H5N1

Two kinds of H7N9 story we could do with less of

Sometimes I run across online reports that automatically disqualify themselves, like stuff that assumes every new bug is another example of biological warfare. 

Then we have the kind of feel-good story that backfires, like this Reuters report: REUTERS SUMMIT-Current China bird flu strain can't cause pandemic -CDC. Here the headline spins the key quotation, a comment by CDC Director Dr. Thomas Frieden, who says H7N9 can't go pandemic in its present form; he goes on to say that just "a bit of mutation" could convert it into a person-to-person virus. Whoever wrote the headline did both Dr. Frieden and the reporter, Julie Steenhuysen, a disservice.

And on the other side we have the hand-wringer, where despondency over our bleak prospects seems to overwhelm the writer—like this New Scientist report explaining Why we are sitting ducks for China's bird flu.  

Neither approach seems constructive. I much prefer the view expressed in Dr. Chen Ji-Ming's letter to this blog, in which he argued for a "properly prepared and see" attitude as we learn more about H7N9.

Pakistan: Media get H7N9 all wrong

I read a lot of junk news, and usually I don't post it here. But in this case I'll make an exception. Via The Nation in Pakistan: Customs letting virus-infected chicken enter country despite ban.

A large number of consignments of virus-infected Chinese chicken products are being imported from China to Pakistan for big fast food restaurants, despite the fact that Chinese Veterinary Authorities have endorsed presence of influenza virus A(H7N9) in their poultry. 

Though the Ministry of Commerce, in its trade policy for 2012-15, has imposed ban on import of chicken products from those countries which are under virus attack, yet Customs department is violating the rules openly. 

Due to presence of the new virus at least 180 cases have been reported in China while more than 24 people have died there just in one month, industry sources informed and added that fatal virus can easily be transmitted into human beings particularly in children and aged people. 

Sources confirmed that around 4500kg to 2000kg of chicken products are being imported from China, putting at risk thousands of citizens’ lives who are unaware of the situation while Chicken products including crispy chicken patty, grilled chicken patty, chicken nuggets, value chicken and chicken meat in large consignments are arriving at Karachi port on regular basis and all consignments are cleared without any warning of health hazards. 

Sources said that Customs authorities have endangered lives of Pakistani citizens by allowing unchecked import of Chinese chicken for large fast food restaurants in Pakistan. 

Chinese authorities have killed 20,000 birds at a wholesale market in Shanghai with an advice to people to avoid live poultry while Hanoi chicken market has been shut down after isolating Avian Influenza virus H7 N9 from a pigeon. 

Sources confirmed that consignment of crispy chicken patty from China (Xiadian Town) of 6804kg arrived on 06 March 2013. Similarly, consignment of grilled chicken patty of 950kg, consignment of chicken patty of 1768kg, consignment of chicken nugget of 4665.6kg, consignment of value chicken patty of 1152kg, consignment of chicken patty of 2652kg and consignment of value chicken patty of 2288kg arrived on March 06 2013. 

Sources also revealed that different consignments of crispy chicken patty, grilled chicken patty, chicken nuggets, value chicken and chicken meat totaling 41931.44kg was imported from China on March 27, 2013. 

According to FAO (Food & Agriculture Organization of UNO), it is revealed that a previously unknown Avian Influenza virus H5N1, which is not so lethal, has infected 7 persons in China with at least six deaths but the up to date reported cases have increased to 24. The World Health Organization has shown its concern as to how the said virus has infected humans.

This report is more or less incoherent. It gets the number of H7N9 cases in China wildly wrong. While meticulously reporting the precise number of kilograms of chicken patties, it makes no effort to link them to any hot zone. ("Xiadian" could refer to any of several towns in various provinces.) Then it breaks the news of a "previously unknown" "not so lethal" H5N1 that has supposedly killed 6 out of 7 cases...this in a country that had a hell of an H5N1 disaster seven years ago. 

Tracking H7N9 in the twitterverse

Far more than during the H1N1 pandemic, Twitter is playing a critical function in spreading information about the emergence of a new disease. We have been living with H7N9 for less than a month, and we still know very little. But we'd know far less without the tweets of some remarkable individuals and agencies. So here, with some annotations, are the handles (Twitter names) of those I most rely on for solid information about H7N9:

Helen Branswell: The star health writer for The Canadian Press and present at the creation of Flublogia. 

Mike Coston: The author of Avian Flu Diary offers breaking news plus highly useful background and context.

FluTrackers: They handle floods of information. Don't even try to keep track without them.

Jennifer Yang: The health reporter at the Toronto Star is a welcome new observer.

Declan Butler: A top writer for Nature and a founding father of Flublogia.

Tom Watkins: As Treyfish, Tom is another founding father.

Jason Anthony Tetro: An expert; he knows what he's tweeting about.

WHO: Tweeting H7N9 before it goes on their website.

Gregory Härtl: WHO's tireless communications maestro, patiently answering questions.

Lisa Schnirring: She pulls the news together every day for CIDRAP, picking up what I've missed.

Mara Hvistendahl: Writer/editor for Science, based on Shanghai.

Li Yin: No idea who she is, but she's sending intelligent tweets from China.

Pasi Penttinen: In ECDC's Epidemic Intelligence division, new to Twitter but likely to be a major source.

Not enough? Bookmark #H7N9 and follow everyone.

When it goes without saying, I try not to say it. But in this case I'll say it anyway: Without you folks, I wouldn't have much to say at all. Thank you.

H7N9: China gets serious

This Xinhua report, posted at 9:16 on Monday morning, hasn't been translated yet, but here's what Google gives us: China has confirmed 102 cases of H7N9 cases officially known as to strengthen joint control defense. You'll get the key points. The entire report:

Mainland China confirmed human infection of H7N9 avian influenza in the number of cases continued to rise. The face of the epidemic prevention and control of Ya'an earthquake relief medical rescue a "double pressure", the Chinese official said 21 to further strengthen inter-sectoral coordination linkage and communication, to maintain normal social production and living order. 　　

Up to now, the country reported a total of 102 cases of confirmed cases , including 20 deaths, 12 were recovered, and the remaining 70 are each designated medical unit for treatment. Cases are located in Beijing (1) Shanghai (33 cases and 11 deaths), Jiangsu (24 patients, 3 patients died), Zhejiang (38 cases, 5 cases died), Anhui (3 cases, 1 death), Henan (3) six provinces. 　　

The Chinese Ministry of Health and Family Planning Commission, said 21 cases in the dissemination of state, have not yet found evidence of human-to-human transmission. 　　

Since the H7N9 avian influenza outbreak, the CPC Central Committee General Secretary and State President Xi Jinping made ​​several instructions stressed the need to adhere to the people's lives and safety and health in the first place, strengthen epidemic prevention and control. 　　

Xi Jinping's instructions, Wei Planning Commission held a meeting of human infection with the H7N9 avian influenza epidemic joint prevention and control mechanism. The meeting made ​​positive progress in the joint prevention and control mechanism of the Ministry of Agriculture, Forestry Administration, Business Administration, food and drug supervision bureau, Ministry of Science and Technology and other members of the unit, sector collaboration, epidemic prevention and control. 　　

The national report new cases of human infection of H7N9 avian influenza confirmed cases, new cases from Zhejiang, Jiangsu, epidemic prevention and control task is still arduous. The Guardian Planning Commission, will continue to strengthen the patient's treatment, and strictly control the source of infection, while ensuring timely and accurate, open and transparent informed of the disease and to increase public awareness of self-protection. 　　

Chinese Center for Disease Control said the same day the prevention and control work group has been set up, in which the set of risk communication and media coordination group for the release of information, dissemination of health knowledge and public opinion monitoring analysis. 

They also co-production with the popular science press Q & A brochure of human infection with the H7N9 avian influenza, epidemic prevention and control knowledge animation co-production with the animation company, Chinese Center for Disease Control of human infection of H7N9 avian influenza information management system has also been on-line operation.

So some very big bureaucracies are going into action, and the Chinese CDC is taking the job of risk communication and media coordination. Let's hope that's not a euphemism for spin; I really hope they talk with their colleagues in Hong Kong's Centre for Health Protection about what real risk communication entails, and act accordingly.

More H7N9 news compilations

In addition to SINA English (see below), Liucie Lecomte has found two other news sources that compile H7N9 reports: 

H7N9 avian flu | South China Morning Post: Up to date, with clearly datelined, well-written reports. You may need to register (free) to read the stories; paid subscription required for frequent readers. (I'm paying and glad to.)

Shanghaiist: An expatriate website; sometimes a little too smart-ass, but still informative.

Shanghai stifled 'rumours' of H7N9 bird flu in early days, says report

Via the South China Morning Post: Shanghai stifled 'rumours' of H7N9 bird flu in early days, says report. Excerpt (but click through for the whole report plus a useful chronology of the early weeks of H7N9):

Online speculation about recent flu deaths in Shanghai was quickly muzzled prior to the confirmation of H7N9, reported China’s Southern Metropolis Daily on Wednesday. 

The report said censors had shut down internet talk after the first few deaths from the virus but before a national lab confirmed H7N9 as a new strain of bird flu, weeks later. 

The first weibo post about the H7N9 avian influenza emerged as early as March 7,  three weeks before local authorities alerted the public, said the report. An anonymous blogger on that day posted a message which reads: 

“There have been a few unexplained deaths in the Fifth People’s Hospital of Shanghai. The preliminary diagnosis was flu. Their symptoms included respiratory failures. Will the hospital please tell us the truth?” 

The post was quickly deleted. Other posts about the deaths also disappeared or were drowned out by netizens discussing the thousands of dead pigs found in a Shanghai river. 

Hours later, Shanghai officials explained on weibo that health experts had already excluded the possibility of a bird flu outbreak. They acknowledged that two people had died at the Fifth People's Hospital - an 87-year-old man and his 55-year-old son - but said they died from complications and lung infections. 

On the following day in an attempt to further “dispel rumours”, several Communist Party-owned newspapers in Shanghai published an article that blamed seasonal changes for an increased number of patients with respiratory disease, said the report.

H7N9: FluTrackers are heard from

Business Insider.com has a good report: China's Bird Flu H7N9 Problem Is Getting Worse. But the reason for posting it is the update. Excerpt:

Update: Reports from FluTrackers indicate that a ninth person has died from the virus, as of 2pm EST April 8. 

China has been paralyzed by an emerging human strain of bird flu, H7N9, which has now infected 28 people, 8 of whom died. In just the last two days, four more people have tested positive for the virus, according to Xinhua. 

The latest case has hospitalized a 62-year-old man in Shanghai. About 30 percent of patients who have been diagnosed with the virus have died. 

The virus took its first victims in early March. This is the first time that the H7N9 flu strain has made the jump into humans, so we haven't built up a natural resistance. Luckily, the virus doesn't seem to be able to spread between humans, though it's possible it could mutate and gain this ability.

The mainstream media are beginning to understand that Flublogia is often there first, with current information and reliable background.

H7N9: When a new virus goes viral

The Tyee has published my article H7N9: When a New Virus Goes Viral. While it discusses the events of the past week, it's mostly about the growing usefulness of the online media as a part of global health information systems. Excerpt:

Just before 7:30 on the morning of Sunday, March 31, I opened my laptop, checked my mail, and found a note from Google Alerts saying two people in Shanghai had died of bird flu. 

But this was not the H5N1 bird flu I've been blogging about for eight years; this was something called H7N9. Influenza has many different strains -- so-called "swine flu" is H1N1 -- but this was the first time anyone had ever been infected with this strain, much less died of it. 

This kind of story doesn't happen often in the strange online world of Flublogia, where people share news of diseases outbreaks, public-health problems, and the medical consequences of political decisions. The last time was almost exactly four years ago, when H1N1 came out of nowhere as an aggressive and fast-spreading disease that turned into a pandemic. 

That one email about H7N9 effectively hijacked my blog.

H7N9: Questions fly thick and fast over delay in bird flu report

Via South China Morning Post: Questions fly thick and fast over delay in bird flu report. Excerpt:

Memories of the 2002-03 Sars epidemic are deeply embedded in the mainland psyche. 

While just about everyone learned about severe acute respiratory syndrome, which killed 774 people worldwide, from the news media, they also remember that mainland officials hid the growing toll from the public for weeks before a wave of deaths and rumours forced authorities to reveal the scale of the epidemic. 

It is not hard to understand why many remain wary of what the government does or says in the public-health realm, even though it has repeatedly vowed to promptly disclose any human cases of H7N9 bird flu, the latest killer virus to emerge. 

The National Health and Family Planning Commission said last Sunday that only a few cases had been discovered, and that while it was not clear how the victims became infected, there was no evidence of human-to-human transmission. 

Most state-owned media outlets, especially in Shanghai, praised the quick reaction - even though the outbreak was not revealed to the public until 20 days after the government detected the first suspected case. 

Take Shanghai's Oriental Morning Post for example. Its front-page report on Tuesday designed to stem public panic said the Shanghai hospital that admitted the first patient was "very calm". It also had three other big stories explaining how hard it was to control the disease. "It's quick enough to be able to diagnose a new disease in just over 20 days," it said. 

Amid all this fawning media coverage, the Shanghai Business Daily fired the first broadside at the authorities. In an editorial on Tuesday entitled "Timely release of information is the key to responding to bird flu", it said one or two press conferences could not ease public concerns and the government had to be more transparent so that an epidemic could be prevented. 

Tuesday's China Youth Daily, the Communist Youth League's official paper, was also critical. "People are wondering, why it has been so late for so long in releasing the information? The government believes it revealed the information as soon as possible, but that's still not as fast as the public desired. It's hard to say if the government passed this examination," it said. 

The City Express Press in Zhejiang, also affected by the bird flu outbreak, posted an article, "Sars didn't change China", on its official Sina Weibo microblog on Tuesday night, lamenting that "the Sars epidemic a decade ago was an experience of tears and blood". 

"A country that can no longer remember that would be a hopeless country and a government that has not reflected on that matter would be an unqualified government," it said. "We hope a similar disaster will not happen again." 

The Yunnan City Times said on Wednesday that the Shanghai government would find it hard to earn forgiveness from the public. 

"No matter how difficult the diagnosis was, the revealing of H7N9 was still more than 20 days late … sorry to say this, but we didn't see local governments launch much in the way of disease control resources to meet the challenge," it said. 

For outspoken media like the 21st Century Business Herald, the long wait was like a "hide-and-seek" game between the government and the public. It said the Shanghai government had dismissed a number of rumours earlier last month that a new type of bird flu virus had been found, and yet those rumours turned out to be true.

H7N9: Xinhua goes to battle stations

I like Xinhua partly because it's cognitively dissonant: For a Communist news source, it's oddly fond of celebrity gossip and photos of gorgeous movie stars. But it's also the only media game in town for internal China news, which can be frustrating. However, it's doing pretty well in covering H7N9. For example: Two more H7N9 bird flu cases confirmed. Excerpt:

Two new H7N9 bird flu cases have been confirmed in east China's Jiangsu Province on Friday, the provincial health authorities announced. 

That brings the total number of infections to 16 nationwide. 

A 61-year-old woman, surnamed Yin, became ill on March 20 and was sent to a hospital on Tuesday after her condition worsened. She was confirmed to be infected with the H7N9 bird flu strain after the provincial disease control and prevention center said she tested positive for the virus. 

A 79-year-old man, surnamed Lu, fell ill on March 21 and was sent to a hospital for treatment ten days later. It was also confirmed Friday morning that he has been infected with the H7N9 virus. 

Sixty-five people, who have been in close contact with the two patients, have not reported symptoms of fever, runny rose or a cough to date. 

Another two suspected cases were also reported in the province. 

As of Friday afternoon, China has confirmed 16 H7N9 cases -- six in Shanghai, six in Jiangsu, three in Zhejiang and one in Anhui, in the first known human infections of the lesser-known strain.

And look at Xinhua's health page  and home page to see how seriously they're covering the story—not yet a week old.