More Pessimism about Tamiflu & Avian Flu:Theoretical Effectiveness vs. Use Effectiveness

I wrote a couple of days ago about the likely difficulty of using Tamiflu effectively to help fight Avian Flu. Here is more from my friend:

This distinction [between theoretical and use effectiveness] is often employed in discussion of contraceptive use, and should be applied to proposed H5N1 medications as well.

Just as condoms are far less effective in the bedroom (or stairwell) as they are in mathematical models, one might expect a similar discrepancy between ideal use of Tamiflu, and what is likely to happen in the community.

For usually non lethal Influenza A (your annual scourge) the importance of starting, for non immunized folks, antiviral medication within the first 48 hrs has been well publicized. Such a restriction has limited the effectiveness of antivirals. Recognition of illness, delay in getting to a physician - almost impossible in some settings within 48 hrs except through emergency or drop-in clinics - and a further delay in acquiring the medication, all conspire against effective early use.

Bird flu H5N1 promises to make effective use of available antiviral medication even tougher, given the shorter incubation period, and earlier arrival time of peak viral load. If we add to this dilemma the proposal of central control of medication and all the logistical snafus inevitably attached.........

Then we get to problems in applying the medication. How much, how long, and compliance given known side effects.

The optimistic among us will think of this as a challenge.