Pandemic Awareness/Preparation

Nurses COVID

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It has been my own personal project to follow H5N1 for the last 3 years simply because it interests me. Attracted to this type of information like a magnet, I've been watching this relatively new influenza virus to see where it will go, how it will change itself, and possibly change our world. I have followed its country by country outbreaks, and watched for the important viral mutations such drug resistance or changes that allowed it to more specifically target mammals.

Keeping in mind at all times that we will be cleared impacted as HCW, as well as being members of our communities, and having families of our own to care for, I wanted to start the new year by opening a single focused pandemic thread that would also look at what we are doing nationally to prepare for a future pandemic. Is this the virus to spark the next pandemic? No one can answer that question. We can look back at the past to the last few pandemics, and in particular to the most devastating one in 1918, and extrapolate useful information about them, but we can not predict the future. We can only make comparisons with our situation now, and learn what worked to lessen morbidity and mortality in those past events. And, we can look at those other viruses, and compare them with what we are seeing now. For example, H5N1 is a Type A virus. We know that all pandemics are caused by Type A viruses. It is also an avian virus. The deadly 1918 virus, H1N1 was also an avian virus.

For this thread, as in the previous threads, I will be making use of news sources, scientific studies, govt bulletins such as the MMR, as well as flu forums and blogs devoted to this subject for my sources. Because press information, particularly the foreign press, is not always available for later access when I am looking back to check recent historical information, the use of these blogs and forums are important because archived information quoting the media and all other sources is always fully and easily available there with no worries about information disappearing or no longer being available. They also fully document their sources or I would not be using them.

With this link from Avian Flu Diary, a well researched source that I highly recommend, we can read the words of outgoing HHS Secretary Leavitt on our state of preparedness. Leavitt has done an admirable job during his tenure, but admits that there is much left to do.

http://afludiary.blogspot.com/2009/01/hhs-releases-6th-pandemic-planning.html

afludiary.blogspot.com said:

A scant 33 months ago, I sent my first message about a race that HHS had just begun. As I said then, it was a race against a fast-moving virulent virus with the potential to cause an influenza pandemic. Since then, we have mobilized experts and resources across the country and around the world. I now send you this final message, as I look back at the unprecedented progress we have made in energizing a national pandemic influenza preparedness movement in those 33 months.

Today, many people mistakenly think influenza pandemics are a thing of the past, but influenza has struck hard in the era of modern medicine – much harder than most people realize. And it will strike again. Pandemics are hard things to talk about. When one discusses them in advance, it sounds alarmist. After a pandemic starts, no matter how much preparation has been done, it will be inadequate.

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Update Needed on the Bird Flu Outbreak in Canada

It's beyond strange that there still has been no real identification of the avian flu virus that caused the outbreak at Abbotsford in British Colombia. We last heard Canada's National Centre for Foreign Animal Diseases in Winnipeg reporting that this was an H5 virus, 99% similiar to an H5N2 virus recovered from a green-winged teal in California in 2007.

It is important for governments to have a certain level of transparency about the cause of such events. The OIE report was filed on 1/23/09, and it's now 2/03/09, and they still have not announced the serotype of that virus. So, is it H5N2 or maybe a low pathogenic H5N1?

This is rather uncomfortably reminiscent of the handling of another bird flu event that occurred in Canada a few years ago where there was no definitive result given then either.

http://www.flutrackers.com/forum/showpost.php?p=77563&postcount=58

There is little reason to aggressively test. The best example for North America was the H5 positive dead geese on Prince Edward Island. All real data STRONGLY suggested the H5 positive geese died from Qinghai H5N1, yet Canada managed to "control" damage, so no OIE report was filed and no country banned Canadian exports.

http:////www.flutrackers.com/forum/showpost.php?p=87058&postcount=11

...one really has to want to find these viruses. It takes diligence because the process is not all that simple and subject to a lot of problems along the way. I would be concerned that an agency whose primary job is to protect the beef and poultry industry might lack a certain level of independence necessary to seek out and find a virus that could cause significant economic disruption to the very food industry that it supports.

http://www.flutrackers.com/forum/showpost.php?p=206561&postcount=107

It's beginning to sound like the dog ate the homework AGAIN!

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Canada - Low Path H5N2

http://www.flutrackers.com/forum/showpost.php?p=206917&postcount=111

At last a diagnosis! Canada gets to say it is still free of any highly pathogenic bird flu. A highly pathogenic influenza would have had an even worse adverse economic effect on the region.

This is in contrast to an earlier outbreak that occurred on Prince Edwards Island a few years ago. In that case they said that the specimens were too degraded to be serotyped. Someone sent them too late. They did say that it was an H5 virus, but would not acknowledge the size of the probe insert. Doing so would have given information about the cleavage site of the virus, and that would have indicated if the flu was highly pathogenic. Instead, they claimed "privacy" issues (of geese?). They did however, offer Tamiflu to the folks on the farm.

Just saying, there has to be a certain level of transparency to maintain trust in the accuracy of what they are claiming as truth because this is not just about the economic security of the Canadian agricultural industry anymore.

The Canadian Food Inspection Agency reported Tuesday that tests at the National Centre for Foreign Animal Diseases in Winnipeg confirm the H5 bird flu virus detected on the farm is H5N2.

The agency also reiterated that preliminary tests at the outset of its investigation on Jan. 24 indicate this strain of bird flu is of low pathogenicity ("low-path").

It's thus likely that Canada will keep its status as free of "high-path" bird flu, which it's held since April last year after the cleanup of an outbreak of H7N3 on a poultry farm near Regina Beach, Sask.

http://www.flutrackers.com/forum/showpost.php?p=206919&postcount=112

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France - Low Pathogenic Bird Flu Outbreak

http://crofsblogs.typepad.com/h5n1/2009/02/france-an-outbreak-of-h5n3.html

This is the same type of flu (H5N3), a low pathogenic one, as what was just found in Canada, however the French did all of their testing, and reporting of results in only 4 days. Are the Canadians just inept?

This does not bode well for H5N1 surveillance in North America.

...the first signs were on January 29, a Thursday, and on Sunday the whole population on the farm was culled. The first positive test results were on January 30, with a follow-up test (also positive) on February 1.

Egyptian Baby Diagnosed with Bird Flu

http://www.flutrackers.com/forum/showpost.php?p=207113&postcount=64

Another baby was found to be infected with H5N1 in Egypt. Fortunately, most of these little kids have been recovering including the recent case in China. It's the teenagers and young adults that die which is reminiscent of 1918.

...Egyptian Health Ministry confirmed on Wednesday that a two-year-old baby has been infected with bird flu virus, which brings the number of human case of bird flu to 54 in the populous country. Mahmoud Sobhi Gharib, from the Suez governorate, some 120 km east of Cairo...

Chinese Toddler Recovers

http://crofsblogs.typepad.com/h5n1/2009/02/china-miss-peng-goes-home.html

A 3-year-old girl has become the youngest person ever in China to recover from bird flu infection.

The girl, identified only by her surname Peng, was hospitalized last month in north China's Shanxi Province after being diagnosed with the H5N1 strain of avian influenza.

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What Is Going on in China?

http://afludiary.blogspot.com/2009/02/china-denies-h5n1-outbreaks-in-poultry.html

Everyone remembers how the Chinese denied the rumors of a new infectious disease in their country. The rumors turned out to be frighteningly true. That was SARS. Again, we are seeing clues that the Chinese are covering up something. Dead birds are washing up in Hong Kong. There are 8 human cases of bird flu that the Chinese are admitting too, but they deny any outbreaks in poultry.

The real reason to be concerned is that what is happening there, easily could fly here.

China has reported 8 human cases of H5N1 infection over the past month -and they attribute these infections to close contact with infected birds - but at the same time they deny any outbreaks of the virus among poultry.

Additionally, a small number of infected bird carcasses have washed up on the beaches of Lantau Island, near Hong Kong over the past week. Local officials suspect these birds were tossed into the Pearl River, which flows from Guangdong Province.

All of which is pretty strong evidence that the H5N1 virus is circulating, presumably in the domesticated bird population, in mainland China.

But according to China, they aren't seeing any sick or dying chickens.

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When a recession and a pandemic collide

http://www.scottmcpherson.net/journal/2009/2/5/when-a-recession-and-a-pandemic-collide.html

Scott McPherson is the CIO (Chief Information Officer) of the Florida House of Representatives. He blogs on pandemic preparation in his spare time. He make a few points here. First, that Tamiflu is not the only antiviral that govt should be stockpiling for pandemic preparation especially given that one of our seasonal influenzas is now immune to it and that this could happen with bird flu. Next, he reminds us of the increasing importance of computer data, and that this is part of critical infrastructure.

In Britain, even though its government is also dutifully doling out billions of pounds Sterling to banks and other institutions, its government has declared it is doubling its stockplie of antivirals -- and (wisely) increasing its reliance on the inhalant Relenza/zanamivir for prophylactic use by first responders and law enforcement/military.

What do the Brits know that we don't know?

I read the federal government's recent assessment of the fifty states' preparedness for a flu pandemic, and I am sorry, but I don't believe a word of it. It's not that I think anyone is lying, but I refuse to believe any state is truly, look-in-the-mirror-prepared for a killer pandemic with a mortality rate close to 1918's.

Why? I do not see any state moving beyond the 25% antiviral purchase goal. I see many states meeting their share of that 25% goal, but none really exceeding it.

Why? I see no state embracing innovative solutions, such as the co-administration of probenecid to effectively double the supply of Tamiflu.

Why? I don't think the feds can plan their way out of a wet paper bag.

Why? There is no emphasis on information technology data center and network professionals as among the first to need antivirals, particularly those in the public sector's own front lines of defense -- namely social services, law enforcement and unemployment assistance. Nowhere, in any federal pandemic document, do I see anything other than a cursory reference to "critical infrastructure" as even acknowledging the essential role that government data center and application developer and system engineer and network engineer and cybersecurity professional employees will play in a pandemic.

Computers will route the information that is needed for people to make decisions and move resources. Computers will tell us who is sick and where (look at the Google plan to match search expressions with geography and, in their plan, be able to predict where a pandemic has broken out). Computers will tell us how much of something is left and how much to ration. If data center people get sick (and because they work in enclosed spaces, they work in very close physical proximity to one another and they WILL get sick in disproportionate numbers to the general population), you will have staffing problems and you will have maintenance postponements and database reorgs gone undone and then you will have system failures. Big system failures.

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Chinese expert issues new bird flu warning

http://news.xinhuanet.com/english/2009-02/06/content_10775326.htm

I am behind on the bird flu news lately due to other obligations and illness. Meanwhile there are stories coming out of China, Indonesia, Vietnam, and Egypt. H5N1 is busy this time of year.

First a look at China which is not admitting to much viral activity but some news is leaking out as in this story from one of China's top scientists famous for his role in the SARS epidemic. Dr. Zhong knows the score.

A leading Chinese expert on respiratory diseases has warned the public to be aware that poultry can be infected with the bird flu virus but show no symptoms.

"Special attention should be paid to such animals, including those that have been vaccinated," said Zhong Nanshan.

"The existing vaccines can only reduce the amount of virus, rather than totally inactivating it," he said.

Zhong, an academician at the Chinese Academy of Engineering, is one of the scientists who helped control the spread of the Severe Acute Respiratory Syndrome, or SARS, in China in 2003.

His warning comes after eight human cases of the H5N1 strain of avian influenza have been reported across the country since January.

Zhong said he had noticed that more than half of those infected had no direct contact with birds and nor did they live in the areas where infected fowl with symptoms were reported.

China defends bird flu vaccination plan despite deaths

http://news.yahoo.com/s/nm/20090206/hl_nm/us_birdflu_china

As China defends its vaccination policy, claiming no outbreaks in poultry, dead birds positive for H5N1 are washing up on the shores of Hong Kong.

Apart from the discovery of a case during routine sampling in eastern China's Jiangsu province in December, Chinese testing has not detected any bird flu since June.

Meanwhile, two ducks and a goose found in Hong Kong have tested positive for H5N1, the strain of bird flu that can infect humans. Hong Kong closed its Mai Po nature preserve as a precaution for 21 days from Friday, after a dead grey heron found there also tested positive for bird flu.

Hong Kong authorities are still testing 14 other dead birds found last week on Lantau Island.

"We're checking water currents" to see if the birds were washed ashore from mainland China, a government spokeswoman said.

Dead fowl found in NW China's Xinjiang test positive for H5N1 virus

http://afludiary.blogspot.com/2009/02/china-detects-small-bird-flu-outbreak.html

But wait one, the Chinese do admit that a SMALL outbreak occurred though they don't explain how this happened given that they have this vaccination program in place.

China's Ministry of Agriculture announced Tuesday that dead fowl found in the northwestern Xinjiang Uygur Autonomous Region were confirmed as H5N1 positive in tests by the national laboratory.

The ministry said 519 fowl died of bird flu...

China's Health Ministry: Victims Had Contact With Poultry

http://afludiary.blogspot.com/2009/02/china-health-ministry-victims-had.html

And, now the Chinese change the story yet again about the recent human victims of bird flu saying that these people did have contact with poultry even while they still say that there has not been any poultry deaths except for the one small outbreak in Xinjiang. Yes, it's confusing alright, and very hard to take anything that they report at face value particularly when they try to reassure everyone that there has been no mutation in the H5N1 virus that would allow human to human transmission. Of course there has been human to human transmission, but it's not been efficient nor often officially admitted to...

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What Do the Japanese Know That We Don't Know?

http://www.bloomberg.com/apps/news?pid=20601204&sid=aMTBGqYHJE4M&refer=technology

Why Panasonic made this decision is open to interpretation.

The company in December instructed staff assigned to parts of Asia, Africa, eastern Europe and South America to repatriate their families by September, Akira Kadota, a spokesman for Osaka- based Panasonic, said by telephone today. He declined to comment on the number of employees or households affected.

Panasonic may be the first major company to order families home on concern people wouldn't receive needed health care in case of a widespread flu outbreak. A pandemic could kill 71 million people worldwide and lead to a "major global recession" costing $3 trillion, according to a worst-case scenario outlined by the World Bank in October.

Honda Motor Corp., Japan's second-biggest carmaker, considered bringing home families of expatriates in China after a woman in Beijing infected with bird flu died on Jan. 5, said Hideto Maekawa, a spokesman for the company. The carmaker has advised employees to cut down on "unnecessary and non-urgent" business trips, he said.

http://pandemicchronicle.com/2009/02/panasonic-pandemic-influenza/

This action by Panasonic is rife for speculation; unfortunately, there is just not enough information in the news blurb to puzzle out anything beyond the fact that this is a precautionary measure in anticipation of a possibility.

All of this is worth noting, it's also worth further monitoring to see if any other companies follow suit. On the purely speculative front: Panasonic has a presence in China. If something is going on in China, and many believe there is a significant likelihood there is, then Panasonic is in a position to know more than I do sitting at my computer in Charleston, SC.

Panasonic's pandemic-related move fuels questions, concern

http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/feb1009panasonic-br.html

Bloomberg News published its initial story on Panasonic's request to its foreign employees last night, citing a Nikkei news story that did not quote any Panasonic sources. That prompted a handful of editors from prominent pandemic flu blogs, such as Avian Flu Diary and A Pandemic Chronicle, to swing into action, said Sharon Sanders, editor-in-chief of FluTrackers, a well-known Web message board that focuses on avian flu developments.

The editors met online late last night to coordinate their coverage of the story and ask their contributors to translate foreign-language information on the Panasonic development, Sanders told CIDRAP News. She said she connected with Panasonic's spokesman in Japan last night to flesh out some of the facts, which Bloomberg obtained and reported in today's updates of its stories.

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Egypt

http://www.recombinomics.com/News/02090901/H5N1_Egypt_Toddler_2.html

This is the second toddler recently diagnosed with bird flu in Egypt. The first child recovered.

Egypt vaccinates its poultry but, as we are seeing in China and Vietnam as well, the virus is still present and can infect people even if the birds do not appear sick. This link is pointing out that the strain of virus present in Egypt appears to be vaccine resistant. The Egyptians are no longer filing reports of outbreaks in poultry as they occur now that the disease is endemic in their country. Supposedly they are doing this on a 6 month basis, sending all the information at once so if there is an increase in the number of outbreaks, we are not going to be aware of it in real time except by translations if the local media comments on it. The Egyptian government also censors its news media.

The translation describes a bird exposure, but external monitoring H5N1 in poultry is somewhat compromised by Egypt's announcement that H5N1 was endemic, leading to OIE reports at 6 month intervals. H5N1 in Egypt has been a concern because of the emergence of a vaccine resistant strain a year ago. This H5N1 was isolated from vaccinated flocks and was widespread in Egypt, and also detected in Israel.

Vietnam

http://www.flutrackers.com/forum/showthread.php?t=93604#post208497

This is a horrific picture of what is happening in Vietnam. Bird flu outbreaks are occurring in seven different provinces. Some of the people are rioting and trying to save their poultry while the govt attempts to cull the birds to stop the virus. Poultry is an important source of cheap protein in that country. You have to wonder just how bad things are when the people choose to eat infected birds or do without. Poverty is helping to drive the epidemic.

Meanwhile a young woman is dying. She is the second human case this month.

Ly Tai Mui, from northern Quang Ninh Province, is seriously ill with pneumonia, having tested positive for human avian flu. The 23-year-old was hospitalised with fever and breathing difficulties in January after eating a sick chicken.

Nguyen Huy Nga, head of the Preventative Health and Environment Agency, told IRIN the woman had shown "no improvement despite continuous positive treatment".

Nga said no other family members had shown signs of the virus even though they had also eaten infected poultry.

Vaccination efforts have become lax because Vietnam had, until recently, considered itself bird flu-free. Farmers have also delayed reporting outbreaks. In one case a crowd tried to prevent authorities from culling birds that were being transported to the capital and lacked proper health certificates.

"Hundreds of people were trying to grab the chickens," said Nguyen Huy Dang, a senior official with Hanoi's Animal Health Department. "They jumped into the pit where we were burning the [live] birds, even after we told them they had been sprayed with chemicals."

Animal health officials and market workers were unable to stop the crowds, which eventually made off with nearly all 1,500 birds. Police arrested nine people for trying to stop the cull.

"We never expected anything like that to happen," said Dang. "It's never happened before so we didn't have the personnel to prevent it."

Indonesia

http://afludiary.blogspot.com/2009/02/indonesian-beat-goes-on.html

Indonesia continues to be a hotspot for bird flu activity. We have to rely on reports from the media now that their govt is no longer reporting outbreaks. They do however, still have a relationship with the WHO and have asked for assistance at times.

For those planning a vacation in Bali, perhaps you should consider another option...

Our first stop this morning is Bali, where some birds have been culled after birds in a backyard flock died mysteriously. Additionally, a 19 year-old (gender uncertain) is receiving Tamiflu, but is not hospitalized.

Anyplace else in Indonesia, 15 dead chickens would not raise much concern. But Bali is a major tourist/vacation destination for much of Australia, New Zealand, and Asia.

An outbreak of Bird Flu there, even a minor one, could have major economic repercussions for the tourist industry.

...in South Sulawesi - six villages are isolated due to an outbreak of the virus in poultry. The exact details of how these villages are `isolated' are not provided.

This may simply indicate restrictions on the transportation of poultry and eggs out of these villages, or it might signify a tighter cordon. It's impossible to tell from this report.

And in East Java, multiple outbreaks of bird flu are still being reported among poultry.

Specializes in Too many to list.

http://afludiary.blogspot.com/2009/02/background-noise.html

Lots of strange information lately regarding bird flu. Of course, this is the time of year that there are many outbreaks in bird populations, and reports of human cases. This is not unexpected. But, none the less, there is some rather puzzling information being reported. I think that you have to look at the overall picture to see where this could be leading.

http://www.scottmcpherson.net/journal/2009/2/13/signs-and-portents.html

The following link is also of note. Tamiflu resistance has developed in the US and most other countries in one of our seasonal influenzas, H1N1. If this seasonal flu infects someone who is also infected with bird flu, there is potential for serious concern. These viruses could recombine genetic material, resulting in bird flu becoming Tamiflu resistant as well. The Japanese are researching this. Their govt as well as a major Japanese corporation have made some announcements lately that would indicate that they are have been taking more serious precautions with regards to pandemic influenza preparations.

http://www.yomiuri.co.jp/dy/national/20090114TDY02309.htm

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The Hidden Outbreak

http://www.forbes.com/2009/02/13/china-bird-flu-markets-economy-0213_asia_05.html

Forbes article regarding the possibility that the Chinese are hiding information on bird flu.

If I lived in Hong Kong, I'd be a little concerned. Note the comments following the article on the Forbes site.

China slaughtered more than 13,218 fowl in its northwestern Xinjiang Uighur autonomous region after 519 dead birds were confirmed to have contracted the H5N1 strain of bird flu, the state news agency Xinhua quietly disclosed on Tuesday night.

Measures were taken, birds were killed, and the epidemic had been brought under control, Beijing's official mouthpiece said in a 75-word article. But is that it? The report, citing the Ministry of Agriculture, provided no details on when, where and how the virus had spread.

http://tinyurl.com/c2h3hp

More than 400 UA students from various colleges will participate in a pandemic flu exercise today at the Arizona Health Sciences Center in order to be more prepared if such a outbreak were to occur.

Students from the Colleges of Medicine, Pharmacy, Nursing, Law and the UA Mel and Enid Zuckerman College of Public Health will discuss various disaster scenarios and also learn how to handle the outcomes of a flu pandemic hitting Tucson.

They'll learn about the consequences of limited resources, the safety of healthcare workers, the role of the private sector, healthcare for non-citizens and also the role of media in informing the public about an outbreak, Strich said.

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Second Bird to Bird Outbreak in Bali

http://crofsblogs.typepad.com/h5n1/2009/02/bali-second-b2b-outbreak-in-10-days

Bird flu is endemic in Indonesia and that includes the beautiful island of Bali. They will do their best to control it but it is not ever going to be completely eradicated.

Vietnam - 10th Province Reporting Outbreaks

http://crofsblogs.typepad.com/h5n1/2009/02/vietnam-now-10-provinces-have-h5n1.html

Vietnam Reports 3rd Human Case for this Year

http://www.chinapost.com.tw/asia/vietnam/2009/02/16/196343/Vietnam-reports.htm

Meanwhile in Vietnam, the spread continues which is not so unusual this time of year except for the fact that they have a poultry vaccination program which appears to have failed. And, another human case is found.

The 35-year-old man from northern Ninh Binh province, some 60 miles (100

kilometers ) south of Hanoi, developed a high fever on Feb. 5 after slaughtering and eating several ducks his family had raised, said Vu Van Can, deputy director of the provincial health department.

Nepal Reporting Bird Flu Is Back

http://crofsblogs.typepad.com/h5n1/2009/02/nepal-h5n1-is-back-in-jhapa.html

Once it is in the environment, it always seems to come back. No doubt this will be a continual battle.

Laos Reporting Outbreak in Birds

http://afludiary.blogspot.com/2009/02/laos-reporting-bird-flu-outbreak-in.html

Another country in the area under attack, and you have to wonder about what the silent nations are not saying. Birds and the H5N1 virus do not respect borders.

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Vietnam Reports Bird Flu Fatality

http://afludiary.blogspot.com/2009/02/vietnam-reports-bird-flu-fatality.html

This is the young woman mentioned in the post from 2/11/09. She never recovered. She was 23 years old, and appears to have had good medical care.

The 1918 Spanish flu had a case fatality ratio of just 2%, but killed 50 million people world wide. The CFR of H5N1 is 63%.

She died after 18 days of medical treatments under the thorough care and close supervision round the clock by three shifts of provincial doctors and experts from the National Tropical Disease Medical Institute and the Bach Mai Hospital.

Her treatments, including the most modern breathing apparatus, blood screening and blood transmission all the time and dialysis, cost an estimated 20 million VND a day, according to the provincial hospital.

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