http://www.kyivpost.com/news/nation/detail/51972/

Update: more death, illness
Today at 14:10 | (Wire reports) Ukraine’s Health Ministry on Nov. 5 said the death toll of patients with flu-related and acute respiratory illnesses (ARI) had jumped to 95.

Deputy Health Minister Zinoviy Mytnik said told journalists during a press briefing that a total of 633, 877 cases of flu-related and ARI have been registered from Oct. 29 through Nov. 5.

Mytnik said 15 of 31 patient samples sent to London for laboratory analysis tested positive for the H1N1, or swine flu, virus.

Meanwhile, over 600 medical workers in Kyiv have fallen sick with the flue and acute respiratory illnesses, according to Kyiv deputy Mayor Iryna Kilchitskaya, who on Nov. 5 told a daily Kyiv newspaper that 200 of the afflicted are doctors.

In a related story, Ihor Pokanevych, head of the WHO office in Kyiv, told Deutsche Welle on Nov. 5 that in Ukraine, as in the rest of the world, there will be three waves of the swine flu virus: the first – which Ukraine is experiencing now, the second – in the spring, and the third – during the autumn of 2010.

Pokanevych noted that the current pandemic is complicated to sort out because it involves three strains of flu virus: two seasonal strains [of the Brisbane] flu and the swine flu, which as a result could lead the virus to mutate into a still more virulent, new virus.

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Roscoe and Miss Priss

http://www.cidrap.umn.edu/cidrap/co...9global-jw.html

....snip....

In the Ukraine, the country's laboratory experts along with WHO experts have so far found no evidence of a worrisome mutation in the pandemic virus isolated from sick patients in the western part of the country. That region has seen dramatically increased virus activity over the past few weeks. However, Fukuda said the virus is still undergoing further characterization at the WHO collaborating center in London.

Today the WHO's regional office in Europe issued a statement that said a five-member WHO team arrived in the Ukraine's western Lviv region, where 100,000 people are reportedly sick with flulike illness. The WHO scientists are visiting some of the affected areas, interviewing medical staff, and talking to patients. They will spend several days in Lviv before traveling to other sites.

The Ukrainian health ministry said today it has receive reports of 633,877 acute respiratory illnesses since Oct 29, including 95 pneumonia deaths, the National News Agency of Ukraine reported.

So far 15 cases of pandemic H1N1 flu have been confirmed, and two deaths from the virus have been reported in Kiev, according to a report today from the National Radio Company of Ukraine that quoted the health ministry.

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Roscoe and Miss Priss

These reports from November 2nd to November 4th are from Dr. Niman's website, http://www.recombinomics.com/whats_new.html.

The The sharp increase in cases in the Ukraine and the Hemoragic Fever complications in some of the patients is alarming (H1N1 mutatiing?). It certainly bears watching.
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Reported Cases in Ukraine Double in Two Days
Recombinomics Commentary, November 4, 2009
478,456 Influenza/ARI

24,003 Hospitalized

60 Ventilators

81 Deaths

The above numbers are from the latest update from Ukraine. The number of infected patients has almost doubled to just under ½ million, compared to the report two days ago (see map). Hospitalized patients also have spiked higher, to 24K from 15K. ICU cases are not listed, but 60 on ventilators are. However, most (37) of those on ventilators are Chernivisti Oblast, but Lviv, which has the most fatalities and cases, has none, suggesting the data is incomplete or there are significant shortages of ventilators. The number of dead has risen to 81, but media reports describe additional fatalities, include those in the Kiev Oblast.

The explosion of cases again raises concerns that the number of fatalities is significantly higher than the 81 listed. Media reports have described an equal number of pneumonia fatalities which were not considered flu related. The basis of these exclusions remains unclear. Similarly, anecdotal reports suggest the number of fatalities is markedly higher than the 81 in the table.

The rapid rise in reported infections, hospitalizations, and deaths in the past few days raise concerns that the virus is transmitting very efficiently. Spikes in cases have been reported throughout the northern hemisphere, but the spike in fatalities and the frequency in hemorrhagic cases in Ukraine have raised concerns.

Earlier media reports suggest that an update by WHO might be issued today and include preliminary analysis of samples sent to Mill Hill in London.

Daily updates on the rapidly evolving situation in Ukraine, including sequence analysis, would be useful.
Media Links
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Clusters of Hemorrhagic H1N1 Pneumonia in Ukraine
Recombinomics Commentary, November 4, 2009

Ivano-Frankivsk Oblast

All the six dead young people had symptoms of severe hemmorhagic pneumonia. The disease starts slowly, with temperature rising to 37.2 - 37.3 degrees, slight cough and pain in joints. Nasal catarrh developed at the end of the second or third day. Autopsy revealed that the lungs were soaked with blood, the oblast chief specialist said.

The above comments are from an early story describing cases in Ukraine. The clustering of hemorrhagic cases raised concerns. The concern was increased by anecdotal reports citing a high frequency of such cases in Lviv (see map). The recent WHO announcement that they were initially focusing of severe acute respiratory illness in Lviv also increased concerns.

Hemorrhagic pneumonia was also observed in the 1918 pandemic and was thought to be linked to cytokine storm. Consequently, those with robust immune systems (previously health young adults) disproportionately died, which has also been seen in the current outbreak (Mexico, US, and worldwide). However, the cases in Ukraine appear to be clustered, raising concerns that the virus has changed.

However, the change may be minor, since the current H1N1 has produced the above symptoms in earlier cases. More severe cases may be linked to a higher viral load, which could be linked to minor genetic changes, or simply due to concentration of virus in schools. In the US the spread of the virus has been linked to school openings, which lead to an explosion of cases and subsequent student deaths. However, now there are increases in fatalities in teachers and administrators, increasing concerns worldwide.

In Ukraine, weather changes and heating issues may have led to a surge in cases, and increased concentrations of virus could have produced conditions favoring high viral loads and increased cytokine storms.

Samples have been sent to Mill Hill, and sequence data should be released shortly. Similarly, investigations on hemorrhagic pneumonia in lviv should help resolve the mechanism for the high concentration of such cases in western Ukraine.

However, H1N1 spread in Kiev has been noted, and other countries such as Belarus have announced additional H1N1 suspect or confirmed fatalities.

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WHO Targets Hemorrhagic H1N1 Cases in Lviv Ukraine
Recombinomics Commentary, November 3, 2009

Work will initially begin in Lviv region, where reported numbers of cases showing severe manifestations of acute respiratory illness have been especially high. Two virologists on the team have started working at the National Influenza Centre and the laboratories of the Central Sanitary and Epidemiological Station in Kyiv to provide diagnostic support.

The above comments from the WHO update on Ukraine strike a more serious tone than yesterday's quotes from WHO spokespersons playing down the alarming number of hospitalized and fatal cases, as well as media reports spinning political considerations, or politicians claiming only 15 confirmed H1N1 cases. As the WHO update clearly states, the dominant influenza circulating worldwide is swine H1N1 and it is assumed that most cases in the Ukraine (see map) are swine H1N1. Since the official government website lists 19,189 influenza cases (in addition to more than 235,000 ARI cases), the willingness of politicians to cite 15 confirmed cases, as well as media support in the distribution of the propaganda, is unfortunate.

The more severe manifestation of ARI cases are clearly hemorrhagic disease that fills lungs with blood and produces bleeding at all orifices, which are stark reminders of 1918 pandemic cases which were also linked to a swine H1N1.

Samples have arrived at Mill Hill in London, and sequence data should be available shortly. Since current swine H1N1 produced lethal infections in previously healthy young adults, and produced hemorrhagic disease, changes in the viral genome may be absent or minor. Therefore, release of the sequences to the entire scientific community would be useful.

Similarly, an update on the number of hemorrhagic cases would be useful. Rumors have suggested that such the number of such cases is significantly higher than the six described in media reports.

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Belarus H1N1 Deaths Raise Concerns
Recombinomics Commentary, November 3, 2009

The first Belarusian death from swine flu was registered by health officials on Tuesday. The victim, a 37-year-old female resident of the town of Drogichin, died on Friday, but results of blood tests confirming the presence of the H1N1 virus only became available Tuesday, said Oleg Arnautov, chief doctor of the western Brest province.

The woman reportedly had visited Ukraine's western Kovel region, currently near the centre of Ukraine's flu outbreak, in early October.

In recent weeks, the Belarusian capital Minsk has seen an estimated 10 deaths of persons suffering from pneumonia preceded by flu-like symptoms. Public health workers were working to identify the virus causing the illnesses.

The above translation describes the first confirmed H1N1 fatality in Belarus, as well as ten more likely swine flu deaths in Minsk. These deaths are not surprising. Although Belarus has acknowledged 59 confirmed pandemic H1N1 cases, the flu activity is characterized as widespread, and over 99% of influenza A in Europe is swine flu.

The outbreak in western Ukraine (see map) has raised concerns that transmission and virulence has increased. The number of cases may be related to seasonal weather changes. Flu Trends shows that the Ukraine has historically had a jump in cases at this time of year, presumably linked to colder weather and availability or lack thereof of heat for homes. Since virtually all flu in Europe at this time is swine flu, this jump in flu cases would create a jump in swine flu cases. Moreover, the spike this year is markedly higher than prior years, which could explain the increases in hospitalizations and deaths.

However, the hospitalization of more than 15,000 raises concerns that the death toll could increase dramatically. Today's government update has been delayed, but a local media report on Lviv described a sharp increase in cases to 104,019 and an increase in fatalities from 30 to 37.

The above reports of fatalities in neighboring Belarus raises concerns that there are also significant numbers of hospitalized and fatal cases there. There have been some efforts of limiting border crossings out of Ukraine, but it seems likely that the H1N1 associated with these fatal cases has already spread throughout the region.
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Regarding Ukraine:

The current influenza epidemic seems to be highly politicised, the president and the health minister are political rivals, elections coming up in januari. They are trying to show who is best in handling the situation?

Influenza, ILI in this time of year seems to be normal, higher levels than in western european countries.

Health infrastructure is bad? Preparedness was almost zero? No Tamiflu etc?

Everything seems to point at a "normal" new H1N1 epidemic?

Consequences in terms of numbers of patients and deaths should be related to this context?

I hear you Dutchy, but the hemorrhagic fever complication of even a few patients is quite alarming (lungs full of blood, blood coming out of every orifice, etc.).

One of the hallmarks of the H1N1 virus is it's very efficient transmission (highly contagious). What a disaster it would be if the H1N1 virus dated and mated with a hemorrhagic fever virus or some other high fatality bug, and we got a highly contagious and lethal new version of H1N1.

This has to be a concern of health care authorities around the world. Glad the WHO has feet on the ground in the Ukraine now and is working with that world renowned London lab.

Because of the political situation, poverty, and poor health care infrastructure, the Ukraine H1N1 case numbers are almost certainly several times more than officially stated.

"The current influenza epidemic seems to be highly politicised, the president and the health minister are political rivals, elections coming up in januari. They are trying to show who is best in handling the situation?"

Dutchy is very right if you look into the situation.

The situation in the Ukraine is being handled in a very politically maneuvering manner.

But then that's for you to judge.

__________________
Being happy doesn't mean everything is perfect.
It means you decide to see beyond the imperfections.
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Live each day as if there is World enough and Time~
Arubi

Update, nov 7

Influenza continues to rage. Last night killed 25 Ukrainians

In Ukraine, at the evening on November 6 from influenza and SARS deaths of 135 people, including the last day - 25 people. It is reported by the Ministry of Health of Ukraine.

Since the beginning of the epidemic ill 871 037 people, including the last day 101 317 people.

Hospitalized since the beginning of the epidemic 39 603 people over the past day - 4 732, of whom at resuscitation are 317 people, reported "Interfax-Ukraine".

Over the past day in Ukraine killed 25 people, in particular, 12 people died in the Lviv region, 5 people - in Ivano-Frankivsk, 4 - in Chernivtsi and one person in Donetsk, Kiev, Poltava, Khmelnytsky region.

Epidporog exceeded in 14 regions. Approached epidporogu 9 regions - Dnepropetrovsk, Zaporozhye, Kirovograd, Lugansk, Odessa, Poltava, Sumy, Kharkiv, Cherkasy region.

Remain relatively unharmed by the epidemiological situation several regions: the Autonomous Republic of Crimea, Mykolaiv, Kherson regions and Sebastopol.

As reported ForUm, Ukraine on October 30 an outbreak of highly influenza A/H1N1.

According to the morning of 6 November, chief state sanitary doctor of Ukraine Alexander Bilovol said that in Ukraine died of pneumonia on 109 persons, laboratory-confirmed influenza A/H1N1 disease (swine flu) in 32 men, 14 of them died.

Laboratory in Britain has confirmed 15 cases of swine flu in Ukraine.

On Friday, President Viktor Yushchenko expressed opinion that the peak incidence of influenza in the Western Ukraine has passed. "In virtually all areas of the Western Region can say that the peak (incidence), we held" - said the President. According to Yushchenko, the incidence is declining, and this trend is primarily in Ivano-Frankivsk and Lviv regions.

http://for-ua.com/incident/2009/11/07/090628.html

Hemorrhagic cases are very, very bad. But not new in relation with the new H1N1?

We saw reports on such cases coming in from a lot of countries?

From clinical reports, very different than H5N1 "Cytokine" ARDS. Straight forward ARDS cases are like filling a frozen flat tire. H1N1 cases are like filling a frozen flat tire full of sand. Significant problem to solve.

__________________
There Are 10 Kinds Of People In The World. Those That Understand Binary, And Those That Don't

Fifth swine flu-related death in Serbia

7 November 2009 | 11:53 | Source: B92, Tanjug
NIŠ -- An elderly man died in the Niš Infective Clinic from complications arising from swine flu, health expert Branislav Tiodorović said.

Tiodorović, a member of the government’s working group for following the pandemic, confirmed that this was the fifth person to die of swine flu-related health problems.

Tiodorović is also an epidemiologist at the Public Health Institute in Niš and was following the case closely.

http://www.b92.net/eng/news/society...07&nav_id=62874

http://www.focus-fen.net/index.php?id=n199561

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http://www.recombinomics.com/whats_new.html

Swine flu panic — and politics — hit Ukraine
By David L. Stern - GlobalPost
Published: November 10, 2009 06:46 ET
http://www.globalpost.com/dispatch/...ine-flu-ukraine


KIEV, Ukraine — It was perhaps inevitable, given Ukraine’s hyper-politicized climate — heightened by a partisan, mudslinging presidential race — that the H1N1 pandemic would become the biggest political football of all.

Ukraine is gripped by a swine flu panic, as an outbreak of acute respiratory illness has swept the country. So far, more than 750,000 people have been infected, and on Friday, 109 were said to have died. Officials from the World Health Organization (WHO) say that they believe the majority of cases to be H1N1.

“There is no question that this is a rapidly involving illness,” said Jukka Pukkila, team leader for the WHO international expert team that arrived this week in Ukraine at the government’s request.

“We have all reason to believe that this is a spreading of the H1N1 illness,” he continued, adding that laboratories in the United Kingdom and Ukraine confirmed the presence of the disease.

The Ukrainian government has undertaken some of the most extreme steps in Europe to contain the contagion. Last week, officials closed schools and universities for three weeks, and banned large political demonstrations. (Elsewhere last week, others from high-risk groups lined up around city blocks in Canada to receive swine flu vaccinations, only to be boxed out by members from two professional hockey teams who received preferential treatment.)

In the capital Kiev, where only two have died so far, many wear face masks and restaurants and cafes have seen a dip in business. But movie theaters and swimming pools remain open, and while many individuals are concerned, panic has not erupted.

The situation is much worse in the country’s west, especially in Lviv near the Polish border, where the outbreak is centered. There, some 45 people have died so far and officials have urged cinemas, restaurants and other public institutions to close for the near future.

No sooner had the government announced its containment measures, however, than the pandemic became a way for the country’s politicians to beat each other up or score points.

Prime Minister Yulia Tymoshenko, who is running second at this point in the Jan. 17 presidential elections, made a public show of meeting — in a surgical mask — deliveries of the anti-flu medication Tamiflu at the Kiev and Lviv airports.

Others called this show-boating. “Ukrainian authorities are using the hysteria over the flu outbreak to distract citizens’ attention from the country’s economic and social problems,” said presidential candidate Sergey Tigipko, a former member of Tymoshenko’s team who is now running against her. “Flu is a serious threat, but in Ukraine they have contrived to turn it into a political tool used to distract public attention from real problems.”

The H1N1 outbreak has led Ukrainian officials to accuse each other of inappropriate responses.

President Viktor Yushchenko announced that he was asking the country’s prosecutor to launch an investigation into “criminal negligence” by Tymoshenko, front runner Viktor Yanukovich and former parliament speaker Volodymyr Lytvyn for holding mass rallies to launch their campaigns, just as the pandemic was breaking out.

“The parliament speaker and the leader of the opposition and, most importantly, the prime minister, ignored the facts of the epidemics,” Yushchenko said on national television.

“This is completely similar to the May Day rallies in Kiev after the Chernobyl disaster,” he said, referring to the mass demonstrations held by communist authorities in 1986, just after the world’s worst nuclear accident had taken place.

On Friday, one of Yushchenko’s close advisors suggested that the presidential elections could be delayed until May because of what he said was the Tymoshenko government’s mismanagement of the crisis.

Ihor Popov, deputy head of Yushchenko’s secretariat, wrote on the Ukrainskaya Pravda website that if conditions worsen, a state of emergency could be introduced. That would push back the election date since it would keep candidates from campaigning fully.

WHO officials actually praise the Kiev government’s reaction, however. Pukkila said that although his delegation’s main goal was not to deliver a verdict on the appropriateness of the Ukrainian response — WHO intends simply to assess the nature of the outbreak — he found the official measures “in line with the situation.”

There is a risk nonetheless that the outbreak will become much worse. Though the number of deaths in Ukraine is lower than in other parts of the world, health officials are concerned at the speed at which the illness is spreading, and the possibility that Ukraine may be experiencing a new strain.

More worrisome is the pressure that H1N1 will place on the country’s medical system, beset with corruption, inefficiency and Soviet-era practices. So far authorities in Lviv seem to be able to cope with the added demand, WHO officials say — hospitals have the necessary supplies and there is no shortage of beds.

But Ukraine has the first major H1N1 outbreak in an eastern European country. As it spreads eastward through the former Soviet Union, medical systems in Russia, the Caucasus and Central Asia — not known for their efficiency or high-standards — will come under similar stress.

“How does the virus behave in a country like Ukraine with a health system with low resources, and how does this system cope? This is what we’re watching,” said Pukkila

__________________

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

There is currently a lot of H1N1 activity in the Ukraine and spreading outward. The WHO and the sequence lab in England are suspiciously late in releasing the H1N1 sequences, the virus is spreading like wildfire, thousands of the infected are hospitalized, Almost 200 have died, and the hemorrhagic pneumonia complication (bloody lungs) is alarming.

Here is a list of the Commentaries written by Dr. Niman in the last three days. Too many to copy over. For further information, they can be found at:

http://www.recombinomics.com/whats_new.html


Recominomics Archived Commentaries:

Media Myths on Swine Flu in Ukraine Raise Concerns (11/11/09 )

WHO Appeals to Ukraine for Help with Hemorrhagic Pneumonia (11/11/09)

Belarus Reports Almost 1/4 Million Flu Cases (11/10/09)

189 Deaths Reported in Ukraine - Belarus to 223K Cases (11/10/09)

Suspect H1N1 Death in Romania Near Ukraine Border (11/10/09)

Timeline on WHO Silence on H1N1 Sequences (11/09/09)

Pneumonia Death of Belarus Doctor Near Ukraine Border (11/09/09)

WHO Silence on Ukraine Sequences Raise Pandemic Concerns (11/09/09)

Reported Cases in Ukraine Top One Million - 174 Fatalities (11/09/09)

Over 2000 Health Care Workers Ill in Ukraine (11/09/09)

Total Destruction of Lungs in Ukraine Fatal H1N1 Cases (11/09/09)

1918 RBD Polymorphism in Ukraine H1N1? (11/09/09)

Reported Ukraine Fatalities Increase To 155 (11/09/09)

Swine flu causes surge of garlic sales in Serbia
By DUSAN STOJANOVIC
http://www.ajc.com/news/nation-worl...rge-196096.html


BELGRADE, Serbia — Belgrade's open-air markets were a welter of busy customers on Friday, pushing and shoving to buy one item — garlic.

In Serbia, garlic has long been regarded as a good luck charm and a guard against many ailments. As far as the public is concerned, that includes the swine flu pandemic, which recently has spread in Serbia and triggered near panic among the local population.

That is now evident in Belgrade's produce markets, where the price of garlic has shot up, thanks to a sudden increase in demand. The smell of the little white cloves also has become prevalent in public places as people munch on them as if eating apples.

Health officials have publicly urged the population not to take garlic's healing properties so seriously. Instead, they recommend opting for more conventional precautions, such as washing hands, wearing face masks, or eventually getting vaccinated.

But those calls seem to have been in vain.

"Garlic is the best, forget the vaccines," said Marko Jankovic, an elderly Belgrader, with the pungent smell of garlic obvious as he spoke at the crowded Kaleniceva Pijaca market. "From the vaccine, you can get sick. From garlic, you can only get bad breath."

Facing a surge of swine flu cases, Serbia's Health Ministry on Friday ordered 3 million vaccines from Swiss pharmaceutical company Novartis AG.

The authorities said Serbia has about 270 proven swine flu cases and eight deaths — up from about 130 cases and two deaths at the beginning of November.

In many parts of the world, the distinct taste and smell of garlic are considered essential in many meals. But in Serbia — as elsewhere in the Balkans — many people consider it more important than that.

Garlic is kept on doorsteps or in pockets to keep vampires away, and under babies' pillows to ensure a healthy and prosperous life. Serbs often consume garlic as a snack together with slivovitz, a strong plum brandy.

These days, Serbian media often compare what happened at two popular music festivals as proof of the alleged medicinal virtues of garlic.

That's because Serbia's first swine flu cases were confirmed after the annual Exit rock music festival in July in the town of Novi Sad, where authorities say the mostly young audience indulged in beer and marijuana.

By contrast, the media say, no swine flu cases resulted from the equally popular folk music festival in Guca, central Serbia, where the generally older, more tradition audience gorged on meat dishes heavily spiced with garlic, and drank slivovitz.

For centuries, garlic has been regarded by many people around the world as a successful medical treatment for everything from indigestion to respiratory problems. Recent medical studies also have shown that garlic can reduce a person's blood pressure.

But in Serbia, doctors are telling the public to stop considering it as a swine flu defense.

"People must take this pandemic more seriously and focus on real prevention and medicine," not garlic, said Zoran Djordjevic, a virology doctor at a Belgrade hospital.

__________________

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Poland confirms first swine flu fatality
November 14 2009 at 02:50PM
http://www.iol.co.za/index.php?from...35839494C783581


Warsaw - Swine flu has claimed its first victim in Poland, after a 37-year-old man died of respiratory complications, a medical official said Saturday.

Jerzy Karpinski, head of the medical service in the Gdansk region of northern Poland, told reporters that tests had confirmed the presence of the H1N1 virus in the man who died Friday afternoon in hospital.

The individual had initially been hospitalised with suspected severe pneumonia in the northern town of Puck, before being transferred Thursday to Gdansk's contagious diseases unit.

A specialised laboratory in the northern city of Olsztyn confirmed the presence of the H1N1 virus Saturday, he said.

Poland has so far recorded 237 cases of swine flu.

The government, however, has decided to hold off buying vaccines against the virus, arguing that those on offer have not yet been sufficiently tested.

Earlier this month, Polish Prime Minister Donald Tusk slammed drug companies selling swine flu vaccines for allegedly refusing to take legal responsibility for any possible side effects.

He also claimed that mass vaccination programmes in other countries seemed excessive and out of step with the real epidemic.

More than 6,250 people have died worldwide since the swine flu pandemic was first discovered in April in Mexico, according to the most recent World Health Organisation data, with more than two-thirds of victims in the Americas. - Sapa-AFP

__________________

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Doctors learned why Ukrainians dying
13.11.2009
http://mignews.com.ua/en/articles/378759.html


All victims of the virus in Bukovyna (22 people at the age of 20-40) died not from bilateral pneumonia, as was previously thought, but as a result of viral distress syndrome, i.e the total destruction of the lungs.

At first the cardio-pulmonary insufficiency comes, and consequently cardiogenic shock is developed, which causes cardiac standstill and death, told the chief of bureau of the Chernivtsi regional forensic examination, doctor of science, Professor Viktor Bachynsky, UNIAN reports.

"During a bilateral pneumonia some morphological picture is observed. As of data of deaths, there is no such morphological picture. The virus, which causes death, is very aggressive, it does not strike the trachea, but immediately gets into the lungs and causes heavy swelling and solid hemorrhage. Mixed types of parainfluenza and influenza A/N1N1 lead to this state. This is a very toxic strain, which has not yet answered to the treatment of the Ministry of Health", - said Viktor Bachinsky.

According to him, there is a need to change the treatment standards, because those which were used earlier, resulted in nothing – doctors failed to save all people infected with the virus in the reanimation. The belt ventilators did not help also.

For this reason a group of professors of Chernivtsi Medical University appealed to the Ministry of Health and National Security and Defense Council with a demand to review the standards of treatment of patients in Bukovyna. Scientists-morphologists sent to Kyiv reports, studies and analysis of critically ill patients and people who died of virus.

Viktor Bachinsky noted that the virus is extremely toxic, it is able to penetrate not only through respiratory apparatus but also through the eyes. Chernovtsy scientists recommend in any case use masks and even wear protective spectacles. An important condition to prevent deterioration of the situation is also the observance of quarantine regime.

06:19 p.m. Ministry of Health does not consider it is necessary to publish data on the number of confirmed cases of influenza pandemic in the laboratory. "Ukraine is in the A/N1N1 influenza pandemic, and now it does not matter how many of these cases will be detected, we should treat everybody equally," - said Deputy Minister of Health Vasyl Lazoryshynets at a briefing on Friday.

Vasyl Lazoryshynets also reminded that in Ukraine since the beginning of the epidemic 1,25 mn people became ill with pandemic influenza, influenza and acute respiratory diseases, including 61,000 people - over the past day, which is by 8,500 less than the previous day. 65,615 people are treated in hospital, including 392 - in the reanimation, 60 have artificial pulmonary ventilation.

Since the beginning of the epidemic in Ukraine 239 people died, including 26 people during the last day, most of them are in the Ivano-Frankivsk, Chernivtsi, Lviv and Ternopil Regions. He also said that according to the laboratory data, 14 people died of pandemic influenza, Interfax-Ukraine reports.

06:25 p.m. To date, swine flu in Ukraine is dominant, but not the only strain, said the head of mission of the World Health Organization in Ukraine Yukka Pukkila.

Yukka Pukkila said that the strain of pandemic virus is detected in 22 cases of 34 samples sent to the control laboratory, which collaborates with WHO in London.

At the same time, Yukka Pukkila stressed that, besides Californian flu in Ukraine there is a large number of varieties of acute respiratory viral diseases and many other viruses that infect the respiratory system, reports Liga.



.

__________________

Just read this feed from NNow/birdflu
http://www.newsnow.co.uk/h/Hot+Topi...emics/Swine+Flu

Might be a new flu. My hope is that it just burns out.

http://www.express.co.uk/posts/view...-than-swine-flu-

__________________
"We cannot live for ourselves alone. Our lives are connected by a thousand invisible threads, and along these sympathetic fibers, our actions run as causes and return to us as results." Herman Melville

For as long as space endures, for as long as living beings remain, until then may I too abide to dispel the misery of the world. by Shanti Deva

http://www.nytimes.com/2009/11/14/w...14flu.html?_r=1

Fragile Care Worsened Swine Flu in Ukraine

By ELLEN BARRY
Published: November 13, 2009
LVIV, Ukraine — When patients began arriving in Vyacheslav Bonder’s intensive care unit two weeks ago, their lungs so saturated with blood that they could barely gasp, the only thing he could compare it to was a field hospital in wartime. As soon as he hooked one patient up to a ventilator, a second and third would appear in the doorway.

By that time, hospitals were clearing wards to make room for a wave of pneumonia cases, and people were crowding into drugstores to buy whatever they could get their hands on. Rumors were circulating that the government had ordered the city aerially sprayed with chemicals, to cure Lviv (pronounced luh-VEEVE) of disease or, in a grimmer version, to exterminate its carriers.

The panic lifted almost as quickly as it had arrived, and the World Health Organization announced Friday that the swine flu illnesses and deaths so far in Ukraine — 265 fatalities nationwide, with 87 in the Lviv region — were statistically no worse than those in other countries. But what happened here has drawn rapt attention from experts bracing for the epidemic to hit Europe, and especially the fragile health care systems of countries of the former Soviet Union.

Early findings are that serious cases mounted because the sick avoided hospitalization until their illness was dangerously advanced, stockpiles of Tamiflu were locked in centralized locations and the supply of ventilators fell short, said David Mercer, of the World Health Organization’s European regional office.

“It’s not like this caught us by surprise; we’ve known for months that this was coming,” said Dr. Mercer, who heads the office’s communicable disease unit. “We’ve been working very hard on plans, but sometimes the battle plan doesn’t survive the first contact with the enemy. We’ve had to change a lot of things on the fly.”

With the worst of the health care crisis here past, many in Ukraine’s western provinces are trying to puzzle out what led to it. Doctors blame the news media and politicians for spreading fear and misinformation. The mayors of Ternopyl and Lviv, which reported their first deaths from atypical pneumonia on Oct. 12 and 19, have complained that the federal epidemiological service refused to act without laboratory confirmation that the virus was present, delaying serious measures by nearly two weeks.

Others point to more remote causes, among them the desperate poverty of Ukraine’s health care system 20 years after the Soviet Union collapsed.

In Lviv, senior doctors earn a monthly salary of 1,500 hryvnas, approximately $184, pay so low that many physicians leave their practices to work as home health aides in Western Europe. Though health care is officially free, patients typically pay a stream of cash bribes for services as large as X-rays and as small as blood tests or linen changes.

Ukrainians rely heavily on home remedies, and that is what they did for the third and fourth weeks of October, resorting to garlic and lemons and waiting so long to check into hospitals that by the time they did, many were beyond treatment.

“Medicine is underdeveloped in Ukraine, and people don’t believe in it — it’s a vicious circle,” said Oleh Berezuk, a physician who heads the mayor’s administration in Lviv. “In a mature country, if you get sick you will not say, ‘Nobody can help me.’ ”

Now, the doctors at Lviv’s main pulmonological hospital have the shaky good humor of people who have come through a crisis, though portions of their hospital are clammy and unlighted (“to scare the viruses,” one doctor joked), and some of their breathing equipment dates from Soviet times.

Two weeks ago, though, doctors here thought they were looking at a medical mystery: the deaths of healthy young people — not the drunks or addicts they usually see — with lungs so inflamed that they resembled liver. Dr. Bonder recalls the numb realization that his ordinary protocol for treating pneumonia was having no impact at all.

“You would come in to work and the next time you looked at your watch it was midnight,” said Dr. Bonder, who heads the intensive care unit. “You didn’t even think what could happen next.”

Nurses and doctors were falling ill at an alarming rate, in part because of shortages of gloves and disinfectant. Irina Mykychak, the assistant director of Lviv’s regional medical department, said around 3,500 medical professionals fell ill, of whom 300 were hospitalized and 4 died.

When they did suspect H1N1, physicians were stuck in a Catch-22. Though the government had stockpiled Tamiflu in preparation for an outbreak they expected later in the year, the drug was available only at the region’s single infectious disease station — and only with proof that a patient had H1N1. Obtaining proof was a three-to-four-day process that required that samples be sent to Kiev, said Lyubomir Rak, the hospital’s director.

Nadia Rudnitskaya, chief of pulmonology, was carefully putting the pieces together. On Oct. 27, she examined the body of a 32-year-old man — the latest in a series of four deaths from four parts of western Ukraine that, as she put it, “shouldn’t have happened.” Dr. Rudnitskaya gathered her samples together and appealed urgently to Kiev.

Right then the logjam broke: The next day the governor ordered a quarantine and released the emergency stockpile of Tamiflu to clinics and hospitals. A day after that, Prime Minister Yulia V. Tymoshenko announced on television that the virus had “reached epidemic threshold,” and all of Ukraine was talking about H1N1.

“It was a riddle,” Dr. Rudnitskaya said. “There was an answer.”

For some, it came too late. Marta and Nazar Martin insisted that their mother, Galina, 43, check into a hospital on Oct. 23, after her cough worsened into shallow, labored panting. A dentist, she had been treating herself with intravenous antibiotics and flu medications, as she had always done before.

“No one knew there was an epidemic,” said Marta, 18. “Nothing was said, not at work, not on television.”

The hospital offered no answers either. Doctors first prescribed antibiotics for bronchitis, then punctured Ms. Martin’s spinal column to test for meningitis and encephalitis, then gave her an M.R.I. to rule out a brain tumor. With every new prescription, her children scraped up the money and set off to find a pharmacy where it was available, Marta said.

“A poor person would just die,” she said. “They will not start a medication until you pay for it.”

On Oct. 29, when information about H1N1 flooded the region, doctors and nurses showed up wearing masks for the first time, Nazar said. He watched incredulously; his mother had already declined so much that she was “half a corpse,” he said. After she died, the next day, samples from her body were sent to be tested for swine flu.

Her children estimate they paid 35,000 hryvna, or about $4,300, in cash payments to nurses and doctors during the week she spent in the hospital. The more they hear about swine flu, the angrier they get.

“Why didn’t they take measures before then?” said Nazar Martin, 19. “I’m interested in knowing what they were thinking. They took this seriously only when people began to die, when the death statistics began to rise. Where were they before then?”

“It’s on their conscience,” he said, of the medical authorities. “They should have done something to prevent it.”

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Roscoe and Miss Priss

http://scienceblogs.com/effectmeasu...aine_a.php#more

WHO, swine flu in the Ukraine and bin Laden's beard
Category: Pandemic preparedness • Public health preparedness • Swine flu • WHO
Posted on: November 16, 2009 6:23 AM, by revere

We were asked repeatedly offline and in the comments for our views on what was or was not going on in the Ukraine, but we steadfastly declined to post on it. We didn't know any more than you can find out from news sources, so we had nothing to add in the way of hard information, We did know there was a WHO team on the ground and we thought it best to wait to find out more. We still don't know much, except that news reports are suggesting that the health care system in the Ukraine is a shambles and its likely the chaos and panic were self-inflicted more than virally inflicted. Mike Coston over at Avian Flu Diary has a great run down and we agree with the way he approached it -- gingerly, cautiously but with the right amount of anxiety that something could be happening but it was best to wait for information before hitting the alarm button (I didn't say panic button because it's never appropriate to hit the panic button).

Meanwhile, multiple stories out of the Ukraine were detailing disorganization, incompetence, politicization of the outbreak during a presidential campaign and much else. Few citizens believed what their leaders or government were saying, which is probably just as well because the messages were often contradictory and confused. The most recent version of this is from the New York Times:

Here's an earlier report from Ukraine's English language Kyiv Post:

WHO's regional office in Europe did send a team there and the above notwithstanding, here is what it reported on November 12, 2009:

So while we waited for WHO's team to report about reports that were at the least, worrying, they were concocting crap like this. Anything in this statement that isn't completely vacuous is just plain bullshit. WHO is an intergovernmental organization that is subservient to its member nations. We've explained that often here, often in sympathetic terms. But there comes a time when the niceties of diplospeak conflict with telling the truth. When that time comes, it's better to shut up rather than mouth utter tripe.

Sometimes it's the opposite of what our mother's taught us about polite discourse: if you can't say something bad about someone, you shouldn't say anything at all. Because once you start telling the world what a nice beard Osama bin Laden has, they will stop listening to you, no matter what else you say.

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Roscoe and Miss Priss

Health Ministry sees no need to publish information about confirmed cases of A/H1N1 flu

Today at 15:11 | Interfax-Ukraine

The Health Ministry of Ukraine sees no need to publish information about a number of laboratory-confirmed cases of А/Н1N1 flu.

"Ukraine has pandemic of А/Н1N1 flu and now it doesn't much matter how many cases are confirmed, as we should treat everyone equally," Ukrainian First Deputy Health Minister Vasyl Lazoryshynets said at a briefing on Nov. 13.

He noted that in Ukraine as of Nov. 13, since the start of the epidemic 1.25 million people have contracted flu and acute respiratory infections.

The first deputy health minister said that A/H1N1 flu had been laboratory-confirmed in 14 people.

According to Jukka Pukkila, the Head of a WHO international mission that has been in Ukraine for two weeks, the mission will publish its final decision by the end of this week.

"According to the preliminary results, there is no difference concerning the rate of A/H1N1 flu infection in Ukraine compared to other countries," he said.

http://www.kyivpost.com/news/nation/detail/52878/

thanks to http://twitter.com/Crof

WHO release

Pandemic (H1N1) 2009, Ukraine - update 2

17 November 2009 -- Preliminary tests reveal no significant changes in the pandemic (H1N1) 2009 virus based on investigations of samples taken from patients in Ukraine. Analyses are being performed by two WHO influenza collaborating centres as part of the global influenza surveillance network.

Preliminary genetic sequencing shows that the virus is similar to the virus used for production of the pandemic influenza vaccine, reconfirming the vaccine's efficacy at this time.

Additional questions about the pandemic virus circulating in Ukraine will be answered as more data is available.

WHO commends the government of Ukraine for its open sharing of samples to inform global monitoring of the virus for signs of change.

A total of 34 samples were analysed independently by the WHO Collaborating Centre for Reference and Research on Influenza, Mill Hill in London, UK, and the WHO Collaborating Centre for the Surveillance, Epidemiology and Control of Influenza in Atlanta, Georgia, USA.

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http://octopuswithafez.blogspot.com/

Ukraine reports 12 flu deaths in 24 hours
14:5818/11/2009
http://en.rian.ru/exsoviet/20091118/156888973.html


The death toll from the flu epidemic in Ukraine has reached 328, with 12 deaths registered over the past 24 hours, the health ministry said on Wednesday.

The number of officially confirmed H1N1 strain swine flu deaths in Ukraine has reached 15, with 166 people infected.

Last week, Ukraine's National Security and Defense Council (NSDC) chief, Raisa Bohatyryova, said there were "constitutional prerequisites" for a state of emergency amid the flu epidemic, which has left a total of 1,457,564 people infected as of November 18.

A state of emergency, if it is declared, could delay the presidential polls scheduled on January 17, 2010 until May.

Ukraine's Prime Minister Yulia Tymoshenko said she saw no need for such measures.

The Ukrainian government imposed quarantines in nine western regions in late October in an attempt to curb the spread of flu. All educational establishments in Kiev were closed, and people were obliged to wear medical masks in all catering establishments, shops and social services facilities across the former Soviet republic.

The Ukrainian parliament has approved the allocation of 1 billion hryvnias ($125 million) on measures to fight swine and seasonal flu.

However, President Viktor Yushchenko has not signed the allocation plan, citing it would accelerate inflation and cause a decline in Ukraine's standards of living.

Yulia Tymoshenko said the president's refusal to allocate money would impede governmental efforts to fight the epidemic.

Yushchenko and Tymoshenko, as well as Party of Regions leader and former premier Viktor Yanukovych, who lost the previous vote to Yushchenko following the 2004 "orange revolution" are among the 16 candidates to run in the Ukrainian presidential election.

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"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Macedonia reports its first swine flu related death
By THE ASSOCIATED PRESS (CP) – 9 hours ago
http://www.google.com/hostednews/ca...wxJQFvq6nFKQjEA


SKOPJE, Macedonia — Macedonia has reported its first swine flu-related death.

Officials from the Clinic for Infectious Diseases in the capital Skopje say a 32-year-old man died Tuesday of complications from severe pneumonia brought on by swine flu.

The death was announced Wednesday. Macedonian health authorities say more than 300 cases of the virus have been recorded in the Balkan country.

__________________

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

According to Jukka Pukkila, the Head of a WHO international mission that has been in Ukraine for two weeks, the mission will publish its final decision by the end of this week. "According to the preliminary results, there is no difference concerning the rate of A/H1N1 flu infection in Ukraine compared to other countries," he said.

This may be true, but it is not really what is important, here. The sequences of ten cases from Ukraine were made public in the last day or so. Of those ten sequences, four contained a polymorphism, D225G, in the receptor binding domain of the virus. Henry Niman pointed out that these four sets of sequences were obtained posthumously, and not by means of throat swabs. This polymorphism allows the virus to attach to cells in deep lung tissue, rather than to cells in the upper respiratory tract. The outcome is similar to what happens in an H5N1, or 1918 pandemic H1N1 infection. Niman goes on to point out that initial testing is not going to show an H1N1 infection, when this polymorphism is present. He also says that it has already shown up in other geographically discrete locations on the globe; this doesn't indicate, as WHO correctly claims, that there is a "major" genetic modification taking place, here (no antigenic shift). But this is a "minor" accretion that can have enormous implications, with regard to virulence levels. A virus adapted to binding with cells deep in lung tissue is inherently more dangerous than one adapted to binding with cells in the upper respiratory tract. This is where all of the dangerous complications necessarily evolve. Transmissibility, at this point, is an unknown; and to be particularly dangerous, this modification of the receptor binding domain has to be capable of being easily transmitted from person to person, of course. If it should be the case that this "minor" alteration doesn't interfere with the viruses current level of transmissibility, then this would be the first instance in which I think that we could be seeing something very unsettling occurring, here, since the advent of the beginning of the pandemic. No doubt the situation in Ukraine will now be watched even more closely than it already has been. The six people who presented with the sequences that did not contain D225G all lived.

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For the country of death is the heart's size
And the star of the lost the shape of the eyes.

Dylan Thomas (Vision And Prayer)

(This was just posted over at "EffectMeasure;" it is another case of posthumous identification of H1N1 infection; initial tests missed the presence of the virus. I wonder whether this, too, might be another case where the D225G polymorphism is present?)

Early this AM the 58-year-old mother of my step-son's fiancee died in an Ohio Hospital of H1N1. She had been in ICI/Isolation for two weeks on a vent, medically induced coma and medcially induced paralysis for about a third of that time. The first two rapid tests were negative although she clearly had the classic symptoms plus double pneumonia ( a biopsy of the lungs did not show any antibiotic resistant bacterial infection ). She was "in" a rotating bed that looked like something out of Alien. She never regained consciousness. Yesterday the PCR test came back from the state as positive for H1N1.

Not like I'm a physiciam but I texted them over a week ago about trying an ECMO and found where they were near her. The doctor called Ohio State but told the family it would be pointless "because everyone dies right after they come off the machine."

I texted them the CDC page for emergency use of Peramivir (sp?) but this wasn't tried either. I obviously can't second guess the physician but in light of your article on testing, here was a example of someone who "obviously" had H1N1 but whose correct test results took almost two weeks. She "died" of liver and kidney failure.

She had never had pneumonia before but had been diagnosed with possible mild asthma a few years ago and given a rescue inhaler, which she never needed.

Posted by: tymbuktu | November 19, 2009 3:09 PM

__________________
For the country of death is the heart's size
And the star of the lost the shape of the eyes.

Dylan Thomas (Vision And Prayer)

Dr. Niman continues to track the Ukraine situation and posts a number of Commentaries each day on the progress of H1N1 evolution and the effect of H1N1 on the Ukraine population. Over 85 thousand people have been hospitalized in Ukraine in the past month to treat respiratory infections and complications. At least 344 have died, and the numbers grow daily.

The Mill Hill Lab in London and the CDC have tested the Ukraine strain of H1N1 against the current H1N1 vaccine, and found the vaccine to be effective against the Ukraine strain. Here is a listing of recent Recombinomics Commentaries which can be accessed at:

http://www.recombinomics.com/whats_new.html

Recominomics Archived Commentaries:

D225G Lung Tropism Driving H1N1 False Negatives? (11/19/9)

Media Myths Cloud Joint Hearings on Pandemic Vaccine (11/19/09)

All Fatal Ukraine H1N1 Cases at GISAID Have RBD D225G (11/19/09)

Ukraine Dead Increase to 344 - Sequences Released (11/18/09)

RBD Change D225G in Ukraine Lung Raises Concerns (11/18/09)

Receptor Binding Domain Change D225G Confirmed in Ukraine (11/18/09)

RBD D225G in China and Australia Raise Ukraine Concerns (11/18/09)