Four doctors died of flu in Ukraine's Ternopol and Lvov regions, Health Minister Vasily Knyazevich said at the Sunday meeting of the operative headquarters for the prevention and treatment of A/H1N1 flu.

The above comments describe the death of four health care workers (HCWs) at two sites in western Ukraine. The government website shows a total of 53 deaths (see map), which is quite low if four HCWs have already died. HCW are trained in methods to minimize infections from parents, and they are likely to get prompt medical attention, yet four have already died. These numbers add to the confusion in Ukraine.

Initial reports denied the outbreak was due to H1N1 even though there was virtually no seasonal flu circulating in Europe (or North America). The explosion in cases of acute respiratory illness (ARI), in view of the exploding H1N1 pandemic throughout the northern hemisphere, would signal involvement in the cases in Ukraine.

The number of fatalities suggests that most ARI cases are swine flu, because in some instances the number of fatalities is between 0.5 and 1% of listed influenza cases. The ARI cases are 10-20 fold higher, which would significantly lower the Case Fatality Rate (CFR), but even with the listed ARI cases, the CFR would be alarmingly high. Thus, the number of ARI cases may be higher, or the virus is producing a significantly higher CFR.

Even after H1N1 was confirmed in influenza and ARI patients in western Ukraine, Kiev was still maintaining that the cases there were not H1N1, even though 300,000 doses of Tamiflu are scheduled to arrive today, and a WHO investigative team is scheduled to arrive tomorrow.

The denials of H1N1 in obvious cases raise concerns that the number of fatalities is markedly higher that the 53 acknowledged, especially when 4 of the 53 are HCWs.

More details on the HCW deaths and on those hospitalized would be useful.

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.

Ukraine asked for monetary aid and got Tamiflu and Vaccines, according to -snip-. None of the people in those regions meet the CDC good candidates list for these drugs and vaccines, so basically it is "that" particular help or no help. The government of the Ukraine has started appealing to NGOs for help. She says they are very confused and feel trapped. So even the government officials of the Ukraine feel worried. They have to take the aid, but their health officials are telling them it won't work, and will hurt.

No one wants to be the government that says they're not taking the flu vaccine or the treatment.

Also, this has a severe respiratory that, yes, Russians have stated is near 1918 flu epidemic. However, -snip- (former head of Soviet Pediatrics and former head of Oncology) believe that the OTC drugs PLUS the vaccines cause an immuno-weakened state, and then the Tamiflu destroys what's left of the bodies resistence. They believe that this is a "warning" to Russia.

Always they believe the world is out to get them. There was/is a lot of travel between Kiev and Moscow and they feel it is a way of killing them off.