Battling a Virus and Disbelief

By Alan Sipress
Washington Post Foreign Service
Wednesday, August 30, 2006

JANDI MERIAH, Indonesia -- Dowes Ginting, the most wanted man on Sumatra island, lay dying. He had abandoned the hospital where he had seen his relatives succumb one after another, and he had fled deep into the mountains, trying to outrun the black magic he feared had marked him next. For four nights, witnesses recalled, a witch doctor hovered over him in a small clapboard home, resisting the evil spell.

Ginting, a wiry 32-year-old, had watched disease burn through his family over the previous two weeks, killing six and sickening two others, including himself. International health experts grew increasingly concerned when laboratory tests confirmed they were sickened by bird flu, the largest cluster of the disease ever recorded. But Dowes feared medical treatment more than he did the flu. And so he ran, potentially exposing villagers across the province to the highly lethal virus.

In the end, the outbreak in May did not presage the start of a worldwide epidemic. But the enormous difficulties that Indonesian and international disease specialists confronted in investigating the outbreak and protecting against its spread raised fundamental questions about whether bird flu could be contained if it mutated into a form more easily spread among people.

"If this were a strain with sustainable transmission from human to human, I can't imagine how many people would have died, how many lives would have been lost," said Surya Dharma, chief of communicable disease control in North Sumatra province.

Officials from the World Health Organization, drawing on sophisticated computer modeling of a theoretical bird flu outbreak in Southeast Asia, have suggested that a pandemic could be thwarted through a rapid containment effort in the affected area, including the right mix of drugs, quarantines and other social controls. To succeed, the antiviral drug Tamiflu would have to be distributed to 90 percent of the targeted population, roughly defined as those within at least a three-mile radius of each case. The drug would have to be administered within 21 days from the "timely detection" of the initial case of an epidemic strain. Residents would have to stay home, limit contact with others and take the medicine as prescribed.

In the case of the North Sumatra cluster, almost none of this happened, according to extensive interviews with health officers, family members and villagers in several areas of the province. The underlying problem was that most family members and many villagers were convinced that black magic, not flu, was to blame.

"How can you ever get people to cooperate if they don't even believe you?" Dharma said.

Tracking the Flu's Path

Scientists are still working to determine how bird flu is transmitted to and between humans. More than 200 people worldwide have contracted the deadly H5N1 strain of the virus since 2004. Most of the cases have resulted from direct or close contact with infected live or uncooked poultry, or with surfaces contaminated with secretions and excretions from infected birds.

Health investigators have concluded that the eight-person cluster in Sumatra began with Ginting's older sister, who fell ill in late April. They suspect she was infected with bird flu from live chickens sold in a market where she peddled oranges, limes and chili peppers, or from contaminated poultry droppings in manure used in her garden. She died and was buried before any samples were taken to confirm bird flu.

Several days after she became sick, the extended family gathered in the village of Kubu Sembilang for a feast of roast pig and chicken curry to celebrate the annual harvest festival. That night, many of the relatives slept in the same small room with the sister, who had developed a serious cough. By the time she died, a sister, a brother, two sons, a niece and a nephew had become ill. Flu specialists said the final victim, Dowes Ginting, in turn likely caught the virus from his infected son.

Health experts have concluded this was the first time the bird flu virus was passed from one person to another and then on to a third person.

"None of us thought it was bird flu. We thought it was black magic," said Anestia Tarigan, the wife of the youngest Ginting brother, Jones, the only victim to survive. "Everyone in the family was getting sick and no one else was. Someone had put a spell on our family. Black magic is very common in our place."

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Confirmed human cases
Cumulative number reported to the World Health Organization as of Aug. 23.
Confirmed human cases
SOURCE: World Health Organization | GRAPHIC: The Washington Post - August 30, 2006
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