Concerns arise over symptomless Egypt bird flu cases

[HenryN]

INTERVIEW-Concerns arise over symptomless Egypt bird flu cases
08 Apr 2009 11:13:26 GMT
Source: Reuters

* WHO concerned about possible bird flu human carriers * U.N. body to test if cases exist * Worries about mutation of the pathogenic virus

By Cynthia Johnston CAIRO, April 8 (Reuters) - The World Health Organisation is concerned some Egyptians may carry the highly pathogenic bird flu virus without showing symptoms, which could give it more of a chance to mutate to a strain that spreads easily among humans. Whether such cases exist still has to be put to the test and will be the focus of a planned Egyptian government study backed by the global health body, said John Jabbour, a Cairo-based emerging diseases specialist at WHO. "This is a concern only, now. It is a question to be asked," Jabbour told Reuters.

He said a change in the pattern of human bird flu infections this year in Egypt had raised concerns about the existence of so-called sub clinical cases. The most populous Arab country, which has been hit harder by bird flu than any other country outside of Asia, has seen a surge in infections this year. While the H5N1 virus only rarely infects people, experts fear it could mutate into a form that humans could easily pass to one another, sparking a pandemic that could kill millions.

The emergence of symptomless human carriers of the virus would be a worrisome development because it could allow the virus, undetected and untreated, more time to mutate inside the human body, Jabbour said. "If there is any sub clinical case in Egypt, the aim is to treat immediately to stop the reproduction of the virus. Because whether (through) mutation or reassortment, this will lead to the pandemic strain," he said.

Of the 11 Egyptians infected with bird flu this year, all but two have been children under age three while adult cases have all but dried up. All have survived. That is starkly different from the same period a year ago, when seven people -- mostly adults and older children -- contracted the virus and three died.

'SOMETHING STRANGE HAPPENING' Jabbour said the rise in infections in children without similar cases among adults had triggered questions as to whether adults were being infected with the virus but not falling ill. "There is something strange happening in Egypt. Why in children now and not in adults?" he said. "We need to see if there are sub clinical cases in the community."

Jabbour said there had been no known instances of sub clinical bird flu cases in humans in other countries where the disease was present. Some birds, like ducks, are known to carry and spread the virus without showing symptoms, he said.

The Egyptian study, which Jabbour said should begin in the coming months, would test the blood of people who may have been in contact with infected birds but had not become sick.

Since 2003 the avian influenza virus has infected more than 400 people in 15 countries and killed 256 of them. It has killed or forced the culling of more than 300 million birds across Asia, the Middle East, Africa and Europe. Some 23 Egyptians have died after contracting the virus, most after contact with infected domestic birds in the country where roughly 5 million households depend on domestically raised poultry as a major source of food and income.

But Jabbour said there was still no evidence of the disease being passed from person to person in Egypt. He added that two toddlers from the northern province of Beheira infected within days of one another in March were cousins. But he said the boys were believed to have contracted the virus from the same sick birds, not from each other. "There is no change in the virus at all in the virus strain in Egypt.

It is the same since the beginning of the outbreak. There is no mutation, nothing," he said. (Writing by Cynthia Johnston)

http://www.alertnet.org/thenews/newsdesk/L7467886.htm

[HenryN]

Originally Posted by niman

INTERVIEW-Concerns arise over symptomless Egypt bird flu cases
08 Apr 2009 11:13:26 GMT
Source: Reuters


But Jabbour said there was still no evidence of the disease being passed from person to person in Egypt. He added that two toddlers from the northern province of Beheira infected within days of one another in March were cousins. But he said the boys were believed to have contracted the virus from the same sick birds, not from each other. "There is no change in the virus at all in the virus strain in Egypt.

It is the same since the beginning of the outbreak. There is no mutation, nothing," he said. (Writing by Cynthia Johnston)

http://www.alertnet.org/thenews/newsdesk/L7467886.htm

Toddler to toddler transmission confirmed (sick bird nonsense notwithstanding).

[HenryN]

Originally Posted by niman

INTERVIEW-Concerns arise over symptomless Egypt bird flu cases
08 Apr 2009 11:13:26 GMT
Source: Reuters

"There is no change in the virus at all in the virus strain in Egypt.

It is the same since the beginning of the outbreak. There is no mutation, nothing," he said. (Writing by Cynthia Johnston)

http://www.alertnet.org/thenews/newsdesk/L7467886.htm

Beyond absurd. WHO has already selected TWO vaccine targets from Egypt, and NEITHER match the strain from 2009 linked to the mild cases.

http://www.who.int/csr/disease/avian...irusUpdate.pdf

[HenryN]

Originally Posted by niman

Beyond absurd. WHO has already selected TWO vaccine targets from Egypt, and NEITHER match the strain from 2009 linked to the mild cases.

http://www.who.int/csr/disease/avian...irusUpdate.pdf

The selected targets are
A/Egypt/2321-NAMRU3/2007 and
A/Egypt/3300-NAMRU3/2008

which are distinct form the 2009 mild cases
A/Egypt/0585-NAMRU3/2009
A/Egypt/0001-NAMRU3/2009

but NAMRU-3 has not released ANY late 2008 / early 2009 sequences (poultry or patients)

[sharon sanders]

I have felt for a long time that some of the suspected cases in Egypt were possibly actual cases of H5N1.

Children with "light" cases of bird flu in Egypt is nothing new. It begs the question of how many other cases, that were undiagnosed, may have escaped detection.

As I read this from above:

"...But Jabbour said there was still no evidence of the disease being passed from person to person in Egypt. He added that two toddlers from the northern province of Beheira infected within days of one another in March were cousins. But he said the boys were believed to have contracted the virus from the same sick birds, not from each other..."


......apparently poultry is the contagion.

[HenryN]

Originally Posted by Florida1

I have felt for a long time that some of the suspected cases in Egypt were possibly actual cases of H5N1.

Children with "light" cases of bird flu in Egypt is nothing new. It begs the question of how many other cases, that were undiagnosed, may have escaped detection.

As I read this from above:

"...But Jabbour said there was still no evidence of the disease being passed from person to person in Egypt. He added that two toddlers from the northern province of Beheira infected within days of one another in March were cousins. But he said the boys were believed to have contracted the virus from the same sick birds, not from each other..."


......apparently poultry is the contagion.

Please. "Beliefs" are NOT science. The 4 day gap in disease onset dates DEFINES H2H.

[sharon sanders]

We can argue about cases #61 and # 62 all day long but the larger picture is also very important.

"There is something strange happening in Egypt. Why in children now and not in adults?" he said. "We need to see if there are sub clinical cases in the community."

And while they are checking Egypt, they can look at Indonesia and China as well.

[HenryN]

Originally Posted by Florida1

I have felt for a long time that some of the suspected cases in Egypt were possibly actual cases of H5N1.

Children with "light" cases of bird flu in Egypt is nothing new. It begs the question of how many other cases, that were undiagnosed, may have escaped detection.

As I read this from above:

"...But Jabbour said there was still no evidence of the disease being passed from person to person in Egypt. He added that two toddlers from the northern province of Beheira infected within days of one another in March were cousins. But he said the boys were believed to have contracted the virus from the same sick birds, not from each other..."


......apparently poultry is the contagion.

The same agency that "believes" the OBVIOUS H2H is not H2H also failed to note that the two H5N1 CONFIRMED toddlers were NEIGHBORS and COUSINS, in the official update.

The "belief" is well beyond propaganda.

[HenryN]

Originally Posted by Florida1

We can argue about cases #61 and # 62 all day long but the larger picture is also very important.

"There is something strange happening in Egypt. Why in children now and not in adults?" he said. "We need to see if there are sub clinical cases in the community."

And while they are checking Egypt, they can look at Indonesia and China as well.

The larger picture is who is in charge of the "investigation".

The fairy tale is now official:

http://www.emro.who.int/index.asp

Case number 62

The Ministry of Health and Population of Egypt reported a new confirmed human case of avian influenza on 6 April 2009. The new case is a two-year-old male from the Kom Hamada district, El Behira governorate. His symptoms began on 31 March and he was hospitalized at Damanhour Fever Hospital on 1 April. The child received treatment with Tamiflu on the same day of hospitalization. Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 2 April.
Investigations into the source of infection indicate a history of close contact with dead and sick poultry prior to becoming ill. The child is in a stable condition.

Case number 61

The Ministry of Health and Population of Egypt reported a new confirmed human case of avian influenza on 6 April 2009. The new case is a two-year-old male from the Kom Hamada district, El Behira governorate. His symptoms began on 27 March and he was hospitalized at Naaora Fever Hospital on 30 March. The child received treatment with Tamiflu on the same day of hospitalization. Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 1 April.
Investigations into the source of infection indicate a history of close contact with dead and sick poultry prior to becoming ill. The child is in a stable condition.

[HenryN]

Originally Posted by Florida1

We can argue about cases #61 and # 62 all day long but the larger picture is also very important.

"There is something strange happening in Egypt. Why in children now and not in adults?" he said. "We need to see if there are sub clinical cases in the community."

And while they are checking Egypt, they can look at Indonesia and China as well.

Please. CLINICAL cases without a poultry connection are NOT tested for H5N1 in Egypt (or elsewhere).

[sharon sanders]

I see you are really into pleasing me lately!

[HenryN]

Originally Posted by Florida1

I have felt for a long time that some of the suspected cases in Egypt were possibly actual cases of H5N1.

Children with "light" cases of bird flu in Egypt is nothing new. It begs the question of how many other cases, that were undiagnosed, may have escaped detection.

As I read this from above:

"...But Jabbour said there was still no evidence of the disease being passed from person to person in Egypt. He added that two toddlers from the northern province of Beheira infected within days of one another in March were cousins. But he said the boys were believed to have contracted the virus from the same sick birds, not from each other..."


......apparently poultry is the contagion.

The mild CONFIRMED H5N1 cases in EGYPT were noted in 2007

http://www.recombinomics.com/News/03...swan_Mild.html

Mild H5N1 in Aswan Egypt
Recombinomics Commentary
March 26, 2007

The case is a female child, three years old. The illness started on the 22nd of March and admitted to the hospital on the 24th where they put her on tamiflu. The samples were taken on the 24th and confirmed positive for H5N1 on 25 March 2007. The patient had a history of contact with backyard poultry. The patient is still in a good health condition and is not epidemiologically linked to the previous two human cases in Aswan.

The above comments (emphasis added) from the WHO Eastern Mediterranean Regional Office supports media reports indicating the three confirmed H5N1 cases in Aswan were mild. Media reports indicate the two earlier cases (10F and 2M) were briefly hospitalized and have been discharged. The above comments indicate the most recent case “is still in a good health condition.” These comments support media reports indicating that the patients had a high fever and “cold” symptoms. None of the reports indicated the patients developed pneumonia, and the short hospital stay supports a mild presentation.............................

[HenryN]

Originally Posted by Florida1

I have felt for a long time that some of the suspected cases in Egypt were possibly actual cases of H5N1.

Children with "light" cases of bird flu in Egypt is nothing new. It begs the question of how many other cases, that were undiagnosed, may have escaped detection.

As I read this from above:

"...But Jabbour said there was still no evidence of the disease being passed from person to person in Egypt. He added that two toddlers from the northern province of Beheira infected within days of one another in March were cousins. But he said the boys were believed to have contracted the virus from the same sick birds, not from each other..."


......apparently poultry is the contagion.

Similary. in 2007 the cases that "were not epidemiologically linked" had H5N1 sequences that were virtually IDENTICAL.

Third H5N1 Infected Child in Aswan Egypt
Recombinomics Commentary
March 25, 2007

Health ministry spokesman Abdel Rahman Shahine said the girl — identified as Hajer Mohammed Awadallah from the southern city of Aswan — was admitted to a local hospital with a fever and cold symptoms.

She tested positive for the H5N1 bird flu strain on Sunday, he added.

The above comments are remarkably similar to the two other recent confirmed H5N1 infections in children (10F and 2M) in Aswan. The sequence of the H5N1 from today's confirmed case (3F) has not been generated, but the HA and NA sequences from the two prior Aswan cases were virtually identical.

[HenryN]

Commentary

http://www.recombinomics.com/News/04...Confirmed.html

[ironorehopper]

WHO | Avian influenza - situation in Egypt - update 10

Avian influenza - situation in Egypt - update 10

8 April 2009 --

The Ministry of Health of Egypt has reported 3 new confirmed human cases of avian influenza.


The first case is a 2 year-old boy from Kom Hamada District, El Behira Governorate. He developed symptoms on 27 March and was admitted to Naaora Fever Hospital on the 30 March where he was started on oseltamivir the same day (30 March). He remains in a stable condition.

The second case is also a 2 year-old boy from the same district and was detected through the investigation around the above-mentioned case. He developed symptoms on 31 March and was admitted to Damanhor Fever Hospital on 1 April where he was started on oseltamivir the same day (1 April ). He remains in a stable condition.

Both boys had contact with sick/dead poultry prior to the illness onset.

Close contacts of both boys have been identified and none has shown symptoms of the infection .

The third case is a 6 year-old boy from Shubra El Khema District, Qaliobia Governorate. He developed symptoms on 22 March and was admitted to Ain Shams University Hospital on the 28 March where he was started on oseltamivir on 3 April.

He was exposed to sick/dead poultry prior to the illness onset. He is in a critical condition.

For all of the three cases reported above, infection with H5N1 avian influenza virus was tested positive by the Egyptian Central Public Health Laboratory and subsequently confirmed by the U.S. Naval Medical Research Unit No. 3 (NAMRU-3).

Of the 63 cases confirmed to date in Egypt, 23 have been fatal.
-

WHO | Avian influenza - situation in Egypt - update 10

[HenryN]

Originally Posted by ironorehopper

WHO | Avian influenza - situation in Egypt - update 10

Avian influenza - situation in Egypt - update 10

8 April 2009 --

The Ministry of Health of Egypt has reported 3 new confirmed human cases of avian influenza.



Close contacts of both boys have been identified and none has shown symptoms of the infection .


-

WHO | Avian influenza - situation in Egypt - update 10

The above is the ultimate commission by omission since the two cases were COUSINS.

[HenryN]

Commentary

http://www.recombinomics.com/News/04...Omissions.html

[GaudiaRay]

Is the clade of H5N1 infecting this boy oseltamivir resistant?
Yes? No?

Is Egypt testing use of Relenza?

At this time, is Relenza the last line in the sand when it comes to pharmaceutical antivirals?

"The third case is a 6 year-old boy from Shubra El Khema District, Qaliobia Governorate. He developed symptoms on 22 March and was admitted to Ain Shams University Hospital on the 28 March where he was started on oseltamivir on 3 April."

[sharon sanders]

I follow the facts where ever they lead. I found this a couple of hours ago and posted on the Egyptian human infection thread:

"...By a specialized committee of the Ministry of Health and Preventive Medicine and Veterinary Medicine to move to the child's home-Shahat, Mohamed Hassan Amer «years», which was No. 61 in the cases of bird flu in the province of the lake, immediately confirmed his illness, to examine the house and the houses nearby, Dr. Mohamed Farid , Director of Veterinary Medicine to maintain, the lack of birds at his home. "


http://www.flutrackers.com/forum/sho...&postcount=299

[AlaskaDenise]

Originally Posted by niman

Commentary

http://www.recombinomics.com/News/04080901/H5N1_Beheira_T2T_Confirmed.html

Commentary


Confirmation of Toddler H5N1 Transmission in Beheira Egypt

Recombinomics Commentary 16:24
April 8, 2009

But Jabbour said there was still no evidence of the disease being passed from person to person in Egypt. He added that two toddlers from the northern province of Beheira infected within days of one another in March were cousins.

The above comments on the Beheira cluster leave little doubt that the infections involved toddler to toddler transmission, based on the four day gap in disease onset dates. Local media reports indicated the two cases were next door neighbors, and the above comments state that they were cousins, yet neither the SAIDR updates, nor the WHO update by its Mediterranean branch mention that these two cases were cousins and almost certainly had contact, supporting human to human transmission.

The failure of these government agencies to include this most relevant information, and the delay in posting situation updates for the three most recent confirmations in Egypt by WHO in Geneva, creates significant cause for concern.

.

[HenryN]

Originally Posted by Florida1

I follow the facts where ever they lead. I found this a couple of hours ago and posted on the Egyptian human infection thread:

"...By a specialized committee of the Ministry of Health and Preventive Medicine and Veterinary Medicine to move to the child's home-Shahat, Mohamed Hassan Amer «years», which was No. 61 in the cases of bird flu in the province of the lake, immediately confirmed his illness, to examine the house and the houses nearby, Dr. Mohamed Farid , Director of Veterinary Medicine to maintain, the lack of birds at his home. "


http://www.flutrackers.com/forum/sho...&postcount=299

Actually, SAIDR has also provided verifiable DATA that casts serious doubt on the poultry connection, because as of April third sample test / collections there was no H5N1 positive poultry anywhere near the cluster

(see 2 purple markers with ZERO blue markers nearby)

http://maps.google.com/maps/ms?ie=UT...3,2.741089&z=8

WHO has been blowing smoke for five YEARS about poultry contacts and lack of H2H.

[AlaskaDenise]

Originally Posted by niman

Commentary

http://www.recombinomics.com/News/04...Omissions.html

Commentary

WHO H5N1 Transmission Omissions in Beheira Egypt

Recombinomics Commentary 17:44
April 8, 2009

Both boys had contact with sick/dead poultry prior to the illness onset.

Close contacts of both boys have been identified and none has shown symptoms of the infection .

The above comments from the latest WHO update represent glaring commission by omission. The update claims “contact with sick/dead poultry”, but fails to give results of testing of such poultry. The SAIDR site, which has poultry results through April 3 does not include any confirmed poultry cases in the proximity (see updated map) of the Beheira cluster.

Moreover, the above comments imply that neither confirmed case has transmitted H5N1 to any contact, yet the update fails to mention that the two confirmed cases live "in adjacent houses", and are cousins.

The four day gap in disease onset dates leaves little doubt that the index case infected his cousin, who lives text door. This toddler to toddler transmission is cause for concern, because both cases had mild H5N1, including the index case, who began oseltamivir treatment after the recommended 48 hours after disease onset.

These mild bird flu cases in Egypt are not new, and were cause for concern in 2007, when children between the ages of 3-10 rapidly recovered and were infected with H5N1 sequences that were virtually identical and signaled extensive human to human transmission because the cases with identical H5N1 sequences were not epidemiologically linked.

Although WHO has recently acknowledged concern for silent transmission of H5N1, the above commissions by omission of an obvious case of human to human transmission raises serious pandemic concerns about WHO’s ability to analyze scientific data and transparently present results of such analysis.

.

[AlaskaDenise]

Close contacts of both boys have been identified and none has shown symptoms of the infection .

Why aren't they looking for extremely mild cases by testing those contacts for antibodies?

I've also wondered the same thing about chickens. Just because there have been no sick/dead poultry doesn't mean they're not the source of an infection, i.e., if the poultry was vaccinated they could still be shedding small amounts of virus.

.

[sharon sanders]

Originally Posted by niman

Actually, SAIDR has also provided verifiable DATA that casts serious doubt on the poultry connection, because as of April third sample test / collections there was no H5N1 positive poultry anywhere near the cluster

(see 2 purple markers with ZERO blue markers nearby)

http://maps.google.com/maps/ms?ie=UT...3,2.741089&z=8

WHO has been blowing smoke for five YEARS about poultry contacts and lack of H2H.

Saidr reports are not 100% correct. For instance:

FT has the following report of the positive H5N1 and resultant culling of 4,000 poultry in Menoufia, on or about, March 11, 2009:

"..Veterinary Directorate executed Menofia 4 thousands of birds after the emergence of two things .."

http://www.flutrackers.com/forum/sho...6&postcount=63


Saidr does not have this reported on their site.


http://www.saidr.org/en/animals.php

[HenryN]

Originally Posted by Florida1

Saidr reports are not 100% correct. For instance:

FT has the following report of the positive H5N1 and resultant culling of 4,000 poultry in Menoufia, on or about, March 11, 2009:

"..Veterinary Directorate executed Menofia 4 thousands of birds after the emergence of two things .."

http://www.flutrackers.com/forum/sho...6&postcount=63


Saidr does not have this reported on their site.


http://www.saidr.org/en/animals.php

SAIDR is linked to government agencies in Egypt and the listings make it clear that central vet is chasing the CONFIRMED human cases and testing local poultry (after human confirmation). They would VERY MUCH like to show positive poultry in Beheira and Qena, but to date they have failed.

[sharon sanders]

Originally Posted by niman

"There is no change in the virus at all in the virus strain in Egypt. It is the same since the beginning of the outbreak. There is no mutation, nothing," he said. (Writing by Cynthia Johnston)

http://www.alertnet.org/thenews/newsdesk/L7467886.htm

There have been genetic changes to H5N1 in Egypt "since the beginning".

"...The ‬ * ‬ Spokesman of the Ministry of the injury, No. * ‬ 63 * ‬ Qaliubiya province, injuring a baby and was preceded by less than two years old in the province, the lake * ‬ *. ‬ warned the collapse of agricultural sources of the poultry industry and the closure of a large proportion of the poultry farms because of fears of disease,* ‬ and the high cost of production, * ‬ and the escalation of prices of chickens, * ‬ and doubling the price of * »‬ vaccine immunization *« ‬ against the disease, * ‬ and * ‬ useless because of several types of mutation of the virus that causes the disease *"


http://www.flutrackers.com/forum/sho...&postcount=298

[Shiloh]

Source: http://www.cidrap.umn.edu/cidrap/con...0809asymp.html


Egyptian H5N1 cases prompt speculation about silent infections

Robert Roos * News Editor

Apr 8, 2009 (CIDRAP News) – The recent series of H5N1 avian influenza cases in Egyptian children yet very few in adults has raised concern that some Egyptians may be getting infected without getting sick, according to a Reuters news report published today.

John Jabbour, a World Health Organization (WHO) emerging diseases specialist based in Cairo, said the Egyptian government and the WHO are planning a study to find out if subclinical or asymptomatic cases have been occurring, according to the story.

Jabbour said the occurrence of asymptomatic cases would be worrisome because it could give the undetected virus more time to mutate in human hosts, Reuters reported.

"If there is any subclinical case in Egypt, the aim is to treat immediately to stop the reproduction of the virus," he told Reuters. "Because whether [through] mutation or reassortment, this will lead to the pandemic strain."

The story said that all but two of the 11 Egyptians infected with H5N1 this year have been children under age 3 (the official WHO count for Egypt reached 12 today). In the same period last year, most of the seven Egyptian case-patients were adults and older children, the report said.

Jabbour said the string of cases in children without similar cases in adults had prompted the questions whether adults were being infected without falling ill.

He said the Egyptian study would involve testing the blood of people who were potentially exposed to infected birds but had not gotten sick.

Tim Uyeki, MD, a medical epidemiologist in the Influenza Division at the Centers for Disease Control and Prevention, told CIDRAP News that limited studies in several countries over the past few years have found relatively little serologic evidence of asymptomatic or unrecognized cases of H5N1 virus infection.

When the H5N1 virus first infected humans in Hong Kong in 1997, there were two studies in which investigators looked for H5N1 antibodies in people who had potentially been exposed to the virus, Uyeki said. One study focused on 293 poultry cullers, of whom only nine (3%) were found to have H5N1 antibodies, indicating past infection. In the other study, involving 1,525 poultry workers, an estimated 10% had antibodies.

More recent studies "have either found no evidence of H5N1 virus infection or very low seroprevalence of H5N1 antibodies, around 1% or less, among different exposed populations," Uyeki said. "Since H5N1 virus strains continue to evolve, there's a continued need for these studies in people who have contact with poultry in countries where H5N1 virus strains are circulating in birds, since the risk of transmission to exposed persons could change."

Uyeki also noted that subclinical infection with seasonal influenza virus is known to occur. "But how that relates to H5N1 is unclear," he said.

See also:

Jan 25 2008 CIDRAP News story "Cambodian study hints at subclinical H5N1 cases"

[AlaskaDenise]

From the referenced Jan 25, 2008 CIDRAP story on Cambodia study:

More cases of mild disease might suggest that the virus is improving its ability to spread among humans, while becoming less virulent

.

[jasonfoster]

Originally Posted by AlaskaDenise

Why aren't they looking for extremely mild cases by testing those contacts for antibodies?

I've also wondered the same thing about chickens. Just because there have been no sick/dead poultry doesn't mean they're not the source of an infection, i.e., if the poultry was vaccinated they could still be shedding small amounts of virus.

.

A chicken that have been vaccinated will likely show an antibody response to the vaccination so a false positive is likely.

The humans are tested in this way to show "exposure" because they have not been vaccinated.

PCR would show "active" infection.

[Dutchy]

I wonder what the definition is of "mild cases":

- a less virulent virus?

- higher resistance at the host?

- both?

No proof so far, we can only speculate?

Is the testing improved in Egypt? New (rapid) testing device used?