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Thai Boy's Bird Flu Death Leaves Somber Questions

Posted - Feb. 4, 2004 at 7:20 a.m.



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BENYAPAD, Thailand -- Brimming with life, the little boy scooped up the squawking chicken and carried it the short distance to his uncle's home. It was a walk through this poor Thai village that lasted no more than two minutes. But in the end, it was a walk that killed a 6-year-old schoolboy named Captain Boonmanuch.

The bird flapping in his arms likely was shedding the avian influenza virus, a virulent disease that governments in 10 Asian countries are struggling to contain. So far, officials report that 13 people in Thailand and Vietnam -- all but two shown to have been infected through direct contact with animals -- have died of so-called bird flu. Public health officials across the region have killed millions of chickens, ducks and other birds in an increasingly frantic bid to quell the virus. The latest worry: outbreaks in parts of China, where diseases thrive in cramped quarters shared by peasants and their animals.

As the virus spreads, so does fear. In Bangkok, Sudarat Jiamwijitkul rushed her 14-year-old son to the doctor last week when he complained of a fever. The doctor said it was just a cold, but the mother of four plans to bring him back for another checkup, just to be safe.

''I won't buy chickens. I won't eat chickens, including eggs, to protect my family,'' she says. ''Because what can I do if we eat it and then have a problem? I'm very scared now.''

For Americans, this exotic illness remains a remote peril. The United States imports no poultry from the affected countries, and the migratory birds suspected of carrying the disease don't fly to the USA. (Health officials say there is no danger in eating chicken or eggs, as long as they are well cooked.)

Unlike last year's deadly SARS virus, avian influenza can't easily be passed from human to human. The World Health Organization says it is possible that one of two Vietnamese sisters who died of avian flu late last month could have caught the disease from their brother, who was cremated after dying of an unidentified respiratory illness. But because there has been no wider outbreak in their village, that limited transmission isn't regarded as especially dangerous. Scientists' big fear is that bird flu could one day mutate into a new strain combining the lethality of the animal disease with the contagiousness of the human flu bug. The result, WHO warns, could be a global pandemic that leaps from Asia and counts its fatalities in the millions.

'Hold my hand'

Such a contagion would be played out in endless repetitions of the Boonmanuch family's tragic vigil. Inside their front room, a gleaming white casket floats on a bed of red, white, pink and yellow flowers. Colored lights blink cheerlessly. To one side, a low table holds some of Captain's toys, including a plastic Dalmatian pulling three puppies in tiny brown wagons. Sweet incense thickens the warm air.

Surrounded by neighbors and relatives, the boy's parents struggle to make sense of their loss.

The nightmare began with a sore throat. ''I started to notice my son wasn't well on the 5th of January,'' says his father, Chamnan Boonmanuch. ''It was like he had a normal cold, but he had a very high temperature.''

The next day, his father, a rice farmer with a sixth-grade education, drove the boy to a hospital about 25 miles away, where doctors diagnosed pneumonia. They gave the boy some medicine and sent him home.

But Captain didn't improve. So on Jan. 9, the father brought him back to the hospital. This time, doctors thought the boy might have dengue fever, a tropical illness spread by mosquitoes. So they transferred him to a second hospital. For the next three days, his fever never dipped below 102, and it became difficult for him to breath.

''He complained to me: 'I feel like my chest is swollen,' '' his red-eyed mother, Jongrak, recalls. ''He said, 'I'm very cold, mother. Hold my hand.' ''

On Jan. 12, a chest X-ray showed a glowing white spot on the lower half of Captain's left lung, a sign of pooling fluid. His fever had spiked dangerously to 105 degrees. Alarmed, his father paid $36 for an ambulance to speed him to better care in the capital, Bangkok, more than an hour's drive away.

By Jan. 14, Captain was in the intensive care unit. A new X-ray revealed that his entire left lung, as well as much of his right lung, was white. Doctors said the boy was breathing with less than one-third of his normal lung capacity.

Captain's mother told doctors her boy's symptoms sounded remarkably similar to those in stories she had read about a mysterious bird flu virus spreading in other Asian countries The doctors, who had considered dengue fever, malaria and simple pneumonia, conceded that they were puzzled but said there was no evidence of bird flu in Thailand.

They didn't know that birds in this village of about 2,500 people had begun dying in mid-December. And not the typical isolated deaths of sick animals. This time, hundreds were dying, often suddenly.

At the time, no one connected the bird deaths with Captain's condition.

The boy grew still worse. Finally, on Friday, Jan. 23, doctors told his parents that Captain indeed was infected with the H5N1 virus, avian influenza. The news came after weeks of official government denials that the disease existed in Thailand. To reassure a nervous public, Prime Minister Thaksin Shinawatra and his ministers had even been photographed eating a chicken lunch.

''The government said there was no bird flu in Thailand. I believed them. . . . I thought my son was sick from something else,'' his mother says.

Accusations of a coverup

Critics have accused Thaksin of covering up the outbreak to protect the country's poultry exporters. The government denies the accusation. But on Jan. 30, officials of the National Institute of Animal Health told a parliamentary committee they had detected the disease as early as November, had quietly implemented epidemic-control measures and withheld findings to prevent panic.

Now, Thailand's government, which hurriedly convened a global health summit last week, is scrambling to prevent additional cases. From rural poultry farms to Bangkok's urban markets, improvised mass graves are filling with bird carcasses.

All the government's action came too late for little Captain Boonmanuch. Once his illness was identified as bird flu, doctors began giving him special antiviral medicines. But such drugs are most effective in the early stages of influenzas, says Supamit Chunsuttiwat, senior medical officer for the Department of Disease Control.

By Jan. 24, Captain was in a coma. ''The doctor told me and my wife to be strong. He said my son will not be with me anymore,'' the father recalls with a look of sleepless grief.

At 11 p.m. Jan. 25, doctors removed Captain from the respirator. At 20 minutes past midnight, drowning in his own fluids, he became Thailand's first casualty of bird flu.

In an interview a few days before their son was given a traditional Buddhist cremation, his parents sat barefoot in low chairs framed by sizeable funeral wreaths. The $25 bouquets bore the names of numerous Thai politicians, including the minister of public health.

The parents had wanted truth from their leaders; they received only condolences.

''If they had told people, my child wouldn't have died. If they didn't cover up and had been open about it, we'd have prevented this,'' the father says. ''It's like they killed my son.''

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© Copyright 2004 USA TODAY, a division of Gannett Co. Inc.

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