On Mon, 11/16/09, ProMED-mail <promed@promed.isid.harvard.edu> wrote:

From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Influenza pandemic (H1N1) 2009 (103): Ukraine
To: promed-ahead-edr@promedmail.org
Date: Monday, November 16, 2009, 6:31 PM

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sat 14 Nov 2009
Source: The New York Times [edited]

When patients began arriving in Vyacheslav Bonder’s intensive care
unit 2 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 2nd and 3rd 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 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 [13 Nov 2009] that the swine flu
[pandemic (H1N1) 2009 virus infection] 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
1st 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
1st deaths from atypical pneumonia on 12 and 19 Oct 2009, have
complained that the federal epidemiological service refused to act
without laboratory confirmation that the virus was present, delaying
serious measures by nearly 2 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 1500
hryvnas, approximately USD 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 3rd and 4th weeks of October 2009, 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 3500
medical professionals fell ill, of whom 300 were hospitalized, and 4 died.

When they did suspect [pandemic] H1N1, physicians were stuck in a
Catch-22 situation. 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
3-to-4-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 27 Oct 2009, she examined the body of a
32-year-old man, the latest in a series of 4 deaths from 4 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 [pandemic]
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 23 Oct 2009, 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 1st
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 29 Oct
2009, when information about H1N1 flooded the region, doctors and
nurses showed up wearing masks for the 1st 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 USD 4300, 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?”

[Byline: Ellen Barry]

Communicated by:
ProMED-mail <promed@promedmail.org>

Date: Sat 14 Nov 2009
Source: Ukrainian News [edited]

The Health Ministry confirmed 282 deaths of flu and acute respiratory
viral infections in 23 regions, the city of Kyiv and Crimea as of 14
Nov 2009. Ukrainian News learned this from a statement by the Health
Ministry. Of 282 lethal cases, 17 cases were registered over the past 24 hours.

According to the statement, since 29 Oct 2009, 87 fatal cases have
been registered in Lviv region, 35 lethal cases have been registered
in Ivano-Frankivsk region, 25 cases in Chernivtsi region, 21 cases in
Ternopil region, 13 cases in Khmelnytskyi region, 12 cases in Kyiv
region, 11 cases in Donetsk region, 9 cases in Rivne region, 9 cases
in the city of Kyiv, 8 cases in Volyn region, 8 cases in Chernihiv
region, and 7 cases in Zakarpattia region.

Also, 6 people have died of flu and acute respiratory viral
infections in each of Cherkasy region and Kharkiv region, 5 people in
each of Vinnytsia region and Sumy region, 3 people in each of Poltava
region and Kherson region, 2 people in each of Zhytomyr region and
Zaporizhia region, and one person in each of Crimea, Dnipropetrovsk
region, Kirovohrad region, Mykolaiv region, and Odesa region.

Since 29 Oct 2009, a total of 1 347 538 people have contracted flu
and acute respiratory viral infections in Ukraine, according to the
statement. A total of 73 373 people have been hospitalized with flu
and acute respiratory viral infections and 39 380 patients have been
discharged. The epidemic threshold has been [exceeded everywhere]
except in Crimea, Dnipropetrovsk region, Odesa region, Kharkiv
region, Kherson region, and the city of Sevastopol.

As Ukrainian News earlier reported, the Health Ministry confirmed 265
deaths of flu and acute respiratory viral infections in 21 regions,
the city of Kyiv and Crimea as of 13 Nov 2009.

Communicated by:
ProMED-mail <promed@promedmail.org>

Date: Sun 15 Nov 2009
Source: Global Research [edited]

Interview with Dr. Victor Bachinsky: [Professor Victor Bachinsky,
M.D. is a coroner in the Chernivtsi region of Ukraine. He also
teaches at the Department of Anatomical Pathology and Forensic
Medicine of Bukovynian State Medical Academy.]

Introduction: The Head of the Chernivtsi regional forensic bureau,
Professor Victor Bachinsky M.D. makes a strong statement: all the
victims of the virus in Bukovina (22 persons aged 20 to 40 years)
died not from bilateral (double) pneumonia, as previously thought,
but as a result of viral distress syndrome, i.e. the total
destruction of the lungs. We caught up with Professor Bachinsky, to
find out how he came to this conclusion, and how people can protect
themselves from this disease.

VB: Based on autopsies, we have come to the conclusion: it’s not
pneumonia, but cardiopulmonary insufficiency and cardiogenic shock
… The virus enters directly into the lungs, there is bleeding …
Antibiotics should not be used.

Q: Why do we have such a high mortality rate in the country?

VB: Because people are going to pharmacies to get medicine instead of
going to their doctors to be treated… No, it is not pneumonic
plague. It’s all nonsense …antibiotics do not help… Those with
strong immune systems will survive. People with weak immune systems
will succumb to the illness … Face masks provide 30 percent extra
protection. Wearing glasses gives an additional 10 percent
protection, that is 40 percent, because the virus penetrates the
mucous membranes.

Q: Professor, you said earlier that the virus, from which many people
have died, is a mixture of types of parainfluenza and influenza
A/H1N1. How do you cure this disease?

VB: The question of how to treat this virus is not up to me. I am a
pathologist. I just found out what it is and made an exact diagnosis.
It is important to provide the correct treatment based on diagnosis.
There are strict protocols and standards of treatment in medicine. If
a doctor treats a patient who dies, their relatives can make a
complaint that they were not treated properly (misdiagnosed). The
Ministry of Health has set the protocols and standards of treatment
for each diagnosis. If diagnosed correctly, the treatment should be correct.

In the Chernivtsi region, 18 people have died. We studied all the
history and evidence from this disease, preclinical, clinical,
resuscitation. When we perform an autopsy, organs and tissues have
histological studies (cell analysis), and we concluded that it was
not pneumonia and has no relation to pneumonia whatsoever. These
results are the foundation to ensure that doctors who treat this
disease all over Ukraine change their tactics and standards of care.

Q: Can this new virus be cured?

VB: It depends on the immune system. If a person’s immune system is
strong, they will overcome it. There are people who carry this strain
of H1N1 and remain on their feet and don’t even realize they are
sick. Antibiotics definitely should not be taken. Antibiotics are the
reason we have such a high mortality and infection rate in this
country, because people go to the pharmacy, describe their symptoms
to the pharmacist and ask for drugs. They buy antibiotics, take them,
this lowers their immune system, and as a result they become sick. If
prescriptions were required to buy these medications, as in other
countries, this would not have happened. It is the ability to buy
antibiotics over the counter without a prescription which has done so
much harm to the state.

Q: During autopsies, what did the lungs look like? Were they really
black, which gave rise to so much talk of pulmonary plague?

VB: No, they are not black … This is not pneumonic plague. It’s all
nonsense. Pneumonic plague has a very different morphology. We have,
for example, 60 000 people who became sick, and 23 have died. With
pulmonary plague, we would now have a mortality rate of 59 000. This
is a viral attack that destroys the lungs.

Q: It turns out that not only in Bukovina but also throughout
Ukraine, people did not die from pneumonia but from this toxic strain?

VB: Yes, It’s not pneumonia, this destruction of the lungs! This
strain is very toxic, and if the immune system is weak, there is
bleeding in the lungs. In the lungs, there is a tiny structure,
acinus, which looks like a bunch of grapes. When you breathe, oxygen
enters this tiny “bunch of grapes” (pulmonary alveoli). On the
surface of the acinus are the capillaries, where red blood cells
saturate with oxygen and which supply all tissues and organs in the body.

And once the virus enters the lungs, hemorrhaging begins immediately
in the acinus. A continuous hemorrhage… It takes several hours. In
the blood, fibrin is formed, and giolinovaya membrane, resembling a
plastic bag. It envelops the acinus, and the person breathes in
oxygen, but it is not transferred to the tissues. And people just
gasp. There is a cardio-pulmonary insufficiency and cardiogenic
shock. People die of cardiogenic shock. And there is no pneumonia.
Pneumonia is an inflammation, which is treated with antibiotics.
Antibiotics cannot help at any stage. There should be absolutely
different treatment.

Q: And how about Tamiflu — does it help?

VB: This is not an antibiotic, it is an antiviral drug, which should
be applied on the 2nd or 3rd day of the disease. But you cannot use
Tamiflu as a preventative, because it is toxic.

Q: What are the best measures to resist the disease? Is it advisable
to use a mask, garlic, vitamin C?

VB: The primary method of prevention is a face mask. This gives 30
percent extra protection. If you wear glasses [goggles], it is 40
percent, because the virus enters through the mucous membranes. It is
necessary to improve the human immune system. Not only now, but in
general, garlic, onions, wild rose, viburnum (guelder rose),
raspberries, citrus fruit, honey, and other fruits and vegetables,
whatever you want. Those with a strong immune system will survive.
Those with weaker immune systems will succumb to the disease. We have
a lot of people in Ukraine who like shopping at open markets. If we
can avoid open markets, the less people will be in contact with each
other and more lives will be saved.

Q: You have contacted the Health Ministry and advised them to review
the standards for treatment of patients. What did they say?

VB: We sent them all our data, the necessary protocols and standards
of treatment, our diagnosis. But it is clear that decisions cannot be

Q: And why until now has nobody else known about this disease? What
were the leading specialists in the Ministry of Health doing all this time?

VB: Perhaps this is due to the fact that there are scientists who are
working on a purely theoretical basis. And there are scientists who
have seen the autopsy results. I practice as head of the regional
forensic bureau and as a professor. The fact that we have established
this diagnosis, it is not just to my credit, and this is not my
personal opinion. This is the opinion of specialists, morphologists
and doctors in Bukovina. There are 5 professors in our group. I just
head the group.

[Original interview in Russian by Anna Yashchenko published by Unian:

Communicated by:
ProMED-mail <promed@promedmail.org>

Date: Mon 16 Nov 2009
Source: The Moscow Times [edited]

The World Health Organization (WHO) said on Fri 13 Nov 2009 that a
“high to very high intensity of respiratory diseases” had been
reported in Russia and Belarus, but it was now less concerned about a
big outbreak in Ukraine. “The initial analysis of information from
Ukraine indicates that the numbers of severe cases do not appear to
be excessive when compared to the experience of other countries and
do not represent any change in the transmission or virulence of the
virus,” the WHO said in a statement posted on its web site.

Ukraine, Belarus and some Russian cities have recently extended
school breaks because of fears about the pandemic virus. WHO
spokesman Gregory Hartl said school closures were among steps that
could slow viral spread at the beginning of an outbreak, but had less
usefulness once the flu had reached 5 percent of a given population.
“After the virus becomes more widespread in a country, closing
schools has less of an impact,” he told a news briefing earlier in
the week. “If you make a decision to close schools and universities
and other institutions, you have to be aware there are social and
economic consequences of this decision.”

The Russian areas worst hit by swine flu are in the Far East, Siberia
and Northwest Russia, Health and Social Development Minister Tatyana
Golikova said last week, without elaborating. At least 31 deaths have
been linked to swine flu in Russia, also known as the [pandemic
(H1N1) 2009 virus], and more than 4560 people have been registered as infected.

The WHO said on Friday [13 Nov 2009] that the winter flu season,
which began early in the northern hemisphere this year, may be
peaking in parts of North America and western Europe, including parts
of the southern and southeastern United States, Iceland and Ireland.
The [pandemic] H1N1 virus has now spread to 206 countries, with the
latest confirmed cases in Somalia, Nigeria and Burundi. More than
6250 people have died, mostly in the Americas.

Communicated by:
ProMED-mail <promed@promedmail.org>

[These are 4 contrasting accounts and interpretations of the current
outbreak of influenza and acute respiratory disease in Ukraine,
ranging from the darkness of the New York Times account to the
blandness of the WHO message. The interview with Professor Bachinsky
perhaps sheds the most light on the reasons for the confused
situation in Ukraine and deserves the most attention. He disposes of
the pneumonic plague rumour and identifies past and present
inappropriate resort to the use of antibiotics as a major factor in
the poor public health situation in Ukraine. He suggests that the
lethal effect of pandemic 2009 influenza virus infection is a direct
consequence of replication of the virus in pulmonary tissue and not
as a promoter of pneumonia, the cause of death thus being
cardio-pulmonary failure. – Mod.CP

It sounds like Professor Bachinsky is describing hyaline membranes
which are a part and parcel of the ARDS which accompanies acute
diffuse overwhelming viral influenza pneumonia. Thus when he says
this is not pneumonia, he apparently means it is not bacterial
pneumonia. Furthermore it is misleading to say that those with a
srong immune system recover versus those with a weak immune system,
as many of the manifestations of the lethal diseases are thought to
be due to cytokine storm. – Mod.DK

A map of Ukraine with its administrative sub-divisions can be
accessed at: <http://www.infoukes.com/ua-maps/oblasts/>. – Mod.CP]

[see also:
Influenza pandemic (H1N1) 2009 (102): Iran 20091115.3946
Influenza pandemic (H1N1) 2009 (101): Afghanistan, Pakistan 20091115.3945
Influenza pandemic (H1N1) 2009 (100): Ukraine (DT) 20091114.3940
Influenza pandemic (H1N1) 2009 (99): Russia 20091114.3939
Influenza pandemic (H1N1) 2009 (98): Madagascar 20091113.3933
Influenza pandemic (H1N1) 2009 (97): Ukraine (Lviv) 20091113.3931
Influenza pandemic (H1N1) 2009 (96): Viet Nam, dengue co-infection
Influenza pandemic (H1N1) 2009 (95): Africa 20091112.3920
Influenza pandemic (H1N1) 2009 (94): E.Europe, Russia 20091110.3893
Influenza pandemic (H1N1) 2009 (93): USA (AK) susp 20091107.3860
Influenza pandemic (H1N1) 2009 (92): Europe 20091107.3858
Influenza pandemic (H1N1) 2009 (91): Ukraine 20091105.3827
Influenza pandemic (H1N1) 2009 (90): Venezuela, Yanomami 20091105.3820
Influenza pandemic (H1N1) 2009 (80): Ukraine susp. RFI 20091031.3764
Influenza pandemic (H1N1) 2009 (70): Nepal 20091016.3563
Influenza pandemic (H1N1) 2009 (60): bacterial coinfection 20090930.3410
Influenza pandemic (H1N1) 2009 (50): oseltamivir-resistance 20090917.3260
Influenza pandemic (H1N1) 2009 (40): global update 20090906.3138
Influenza pandemic (H1N1) 2009 (30): assumptions 20090813.2879
Influenza pandemic (H1N1) 2009 (20): Peru, 33 percent asymptomatic
Influenza pandemic (H1N1) 2009 (10): vaccine 20090720.2577
Influenza pandemic (H1N1) 2009 – Viet Nam: patient data 20090708.2450]

ProMED-mail makes every effort to  verify  the reports  that
are  posted,  but  the  accuracy  and  completeness  of  the
information,   and  of  any  statements  or  opinions  based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by  ProMED-mail.   ISID
and  its  associated  service  providers  shall not be  held
responsible for errors or omissions or  held liable for  any
damages incurred as a result of use or reliance upon  posted
or archived material.
Become     a    ProMED-mail    Premium     Subscriber     at
Visit ProMED-mail’s web site at <http://www.promedmail.org>.
Send  all  items  for   posting  to:   promed@promedmail.org
(NOT to  an  individual moderator).  If you do not give your
full name and  affiliation, it  may  not  be  posted.   Send
commands  to  subscribe/unsubscribe,   get  archives,  help,
etc. to: majordomo@promedmail.org.    For assistance  from a
human  being  send  mail  to:   owner-promed@promedmail.org.