H5N1

China: Quake survivors take refuge on streets of Longmen

As I write this, it's 5:00 pm Saturday on the West Coast; about 8:00 a.m. Sunday in China. Via South China Morning Post: Quake survivors take refuge on streets of Longmen. Excerpt:

Thousands of fearful people in Longmen, a mountain town close to the epicentre of yesterday's earthquake in Sichuan, spent last night out in the open. 

The earthquake that hit Lushan county at 8am toppled most of the old buildings in Longmen, a town of about 20,000 people. 

Residents said the frequent aftershocks had driven them out of their homes to the relative safety of the streets, despite the hot weather. 

An entire street of old houses was toppled. 

"I was scared to death to see everything dropping down just as we were having breakfast," said Sha Qingqing, a 27-year-old mother, as she held her wailing daughter tightly. Sha's husband is working away from the town. 

"I felt so helpless when my four-year-old daughter was crying during the shocks." 

She said the local government had provided some food, but they still weren't sure where they should spend the night. 

Of the towns worst hit, Longmen was the furthest rescuers and the People's Liberation Army could reach yesterday. 

The winding road connecting the town to the outside world was packed with military vehicles, ambulances and fire engines, and more were expected to arrive. 

Electricity and water supplies to the town were cut. 

A pilot with the PLA Air Force based in Chengdu told the Sunday Morning Post that the village of Baosheng and the township of Taiping, both deep in the mountains, were more seriously damaged than Longmen. Helicopters had been sent to find landing zones as all roads to both settlements were blocked by debris. 

A man who works for the Longmen hydroelectric board said yesterday's quake came as a bigger shock than the earthquake of 2008. 

"At that time, there were some shocks and rumbling before the main quake arrived, so we still had time to run. But this time the quake came in a split second."

In another report, the South China Morning Post says "at least 160" have died in the quake, and 6,000 have been injured.

Pakistan: Losing the war against polio?

Via The Express Tribune, an April 20 editorial: Losing the war against polio.

In another statistic, which shows just how far behind the rest of the world we have fallen, over 1.4 million children missed polio vaccinations in the country during the first polio drive of the year. 

This number does not include the 260,000 children in North and South Waziristan, who cannot be vaccinated as teams cannot go into the area. Indeed, the security situation is one of the major reasons for the setbacks in the elimination of polio from the country, with Pakistan being one of the three countries where polio is endemic. 

There seems to be no end in sight to the difficulties in administering polio vaccinations. On April 19, a team of polio vaccinators was attacked in Tank, leaving two levies personnel injured. Earlier, four people opened fire at a polio team in Karachi, while on April 17, three people were injured when villagers themselves pelted polio vaccinators with stones in Benazirabad district. 

Clearly, conspiracy theories built around polio drops have taken strong hold in the minds of many, with groups protesting the vaccinations across the country. The people must be educated on the need for polio drops, for the price of ignorance here is too high. The security problems in the tribal areas preventing the vaccinators from carrying out their duties are another matter, where the fight against militancy and polio coincides. 

Whilst most of the gaps in the campaign are due to security concerns, some also have to do with a delay in training of teams, which should be given the utmost priority given the importance of the matter. 

Furthermore, the work of the vaccinators and the security details given to protect them cannot be appreciated enough, for they are putting their lives at risk to ensure the health of our children. 

It must be ensured that the workers have adequate security to enable them to carry out their work. Those who lose out the most in all this are, of course, the children, and it is heartbreaking to see polio cases when we know that they could have been prevented had the child been vaccinated.

H7N9 and pandemic porn

Via The Globe and Mail: Fears rise in China about bird flu passing between humans. Excerpt and then a comment:

As the number of cases of a deadly strain of bird flu rises in China, health officials there are investigating the possibility that the disease has spread from human to human. 

World Health Organization spokesman Gregory Hartl cautioned Thursday that there was no conclusive evidence that the new virus, known as H7N9, has been transmitted between people, but said investigators have homed in on three families in Shanghai and two young children in Beijing as possible examples of human-to-human transmission. 

The development followed comments a day earlier by a Chinese expert on the disease who said about 40 per cent of people infected with the virus claimed not to have had contact with poultry, which has been suspected to be the primary source of infections. The expert, Feng Zijian, director of the health emergency centre at the Chinese Centre for Disease Control and Prevention, also played down the possibility of “effective” transmission between people.

I don't really object to this report; it's a straightforward account of H7N9 near the end of its third week in public. That is, it's more about people's emotions than about the new virus.

After eight years of following first H5N1 and then a host of other diseases, I recognize the routine phrases: "experts fear," "played down," "suspected." This is how we try to explain new disease threats to populations that are as clue-free about disease as Europeans in the 14th century when the Black Death arrived.

As an educator, I blame myself more than I probably should. But it does raise questions when computer-literate citizens of spacefaring nations don't believe in vaccinations. How did these people coast through a decade or more of formal education without learning that washing your hands is more than a ritual?

Given such bovine ignorance of the microscopic world, it's understandable that scare language is needed as a cattle prod to get the livestock moving toward the veterinarian. But it has its limits, especially when it shades into pandemic porn.

By "porn" I don't mean gross sexual acts, but a natural human tendency to enjoy imagining extreme experiences of all kinds: teetering on the edge of cliffs, fighting a duel against the best swordsman in France, growing a date palm in northern Saskatchewan. We know it won't happen if have a scrap of common sense, but still...just imagine.

Some of us think of a severe pandemic as just such an extreme experience. I've been thinking of it ever since, as a boy, I read George R. Stewart's remarkable 1949 SF novel Earth Abides, which imagines a disease that wipes out over 95 per cent of us (and "secondary kill" finishes off most of the survivors). Horrible, but also thrilling, and an opportunity to start over. If you shopped fast, you could get a lot of good stuff, free, before the rats did.

Pandemic porn is even a genre in literature and film, and it has unfortunately shaped public attitudes toward the real thing. When H1N1 hit us four years ago, the media response reminded me of an old Charles Addams cartoon: A Patent Office bureaucrat stands pointing a strange kind of weapon out an open window. He looks scornfully at the inventor and says, "Death ray, fiddlesticks! It doesn't even slow them down."

The failure of H1N1 to kill millions (not to mention the absence of zombies in the streets) was a severe blow to global health in general—a blow based not on scientific fact, but on the stupid entertainments of Hollywood.

In the early years of this blog I ran into a lot of that "omygod we're all gonna die" attitude. People were stocking up on food and water to endure months of isolation in their homes, fighting off their less-provident neighbours. It was remarkably like the fallout-shelter debates of my youth in the 1950s and 60s.

Granted, everyone should be ready to live for a few days off the water and power grid in a disaster, but this was ridiculous. After all, we're living in at least two ongoing pandemics right now: the 7th cholera pandemic, which began in Peru in 1991, and the HIV/AIDS pandemic, which began in the early 1980s. Neither, alas, shows much sign of abating, but somehow we soldier on through them. In fact, we pay them entirely too little attention, just as we ignore the millions of children who die of diarrhea and pneumonia every year.

H5N1 first interested me precisely because of the scare rhetoric of "experts fear," added onto my boyhood interest in stuff that blew up real good. But this blog is a self-educational venture, and it's taught me that the experts don't fear zombies in the streets—they fear people getting sick and dying out of sheer ignorance.

Like H5N1, H7N9 is interesting because it's new and we have no hard-won immunity to it. We know "naive" populations like the natives of the Americas died in scores of millions after exposure to unfamiliar diseases like smallpox and measles. We don't like the idea of that happening to us. But it's still kind of a thrill, unless we put it out of our heads and refuse to think about it at all, just as right-thinking people don't like to imagine sexual pornography.

With every health scare we also get the pandemic-porn addicts, some of whom have been waiting since SARS if not before for the aorta-busting orgasm of the Big One. They remind me of the classic Beyond the Fringe sketch of a little cult gathered to await the end of the world. When it doesn't arrive, their leader tells them, "Never mind, lads—same time tomorrow. We must get a winner one day."

We are still far too ignorant of H7N9 to judge whether it's going to evolve from a minuscule infection to a serious public-health hazard, let alone to a severe pandemic. When we imagine it as a pandemic, we are fighting all the old wars of the Spanish flu, of the Black Death, of smallpox in the post-Columbian Americas.

But what little we do know suggests that it's strangely different from the influenzas we're used to fighting, and the global health system has responded with a coherent ferocity that I find both fascinating and encouraging. After surviving all those earlier wars, we have learned something. We are not to be fooled around with by some upstart virus.

We will be an even more formidable foe when our experts explain to our politicians that "doctor's orders" is more than just an old expression. Dr. Zhong Nanshan and the Hong Kong experts effectively bullied the Chinese Communist Party into sanitary behaviour that ended SARS and slowed down H5N1. (Lenin in 1918 said: "What's the point of a revolution if you can't shoot people?" And what's the point of a medical revolution if you can't vaccinate them?)

It's not so much the public that needs to be scared as the public's rulers. So far, China's seem to be adequately scared, and fewer than a hundred H7N9 cases have moved 1.4 billion people into action. In the process they may well stop the progress of H7N9, but with luck they may also reduce the incidence of many other diseases.

And if a little pandemic porn helps all of us protect our health, and outgrow the need for such porn, then maybe it's worthwhile.

H7N9: The latest from Bejiing Ditan Hospital

Via Google Translate, a very interesting (re-paragraphed but unedited) report from Beijing Ditan Hospital. Excerpt:

Ma Xiaowei, vice minister came to inspect the diagnosis and treatment of the first case of human infection with the H7N9 avian flu patients in Beijing   

at 10:00 on April 13 the National Health and Family Planning Commission, Ma Xiaowei, Vice Minister, deputy director of the Beijing Municipal Health Bureau, Guo plot Yong, who came to my hospital, inspection of Beijing's first case of human infection with the H7N9 avian flu diagnosis and treatment of patients. 

Ma Xiaowei, vice minister of the remote video visit patients, and treatment of patients to listen to the introduction of Zhang Yongli Dean made ​​important instructions: 

a highly positive Ditan Hospital for treatment. Ma Xiaowei, vice minister said Ditan Hospital patients early diagnosis, early treatment, admissions of suspected patients immediately after the implementation of the anti-viral treatment, the patient's condition is stable, significant improvement of symptoms and signs of great significance, provide a good experience and a major draw to the national prevention work to the World Health Organization survey basis. 

Prevention work in Beijing, to summarize. Beijing epidemic prevention and control work arrangement thorough walkthrough timely, timely submission in a timely manner, timely consultation and timely diagnosis, timely treatment, and released in a timely manner, the work is standardized and orderly, to sum ​​up the good experience. 

Third, the Beijing epidemic prevention and control work has entered a new stage. Beijing to close around four to do a good job early, to strengthen the monitoring of birds, including poultry personnel to focus on the patient, the key areas to be timely disposal, especially in medical institutions at all levels must be prepared so that early treatment. 

Ditan Hospital's success proved that early intervention is the focus of the treatment work. Medical institutions at all levels to learn from the experience and lessons learned in the Yangtze River Delta region, in particular, is a grass-roots health institutions and must do well in a large general hospital treatment preparation, do not rely solely on infectious disease specialist hospital work, a large general hospital earlier intervention, or deaths will be increased. 

Large general hospitals should have the courage to answer the patient. This will reassure the public, social stability is very important to the overall situation.

This is just another sign of how seriously the Chinese are taking this outbreak: The health vice-minister, no less, shows up to check on a poultry dealer's 7-year-old daughter, and to give a pep talk to the hospital staff.

And social stability is indeed very important, the reason why China remains an authoritarian state. Lose credibility, and the government loses control over 1.4 billion people. And then everything goes to hell.

That's why we're getting so much information, including little Ms. Yao and her stuffed bunny—to show the world, and especially China, that the government is doing everything in its considerable power to fight this outbreak. It's not just the general hospital that needs the courage to answer the patient; the government needs the courage to answer the people. So far, it seems to have found that courage.

Sudan: The silent catastrophe continues

As if to underline the post just below, this Radio Dabanga article reports: Ten thousands of Darfurians fleeing Sudan to seek refuge in Chad. Excerpt:

At least 50,000 people have been fleeing Sudan to Chad in the past week due to fightings between various groups in Central Darfur. The UN Refugee Agency (UNHCR) says it is the largest exodus of people from Darfur since 2005. 

UN agencies and local sources in Chad have confirmed the arrival of at least 50,000 people who are fleeing inter-tribal fighting in Central Darfur. They are joining another 24,000 who have previously sought shelter in Tissi town due to other conflicts. 

Civilians escaping the recent violent clashes in Umm Dukhun between the Salamat and Misseriya tribes do not have water, food or medicines and are sleeping under trees, a local source told Radio Dabanga. These claims were confirmed by the UN agency for refugees UNHCR:   

"They are in great risk of waterborne diseases as they drink water from a nearby river. More refugees continue to arrive daily. Among them are wounded by bullets that are abandoned to their fate and are sleeping on the ground”. 

It added that most of them are traveling on foot, donkeys or on carts to save their lives. People are "exhausted, traumatized and visibly disturbed by the recent violent events". 

Central Darfur refugees saw their houses being destroyed and villages completely burnt down. Many reported their relatives being killed in the latest round of violence, UNHCR reported. 

According to a Tissi native, refugees come mostly from Abugaratil and surrounding villages, which were heavily targeted during the tribal war. Besides Tissi, the villages of Killi, Rumaliya, Ratret, Haraza and Koza are also housing refugees. 

The source disclosed that the local health center is treating 40 injured people, noting that another eight persons who were in critical conditions have been transferred to a hospital in Abeche.  

"Thick heavy smoke" 

The government of Chad and aid agencies, which had been hosting the first wave of 24,000 displaced, are reportedly deploying committees to assess the current situation in Tissi and send aid to the new arrivals. 

Local authorities have provided 100 tons of food that have already been transported by UNHCR to Tissi. 

In a press statement, however, the UN agency expressed concerns that the number of refugees could increase as clashes continue across the border. 

Its staff has witnessed “thick heavy smoke in the Darfur skies fearing this may be the result of more houses being set on fire in the nearby Darfur villages.”

Millions face starvation as world warms, say scientists

Via The Observer, something to ponder when you've put H7N9 out of your mind: Millions face starvation as world warms, say scientists. And before starvation, public health disasters on a very great scale. Excerpt:

Millions of people could become destitute in Africa and Asia as staple foods more than double in price by 2050 as a result of extreme temperatures, floods and droughts that will transform the way the world farms. 

As food experts gather at two major conferences to discuss how to feed the nine billion people expected to be alive in 2050, leading scientists have told the Observer that food insecurity risks turning parts of Africa into permanent disaster areas. Rising temperatures will also have a drastic effect on access to basic foodstuffs, with potentially dire consequences for the poor. 

Frank Rijsberman, head of the world's 15 international CGIAR crop research centres, which study food insecurity, said: "Food production will have to rise 60% by 2050 just to keep pace with expected global population increase and changing demand. Climate change comes on top of that. The annual production gains we have come to expect … will be taken away by climate change. We are not so worried about the total amount of food produced so much as the vulnerability of the one billion people who are without food already and who will be hit hardest by climate change. They have no capacity to adapt." 

America's agricultural economy is set to undergo dramatic changes over the next three decades, as warmer temperatures devastate crops, according to a US government report. The draft US National Climate Assessment report predicts that a gradually warming climate and unpredictable severe weather, such as the drought that last year spread across two-thirds of the continental United States, will have serious consequences for farmers. 

The research by 60 scientists predicts that all crops will be affected by the temperature shift as well as livestock and fruit harvests. The changing climate, it says, is likely to lead to more pests and less effective herbicides. The $50bn Californian wine industry could shrink as much as 70% by 2050. 

The report lays bare the stark consequences for the $300bn US farm industry, stating: "Many agricultural regions will experience declines in crop and livestock production. The rising incidence of weather extremes will have increasingly negative impacts on crop and livestock production. Climate disruptions have increased in the recent past and are projected to increase further over the next 25 years. 

"Critical thresholds are already being exceeded. Many regions will experience declines in crop and livestock production from increased stress due to weeds, diseases, insect pests and other climate change-induced stresses. Climate disruptions to agricultural production have increased in the recent past and are projected to increase further". 

Lead author Jerry Hatfield, director of the US government's national laboratory for agriculture and the environment, said that climate change was already causing weather extremes to worsen. Very hot nights, fewer cool days and more heatwaves, storms and floods have already devastated crops and will have "increasingly negative" impacts, he said. 

The report follows recent disastrous harvests in Russia, Ukraine, Australia and the US. In 2010, climate-driven factors led to a 33% drop in wheat production in Russia and a 19% drop in Ukraine. Separate climate events in each case led to a 14% drop in Canada's wheat output, and a 9% drop in Australia. 

A separate US government-funded study of the fertile Lower Mekong basin, which includes Vietnam, Cambodia, Thailand and Laos, states that temperatures there could rise twice as much as previously expected, devastating food supplies for the 100 million people expected to live there by 2050. 

"We've found that this region is going to experience climate extremes in temperature and rainfall beyond anything that we expected", says Jeremy Carew-Reid, author of the Climate Change Adaptation and Impact Study for the Lower Mekong.

H7N9 takes toll on poultry industry

Via People's Daily Online: Bird flu takes toll on poultry industry. Excerpt:

Domestic poultry farming has already seen steep losses because of a sharp drop in market demand since the H7N9 virus outbreak began earlier this month, industry insiders said. 

"At present, the company's refrigeration warehouse with a capacity of 5,000 metric tons is almost full of poultry products since few people will buy," said Zhao Binghe, an employee of a private company that processes poultry products in Chifeng, in the Inner Mongolia autonomous region. 

The company processes an average of 30 million ducks every year, and nearly 60 percent of those poultry products are sold to markets in the Yangtze River Delta region, where the current bird flu cases are from. 

The company is now losing nearly 1 million yuan ($162,000) a day, he said. 

Zhao's company is not alone in suffering because of the recent H7N9 outbreak. 

Hou Shuisheng, an animal nutrition professor with the Chinese Academy of Agricultural Sciences, said hatching has now been stopped in his breeding plant in Beijing. 

His breeding plant has about 8,000 ducks, and the ducks were being sold at about 9 yuan per kilogram before the outbreak, he said. 

"But now, even if I reduce the price by 50 percent, it is still hard to sell them," he said. 

"I talked with many poultry farm owners in the past few days, and similar business setbacks have now spread widely to many regions in the country, including Shandong, Henan, and Hubei provinces," he said.

These "setbacks" are not trivial. According to an April 13 report in Forbes.com, China is the second biggest chicken producer in the world, after the US. Over 9 million people work in the poultry industry, whose revenue in 2012 was US$68.7 billion—up over $5 billion from 2011. As the late US Senator Everett Dirksen is supposed to have said: "A billion here, a billion there, and pretty soon you're talking real money."

H7N9: Woman hits officials to save her chickens

Via Shanghai Daily: Woman hits officials to save her chickens.

A Nanjing woman cut the foot tendon of an urban management official yesterday as she tried to save three chickens from be killed as the capital city of Jiangsu Province decimated birds to avoid avian flu outbreak. 

The woman surnamed Su hid the chickens in her house when a group of law enforcement officials showed up at her door around 2pm yesterday, local media reported. 

Su abused and pushed these officials, shouting: "I wish I had bird flu and infect you with the virus," a witness said. 

Seeing two of her chickens were slain amidst the chaos, the furious woman ran to the kitchen, grabbed a knife and a broken beer bottle, and began to attack the officials. One, surnamed Tong, got hit and suffered severed tendons in his right foot. 

The woman fled the scene and went into hiding. Police are now urging her to surrender.

Haiti: 8,060 cholera deaths as of March 31 (it says here)

After a long pause, MSPP has posted another week's worth of cholera statistics on its Documentation page. I'm not sure I believe a digit of it.

Apart from the routine unexplained jump in numbers, which usually happens in the first day after a long pause, at least three departments failed to report at all during this week—Grande Anse, Nippes, and Nord Est. A couple of others went AWOL now and then.

According to MSPP, on March 31 a total of 652,730 cholera cases had been reported since the outbreak began in October 2010. Total deaths are now 8,060, with 4 of them in the last week of March (not counting 3 extra deaths slipped in on March 25). 

Back on March 1, the death tally was 8,055. It rose to 8,057 on March 4, no tally was reported for March 5, and on March 6 the deaths miraculously fell to 8,048. Since then only 6 more have been recorded in the daily count, yet Haiti ended the month with 12 more since March 6.

It really looks as if Haiti's ministry of health, in dealing with the worst cholera outbreak in the world, is pulling numbers out of the air–with the silent acquiescence of the Pan American Health Organization, countless NGOs, the media, and the various governments that fund and staff MINUSTAH, the UN babysitters who brought cholera to Haiti in the first place.

I would be abjectly grateful to be refuted, rebutted, and put in my place by anyone with knowledge of the facts. But until that happens, I'll go on thinking that Haiti and its masters have been telling us all a very implausible story.

Scientists urge extra security for health workers in polio endgame effort

Via The Guardian: Scientists urge extra security for health workers in polio endgame effort. Excerpt:

Health workers vaccinating children against polio in troubled parts of Pakistan and Nigeria must have extra security to prevent any murders of volunteers derailing a new effort to eradicate the disease, experts say. 

The plan, launched by the Global Polio Eradication Initiative – comprising United Nations bodies, health organisations, Rotary International and governments – is a strategy for the polio endgame, envisaging a polio-free world in 2018. 

Last year there were 223 cases of polio in the world, down 66% on the previous year. Only three countries now have endemic polio – Afghanistan, Pakistan and Nigeria – but without tight control there is a danger that the disease will cross borders and spread again. 

Scientists in 80 countries, including Nobel laureates and the heads of public health institutions, have signed a declaration of support for the plan. Eradication of the disease is "an urgent and achievable global health priority", they say. 

They call on governments and all players in global health to do their part. Polio is highly infectious and spreads quickly. Scaling back, they say, would have devastating consequences. 

But the deaths of volunteer vaccinators at the hands of militant Islamist groups in Pakistan last December and in Nigeria in February are widely seen as a setback to the eradication effort. 

The volunteers appear to have been targeted at least in part in response to the use by the CIA of fake vaccination scheme as a pretext for gathering information on the whereabouts of Osama bin Laden in Pakistan. 

The scientists in their declaration call for Pakistan, Nigeria and Afghanistan and their partners "to strengthen security measures and deepen engagement with community and religious leaders to promote demand and protect vaccination teams and volunteers". 

One of their number, Professor Zulfiqar Bhutta, founding director of the centre of excellence in women and child health at Aga Khan University, which has sites in eight countries including Pakistan, Afghanistan and the UK, said he thought talks with the insurgents would be necessary among other tactics. 

"Pragmatically what is needed is a combination of measures including intelligent provision of security to polio teams in high-risk areas, community engagement and contextually relevant approaches to campaigns and integrating polio with other critically important health areas, especial for women and children," he said. "If needed, as I think it is, [there should be] negotiations with the insurgents to make progress."