After a page, I printed out all four pages and started reading again with a highlighter in my hand. Before I was done, I was remembering Sergeant Williams, calling us trainees together on the firing range the morning of November 22, 1963 to tell us the president had been shot.
"Any of you draftees think you're in for your two years and out again—if anything comes out of this, you're in for the duration," he said.
If this paper is accurate, we are all in for the duration. The authors, who appear to be major influenza experts, have drawn on the first 91 cases of H7N9 to project where it might go. Maybe other experts will demolish their conclusions; I certainly hope so.
The paper was submitted to Chinese Science Bulletin on April 11 and accepted on April 23. Less than two months after the first Mr. Li fell ill in Shanghai, the team assessed the cases so far. They offered a formula for judging the severity of outbreaks, and defined the outbreak as Grade III (severe).
Here's what clinched it for me: They predicted that it would become a Grade IV (very severe) outbreak by the end of April, when the case numbers would exceed 100. And so they have.
So I'm prepared to accept their eight-point argument, despite its occasionally incorrect English, that H7N9 "is of enormous risk," and some of those points seem irrefutable: it will be "extremely tough" to eliminate it from China's vast bird and pig populations, so it will spread rapidly. One wild bird with H7N9, found in Jiangsu province, indicates it will spread beyond China.
The eighth argument arrives like a conviction for a capital offence:
Eighthly, the probable long existence of the H7N9 virus in humans will provide the driving force to the virus to adapt to humans through mutations. The virus may thus obtain human-to-human transmission, and may spark a pandemic influenza thereafter. The possible pandemic should likely be very dangerous with the consideration that the virus has showed highly pathogenicity in the first 91 cases.
The paper goes on to call for "forceful scientific measures," ranging from vaccine production to replacement of much of China's food distribution system: Never mind those stupid high-speed trains to Lhasa and Guangzhou, ditch the wet markets!
And while the authors point to the successful suppression of Nipah virus in Malaysia in 1998 and of SARS in 2003, they pin our real hopes on the virus itself: It may be structurally incapable of making itself capable of human-to-human transmission because the mutations that would enable it to do so would also kill it. Failing that, eradicating H7N9 in poultry markets may keep it from getting into poultry farms, and thereby push it toward oblivion.
No doubt more implications of this paper will emerge in coming days, but a few spring to mind at once:
If China really is suppressing some H7N9 news, it has just lost that option. Its own experts have painted it into a corner.
The political and economic consequences will be seismic as 1.4 billion people adjust to a new food-security regime. The same is true of trade and travel.
China will also have to deal with the irony of being a communist country without a real health insurance system. Without such a system, the country can expect that the 2020s will look like the 1920s, when warlords ruled.
I really hope I'm overreacting to this paper, and I will be hugely relieved if other experts can refute it and reassure the world that H7N9 is just another scare, soon to be forgotten. But I'm not holding my breath until they do.