H5N1

McKenna: How to read H7N9

Via her blog Superbug, science writer Maryn McKenna discusses The New Bird Flu, And How To Read The News About It. It starts with a brilliantly concise history of recent outbreaks, and concludes with this (click through for many links):

It will take a while for this story to become more clear. Anticipating that, I want to suggest some things to think about as you follow the news. 

My first caution is: Remember that much of the news published in China is still reviewed by censors before being published. The Chinese government has shown encouraging transparency this week: for instance, it reported the pigeon to the OIE, the usually used French acronym for the World Organization for Animal Health, and its internal CDC quickly popped up a FAQ on this flu. Historically, those are truly unusual steps. Nevertheless, anything that comes out of mainstream media is likely to be conservative. 

Second: China has a Twitter equivalent, Sina Weibo. It. too, is censored, almost in real time. To avoid censorship, messages on important subjects are often written in a kind of allusive code. Machine translation does not pick this up; relying on machine translation for any Chinese reports (as most of the people you will hear talking about H7N9 in North America and Europe will be doing) is simply an invitation to error. 

Third: Twitter. (Ah, Twitter.) There is going to be a lot of good on Twitter — astonishingly, the WHO said this morning that they will publish case updates to Twitter first — but there is already a huge froth of speculation and error. (One example that just flitted past me: “H7N9 hits Hong Kong!” Hong Kong has one suspected case, based on a travel history to Shanghai. Also: It’s flu season in Hong Kong.) 

Fourth, and related: Don’t assume that everyone who is loading information onto their blogs or pushing it onto Twitter is doing it in a sharing spirit of helpfulness. There are people — you can see this already — who are opportunistically using this to feed their egos, angle for jobs, or generally to stir up trouble. More than ever, it’s important to be skeptical about the sources of the information you consume. 

So having said that, who are trusted sources? Here is my short list: people or organizations who understand flu, have excellent sources of information, and can be relied on not to over-hype. 

Reporters: Helen Branswell of the Canadian Press; Declan Butler of Nature; Martin Enserink of Science; my former colleagues Lisa Schnirring and Robert Roos at CIDRAP. (Also Mara Hvistendahl of Science, if she covers this, as she is based in Shanghai.) 

Bloggers/aggregators: Crawford Kilian (@crof) ; Mike Coston (@Fla_Medic). 

Crowdsourced data: HealthMap, a huge Harvard- and Google-backed effort that combines Web-scraping with human review (also on Twitter, as is their blog editor Anna Tomasulo and their founder John Brownstein); FluTrackers, a volunteer, civilian effort that has been going since the H5N1 days. 

Media on the ground: Xinhua; China Daily; South China Morning Post, in Hong Kong, somewhat more free to report. 

Official sources: WHO; China CDC; European CDC and its journal, EuroSurveilance; US CDC; OIE.

You have no idea how relieved I am to have made the cut.

H7N9: Culling pigeons and fighting the echo effect

Via Xinhua, an April 5 report reflecting a growing problem in H7N9 coverage: Shanghai begins culling poultry; one contact shows flu symptoms. Excerpt and then a comment:

Authorities in Shanghai on Thursday closed a live poultry trading zone in an agricultural products market and began slaughtering all birds there after detecting H7N9 bird flu virus from samples of pigeon from the market. 

Meanwhile, a person who had close contact with a dead H7N9 bird flu patient in Shanghai has been under treatment in quarantine after developing symptoms of fever, running nose and throat itching, the Shanghai Municipal Health and Family Planning Commission said late Thursday. 

China's Ministry of Agriculture said Thursday it found the H7N9 virus from pigeon samples collected at the Huhuai wholesale agricultural products market in Songjiang district of Shanghai. 

After gene sequence analysis, the national avian flu reference laboratory concluded that the strain of the H7N9 virus found on pigeons was highly congenetic with those found on persons infected with H7N9 virus, the ministry said. 

The Shanghai municipal agricultural commission said it has ordered proper disposal of the culled birds, their excrements and contaminated food as well as disinfection of the market and vehicles that carried them and other things that have contacts with them. 

The commission will also investigate and track where the pigeons came from, it said. 

Meanwhile, the agency ordered the closure of the live poultry trading areas of two markets in Minhang district after samples there were found with H7 bird flu virus. 

Shanghai reported two more deaths from the H7N9 bird flu Thursday, bringing the death toll from the new deadly strain to five around the country.

And here's the problem: Six deaths, not five. It's an irony of instant online worldwide communication that the more up to date we are, the more we're deafened by a kind of "echo effect": News stories with out-of-date content. 

Check NewsNow's Bird Flu page and you'll see a host of stories from around the world with "five deaths" headlines. Look at Google News' H7N9 reports, and it's even worse--on Thursday afternoon, I can see a 20-hour-old Guardian story announcing the third death, plus other stories going back to the olden times of April 2.

At the same time that Google and other aggregators feed us breaking news, they also clutter the feed with broken news—reports that are literally passé, overtaken by later events.

For those of us trying to feed Flublogia's addiction to this-very-instant news, the echo effect is a problem. It used to be worse in some ways, when NewsNow would occasionally offer some H5N1 report that was months old, not just days. If you didn't check the date on the story, you confused yourself and your readers.

In the case of H7N9, even a slightly delayed echo effect hurts the signal-to-noise ratio: I start wondering whether I've missed something, or a particular report is already obsolete. So I try to check and double-check. Meanwhile, still more reports are pouring into the aggregators and popping up on Twitter. Even a story with today's date may be based on yesterday's case count.

While this predicament makes me a bit sorry for myself, I'm far more sorry for the public-health people in China, WHO, ECDC, and other health-intelligence agencies who are trying to understand events. For them, this is war, a surprise attack by a hitherto unknown enemy. Correct understanding of what's going on is literally a life-or-death matter. And online communication, the very means of understanding events, is also undermining them with deafening echoes of yesterday's news.

China media: Concerns over H7N9

Via BBC News: China media: Concerns over bird flu. Click through for links to the media cited. Excerpt:

Media in China are calling on the authorities to release timely information on a new bird flu outbreak that has already claimed two lives. 

China Central Television and other major media say four new people living in different cities in Jiangsu province are in critical condition with H7N9, a strain of bird flu that was previously unknown in humans. 

However Hong Kong's Sing Tao Daily says tracing the virus is proving difficult. It notes that two sons of one of the men who died in Shanghai contracted pneumonia and one died, even though H7N9 was not found in either of them. 

Local authorities also say they have found no links between cases of H7N9 and over 16,000 dead pigs found in rivers near Shanghai, China Daily reports. 

The Beijing News urges the public to stay calm, but says the authorities have failed to step up checks on livestock and poultry. 

Global Times notes that the government's slow information disclosure has caused "public crises", but says the public should encourage and applaud the government's efforts rather than issuing louder complaints over accident and scandal cover-ups. 

The bird flu outbreak is also on the front pages of many Hong Kong newspapers and it coincides with the 10th anniversary of the Sars (Severe Acute Respiratory Syndrome) outbreak that killed at least 349 people on the mainland, triggering a global epidemic. Nearly 300 people died in Hong Kong. 

South China Morning Post is worried over the apparent mutation of the virus and notes that it took a month and three weeks before the authorities made public the deaths of the two men with H7N9.

Communicating about NCoV

Mike Coston has a good post this morning on Sisyphus And The Media—Sisyphus in this case being WHO's Gregory Härtl, who early today sent out tweets to a lot of people about the potential lethality of novel coronavirus. (If you follow me on Twitter, you've seen my retweet.)

I'm always glad to be corrected; after all, I got into flu blogging because I was totally ignorant about H5N1 and other infectious diseases, and my education continues. What credibility I have depends on my choice of sources and the interpretation I put on them.

I keenly sympathize with the experts' frustration over the media's interpretations. Yes, NCoV is not "SARS-like" just because they're both coronaviruses. Yes, NCoV "could be," not "is," more lethal than SARS. 

And yes, the media often get it flat wrong: Just minutes ago, Google News alerted me to a story about a boy in Shenzhen who was "critical" with H5N1. But the H5N1 was a figment of the headline writer's imagination: the story itself made it clear he's dealing with H1N1. 

Public health, like justice, must not only be done; it must be seen to be done. Certainly the media owe us accurate reports on health issues, but the experts in turn owe the media much more information and analysis than they're usually willing to provide. 

In some cases, like China with SARS and Cuba with cholera, the experts are thoroughly muffled by their political masters. In effect, the politicians fear embarrassment more than they fear disease. 

In other cases, like Cambodia's recent outbreak of H5N1, the information came, so to speak, a day late and a dollar short. We have had no update of the Cambodian Ministry of Health's website since February 26, so we have no sense of what the Cambodians and WHO have actually been doing in the past month.

I realize that agencies like WHO have political masters also, and have to be circumspect about what they say. (Don't get me going on cholera in Haiti.)

But the agencies and media have this in common: They both want a good story, and even the media are happier with an accurate good story than with a bogus one. The onus is therefore on the health agencies and experts to educate the media, repeatedly if need be. 

Admonitory tweets are welcome, but more information in the first place would be better. WHO could set an example in this regard. Its outbreak reports are maddeningly concise, and much heavier on fact than on analysis. They rarely include much follow-up about, for example, H5N1 survivors or measures taken after EV71 outbreaks to forestall another one. 

So if the experts want the media to understand disease, they need to understand the media. If accurate factual information and reasonable interpretation (beyond the usual "experts fear" paragraph) is included in news releases and articles, the media will jump on it with gratitude. So will Flublogia.

Haiti: Some cholera coverage

Prensa Latina has published a news story about Haiti's cholera, which most of the world's media have studiously ignored for many months: More than 8 000 People Died from Cholera in Haiti. Excerpt:

The cholera epidemic in Haiti, which emerged in October 2010, caused until today the death of 8 053 people, according to the Ministry of Public Health and Population. 

Director of Epidemiology, Laboratory and Research of the ministry, Roc Magloire, said that in nearly two years and a half the number of people affected by the virus amounted to 651 250.

Prensa Latina evidently has more current information than that published on MSPP's cholera page, where the latest report is for March 13. That report shows 8,048 deaths and 650,218 cases since October 2010.

NCoV: All quiet in the Gulf

I've been doing a quick check of English-language online media in the United Arab Emirates, including Dubai. So far, I find no mentions of the NCoV death of the unnamed sheikh in Germany, whether in UAE News and information - United Arab Emirates, Emirates News Agency, Dubai.com, Emirates 24/7, or Khaleej Times. I could go on.

Nor do I find anything about the case on Al Jazeera English or Al-Arabiya.

It may be that the local news sources, given a politically sensitive story, are waiting for the official announcement from WHO. As of 9:30 a.m. Pacific Daylight Time, that announcement hasn't been posted yet. I expect it will appear on WHO's coronavirus infections page, and a lot of tweets at #NCoV say it's imminent.

Cuba: Pope Francis asked to intercede for imprisoned Cuban journalist

Via Cafefuerte.com: Piden al Papa Francisco que interceda por periodista cubano preso. [Pope Francis asked to intercede for imprisoned Cuban journalist] The report, in my translation:

La agencia independiente Hablemos Press pidió al Papa Francisco que interceda a favor de la liberación del periodista Calixto Ramón Martínez Arias, quien se encuentra en huelga de hambre tras cumplir seis meses de cárcel. 

The independent agency Hablemos Press has asked Pope Francis to intercede for the liberation of the journalist Calixto Ramón Martínez Arias, who is on a hunger strike after spending six months in prison.

La carta fue entregada este jueves por periodistas de Hablemos Press a la sede de la Nunciatura en La Habana. 

The letter was sent this Thursday by journalists of Hablemos Press to the office of the Papal Nuncio in Havana.

Martínez permanece en la prisión del Combinado del Este desde el pasado 16 de septiembre sin que se le hayan formulado cargos. Fue el periodista que denunció a mediados de junio la existencia de cólera en el oriente de Cuba cuando las autoridades gubernamentales se negaban a reconocerlo oficialmente. 

Martínez has been in East Combined Prison since last September 16 without being charged. He was the journalist who last June reported the presence of cholera in eastern Cuba when the government authorities were officially refusing to admit it.

Recientemente la organización Aministía Internacional pidió una acción urgente para su excercelación, cinsiderando que se trata de un prisionero de conciencia.

Amnesty International recently asked for urgent action to free him, because he is a prisoner of conscience.

Solomon Islands dengue fever wari

Via ABC Radio Australia: Solomon Islands dengue fever wari, by reporter Caroline Tiriman. I'm posting this because it's in Pidgin, a beautiful language, and it's more understandable than many Google translations from other languages into English. Click through to hear an "odio" interview between Tiriman and Chif helt inspekta Tom Nanau, in Solomon-flavoured English and Pidgin.

Dengue fever i kilim pinis tupla pipal long Solomon Islands na moa long 100 pipal igat despla sik. 

Odio: Tom Nanau Chif helt inspekta blong Honiara city kaunsil itoktok wantem Caroline Tiriman 

Gavman i oraetim pinis wanpla tingting blong kirapim wanpla  National Task Force blong lukluk na painim ol gutpla rot blong daonim despla sik. 

Na long trinde bai oli mekim wanpla bikpla cleanup wok long Honiara. 

Dengue Fever i wanpla sik em tupla kaen mosquito isave kamapim, tasol despla sik ino save kamap bifo long Solomon Islands. 

Tom Nanau Chief Health Inspector blong Honiara City Council itok long hau despla sik i kamap nau long kantri.

India: 'Hospitals ready to tackle bird flu cases'

Via The Times of India, a report from Jharkhand state in northeast India: 'Hospitals ready to tackle bird flu cases'. Excerpt:

RANCHI: The city hospitals said there was no bird flu scare and asked people not to panic after reports of birds dying mysteriously in Khunti district surfaced recently. 

While allaying fears, hospital authorities said they were well prepared to handle an emergency situation. 

Tulsi Mahto, director, Rajendra Institute of Medical Sciences (RIMS), appealed to people not to react to rumours of bird flu in the city. 

"People will be provided treatment (if there is an outbreak) and we are making all arrangements here at RIMS. We have an isolation ward for such patients here as those suffering from bird flu need to be isolated from others and have to be treated separately with proper care. Even those who suspect should come to the hospital and get themselves checked," said Mahto. 

D K Singh, a city-based surgeon, said major responsibility of bird flu lies with the veterinary department. It is the veterinary department which will have to keep a check on the birds and send a high alert if such a thing is being reported. 

"We can provide the medicines which are needed for the treatment of patients and if the situation turns worse, we will refer the patients to RIMS which is not very far from the sadar hospital," said Singh. 

Till date, no such case has been reported in the state.

India has never had a human H5N1 case, though its neighbours Bangladesh and Pakistan certainly have. When it does happen, the Indian media's operatic response will doubtless make the situation even worse.

Haiti: 8,057 cholera deaths as of March 4

MSPP has posted more cholera statistics on its Documentation page, taking us from February 26 to March 4. As usual Grande Anse isn't reporting, and the numbers are doubtful in other ways, but here they are:

Total cases as of March 4: 649,449