It appears likely that there have been many more human-to-human infections than the authorities have previously acknowledged. The numbers are still relatively small, and they do not mean that the virus has mutated to pass easily between people — a change that could touch off a worldwide epidemic. All the clusters of cases have been among relatives or in nurses who were in long, close contact with patients. But the clusters — in Indonesia, Thailand, Turkey, Azerbaijan, Iraq and Vietnam — paint a grimmer picture of the virus's potential to pass from human to human than is normally described by public health officials, who usually say such cases are "rare."
Until recently, World Health Organization representatives have said there were only two or three such cases. On May 24 Dr. Julie L. Gerberding, director of the federal Centersfor Disease Control and Prevention in Atlanta, estimated that there had been "at least three." Then, last Tuesday, Maria Cheng, a W.H.O. spokeswoman, said there were "probably about half a dozen." She added, "I don't think anybody's got a solid number." And Dr. Angus Nicoll, chief of flu activities at the European Center for Disease Prevention and Control, acknowledged that "we are probably underestimating the extent of person-to-person transmission."
He may be right. In many clusters in which human-to-human infection may be a more logical explanation than the idea that relatives who fell sick days apart got the virus from the same dying bird.
It may still be more of a bird-to-human contagion since the afflicted families in those countries live very close to fowl, but human-to-human contagion is also possible. I am not surprised that if the numbers are greater than reported, estimated, or expected, it is either due to attempts by the govt. to hush it up or simply the failure of doctors in diagnosing or the lack of civilians' access to healthcare (particularly in the rural areas). For instance, in certain countries during the 80s, the governments did not report the occurence of HIV/AIDS, which was a big mistake as it caused the epidemic to further spread instead of being contained.
Sometimes it is not only the lack od civilians' access to healthcare, it's also the lack of education: they don;t pay much attention to the simptoms and they don't go to the doctor, even if they have this possibility.
Plus, they may not have wide access to the media. Poverty can also play a role. Even if they may panic a bit, they may not go to the doctor because they cannot afford it. Plus, wouldn't it cause stigma, because that would mean their business is over - affected by the notorious bird flu, and this would cause more poverty.
You're right. About the stigma: it's not only affecting their business, it's actually affecting their image in the comunity. As I said before, the lack of education (and of culture) would make people reject them.
Damn, there are so many factors!