizened father recounted between puffs on a traditional bowl pipe in the family's one-room home.

When Tuan started coughing and had trouble breathing, he was taken to the local health center in Thai Thuy district. X-rays showed a white smudge on his left lung. Tuan was transferred after less than a day to a larger hospital in the provincial capital. There, the doctors concluded he had contracted the H5N1 strain of avian influenza and immediately rushed him to the tropical disease institute at Hanoi's Bach Mai Hospital.

Nguyen Sy Tuan lies in bed at Hanoi's Bach Mai Hospital as he recuperates from bird flu. Experts say dropping death rates could signal a wider outbreak. (Alan Sipress -- The Washington Post)

By the time he arrived, X-rays showed, the white smudge had clouded the entire lung. Soon it took over the other one as well. "From one day to the next day, it spread very quickly," recalled Nguyen Thi Tuong Van, deputy director of the Bach Mai intensive care unit.

After 10 days, with his breathing failing, the doctors inserted a tube in Tuan's throat and put him on a ventilator. The infection spread to his kidneys and liver.

"We thought it was very likely the bird flu would kill him," Van said. "Then, when it seemed the situation couldn't get much worse, it started to get better. Two weeks later, when he didn't die, I thought maybe we could cure him."

Tuan's sister, Nguyen Thi Ngoan, a tall, mischievous 14-year-old with large black eyes, fell sick several days after her brother and also recovered.

At the district health center, X-rays revealed her lungs were clear, but a subsequent blood test was positive for bird flu. She was transferred to the Hanoi hospital, where she lay in the cot beside her brother and her temperature soared to 105 degrees.

But the fever broke after four days and returned to normal within two weeks, her doctors said. Ngoan went back to school in late March as a local celebrity, teased by her peers as "Miss H5."

A Vital Question

Vietnamese and international health officials say they are confident that the mortality rate has dropped but are not sure by how much. Better screening and wider public awareness of bird flu could mean health workers are catching and recovering from milder cases that would have gone unreported a year ago. WHO officials have complained, however, that Vietnam is reluctant to provide detailed information about human cases. Senior Health Ministry officials respond that reports are provided in accord with national regulations.

The question now is whether bird flu in Vietnam has begun passing among humans.

If it has, Nguyen Duc Tinh, a nurse who treated Tuan at the Thai Thuy district health center and fell sick with bird flu soon after, would be a likely case. Tinh, 26, said he had no contact with poultry for a month beforehand despite government accounts attributing his illness to infected chickens.

Tinh said he was the hospital staff member who had the closest contact with Tuan during his brief stay at the health center, taking his blood pressure and temperature, giving him injections and helping him walk. Within a week, Tinh had developed muscle aches and a high fever, symptoms of what he believed was a common flu. But when the fever subsided and then returned two days later, he grew alarmed.

"Then I suspected I had bird flu," he recalled, his brown eyes widening. "I was really, really afraid of dying."

But just two weeks after joining Tuan in the Hanoi hospital, Tinh was discharged and went back to his village.

"I had lost hope when the fever came a second time," he said. "When I returned to my home town, I felt as if I were born again."

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