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H7N9
April 23, 2013 6:50 PM   Subscribe

Is China covering up another flu pandemic -- or getting it right this time? A long article from Foreign Policy regarding the recent outbreak of H7N9 flu. [readability link]
posted by (Arsenio) Hall and (Warren) Oates (102 comments total) 25 users marked this as a favorite

 
Influ-Venn-Za: Who Can Catch What?

Illustrates swine/avian/human/equine/pinniped/bat flu.
posted by the man of twists and turns at 6:56 PM on April 23, 2013 [3 favorites]


Try this: http://www.readability.com/articles/oz5x2ziq (and then hit "Readability View")
posted by AceRock at 7:06 PM on April 23, 2013


If you have AdBlock installed and right-click on the stupid popover, you can block it and at least read the article. It's still greyed by some other Javascript bullshit they're running (why can't you disable that stuff on a more fine-grained level without a dozen goddamn add-ons?) but you can at least read the text, just not select anything.
posted by Kadin2048 at 7:07 PM on April 23, 2013


Alternate idea: access the article via this tweet. That's how I read it originally.
posted by (Arsenio) Hall and (Warren) Oates at 7:10 PM on April 23, 2013


[A few comments deleted - the first link was throwing a signup form for some users, please try accessing it via the readability link.]
posted by LobsterMitten at 7:20 PM on April 23, 2013


I've tried to imagine such fever stations positioned along America's superhighways: Visions of angry drivers pulling shotguns on public health nurses and highway patrol officers always dance thru my head.

Hyperbole much?
posted by ZenMasterThis at 7:22 PM on April 23, 2013


Also see the previous H7N9 thread, where smoke and other members have been building a chronology of the disease's reported spread.

The thread also contains tips about how to avoid the pop-up.
posted by LobsterMitten at 7:22 PM on April 23, 2013


I probably mentioned it in the other thread, but I caught what turned out to be the flu and have to travel back to Canada from Japan. I watched "Contagion" during the trip. Worst flight of my life.
posted by KokuRyu at 7:33 PM on April 23, 2013 [5 favorites]


In the existing thread, spock's comments in particular provide some context about why the new flu strain may be significant.
posted by KokuRyu at 7:36 PM on April 23, 2013



In the existing thread, spock's comments in particular provide some context about why the new flu strain may be significant.


It's also good for getting the Contagion soundtrack stuck in your head all day.
posted by The Whelk at 7:44 PM on April 23, 2013 [2 favorites]


It seems hard to believe it's been 13 years since SARS. Mel Lastman was mayor of Toronto then, so perhaps having a dumb oaf as mayor is a harbinger of doom.
posted by KokuRyu at 7:51 PM on April 23, 2013 [2 favorites]


I wonder if the anti-vax crowd would stick to their guns in the face of a truly deadly pandemic? I'd have little sympathy for them but their poor kids...
posted by Justinian at 7:56 PM on April 23, 2013 [1 favorite]


Gene data shows bird flu mutated ‘under radar’
posted by homunculus at 8:07 PM on April 23, 2013


I wonder if the anti-vax crowd would stick to their guns in the face of a truly deadly pandemic? I'd have little sympathy for them but their poor kids...

Actually, I had been thinking of making an FPP about it, but the hysteria over vaccines 15 years or so ago is responsible for a measles epidemic in some parts of England and Wales.

I wonder what the anti-vax folks would say if they knew Andrew Wakefield likely falsified lab results for monetary gain or that he conducted cruel and unnecessary medical tests on children.
posted by KokuRyu at 8:18 PM on April 23, 2013 [4 favorites]


From the OP, this isn't really a "bird" fly any longer but a mammalian flu. Unlike every other bird flu in history, birds don't get sick from this, it doesn't seem to effect them. So there was a mutation from bird to mammal to human .. and what was that "mammal" in the middle? No one seems to know. However it appears to be a mammal that is 1) urban 2) in the north and south of China and 3) easily exposed to elderly men.
posted by stbalbach at 8:56 PM on April 23, 2013 [1 favorite]


...and birds.
posted by KokuRyu at 9:08 PM on April 23, 2013


Is anyone making a guess at the actual number of cases and not just the reported number of cases? I'm sure somewhere, some researcher has a method of estimating the number of cases mistaken for a more normal illness, cases that don't make it to a hospital, or aren't recorded for a variety of reasons.
posted by Slackermagee at 9:16 PM on April 23, 2013


When the pandemic does happen I wonder if people will think I'm weird for walking around in latex gloves, an n95 respirator mask, and lab goggles to prevent droplets in my eyes. Because I am so going to do that.
posted by Justinian at 9:25 PM on April 23, 2013 [1 favorite]


Hmm... Laurie Garrett...

/Homer Simpson...

Now there's a name that takes one back.

Still, despite her cultural historical significance hereabouts, this is her bailiwick, if I recall correctly. So, I don't know whether to take this with a grain of salt or a grain elevator of same.
posted by y2karl at 9:31 PM on April 23, 2013


H7N9 flu

This ominous H# and N# format for naming these things is fucking terrifying enough I gotta say, kudos on whoever's in charge of that...


*shudder*
posted by Skygazer at 9:45 PM on April 23, 2013 [1 favorite]


When the pandemic does happen I wonder if people will think I'm weird for walking around in latex gloves, an n95 respirator mask, and lab goggles to prevent droplets in my eyes. Because I am so going to do that.

I'm no expert, but I think SARS was a very big deal - it had the opportunity to transform into a pandemic - and I think the general precaution was to avoid travel to affected areas (China, for example), wash your hands, and avoid the hospital... like the plague.

The battle for SARS seems to have been fought in the hospital, and besides the patients most of the causalities were sustained by frontline caregivers like nurses.

Most airports also had (and I think Japan still does this as a matter of course) heat-sensing cameras that acted as another line of detection and defense against SARS.

Here's what Wikipedia says about SARS (it has not been eradicated):

Severe acute respiratory syndrome (SARS, pron.: /ˈsɑrz/ sarz) is a viral respiratory disease in humans which is caused by the SARS coronavirus (SARS-CoV).[1] Between November 2002 and July 2003, an outbreak of SARS in South China and then Hong Kong nearly became a pandemic[citation needed], with 8,273 cases and 775 deaths worldwide[2] (9.6% fatality) according to the World Health Organization (WHO).[3] Within weeks, SARS spread from Hong Kong to infect individuals in 37 countries in early 2003.[4]
SARS is not claimed to have been eradicated (unlike smallpox), as it may still be present in its natural host reservoirs (animal populations) and may return to the human population.
During the outbreak the fatality of SARS was less than 1% for people aged 24 or younger, 6% for those 25 to 44, 15% for those 45 to 64, and more than 50% for those over 65.[5] For comparison, the fatality of influenza is usually under 0.03% (primarily among the elderly), but rose to 3% during the 1918–19 flu pandemic.[6]

posted by KokuRyu at 9:46 PM on April 23, 2013 [1 favorite]


In another (deleted) post, someone mentioned that the flu vaccine does not work very well this year, so it's natural that people will have doubts about the efficacy of vaccines in general. However, the Measles vaccine most certainly does work, and the BBC (not the Mail) does report that the rate of measles vaccination has declined, and now Wales and parts of England are seeing an outbreak/epidemic. So far, one adult has died from measles. So it would seem that giving your kids vaccinations, rather than listening to Andrew Wakefield, is the responsible thing to do.
posted by KokuRyu at 10:32 PM on April 23, 2013 [2 favorites]


Thanks for the post and the great FP article! Isn't there also the possibility this is mutating in humans themselves - i.e. we are the mammalian hosts? From what I've read this virus is pretty genetically diverse so the cases might be jumping from birds to humans as well as taking the hypothesised bird-->unknown mammal-->human route.

As for the "older males" angle, elderly men in Chinese cities are fond of keeping songbirds and often gather for singing competitions. The pet birds don't have much contact with other birds though, so I can't see how they would be getting the virus. There isn't another animal I can think of that elderly men get selectively exposed to... so the skew is very strange.
posted by monocot at 10:57 PM on April 23, 2013


Upon reflection, maybe it's all too easy to snark at the messenger because it's all too scary to think about the ramifications of the message, but still, running across a sentence that starts Fang Lin, a country bumpkin who had made his way to the Shenzhen metropolis near Hong Kong and found work in a restaurant that served exotic animal meats... does tend to stick in the craw.
posted by y2karl at 11:15 PM on April 23, 2013


I've tried to imagine such fever stations positioned along America's superhighways: Visions of angry drivers pulling shotguns on public health nurses and highway patrol officers always dance thru my head.

Hyperbole much?


I could definitely see some isolated cases of that occurring in the event of a nationwide quarantine effort. FEMA is at the center of a lot of modern conspiracy theories in the US and literally any crisis is spun on the fringe as some sort of false flag.
posted by Drinky Die at 11:33 PM on April 23, 2013 [2 favorites]


Imagine the missing mammalian animal vector is pets - cats or dogs - and the only way to check it is with a cull. Chickens and pigs are one thing..
posted by stbalbach at 11:43 PM on April 23, 2013


Damn, I'm getting a sore throat reading this
posted by mattoxic at 12:26 AM on April 24, 2013


Terrifying. Let's hope it's no more transmissible than the recent H5N1. Fortunately, most of the really virulent strains of flu tend not to pass between humans well.
posted by professor plum with a rope at 1:02 AM on April 24, 2013


Hong Kong still checjs your temperature on the way in.
posted by awfurby at 1:20 AM on April 24, 2013


Fantastic article. Thank you for posting this!
posted by rozaine at 2:28 AM on April 24, 2013


Can't they be getting it right and covering it up?
posted by Renoroc at 4:30 AM on April 24, 2013 [1 favorite]


Taiwan reports its first confirmed case of deadly H7N9 bird flu in man who visited China. Also WHO says new bird strain is "one of most lethal" flu viruses. Confirmed infections in China are currently at 108, with 22 deaths.

My future updates will now be placed in this thread, rather than the previous one.
posted by spock at 4:30 AM on April 24, 2013 [8 favorites]


That was a great read, I'm concerned about the flu and thank spock for the updates.
posted by lite at 5:07 AM on April 24, 2013


Hong Kong still checks your temperature on the way in.

Beijing, too.
posted by Wolof at 6:11 AM on April 24, 2013


Don't worry, this is only Lieutenant Trips.
posted by WinnipegDragon at 6:50 AM on April 24, 2013 [4 favorites]


This is a concern: Taiwan: 3 hospital staff show symptoms after H7N9 contact. "Three hospital personnel have developed respiratory symptoms after coming into contact with Taiwan's first confirmed case of H7N9 avian flu, the Central Epidemic Command Center said Wednesday. "

Note that these are not yet confirmed cases of H7N9, but if any of them turn out to be they could be a sign that human-to-human transmission is getting easier.
posted by spock at 6:50 AM on April 24, 2013 [1 favorite]


SARS was sort of the same deal, wasn't it?
posted by KokuRyu at 7:21 AM on April 24, 2013


Yes, health care workers contracted SARS. A list of medical professionals who died during the SARS outbreak.

However, the case fatality rate of H7N9 is currently approximately 20%. For context SARS was 9.6%.

On topic: China deserves credit for its rapid response to the outbreaks of H7N9 avian influenza, and its early openness in the reporting and sharing of data. - NATURE magazine editorial
posted by spock at 7:48 AM on April 24, 2013


I've tried to imagine such fever stations positioned along America's superhighways: Visions of angry drivers pulling shotguns on public health nurses and highway patrol officers always dance thru my head.

Hyperbole much?


My immediate response to this is "been to 'merka lately much?" The ability of the average American to scare the shit out of me has never been higher, and I've lived my whole life here. Truly fucking frightening, the average American.

Source: my fucking family.
posted by nevercalm at 7:55 AM on April 24, 2013 [1 favorite]


Japan announces H7N9 defense measures and they are pretty serious ones.
posted by spock at 8:10 AM on April 24, 2013 [1 favorite]


However, the case fatality rate of H7N9 is currently approximately 20%. For context SARS was 9.6%.

On topic:


Smaller sample size so far with H7N9, though, right? I think SARS is somewhat relevant since it was successfully contained through early detection and through quarantine, and I'm guessing the same thing will happen this time.

We're a long way from 1918.
posted by KokuRyu at 8:16 AM on April 24, 2013


> We're a long way from 1918.

I hope you are right, however in 1918 one could not get on a plane in Shanghai and be landing anywhere in the world in less than a day. Most of the world does not even have the capacity to test for or diagnose H7N9 at this time. Also, although the Spanish Flu killed some 20 million people its mortality rate was only 2.5%. In short, if H7N9 goes pandemic, the world could be in for something that rewrites the history books, which is why it got my attention 3 weeks ago.
posted by spock at 8:36 AM on April 24, 2013 [3 favorites]


> However, the case fatality rate of H7N9 is currently approximately 20%.
only about 9 percent of the confirmed H7N9 cases in China have walked out of hospital, cured of their infections; one has been asymptomatic; and the remainder are still hospitalized, many suffering multiple organ failure and illnesses from which they are unlikely to recover.
The injury and death rate looks more like Ebola than the flu.
posted by stbalbach at 8:53 AM on April 24, 2013 [1 favorite]


only about 9 percent of the confirmed H7N9 cases in China have walked out of hospital, cured of their infections; one has been asymptomatic; and the remainder are still hospitalized, many suffering multiple organ failure and illnesses from which they are unlikely to recover.

That was the striking part about reading the Wikipedia entry on SARS - a remarkable number of survivors seem to have developed chronic illnesses as a result of SARS.

>I hope you are right, however in 1918 one could not get on a plane in Shanghai and be landing anywhere in the world in less than a day.

I think that's where early detection comes in. As I understand it, the 1918 flu was spread by troops returning home from the war. While travel these days is comparatively instantaneous, we can also shut things down more easily. There are more rings of defense.
posted by KokuRyu at 9:31 AM on April 24, 2013 [1 favorite]


Any tips on what individuals / households / small businesses can do to prep for a flu pandemic? I mean above and beyond what one would do to prep for a generic disaster scenario.
posted by Jacqueline at 10:52 AM on April 24, 2013


I think that's where early detection comes in. As I understand it, the 1918 flu was spread by troops returning home from the war. While travel these days is comparatively instantaneous, we can also shut things down more easily. There are more rings of defense.

You are missing a couple of important points. First, most parts of the world have no ability to detect H7N9 at the local level. There is no early detection. In fact, unlike H5N1 the birds don't even get sick. So let's say that a doctor is vigilant and sends samples from a patient with respiratory problems off to a lab that does have the ability to test for H7N9. 2-3 days later the diagnosis is confirmed. How many different medical workers have had contact with that patient in the days leading up to the diagnosis confirmation? How many of them went home to their families in the interim?

Secondly, when you say we have the ability to "shut things down more easily" I think you are being naive. There is a huge economic cost to "shutting things down" and this can act as a counterbalance to what would otherwise be prompt prudent action. The economic fallout from a pandemic is going to affect everyone. Please see this insightful comment from someone who lived in Indonesia during the SARS outbreak and see how close the economic dominos were to falling then: http://www.metafilter.com/126649/H7N9-The-next-pandemic#4902292
posted by spock at 11:24 AM on April 24, 2013


Skygazer: "This ominous H# and N# format for naming these things is fucking terrifying enough I gotta say, kudos on whoever's in charge of that...

*shudder*
"

Yes, the naming format makes them all sound like something that escaped from the lab in The Stand.
posted by double block and bleed at 11:25 AM on April 24, 2013 [1 favorite]


Any tips on what individuals / households / small businesses can do to prep for a flu pandemic?

I think it is probably waaaay early for individuals/households to begin worrying about this (beyond staying informed), but if you want to be thinking about what policies your business might take, then I suggest looking at what countries are doing to prepare, such as the Japan link above. Also, you may want to read the CDC's "Interim Guidance for Infection Control Within Healthcare Settings When Caring for Patients with Confirmed, Probable, or Cases Under Investigation of Avian Influenza A(H7N9) Virus Infection". If this guidance is good for health care workers avoiding H7N9, then it is probably good advice for anybody. That said, it is probably a little early for the average person to be wearing an N95 Respirator to work every day.
:)
posted by spock at 11:37 AM on April 24, 2013


I think you are being naive.

I wouldn't say I was being naive, just as I wouldn't say that posts like this promote hysteria.
posted by KokuRyu at 11:39 AM on April 24, 2013


Here's to hoping for a really good vaccine and herd immunity. For things like this where the strain is known, it's relatively easy to create an effective vaccine, right?
posted by stoneweaver at 12:22 PM on April 24, 2013


it's relatively easy to create an effective vaccine, right

It depends upon who you believe. A Taiwan pharmacutical company says they can have vaccine by August. A Chinese expert says it is "hard and requires international cooperation". A US News & World Report article today says it is "six weeks away". I hope the optimistic estimates are correct, but I will not be surprised if they turn out to be wildly unrealistic.

In any event, having a vaccine and having enough vaccine are two entirely different animals.
posted by spock at 12:30 PM on April 24, 2013


This caught my eye in the FP:
In 1985, researchers showed that two key mutations in bird flu viruses occurring simultaneously could switch them to forms capable of spreading among mammals. When H5N1 appeared in Hong Kong in 1997, local flu experts took some comfort in discovery that the virus had not made those mutational changes, so spread among people was unlikely. And since that time the WHO has nervously monitored strains of the virus emerging worldwide, looking for evidence that these mutations had been made. Thankfully, they have not. But in 2012, two labs working independently -- one in the Netherlands, the other in the United States -- controversially deliberately made those mutations in H5N1 under controlled conditions, confirming that a bird virus with those gene switches could spread from one ferret to another, through the air coughed between them.

The H7N9 virus now circulating in China has those mutations.
Are they saying this could a "deliberate" virus? Even if not, there are people out there with the knowledge, tools and experience to do so, intentionally or accidentally.
posted by stbalbach at 1:35 PM on April 24, 2013


Are they saying this could a "deliberate" virus?

Chinese general calls bird flu an American plot A general in the People’s Liberation Army has prompted online outrage in China – after he called the country’s bird flu outbreak an American plot to destabilize the government.

So, yes, a 'they' is saying such.
posted by rough ashlar at 2:07 PM on April 24, 2013


In other news: The Gonorrhea Doomsday Is Nigh
posted by homunculus at 2:57 PM on April 24, 2013


Not only that, but there's a fierce version of meningitis circulating on both coasts in the gay male populations. If you play around a lot, look for a vaccine. No matter WHERE you live.
posted by hippybear at 3:06 PM on April 24, 2013


it's relatively easy to create an effective vaccine, right?

Maybe not. This article cites problems with vaccines for other H7 flus (discussed here). They don't seem to produce particularly strong immune responses, though it obviously remains to be seen if this one has the same problems.
posted by BungaDunga at 3:52 PM on April 24, 2013


Today from Nature:
Mapping the H7N9 avian flu outbreaks
Where are the 104 human cases confirmed so far, and where might the virus go next?
The article has inline Google Earth plugins and downloadable .kmz files. Predictions are based on H5N1 transmission risk factors. [Butler, D. Nature News, 24 Apr 2013, doi:10.1038/nature.2013.12863]

Relatedly, also in this week's Nature:posted by Westringia F. at 3:53 PM on April 24, 2013


In Vancouver, having backyard chicken coops is becoming increasingly trendy, but it seems like a bad idea to raise poultry in a crowded urban environment.
posted by KokuRyu at 8:08 PM on April 24, 2013


Podcast from The Lancet re: H7N9.
posted by (Arsenio) Hall and (Warren) Oates at 6:45 AM on April 25, 2013


The SARS comparison is an apt one but not because SARS was actually well contained. SARS and its containment were a media sensation that caused insane damage to people and economies and may not have actually contained the virus.

I was living in Shijiazhuang during the height of SARS. My teacher was put in quarantine at the Shijiazhuang hospital. Unlike media representations communication was possible; she did not disappear. Shijiazhuang was not ringed by the Chinese military when it became the second biggest hot spot after Hong Kong. One of the funniest articles I ever read was describing the military cordon very specifically including an area literally outside my window at the time. They were not there.

During the last week of April and the first week of May I got sick and ran a fever for two weeks. To this day I don't know what I had, but at the time I was also victim to the hysteria, because I knew that if I went to the doctor with a fever I would be quarantined with confirmed SARS patients, so even if I didn't have it yet, I feared I soon would. So I stayed in my room. This was actually pretty easy to get away with because that is what most people in the country were doing, staying holed up in their rooms.

In the second week of May, (while I popped massive doses of aspirin to hopefully keep my temperature from rising again), I went to Beijing to get a visa for South Korea. Before leaving, I was told by the school and the local government, I would not be allowed to return to Shijiazhuang once I left. My future wife tearfully begged me to stay as I boarded a train car in which I was the only passenger (Thinking back on it, I think it was this painful parting that convinced me how much she meant to me and to eventually ask her to marry me). I stayed in Beijing for a little over a week. It was one of the most amazing weeks of my life. I went to the Forbidden City and saw no one. I climbed Jingshan and chatted with a nice grandmother about how this was the most amazing time ever. She mentioned that we few who dared the streets were getting to experience what life may have been like for emperors, no crowds and no one to tell us what to do.

After this amazing week I boarded a plane for Seoul. I was the only passenger in my part of the cabin. The service was amazing. In Seoul it was proudly being reported that there were no cases of SARS. I continued to gobble down aspirin. The government called my work daily to see if I had a fever. No one ever actually checked; they just asked me if I was feeling okay.

In fact from April to June, no one ever actually checked anything other than my temperature at the airport and McDonalds. I traveled internationally from one of the epidemic hot spots and through another. I had close contact with a person who was actually quarantined. None of these red lights actually stopped me, a potential carrier, from going anywhere or doing anything.

Unfortunately, not everyone was as lucky as me. My In-Laws newly opened restaurant had to be permanently closed due to the entire country shutting down for about four months. This was a common experience. I am still highly suspicious of the statistics quoted about the number of SARS cases and its severity. I am sure that there are many others that had experiences like mine and never actually got checked by a doctor. The largest visible cohorts of victims were health care workers and international travelers. I am guessing there is a pretty massive unreported group of people like me that got sick at this time but never got checked out.

From my very limited understanding this new disease appears to be more deadly and possibly more virulent than SARS. If that is the case, I don''t think that there is any real way to stop the spread and hysterical attempts to do so may cause more harm. Instead focus needs to be placed on quickly developing, producing, shipping and using immunization. If the hysteria gets too high before that happens I fear there will be many fools, like myself who will try to stay in their rooms rather than visit the doctors.
posted by wobumingbai at 7:49 AM on April 25, 2013 [3 favorites]


In the second week of May, (while I popped massive doses of aspirin to hopefully keep my temperature from rising again)

I know everyone makes choices in the moment that make sense to them - and that good choices made in the moment with full on-the-ground knowledge of the situation may not make sense to the uninformed - so please read the next paragraph in a sympathetic, friendly tone rather than a hostile one.

Did you ever worry that you might in fact have had SARS and might transmit it to people who would have worse cases than you? How did you handle the two weeks in your room without seeing anyone? Did you have enough food?

(I had a godawful respiratory thing in Shanghai at Chinese New Year in 1997 and was sick as a dog - almost too weak to get out of bed - for several days, pretty much alone in my wing of the foreign teacher building. And then I had to stagger forth because I was out of food and out of water that wasn't exceedingly metallic tasting and boiled to death in my teakettle. Of course, this was long before there was any concern with pandemic flu. I was plenty scared, though. And I was weak for about ten days after I had basically recovered - I still remember the glorious day when I could wobble along and take the bus downtown to get a nice set of The Story of the Stone at the Friendship Store (then almost the only source for a large quantity of English language books. Also, I went to both summer palaces in Beijing in the dead of winter and they were almost empty, and it was amazing.)
posted by Frowner at 10:16 AM on April 25, 2013


Flutrackers currently has 114 cases and 23 deaths. First case in east China's Jiangxi Province reported.
posted by spock at 1:51 PM on April 25, 2013


This morning's links:
H7N9 is still spreading in China. First confirmed case from the southern Fujian Province.

Study suggests #H7N9 mutates inside humans 2 make genetic shift, not in other mammal. Unprecedented as far as I know.

Wired magazine: How to read the news about H7N9

Now at 118 cases plus the one in Taiwan.
posted by spock at 7:29 AM on April 26, 2013 [1 favorite]


My fever and other symptoms were over by the time I left so I assumed I was ok. I am not a doctor but everything I ever heard about colds and flus was that they are transmitted before and during the onset of symptoms but not after. So at the time I wasn't really worried at all about my transmitting it to others. What I was worried about was quarantine. Although it sounds kind of silly, my fear of being placed in quarantine was so high that I was taking the aspirin as a preventative. I had already spent some time in the hospitals of that area and was terrified of them even without the threat of SARS. While the people working in the hospitals in the area I was in were professional and knowledgeable, their facilities lacked funds and had an over abundance of patients. The environment this created was one that a young spoiled American was not ready to face. Additionally, the infrared cameras were ubiquitous and a high enough fever to land you in quarantine with actual SARS patients, I was told, was only one degree above normal.

My room was a studio apartment, so food was not a problem; I had a fully stocked kitchen. Additionally, my school was in the industrial park suburb of Shijiazhuang. So if I really needed to I probably could have run to a little store that was struggling to keep open without a problem. To keep myself entertained during that time I watched a lot of DVDs and spent a lot of time on the internet.

I actually still wonder if I had SARS that winter rather than spring. I got a serious cold in November that lasted through early January. At that time SARS was not very widely talked about. I tried every medical option I could find including visiting the over-priced foreign hospital in Beijing, Chinese traditional medicine, IVs, etc... I tried so much because that cold actually caused me to develop permanent deafness and tinnitus in my left ear and a little tinnitus in my right ear. None of the professionals I saw ever figured out what was wrong with me even with ridiculous amounts of money spent on tests. The cold eventually went away but the ringing in my ears remains.
posted by wobumingbai at 7:36 AM on April 26, 2013


This comment is not to say "ZOMG pandemic," but I live in San Francisco, and a lot of people at work have what seems to be a cold or allergies. It has been interesting to watch whatever illness that is spread while reading these threads on H7N9. I'm not saying the two illnesses are the same; it seems incredibly unlikely. But I've been wondering whether a serious pandemic could spread while staying somewhat under the radar, so I've been reading with interest the reports that survey for asymptomatic carrieris. Those have been reassuring.
posted by salvia at 1:58 PM on April 26, 2013


This morning's headlines:
First case reported in China's central Hunan province. (Not yet shown on Flutrackers, so I believe that we are at 121 cases*)

*Flutrackers numbers includes the case in Taiwan and the asymptomatic child found in China earlier

The CDC has updated its directives on testing for H7N9. "Based on international research, the incubation time of the H7N9 avian influenza has been increased to 10 days from the previous seven days, a physician said"

New Yorker: How much should we fear H7N9?
posted by spock at 5:46 AM on April 27, 2013


Also from the New Yorker:

New Life for a Deadly Disease: The Threat of Drug-Resistant Tuberculosis
posted by homunculus at 1:38 PM on April 27, 2013


I wonder why H7N9 is spread so far geographically yet small number of cases overall. Is it normal epidemic distribution behavior?
posted by stbalbach at 3:04 PM on April 27, 2013


This article (in Chinese) mentions H7N9 deaths now at 24. It also mentions prosecutions with penalties of "legal detention" and fines levied against individuals for spreading rumors regarding H7N9 via the internet. http://news.xinhuanet.com/health/2013-04/28/c_124643041.htm
posted by spock at 7:24 PM on April 27, 2013


the hysteria over vaccines 15 years or so ago is responsible for a measles epidemic in some parts of England and Wales.

Measles cases in south Wales outbreak climb to 942: Figure for greater Swansea area rises by 56 as experts warn epidemic shows no sign of easing

Measles Epidemic in Wales Has Roots in Antivax Movement
posted by homunculus at 2:35 PM on April 28, 2013


Measles cases in south Wales outbreak climb to 942: Figure for greater Swansea area rises by 56 as experts warn epidemic shows no sign of easing

Measles Epidemic in Wales Has Roots in Antivax Movement


I did a post about this that got deleted (I have no problem with that), although another MeFite said that linking anti-vaxxers to the current Measles outbreak is too simplistic, although she didn't explain why.

From what I gather, fewer measles vaccinations means more cases of the disease. On top of that, some folks in Wales and England are using a "single shot" approach sold by private, lightly-regulated clinics, rather than the more time-consuming six-shot measles vaccine, and the single-shot approach, while allowing the virus to replicate, may also be helping strengthen the measles virus.

Now if I'm totally off-base about the usefulness of vaccinations, and if the anti-vaxxers have a point, I would love to be edumacated.
posted by KokuRyu at 4:33 PM on April 28, 2013


According to Flutrackers we are now at 127 cases. 24 deaths (according to multiple sources).

Two most worrying stories of the weekend: H7N9 approaches Hong Kong: "Concern has mounted in Hong Kong as neighboring Dongguan city in Guangdong started culling poultry after suspected H7N9 bird flu was detected in chicken for the first time."

Also concerning, the child of an earlier H7N9 case now has the disease: " In Shandong, experts confirmed an H7N9 bird flu case in the city of Zaozhuang on Sunday. The patient, a four-year-old boy surnamed Zhang, developed a fever on Saturday.

The boy is the son of Shandong's first confirmed H7N9 patient. But initial investigation found no evidence of human-to-human infection, according to a statement from the provincial public health department. "


Hunan province sets up "isolation wards" for H7N9 patients.

Here's what happens when you get H7N9
posted by spock at 6:52 PM on April 28, 2013


I missed this on Saturday: a 7 minute video interview with Professor Peiris, courtesy of the Wall Street Journal. Malik Peiris is the Chair Professor of Microbiology at The University of Hong Kong, a Virologist at the Queen Mary Hospital and the Scientific Director of the HKU-Pasteur Research Centre at Hong Kong. And if that weren’t enough, Peiris was also one of the genuine heroes of the SARS outbreak in 2003. He and his team were the first to identify the causative agent (coronavirus) behind that epidemic.
posted by spock at 7:09 PM on April 28, 2013


Hong Kong immigration and hospital officials are stepping up efforts to fend off the spread of H7N9 bird flu as 4.2 million mainland Chinese tourists descend on the city for the Labor Day holiday, which runs from April 27 to May 1.
posted by spock at 7:17 PM on April 28, 2013


H7N9 Carries Genes from Rare H9N2, H7N3, H4N9, H11N9 Bird Flu Viruses
“This finding implies that H7N9 viruses have partially acquired human receptor-binding specificity. All of the H7N9 human isolates examined contained a lysine residue at position 627 in the PB2 protein. It is well known that this lysine residue contributes to the replication and transmission of avian influenza viruses in mammalian hosts. It is likely that the acquisition of this lysine in H7N9 viruses during their replication in human hosts has significantly contributed to their virulence and lethality in humans.”
Also, an interesting read: Epidemiological and risk analysis of the H7N9 subtype influenza outbreak in China at its early stage
Possible enormous risk of the H7N9 influenza
outbreak


We think that the H7N9 influenza outbreak is of enormous
risk for the following reasons... (8 reasons follow)
Followed by:
5 Possible mild risk of the H7N9 influenza outbreak

We do not exclude completely the possibility that the H7N9 will disappear naturally, or maintain its low pathogenicity in birds and limited transmission ability in humans for a long period, without forceful scientific control measures. However, such a mild scenario of the outbreak evolution is of less possibility than the very or extremely severe scenario describe above.
posted by spock at 4:20 PM on April 29, 2013 [1 favorite]


The last link in the previous post is a MUST READ. (source: Chinese Science Bulletin). Here is a post written regarding it: also highly recommended reading. Finally, a Flutrackers thread discussing the aforementioned document.
posted by spock at 9:09 PM on April 29, 2013 [1 favorite]


I get a server error on that goo.gl link. Is there another link for it?
posted by kira at 9:29 AM on April 30, 2013 [1 favorite]


Why is China a hot zone for the deadliest strains of bird flu? H7N9 continues to spread — and experts warn it isn't the last outbreak we'll see out of China
posted by homunculus at 12:24 PM on April 30, 2013


I downloaded it and put a copy on a local server: Chinese Science Bulletin: Epidemiological and risk analysis of the H7N9 subtype influenza outbreak in China at its early stage
posted by spock at 4:04 PM on April 30, 2013 [1 favorite]


You may recall the three Taiwanese hospital workers who complained of respiratory problems after contact with Taiwan's first H7N9 patient. This is the first follow-up story I have found, and it says that all have tested "negative" for H7N9 (which is great news).
posted by spock at 7:53 PM on April 30, 2013


China reports another two deaths, bringing the total dead to 26. There have been 19 new cases in the last week, in mainland China. 129 total cases, including the one in Taiwan and the asymptomatic child in China.

While a lot of the questions still cannot be answered with much more than - "we don’t know yet" - the World Health Organization has updated their extensive H7N9 FAQ page.
posted by spock at 6:25 PM on May 1, 2013


Awaking this morning to the news of yet another death from H7N9 in China, making a total so far of 27.

Well worth reading:
"The risk analysis published in Chinese Science Bulletin is so far the most detailed we have, and I've commented on it here and here. The article drew criticism and speculation—criticism about its methods, and speculation about the political implications of its publication in China.

Rather than engage in further speculation, I emailed the corresponding author of the article, Professor Ji-Ming Chen, in Qingdao. I promptly received a long reply, which he has kindly given me permission to publish here. I have re-paragraphed for easier online reading, and corrected some minor English errors."

Full letter here:
http://crofsblogs.typepad.com/h5n1/2013/05/h7n9-from-the-authors-of-the-csb-risk-analysis.html
posted by spock at 6:00 AM on May 2, 2013 [2 favorites]


Nice infographic showing the which creatures are affected by the various flu viruses. http://www.informationisbeautiful.net/visualizations/which-flu-virus/
posted by spock at 8:52 AM on May 2, 2013


New Scientist: The risk of a flu pandemic is very real

Video: 44 minute archive of a live chat Q&A on H7N9

A Flutracker thread discussing the chat above and another discussing inaccuracies in media reporting of H7 Genetic Changes For Human Transmission in H7N9
posted by spock at 10:01 AM on May 2, 2013


Unrelated to H7N9, but possibly related to SARS: Al Jazeera reports that 5 have died of a SARS-like virus in Saudi Arabia.
"Known as novel coronavirus or hCoV-EMC, the virus was first detected in mid-2012 and is a cousin of Severe Acute Respiratory Syndrome (SARS)... The new virus is different from SARS, in that it causes rapid kidney failure.

The strain is shrouded in mystery, and the World Health Organisation does not yet know how it is transmitted or how widespread it is.

A 73-year-old Saudi man died in Germany in March from the lethal new virus.

He had been travelling in Pakistan and Saudi Arabia before falling ill, and was transferred to Munich from Abu Dhabi on March 19 "
posted by spock at 11:41 AM on May 2, 2013


State officials ran Arizona's first test for H7N9 last week on a sample from a sick Arizona resident with a travel history to the parts of China that have been reporting H7N9 influenza. The sample tested negative.
posted by spock at 9:43 AM on May 3, 2013


Al Jazeera reports that 5 have died of a SARS-like virus in Saudi Arabia.

New Diseases and National Transparency: Who Is Measuring Up?
posted by homunculus at 2:36 PM on May 3, 2013


Hi Spock. Thank you loads for your updates.
posted by rozaine at 9:06 PM on May 4, 2013 [1 favorite]


Five Samples from Shandong, Jiangxi, and Guangdong Test Positive for
H7N9
- -------------------------------------------------------------------------
The News Office of the Ministry of Agriculture announced on 5 May 2013
that the National Avian Influenza Reference Laboratory found that 3
environmental samples among 412 collected from Shandong tested
positive for H7N9 avian influenza. The samples were from Xingfu Road
Market in Shizhong District of Zaozhuang City, Shandong.

Jiangxi Animal Disease Control Center sent 4 samples for review by the
National Avian Influenza Reference Laboratory and 1 was found positive
for H7N9 avian influenza. The sample came from a chicken in a
commercial site in Xiangtang Town of Nanchang County in Nanchang City,
Jiangxi... source http://www.moa.gov.cn/zwllm/zwdt/201305/t20130505_3450918.htm

"The Guangdong Animal Disease Control Center sent one sample which was
confirmed positive for H7N9 avian influenza. It was from a chicken in
Dongcheng Sanniao Wholesale Market of Dongguan, Guangdong.
"The confirmation of LPAI A/H7N9 zoonotic virus in a chicken sampled
earlier in a wholesale market in Dongguan, Guangdong, adds this
southeastern province (map at http://tinyurl.com/czjs62a) to the 10
provinces/municipalities in China found, so far, infected by the
virus...
Guangdong becomes the first province in China where animals (i.e.,
birds), not humans, are the sentinels of the virus for humans and not
vice versa. This finding justifies earlier media publications in
neighbouring Hong Kong demanding intensification of the
sanitary-veterinary measures to prevent the introduction of the new
virus from the mainland. Guangdong is the main supplier of live
poultry to Hong Kong."
- Editor's note source ProMED mailing list
posted by spock at 7:59 PM on May 5, 2013


We are now up to 131 cases in mainland China (plus the one in Taiwan, making 132) and 31 deaths. - http://news.xinhuanet.com/english/china/2013-05/06/c_132363202.htm
posted by spock at 7:27 PM on May 6, 2013


US invokes emergency act to keep H7N9 flu at bay

Why we are sitting ducks for China's bird flu
posted by Strass at 5:11 PM on May 8, 2013


Al Jazeera reports that 5 have died of a SARS-like virus in Saudi Arabia.

France records first case of SARS-like virus
posted by homunculus at 7:52 PM on May 8, 2013


The virus, known as nCoV-EMC

How do you pronounce that?
posted by stbalbach at 10:29 PM on May 9, 2013


New Flu Bugs: Too Lethal For a Pandemic? (WSJ) - click-through from Google to bypass paywall.
posted by stbalbach at 9:44 PM on May 10, 2013


So it seems like the infection rate is slowing. Is China doing something right?
posted by Strass at 3:02 PM on May 11, 2013


How do you pronounce that?

Ghoti.
posted by heyho at 2:10 PM on May 12, 2013


Unknown if related to H7N9, the novel coronavirus, or some other new virus: Health officials have reported that an unidentified illness has taken the lives of two area high school students from Montgomery and Liberty counties (Houston, Texas, USA area.)

Officials said that all three shared similar symptoms. The three had pneumonia-like symptoms, fever, coughing and then went into seizures and respiratory failure.

http://blog.chron.com/healthzone/2013/05/two-dead-one-in-critical-condition-from-unknown-disease-in-houston-area/
posted by spock at 7:49 PM on May 12, 2013


>So it seems like the infection rate is slowing. Is China doing something right?

Closing the open poultry markets is generally seen as a good move, but the influenza season normally abates with warmer temperatures that come with Spring in the Northern Hemisphere. The virus is not gone, however, and could reemerge with the next flu season. Hopefully this will buy some time for vaccine research and production.
posted by spock at 7:58 PM on May 12, 2013


U.S. health officials say last year was the worst ever for West Nile virus deaths. The final tally reported Monday was 286 deaths — or two more than the record set in 2002.
posted by stbalbach at 8:43 PM on May 13, 2013


There is an increasing lack of consistency in the reporting of the
numbers of human cases of avian A/(H7N9) influenza virus infection in
China. The reported number of human cases varies from 130 to 135,
irrespective of the source and date of reporting, and may or may not
include the single case reported from Taiwan. The number of deaths is
more consistent and has reached 35.
posted by spock at 10:43 AM on May 15, 2013


Meanwhile, the novel coronavirus (nCoV) has now afflicted 40 (eastern Mediterranean & Saudi Arabia) and killed 20.
posted by spock at 10:47 AM on May 15, 2013


H7N9 bird flu found to spread through the air
Virus can also infect pigs, say HKU researchers, who warn officials to maintain tight scrutiny even though threat seems under control
posted by spock at 2:09 PM on May 23, 2013


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