As Avian Flu sweeps across Russia’s Ural Mountains, ravaging wild bird populations in the area that separates Europe from Asia and continues to threaten domestic bird stocks, the first signs of large scale human-human contact of the deadly virus are beginning to appear in Indonesia.

Health professionals from around the world have descended on Jakarta, Indonesia’s capitol city and home to 12 million people, to help contain the first truly serious outbreak of Bird Flu in a major human population center.

One of the largest cities in the world is now officially home to a Bird Flu epidemic.

Previously, humans infected with the virus were found mostly in rural areas of Viet Nam and Thailand. The outbreak in Indonesia’s largest city means that essentially, we are now at the mercy of whatever evolutionary track the virus takes. At the moment, Bird Flu can only be spread from human to human by direct contact with an infected person and either their waste products or saliva, blood, or other infected secretions. At least, this is the best guess of the experts.

The problem with a Bird Flu outbreak in a city of 12 million people boils down to simple mathematics. Each time the virus infects another human it has the opportunity when reproducing itself to mutate – change its genetic code – so that instead of spreading by direct contact it would be possible to become airborne and spread via casual contact just like any other strain of flu.

It goes without saying that having 12 million chances for the virus to mutate is extremely worrying.

Indonesian health officials aren’t standing around doing nothing. With the help of the World Health Organization (WHO) and teams of scientists and researchers from around the world, the battle to nip any Bird Flu pandemic in its infancy has begun in earnest. This article in today’s Asia Times details what officials term a “21 day Golden Period” where they hope to contain any serious outbreak:

The fate of millions of lives in Asia hangs on the speed with which a patient, infected with a human-to-human transmission of a mutated strain of bird flu, is diagnosed and prevention measures are implemented.

“We will only have a 21-day golden period to stop the virus spreading and becoming a pandemic,” said Dr Kumnuan Ungchusak, director of epidemiology at Thailand’s department o disease control and a key player in plans being mapped out to stall the virus ravaging Southeast Asia. “A longer delay, even a month, can be fatal.”

The new urgency follows the deaths announced Wednesday of two young girls admitted to Jakarta hospitals after they developed symptoms indicating bird flu. Nine others are currently under treatment for suspected bird flu in Indonesia.

Plans regarding what should be done with this 21 day “Golden Period” are both ambitious and problematic:

On Wednesday, Indonesia’s Health Minister, Siti Fadilah Supari, told reporters in Jakarta that she considered the outbreak the possible start of an epidemic on the archipelago and that “most definitely there will be others as long as we are not able to identify positively the sources”.

The pandemic-prevention scenario is expected to follow two broad paths, she explained during an interview. The first is geared toward the immediate family of the patient diagnosed with the lethal virus. Each family member coming in contact with an infected relative will be given – within two days of the patient showing symptoms – a dose of Tamiflu, the only known drug capable of stopping the spread of a mutated form of the H5N1 avian flu virus. This regime of Tamiflu will be for a 10-day period, Kumnuan said.

More challenging, though, is to provide medication for the second part of this preemptive initiative. “It would require giving [medication to] around 10,000 people, 100,000 people or even one million who live within the area where this human-to-human form of the virus has been diagnosed,’’ the Thai epidemiologist said.

Attempting to put 10,000 people (much less a million) on a virus prevention regimen is certainly ambitious. What makes it problematic is that Indonesia has nowhere near the number of Tamiflu doses to make the plan realistic.

The WHO was also working with the government to source new stocks of the anti-viral drug Tamiflu from India to bolster local stocks, he said.

“It’s not very much, it’s rather puny. They definitely need some more,” Petersen said, adding that stocks being rushed from India were less than 1,000 doses.

Tamiflu is an anti-viral tablet that can help against infection. Several companies are working on a vaccine, but tests are not expected to begin until later this year.

Supari said Indonesia had 10,000 Tamiflu tablets.

If the entire country has only 10,000 Tamiflu tablets, how does this jibe with their ambitious plans to initiate an anti-viral regimen by dosing a million people?

Another troubling feature of the Indonesian plan is that while Tamiflu may be effective as an anti-viral agent, the effectiveness of other, less expensive and more widely available antibiotics which are used to treat the symptons of the virus after infection may have been overstated:

In the second paper, researchers from the Centers for Disease Control and Prevention in Atlanta found that influenza viruses, particularly those from the dreaded bird flu strain, had developed high rates of resistance to the only class of cheap antiviral drugs available – drugs mainly used to treat flu once patients have caught it. These resistance rates have increased rapidly since 2003, particularly in Asia.

“We were alarmed to find such a dramatic increase in drug resistance in circulating human influenza viruses in recent years,” said Dr. Rick Bright of the disease control centers. “Our report has broad implications for agencies and governments planning to stockpile these drugs for epidemic and pandemic strains of influenza.”

Indonesian health officials are also at a disadvantage when it comes to quickly identifying Bird Flu victims due to a lack of resources and organization:

Earlier in the week, the head of WPRO said at a conference that there were still many gaps in the health surveillance systems, so pivotal to detecting a new virus and mounting a response within a limited time.

“At the national level we need to improve further the capacity for surveillance and virological investigation. In addition, we need greater cooperation in sharing specimen samples,” said Dr Shigeru Omi, WPRO’s regional director in New Caledonia, an island in the South Pacific.

“Vietnam is on par with Thailand in health surveillance, but poorer countries like Cambodia and Laos don’t have the capacity due to the lack of resources,” Cordingley told IPS. “This is also too big for the WHO and FAO (Food and Agriculture Organization) to handle. We need a lot of international help.”

While it may be too dramatic to portray what is going on in Jakarta as mankind’s last chance to arrest any potential Bird Flu pandemic, the amount of attention being paid by international health officials and the current outbreak being termed “an epidemic” by at least some of the authorities in Indonesia lead one to the inescapable conclusion that this may be a defining moment in the fight to prevent an outbreak of a disease that could decimate the human population of planet earth.

UPDATE 9/23

First of all I have to say it’s a little disconcerting that not very many bloggers are posting about this today. Glenn Reynolds has a little blurb from AP but otherwise, not much in the way of sounding the alarm.

An exception is Bird Dog at Maggie’s Farm. He has an outstanding post with an easy to understand explanation of exactly what a virus is and how the Avian Flu virus is different from other flu viruses. This is a post I will link to everytime I blog about Bird Flu. The information is invaluable for us lay people in trying to get a handle on a disease that looks more and more like it will change our lives forever. Thanks, BD.