In a report on the outbreak that began in China in February, doctors and researchers from from several public health agencies said they suspected that most of the 82 people with confirmed cases of bird flu contracted the H7N9 virus from healthy-looking animals.

“To date, the mortality rate is 21%, but since many of [sic] patients with confirmed H7N9 virus infection remain critically ill, we suspect that the mortality may increase,” they wrote in their study, published online Wednesday by the New England Journal of Medicine. “Since this H7N9 virus appears to have emerged recently to infect humans, population immunity is expected to be low, and persons of any age may be susceptible to infection.”

The report paints a fuller picture of the outbreak, which hascaused Chinese people to become so panicked that one motorist felt the need to flag down police after a bird dropping landed on her car.

Pulitzer Prize-winning journalist Laurie Garrett, who covered the SARS epidemic in Hong Kong and mainland China ten years ago, traces the origin and uncertain path of the H7N9 virus and asks whether the Chinese government has changed its approach to its latest health scare:

People’s Liberation Army Col. Dai Xu insisted via Weibo and on China’s CCTV that the fearfulness felt by the Chinese in the face of H7N9 flu is part of an elaborate American conspiracy — one first executed in the creation of SARS: “The national leadership should not pay too much attention to it,” he wrote. “Or else, it’ll be like in 2003 with SARS! At that time, America was fighting in Iraq and feared that China would take advantage of the opportunity to take other actions. This is why they used bio-psychological weapons against China. All of China fell into turmoil and that was exactly what the US wanted. Now, the US is using the same old trick. China should have learned its lesson and should calmly deal with the problem. Only a few will die, but that’s not even a one-thousandth of those who die in car crashes in China.”

Famous for his nationalistic comments, Xu reportedly gained 30,000 Weibo followers in the 24 hours following this comment. He also drew criticism, to which Xu responded that his detractors were working with “American devils,” adding, “It is common knowledge that a group of people in China have been injected with mental toxin by the U.S. I will not retreat even half a step.”

Just as the virus stands at the fork of a bifurcated road, so does the Chinese Communist Party. Though hardliners within the party may share Xu’s extremist views, the leadership this week took a remarkable step down a different, enlightened path, sending H7N9 test kits and viral samples to Taiwan. If China hopes to avoid the shame it experienced after covering up the SARS epidemic a decade ago, the government and the party will take the high road — that’s the one that shares samples with Taiwan and timely information transparently with the entire world.

Chinese government has acted with more transparency than it did ten years ago, claims The Washington Post’s Max Fisher, but the disease is spreading. He details “three very bad signs” about the new avian flu:

1. It’s very deadly, with 18 percent mortality so far. For comparison, tuberculosis has a mortality rate of about 4 or 5 percent in China. Still, the avian flu virus that had its first outbreaks in China in 2006, known as H5N1, has a mortality rate of 60 percent and has killed hundreds of people on multiple continents. It’s way too early to tell H7N9′s mortality rate, given that many infected patients have not yet fully recovered, but it’s so far killed about 18 percent of patients.

2. “This is definitely one of the most lethal influenza viruses that we have seen so far.” That’s according to Keiji Fukuda, the World Health Organization’s assistant director general for health, security and the environment, who added, “This is an unusually dangerous virus for humans.” Fukuda said the WHO is still struggling to understand the disease, but he certainly seems to be sounding the alarm.

3. More easily transmitted than the 2006 avian flu outbreak. That’s also according to the WHO’s Fukuda, who says this new strain is more easily contracted than the H5N1 virus.

© Scott Greene for China Digital Times (CDT), 2013. | Permalink | No comment | Add to del.icio.us
Post tags: bird flu, H7N9, public health, SARS, transparency, world health organization
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The child is being treated at the Beijing Ditan Hospital, and is in stable condition, Zhong Dongbo, deputy director of the Beijing Municipal Health Bureau, said in a press briefing.

The girl developed flu symptoms, including fever, cough, sore throat and headache, Thursday morning. She was brought to the Beijing Ditan Hospital to seek medical treatment around noon and was then hospitalized for lung infection.

[…] Two people who have had close contact with the child have not shown any flu symptoms, a spokesman said. He added that the girl’s parents were engaged in live poultry trading in a township of Shunyi District in Beijing’s northeastern suburbs.

11 have now died from the disease, which causes “severe pneumonia, septic shock and other complications that damaged the brain, kidney and other organs”, but a four year old boy in Shanghai made the first recognized recovery on Wednesday. Tests suggest possible resistance to drugs such as Tamiflu and Relenza, at least in some cases, but much remains unclear. “Few in the flu world would place strong bets on what the history books will say about this outbreak,” according to Helen Branswell at The Canadian Press:

To date it doesn’t appear as if the virus is spreading person to person, which is perhaps the best feature of this virus. But two weeks after China announced it had found people infected with a new flu, concern among those in the influenza research world remains high.

“I think we are genuinely in new territory here in which the situation of having something that is low path in birds (yet) appears to be so pathogenic in people,” Dr. Keiji Fukuda, the WHO’s assistant director-general for health security and environment, said in an interview.

“And then to have those genetic changes … I simply don’t know what that combination is going to lead to.”

[…] “Almost everything you can imagine is possible. And then what’s likely to happen are the things which you can’t imagine,” Fukuda, who spent years as an influenza epidemiologist at the U.S. Centers for Disease Control before joining the WHO, said of the virus he has studied for so long.

Chinese authorities’ openness compared with the SARS outbreak ten years ago has continued to attract praise, as Gillian Wong reported at The Associated Press:

The new openness is thanks in part to people like Li Tiantian, founder of Dingxiangyuan, an online medical network popular with Chinese health care workers. His microblog is among a number of sites that have been tracking the government’s response to the new bird flu. “It’s evident that the strength of social media can pressure the government to be more open, more transparent,” he said from his base in the eastern city of Hangzhou.

[…] Health experts have given kudos to Beijing for being forthcoming with information, sharing the H7N9 virus’ gene sequencing and samples with the World Health Organization’s global research centers and providing timely updates of new infections and deaths. During the SARS outbreak in 2003, some patients were taken out of hospitals in Beijing and driven around the city to keep them out of sight as a visiting team of WHO investigators toured health facilities.

“I think all of us have been very impressed with the Chinese response,” said Michael Osterholm, a University of Minnesota infectious-disease expert. “You gotta give credit where credit’s due.”

While the flow of official news has greatly improved, however, authorities have taken steps to control competing information. A Central Propaganda Department directive dated April 10th instructed domestic media:

Regarding the epidemic situation in Shanghai, give first place to Xinhua wire copy and information issued by authoritative departments. Avoid confusion of information. Report discreetly on related issues, and do not sensationalize them.

Xinhua reported on Thursday that 11 people had been detained in Guizhou, Zhejiang, Shaanxi, Gansu and Liaoning provinces “for fabricating online posts about H7N9 infections that caused panic among some netizens and local residents.” According to Caijing, the detainees numbered at least 13 but possibly “dozens”. One is said to have “confessed that the posts were all made up in order to boost his popularity on the Internet.” Southern Metropolis Daily reported that a tight lid had been kept on early cases in Shanghai until the presence of the new strain was eventually acknowledged some three weeks later. Relatives of the second victim have previously complained about being kept in the dark, saying that they did not learn his true cause of death until seeing it on TV news. From The Economist:

So far the government’s response has appeared far swifter and more open than it was in 2003. Mr O’Leary said the WHO was “very satisfied and pleased with the level of information shared” by China. After the first two deaths were reported on March 31st (both of them in Shanghai), the authorities looked for the virus among live poultry sold in the city’s markets. When they found it, they were quick to close the markets and cull thousands of birds. […]

The public’s response, however, suggests the government still has some way to go before ordinary people trust it to respond effectively. Even though no cases of the virus’s transmission between humans have been reported, many people in Shanghai and the affected regions nearby are jittery. Pharmacies have been emptied of their stocks of a traditional flu medicine called ban lan gen, despite its dubious worth in dealing with H7N9. Sales of chicken in all forms have plummeted. McDonald’s in Shanghai has responded by cutting the price of its Chicken McNuggets.

[…] Even in the official media, questions have been asked about why 27 days elapsed between the first death from H7N9 and its public announcement. The authorities say it took that long to confirm the cause, because the virus had never before been identified in humans. They have not explained, however, why on March 7th, three days after the first death, health officials in Shanghai denied rumours in social media that people had died of bird flu in a local hospital. One man was later proved to have died there of bird flu, along with one of his sons who was not found to have the virus. Despite official denials, suspicions remain that this could have been human-to-human transmission.

Global Times quoted a Shanghai health official’s own account of the delay, while at The New York Times, Keith Bradsher explained possible technical reasons for it. Meanwhile the World Health Organization has also come under fire over the timeliness of its Chinese-language reports. From Xie Wenting at Global Times:

Beijing resident Wang Weikang said that it is irresponsible that the WHO does not publish its flu report in Chinese in a more timely way.

“It [H7N9] is related to people’s lives. For instance, the flu influences our decisions about whether we can travel to Shanghai. How come they don’t update on time?” said Wang.

Beijing resident Su Ya said that WHO’s slow update is because they do not pay enough attention to Chinese readers.

“Chinese is one of the official languages of the UN. It should be given equal importance as English,” Su said.

[…] “We, the WHO, can only post cases and deaths based on the official notification from the Chinese International Health Regulations Focal Point. Therefore, inevitably, the counts in the media will be ahead of the official counts we post,” the WHO said via e-mail.

With many already put off their pork by the 12,000-plus dead pigs in the Huangpu river last month, Nicola Davison reported at The Guardian that poultry is now also regarded with unsurprising suspicion:

The price of vegetables at Yanqing market have spiked accordingly. Chen says she will pay these premium prices rather than buy meat. “We’re also avoiding pork,” she said, adding: “Actually my family and I don’t dare to eat anything these days.”

In a teahouse in Ninghai, a county in Zhejiang province 180 miles from Shanghai, Tu Youjin counts himself as a victim of H7N9. Tu’s company, Ningbo Zhenning Poultry Breeding Limited, is a co-operative working with 150 farms in the region. It supplies Shanghai and other cities with 4m chickens a year. (Shanghai consumes 130m birds annually, mostly imported from Jiangsu, Anhui and Zhejiang, provinces where H7N9 has been found in people.)

Local officials have found no trace of flu among his fowl, but sales have dropped off a cliff. Normally, the farm sells 10,000 chickens a day, but now they are selling fewer than a dozen, he said.

“We can’t even sell our eggs,” said Tu. “I’m under great pressure as my company makes up the farmers’ losses, most of them are elderly peasants. The government has shown concern but we haven’t had any compensation so far.”

Some airlines, international schools and hotels have taken poultry off menus, and KFC’s parent company Yum has been hit hard, just months after CCTV exposed it for selling tainted chicken. Authorities in Shanghai are reportedly considering a permanent ban on the sale of live poultry, while Nanjing has ordered a cull of domestically kept poultry, bans on live poultry trading and feeding birds in public, and a suspension of “all kinds of bird performances”. Hong Kong has begun testing of live poultry imports from the mainland, which have dropped by almost half in the past week, promising to stop the trade and possibly cull if the virus is identified. The effectiveness of such measures has been called into question, however. From Hu Qingyun at Global Times:

Zeng Guang, chief epidemiologist at the Chinese Center for Disease Control and Prevention, told the Global Times that it was still not certain that shutting down poultry businesses would be effective.

“There is still no solid research data showing that the ban of the live poultry trade has slowed the spread of the virus, though it might to some extent help contain cross-infection between poultry in some infected areas,” Zeng said.

[…] “Banning the trade and culling birds is only an expedient. Research into vaccines and effective medication are critical,” Zeng said.

But the likely effectiveness of vaccines—which in any case are months away—is also in doubt. From Helen Branswell at The Canadian Press:

There hasn’t been enough time to produce even the seed strain to make H7N9 vaccine, let alone small batches of a prototype vaccine for testing. So researchers haven’t had a chance to see how a vaccine against this new flu strain might work in people.

But clinical trials of vaccines made to protect against other viruses in the H7 family have shown the vaccines don’t induce much of an immune response, even when people are given what would be considered very large doses.

“In all cases where these vaccines were trialed, it was found that the vaccines were poorly immunogenic,” said Nancy Cox, the virologist who heads the influenza branch at the U.S. Centers for Diseases Control in Atlanta.

[…] “If you add all those [questions] together, it doesn’t paint a really very optimistic picture about influenza vaccine being a really significant weapon against this, should a pandemic emerge quickly,” [Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota] said.

Beyond food and farming, businesses have met varying fortunes. Indonesian importers of badminton equipment may suffer, but speculation that the outbreak has depressed house sales in Shanghai is said to be ill-founded. Face masks and hand sanitizer are naturally selling well, and there have been promising signs for Malaysian rubber glove manufacturers, while shares in car manufacturers climbed based on an anticipated exodus from public transport. Despite skepticism about proclaimed benefits, vendors of traditional Chinese remedies have also enjoyed a windfall.

As with other public health hazards, many have greeted the outbreak with dark humor. Dexter Roberts compiled a handful of jokes at Businessweek, including one referring to Shanghai’s recently pork-infused water and Beijing’s famously bad air:

The two best ways to safeguard against bird flu: 1) drink a lot of water; 2) keep the air flowing. People living in Shanghai, please ignore No. 1. People living in Beijing, please ignore No. 2.

© Samuel Wade for China Digital Times (CDT), 2013. | Permalink | No comment | Add to del.icio.us
Post tags: Beijing, bird flu, food safety, H7N9, Huangpu pigs 2013, meat, Ministry of Agriculture, Nanjing, public health, rumors, SARS, Shanghai, transparency, vaccines, world health organization
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• Masanjia Women’s Labor Re-education Camp (马三家女子劳教所): An investigative report on the camp, which exposes torture of inmates, appears in the April issue of the mainland magazine Lens. According to a leaked propaganda directive translated by CDT, the media are under instruction not to report on the article.

• SARS ten years ago+bird flu ten years later (十年前非典+十年后禽流感): The beginning of a short piece circulating online comparing the official response to SARS in 2003 and the H7N9 bird flu now, translated below:

SARS ten years ago, bird flu ten years later. The Pearl River Delta ten years ago, the Yangtze River Delta ten years later. Delayed action ten years ago, delayed action ten years later. False reports ten years ago, false reports ten years later. Banlangen ten years ago, banlangen ten years later. Experts blathering ten years ago, experts blathering yet again ten years later. We saw all of this ten years ago. Nothing has changed, nothing at all has changed. We have come full circle and ended were we began. We donkeys are so stupid it’s tragic. Only the virus has made a change.

十年前非典，十年后禽流感。十年前珠三角，十年后长三角。十年前拖延，十年后仍然拖延。十年前瞒报，十年后继续瞒报。十年前板蓝根，十年后还是板蓝根。十年前专家胡扯，十年后专家又在胡扯。十年一切照旧，没有改变，没有任何改变。转了一圈，回到原点，我们象驴，笨到哀伤，只有病毒在用心改变。

Alternate Renderings of “Chairman” (主席 zhǔxí):

• bamboo mat (竹席 zhúxí)
• pig Xi (猪习 zhū Xí): The second character is Xi Jinping’s surname.
• pig mat (猪席 zhū xí)
• lord Xi (主习 zhǔ Xí)
• zhu mat (zhu席 zhu xí)

All Chinese-language words are tested using simplified characters. The same terms in traditional characters occasionally return different results.

Browse all of CDT’s collected sensitive words in this bilingual Google spreadsheet.

CDT Chinese runs a project that crowd-sources filtered keywords on Sina Weibo search. CDT independently tests the keywords before posting them, but some searches later become accessible again. We welcome readers to contribute to this project so that we can include the most up-to-date information. To add words, check out the form at the bottom of CDT Chinese’s latest sensitive words post.

© Anne.Henochowicz for China Digital Times (CDT), 2013. | Permalink | 2 comments | Add to del.icio.us
Post tags: bird flu, censorship, H7N9, Internet censorship, Masanjia, Ministry of Truth, SARS, Sensitive Words Series, weibo, Xi Jinping
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China now has confirmed 16 cases of H7N9 nationwide, with patients ranging in age from 4 to 87, who became ill between Feb. 19 and March 31. The number of cases, while small, is large for the early stages of an outbreak, and some flu experts said the fact that they are spread over a relatively wide geographic area is reason for concern.

Among the people found to be infected, several are believed to have been in close contact with birds, including a 48-year-old who transported poultry, a 45-year-old poultry butcher and a 38-year-old chef.

Authorities stressed they have yet to find a case of human-to-human transmission, which would make the disease more dangerous; the cases they have seen appear to come from human contact with birds.

[…] Shanghai authorities moved Friday to destroy thousands of birds, ordering the closure of wholesale poultry markets and instructing vendors in smaller markets to immediately cull their chicken populations. Authorities had banned sales of live pigeon and ducks starting the morning after discovering H7N9 in samples taken from pigeons at three wholesale markets.

Hangzhou has also suspended live poultry trading and begun culling at one market after the city’s second case was traced to quails that had been bought there. Officials in Shanghai promised that vendors would receive compensation of at least half the market price for any birds destroyed, which Bloomberg World View contributor Adam Minter pointed out was likely to send some looking for better prices elsewhere, potentially encouraging the virus’ spread.

The Council on Foreign Relations’ Laurie Garrett, who has been tweeting frequent updates on the outbreak, told PRI’s The World that “this has all the hallmarks of potentially turning into a new and quite striking pandemic …. That doesn’t mean it will, it doesn’t mean it won’t, it just says that all the pieces are falling into the kind of worrisome places that we keep an eye on at this stage of an outbreak.” She expressed caution about official assurances that there has been no human-to-human transmission, and that no link exists with the thousands of floating pig carcasses that descended on Shanghai last month.

Vietnam, where food safety has already become a focal point for anti-Chinese sentiment, and Hong Kong, where a seven-year-old girl who visited Shanghai late last month has tested negative for the disease, have both temporarily banned imports of Chinese poultry. In Hong Kong, random temperature checks are being conducted at immigration points, while warning notices have appeared at Japanese airports. Taiwan has stepped up sanitization of poultry farms and monitoring of air travelers. Cross-strait passenger numbers are higher than usual because of the Qingming festival, but airline stocks have slumped amid worries that the outbreak will start to discourage people from flying.

China has won widespread praise, tinged with relief, for its apparent transparency over the outbreak, though questions still hang over the initial delay in reporting it. A World Health Organization spokesman described the government’s response as “excellent”, and the swift posting online of the new strain’s genetic sequence has assisted worldwide research into its characteristics and a possible vaccine (see below). But while there is a stark contrast with the shroud of official secrecy over the SARS outbreak ten years ago, participants in a ChinaFile conversation on the government’s handling of the situation pointed out that celebration may be premature. George Washington University law professor Donald Clarke, for instance, argued that “the problem is not just whether the government is sincerely interested in transparency. It’s whether it has the credibility that’s needed to make certain policies effective.”

The outbreak’s absence from Friday’s flagship Xinwen Lianbo broadcast on CCTV has not helped the credibility situation. Neither have accusations of a cover-up from the family of the second victim, or the fact that news of Nanjing’s first case came not through official channels but from Sina Weibo. Another dent came from some provincial authorities’ recommendations for avoiding the disease. From Stephen Chen and Lo Wei at South China Morning Post:

Gansu’s health commission, for instance, encouraged residents to go outdoors, preferably into wooded areas, for fresh air and sunshine. Listening to music was also deemed an effective way to keep the H7N9 virus at bay.

Massaging the side of one’s nose was also said to help, as was exposing parts of one’s legs and stomach to incense once a day.

Health authorities in the eastern province of Jiangsu suggested a long list of herbal drinks, including the popular ban lan gen, a type of root that is often taken to fight the flu and was prescribed during the Sars outbreak a decade ago.

Dr Fang Shimin, biologist and a popular science writer […] reminded people that Gansu health authorities have promoted the eating of pig’s feet as an effective treatment for various diseases, including Aids and cancer.

“The traditional Chinese medicine industry is trying to cash in,” he wrote.

The ban lan gen recommendation in particular has sparked ridicule, as well as nostalgia and some apparent panic-buying. From Offbeat China:

Not all are buying the official promotion of TCM and ban lan gen. Many Chinese netizens joked: “After 10 years, we have a new president. Yet when it comes to flu, we still have the same old ban lan gen, the miracle medicine.”

[…] Even Peopl’s Daily, the mouthpiece of the Chinese government, also stood out to calm down the ban lan gen frenzy. In an inforgraphic that laid out what ban lan gen can and cannot do in detail, the newspaper said: “Ban lan gen has nothing more than a placebo effect.”

Jokes and criticism, however, don’t mean people won’t buy ban lan gan. There are already news about ban lan gen being sold out in some pharmacies in Shanghai and Beijing. In a Weibo poll (China’s Twitter), netizens were asked whether they will consider buying ban lan gen in the face of H7N9 flu. The result was half and half. Among the 5000-something netizens who weighed in, about 49% said yes, they would buy just in case. About 44% said no, because they don’t buy the hype.

Photographs of dead birds apparently fallen from the sky have done little to soothe the online mood:

A lot of dead birds found in Nanjing and Chengdu. “@wenyunchao: 南京 @猫xiao囧：建邺区茶南小区拓园东小区，成都 @cdtv刘燕: 府南河twitter.com/wenyunchao/sta…”

— Yaxue Cao (@YaxueCao) April 5, 2013

The birds have reportedly tested negative for the flu virus, however.

Meanwhile, investigation of the new viral strain has continued around the world. From Simeon Bennett at Bloomberg:

The H7N9 strain, which is a new virus formed as a result of two others merging their genetic material, has features of viruses that are known to jump easily from birds to mammals, and a mutation that may help it attach to cells in the respiratory tract, said Ron Fouchier, a professor of molecular virology at Erasmus Medical Center in the Netherlands, in a telephone interview yesterday.

“That’s certainly not good news,” said Fouchier, who reviewed a gene sequencing of H7N9 published by Chinese health authorities. “This virus really doesn’t look like a bird virus anymore; it looks like a mammalian virus.”

[…] Fouchier authored a study last year that showed five genetic tweaks to the deadly H5N1 virus, which has killed more than 600 people since 2003, made it airborne in ferrets, the mammals whose response to flu most closely resembles that of humans.

[…] “This virus is certainly of more concern than the vast majority of bird flu viruses,” Fouchier said. “Most bird flu viruses that we know do not have these mutations.”

The outbreak poses the difficult question of whether to divert attention and resources towards the development of a vaccine, which would not reach mass availability for several months. From Ben Hirschler and Kate Kelland at Reuters:

“It is an incredibly difficult decision because once you make it you have to change from making seasonal flu vaccines and go to making a vaccine for this virus,” said Jeremy Farrar, a leading expert on infectious diseases and director of Oxford University’s research unit in Vietnam.

That could mean shortages of vaccine against the normal seasonal flu which, while not serious for most people, still costs thousands of lives.

[…] There is no evidence yet of person-to-person transmission of H7N9 flu, and scientists do not yet know how what the strain’s potential is to develop into a human pandemic. Wendy Barclay, a flu virologist at Imperial College London, said one major argument against moving too soon would be financial.

“There is a possibility now that flu researchers will all rush to work on H7N9 and grants will be awarded for intensive research to develop vaccines … and that could be pouring money down a drain because it could be that the barriers for this virus are high enough that we don’t need to worry about it.”

Nevertheless, the U.S. Center for Disease Control has begun preliminary work as a precaution. From Donald G. McNeil Jr. and Andrew Jacobs at The New York Times:

It will take at least a month to create the seed vaccine, even though the agency is speeding the process by building it from synthetic DNA rather than waiting for a virus sample to arrive from China, said Michael Shaw, associate laboratory director for the C.D.C.’s influenza division.

Because China has posted the genetic sequences of the virus on public databanks, it is possible to build the genes for the virus’s outer spikes in a laboratory and attach them to a viral “backbone” that has already been proven to grow well in labs and in the sterile chicken eggs in which flu vaccines are made.

Then the seed vaccine must be tested in ferrets. They will be vaccinated and given some time to grow antibodies, then a solution of the H7N9 flu will be squirted into their noses. Doctors will then have to wait a few days to see if they get sick.

“If everything works smoothly the first time, we could theoretically have it ready to send to manufacturers within four weeks,” Dr. Shaw said. “But some things, like ferrets, you can’t speed up.”

© Samuel Wade for China Digital Times (CDT), 2013. | Permalink | No comment | Add to del.icio.us
Post tags: agriculture, bird flu, diseases, H7N9, Hangzhou, Nanjing, public health, SARS, Shanghai, traditional medicine, transparency, vaccines
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With the two new cases in Hangzhou, the total number of identified H7N9 infections now stands at nine in China [now ten; see above]. The other two deaths occurred in Shanghai in early March. Authorities have yet to find any connection between the cases and say there is so far no evidence of human-to-human transmission.

[…] The H7N9 virus, previously known only to infect birds, appears to have mutated so that it can more easily jump to animals like pigs, meaning the range of potential hosts has expanded, the Associated Press reported Wednesday, citing a World Health Organization scientist studying the virus’s genetic makeup.

In marked contrast with their opaque handling of the SARS crisis 10 years ago, China authorities have produced a steady stream of information and updates on the virus since the first human cases were revealed on Sunday. That publicity effort, combined with a relatively rapid mobilization of disease-prevention resources, suggests the country has learned its lesson about handling such outbreaks, experts say.

Global Times agreed:

The public health crisis of a decade ago became a turning point in many aspects, such as China’s disease control and government information disclosure mechanism. China has learned a lesson from the great losses it suffered from that crisis.

It would have been unbelievable 10 years ago for the government to take the initiative to publish the facts about the epidemic. The government tried to hide the true extent of the SARS outbreak until the situation could not have been worse.

[…] But reforms on governmental information disclosure are far from complete. In the past decade, China suffered from various losses due to a lack of transparency of information and witnessed many crises.

[…] The past model in which reforms are undertaken from top to bottom has come to an end. China’s future reforms need efforts from all walks of life. Looking back, we can see the government came under public scrutiny for being opaque. The public’s criticism of the government has pushed a transparent system forward.

But grounds for caution remain. A case in Nanjing, for example, came to light not through official channels but through a Sina Weibo post by a hospital worker, while the family of 27-year-old Shanghai pork butcher Wu Liangliang did not learn the true cause of his death until they saw the news on TV three weeks later. The Council on Foreign Relations’ Yanzhong Huang expressed dissatisfaction with official explanations for the delayed news:

Compared to its response in the initial stage of SARS outbreak, China appears to have done a better job so far of handling the new H7N9 virus. The newly formed National Health and Family Planning Commission—the successor of China’s Ministry of Health—shared information about the disease with the WHO, Taiwan, Hong Kong, as well as “related countries.” The health authorities in China have also tracked and are monitoring 88 people who came into close contact with the three cases.

But questions have also been raised about the government’s effectiveness in handling the novel virus. The two fatal cases both occurred when China’s parliament convened to elect the fifth-generation leadership. The two victims died on March 4 and March 10, respectively, but the government did not publicize the disease until March 31. Some have questioned whether the government deliberately covered up or delayed reporting the disease. However, the government explained that H7N9 was not a reportable disease under the Law on the Prevention and Control of Infectious Diseases, and it needed time to confirm the virus. But even accepting the government explanation, one still wonders why it took the government more than three weeks to confirm the virus. This is troubling because maybe ten years after SARS, China still has not built adequate laboratory and epidemiological capacities, which is crucial to detect, assess, notify, and respond to public health emergencies of international concern.

While there is no reported evidence of human-to-human transmission, and while state media report no sign of it in poultry, scientists examining the virus have warned that it could potentially build up stealthily among farm bird populations. From Declan Butler at Nature:

Emerging preliminary analyses of the genome of the virus point to the possible spectre of a pathogen that might spread silently in poultry without causing serious disease. That would make the virus difficult to monitor, with animal reservoirs of the virus likely going undetected. Should the virus become established in birds or other animals, regular human infections might then occur — providing opportunities for the virus to adapt better to humans, and ultimately to spread between them, potentially sparking a pandemic.

Scientists stress that it is much too early to do a full risk assessment of the potential pandemic threat. But the initial analysis of viral sequences is “worrisome” because they show several features that are suggestive of adaptation to humans, says Masato Tashiro, a virologist at the Influenza Virus Research Center in Tokyo, the World Health Organization (WHO) influenza reference and research centre in Japan.

The epidemiological picture is troubling too, says Malik Peiris, a flu virologist at the University of Hong Kong. “Any time an animal influenza virus crosses to humans it is a cause for concern, and with three severe cases [of disease] over a short period of time, we certainly have to take it seriously,” he says. “There’s no obvious indication of human-to-human spread, so we should not overreact, but neither should we be complacent.”

South China Morning Post offers a table comparing the new H7N9 with various other viruses, while Foreign Policy has posted a timeline of its emergence.

While the number of cases remains low, many suggested precautions are circulating for those fearing exposure. In a widely-weibo‘ed letter to his employees, an e-commerce executive prescribed a diet of vegetables and fish, among other measures. As part of a general Q&A on the virus, the World Health Organization recommended some basic hand, respiratory and food hygiene precautions, while at Businessweek, Christina Larson cited advice from the Council on Foreign Relations’ senior fellow for global health, Laurie Garrett:

“Stop shaking hands, and wear gloves in crowded public places like subways or stairs. Wash hands before touching your face, and try to avoid unconsciously touching your nose, mouth or eyes unless your hands are clean …. There is no drug to take that keeps you from getting infected—anybody trying to sell you one is a thief.”

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Post tags: bird flu, diseases, public health, qingming, SARS, transparency, world health organization
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“Wash your hands, and cover your nose and mouth when coughing or sneezing,” was the advice published in the Oriental Morning Post, Shanghai’s most popular newspaper (and repeated in others). “And avoid eating or contact with dead and diseased livestock.”

That last directive might be a little tricky to fulfill. Since early March, Shanghai’s waterways have been clogged by dead pigs — officially at least 11,000 of them but likely a lot more. Many of those pigs have found their way into tributaries that feed directly into the municipal water supply. […]

For Shanghai, a town whose cuisine is largely built on pork, this news would be unsettling under any circumstance. But in light of a bird flu that even Communist Party newspapers are implying could be caused by contact with dead and diseased livestock, it’s reason for panic. And, sure enough, Chinese social media were quickly filled with speculation on whether the month-long dead pork tide had played any role in this emerging strain of flu. Adding to the sense of unease was the late- arriving information that the younger of Shanghai’s two bird flu victims was a 27-year-old pork trader.

Xinhua reports, however, that no bird flu was found in 34 samples from the river pigs (via a Foreign Policy photo gallery on ‘China’s Love Affair With Pork‘). The timing of the flu deaths also points away from a direct link. While the plague of pigs began to appear about a week into March, the two men are both reported to have contracted the disease in late February. One died on February 27th; the other, on March 4th. As Human Rights Watch’s Phelim Kine pointed out on Twitter, the delayed news of the fatalities raises its own questions about what lessons the authorities learned from the SARS outbreak whose tenth anniversary has just passed.

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Authorities have been pulling out the swollen and rotting pigs, some with their internal organs visible, since Friday — and revolting images of the carcasses in news reports and online blogs have raised public ire against local officials.

“Well, since there supposedly is no problem in drinking this water, please forward this message, if you agree, to ask Shanghai’s party secretary, mayor and water authority leaders if they will be the first ones to drink this meat soup?” lawyer Gan Yuanchun said on his verified microblog.

[…] “Ever since the police have stepped up efforts to crack down on the illicit market of sick pigs since last year, no one has come here to buy dead pigs, and the problem of pig dumping is worse than ever this year,” an unnamed villager told the Jiaxing Daily newspaper, which is run by the local Communist Party.

In Shanghai itself, farmers are compensated for proper disposal of carcasses, but no such incentives are in place upstream. In any case, Reuters’ Jane Lanhee Lee reported, at least some of the official disposal points around Jiaxing are already full:

Click here to view the embedded video.

At Bloomberg’s World View, Adam Minter examined the timing of the spectacle, which coincided with the 10th anniversary of the 2003 SARS outbreak:

Over the past several weeks, Chinese news outlets have been running features looking back on the mistakes made, lessons learned and steps taken during SARS outbreak. They call for increased monitoring, unspecified mechanisms for notifying the public and relevant public-health institutions, and greater transparency. Needless to say, whether it was the fault of farmers or public-health officials, none of those standards were met in the run-up to the dead-pig tide.

To be sure, this isn’t SARS, but for a global-health community dependent upon Chinese transparency in the event of another epidemic, official Chinese reticence, if not ignorance, about whatever and whoever led to thousands of virus-laden pig carcasses in Shanghai’s water supply is deeply worrying.

Following recent high-profile spills of industrial chemicals into China’s rivers, the plague of pigs highlights agricultural water pollution, whose scale actually exceeds that of industrial and other pollutants. From Lily Kuo at Quartz:

In fact, waste related to animals made up about 90 percent of organic pollutants in China’s water, according to Wang Dong of the Chinese Academy for Environmental Planning. In a 2012 study from Huazhong University, waste from pigs, cattle, sheep, and other animals left 228,900 tonnes (252.6 tons) of biochemical oxygen demand, a standard measure for organic pollution, in part of the Han River in central China. Now, about 15 percent of China’s major rivers are too polluted for safe use, not just from local factories, but farmers who throw animal carcasses and waste into nearby streams.

[…] And the health consequences of this trend can be severe. For example, in 2011, a farm was found throwing duck excrement into a river in Henan province, giving thousands of people diarrhea.

See photos of the porcine tide at Global Times, and of the clean-up operation at The Telegraph.

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Post tags: agriculture, Huangpu pigs 2013, Jiaxing, pig disease, pig farming, river pollution, SARS, Shanghai, water pollution, Zhejiang
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The poor air quality, according to a leading Chinese public health expert, is worse than SARS because nobody can escape it. Research suggests that air pollution can “raise the risk of cardio-respiratory death by 2 to 3 percent for every increase of 10 micrograms per cubic meter of pollutants.” Only 1 percent of China’s 560 million urban residents breathe air considered safe by the European Union, according to a 2007 World Bank study. A report released by China’s Ministry of Environmental Protection in November 2010 showed that “about a third of 113 cities failed to meet national air standards.” The 2012 Cancer Registry Annual Report revealed that lung cancer is top among all types of cancer in terms of the number of cases and deaths in China. Indeed, the number of lung cancer-caused mortality in China has increased by 465 percent in the past three decades. In Beijing, the number of lung cancer patients has increased by 60 percent in the last ten years. The rising incidence rate of lung cancer coincides with drastic reduction in the incidence rates of stomach cancer and cervical cancer, which is thought to be a result of improvements in public health standards.

For years, public health experts considered smoking the leading risk factor of lung cancer. Yet a recent report prepared by some prominent Chinese public health experts and economists did not find any significant change in China’s overall smoking rate over the last decade. A group of scientists analyzed historical records of aerosol particles and lung cancer incidence in Guangzhou and found that a dramatic increase in the occurrence of air pollution from 1954 to 2006 was followed by a large increase in the lung cancer incidence rate despite the drop in the overall smoking rate. It was found that 750,000 Chinese die prematurely each year, primarily because of air pollution in large cities. According to more recent estimates by Greenpeace and Peking University’s School of Public Health, exposure to PM2.5 contributed to more than 8,500 premature deaths in Beijing, Shanghai, Guangzhou, and Xi’an in 2012 alone.

Business Insider Adam Taylor reports that a Beijing journalist asked a question about air pollution that lasted longer than 3 minutes, and “saw her almost break down in tears numerous times,” yet the appeal received no response from the delegates to the NPC.

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Myth #1: Strong political commitment and a centrally coordinated response was the most important factor in the control of SARS in China.

Not really. Once the initial dilly-dallying gave way to decisive and swift state action, resources were effectively mobilized against the epidemic and policy coordination was significantly improved. Yet many of the measures widely credited for stopping the spread of the virus, such as isolation and quarantine, were only implemented after the virus reproduction number or Rt—a critical value below which sustained transmission of the virus is impossible—dropped below one, or when the epidemic was already dying down. According to a study published in Tropical Medicine & International Health, those decisive government measures might have played a role in speeding up the disappearance of SARS or preventing the outbreak in yet unaffected regions, but they “contributed little to the factual containment of the SARS epidemic.”

[...] Myth #3: Government cover-up is no longer a major concern in the post-SARS era.

Not true. The SARS crisis has forced the Chinese leaders to take steps to be more open and transparent in disease reporting and information sharing. Yet as shown in the 2008 hand, foot, and mouth disease (HFMD) outbreak, local government officials found it difficult to adjust their existing behavioral patterns for crisis management, which still value secrecy and inaction. Similar communication problems also bedeviled the government’s response to the 2009 H1N1 outbreak. China’s SARS crusader Zhong Nanshan publicly expressed his distrust in government data on H1N1 fatalities. Political expediency continues to be put before epidemiological reality in sharing disease-related information with the public. The health authorities stopped updating the spread of H1N1 cases between September 30 and October 9, apparently fearing that reporting H1N1 deaths would ruin the celebrations planned for October 1, the National Day that marked the 60th anniversary of the People’s Republic of China. That said, government cover-up and inaction are not unique to China; India’s response to the 2012 dengue fever epidemic was riddled with similar problems.

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The translations are by Rogier Creemers of China Copyright and Media.

30 September 2005

On 1 October, the main media in Guangdong Province will publish a news article on “The Earlier Motion to Dismiss the Village Committee Chair in Taishi Village Has Become Invalid, Safeguarding the Lawful Rights and Interests of the Villagers of Taishi According to the Law,” all websites are requested to not transmit this news article, forum trackers are also not to post this article.

30 September 2005

(1) It is not permitted to publish “Zhuhai Municipal People’s Congress Launches Appraisal and Judgment Activities, Designs Dismissal Rules” and other reports, existing reports must be promptly removed. Do not disseminate or discuss the viewpoint that “major matters must go through the National People’s Congress.”

2005-9-30

(2) The Yannan Community has already been closed, no website may discuss this topic!

29 September 2005

(1) Concerning the “Wang Binyu Case” and the “Panyu Taishi Village Incident,” only use Xinhua copy, it is strictly prohibited to use copy from any other source. Concerning the Wang Binyu case, only positive guiding posts can be issued, and these may only been posted after the Foreign Propaganda Office appoints a special person to examine and verify the “keeping the gate,” other posts must be completely cleaned up. Concerning the incident of recalling village officials in Taishi Village, Panyu, all posts already on forums are to be completely deleted without exception.

(2) Concerning matters of “civil servant salary system reform,” the following requirements are reiterated: websites are only to reprint Xinhua copy, without permission, they may not reprint information from any other source. Articles concerning this matter are not to be dealt with prominently, do not set up news trackers, do not set up special subject pages, forums are not to discuss this.

(3) Concerning the matter of “the Suicide of the Major of Korla City, Xinjiang,” without permissions, websites may not report this without exception. They must strengthen management, and timely block and delete relevant information.

28 September 2005

Do not report or play up the “Minister of Communications Zhang Chunxian Welcomes Information on Honest and Clean Government Supervision,” corresponding reports and commentaries must be immediately deleted.

28 September 2005

This week, focus on inspection and control of: online information aimed at the Beijing “Aircom” company withholding donations from netizens to the plaintiff in the Harbin “Japanese Army Gas Shell Case.”

This week, focus on inspection and control of: domestic and online information concerning incidents on the strike of workers of Special Steel in Chongqing, the incident of the rally of Anshan Steel workers in Liaoning, the incident of student protest of Sichuan Science and Engineering Institute students, and on the cholera epidemic in Fuzhou.

Matters concerning the Anshan Steel worker rallies may not be reported online without exception, timely block and delete corresponding information.

26 September 2005

(1) It is prohibited to explore the 17th Party Congress (The 17th National People’s Congress); note: regardless of whether netizens themselves start discussion or news media reports are reprinted, it is to be deleted without exception.

(2) Content related to foreign reports on any epidemic happening in our country is to be deleted without exception. Note; regardless of whether it is foreign or domestic, all media reports concerning disease epidemics (past ones that the masses know about are not included, such as SARS, etc.), are to be deleted first, afterwards, obey Notices.

25 September 2005

Matters related to the construction of a luxurious schoolhouse in Linhai, Zhejiang are not to be reported without exception!

22 September 2005

On 25 September, Xinhua will issue the “Copy concerning Website Clean-up and Rectification,” this may not be transmitted and may not be discussed. Content related to this is to be deleted without exception once discovered.

20 September 2005

The recent matter of a Henan person hijacking a taxi in Wangfujing, killing the driver and hitting some people, is not to be reported without exception.

10 September 2005

(1) Do not report on the event concerning the walkout of Peking University student Liu Jianfeng anymore. Existing content is to be deleted, forums are not to discuss it.

(2) Xinhua foreign-oriented copy concerning the Chinese Catholic leader responding to journalists’ questions may not be reprinted.

2 September 2005

During supervision, if the text “Notes from Birth Planning Investigation in Linyi, Shandong” is encountered, it is to be immediately deleted!

2005年9月北京网管办发出的禁令

2005-9-30

10月1日，广东省主要媒体将刊发”太石村原罢免村委会主任动议失效 依法维护太石村民合法权利”新闻稿，请各网站不转发此新闻稿，论坛跟帖也不贴发此稿
2005-9-30

1：不准发“珠海市人大开展述职评议活动、设计罢官规则”等报道，已有的要迅速撤除。不传播讨论“重大事项必须通过全国人大”的观点。

2：燕南社区已被关闭，关于此话题任何网站不准讨论！
2005-9-29

1、关于“王斌余案”和“番禺太石村事件”只使用新华社通稿，严禁使用其他任何来源稿件。关于王斌余案，只能发正面引导的贴文，并由外宣办指定专人审核把关后方可贴发，其余的贴文要全部清理。关于番禺太石村罢免村官事件，对论坛已有贴文一律全部删除。

2、有关“公务员工资制度改革”事，重申要求如下：网站只转发新华社通稿，未经许可，不得转载其他任何来源的消息。关于此事的文章不突出处理，不开新闻跟帖，不设专题，论坛也不讨论。

3、有关“新疆库尔勒市市长自杀”事，未经允许，网站一律不得报道。要加强管理，及时封堵和删除相关信息。
2005-9-28

不要报道和炒作“交通部长张春贤欢迎廉政监督的消息”相关报道和评论要立即删除。
2005-9-28

本周重点监控：网上针对北京“易索得”公司截留网民对齐齐哈尔“日军毒气弹案” 原告团捐款的相关信息。

本周重点监控：境内外网上有关重庆特钢工人罢工事件、辽宁鞍钢工人集会事件、四川理工学院学生抗议事件、福州霍乱疫情的信息。
有关鞍钢工人聚集事网上一律不得报道，及时封堵和删除相关信息。
2005-9-26

1、禁止探讨有关十七大（第十七届全国人民代表大会）；注：不论是网友自发讨论还是转载新闻媒体的报道，一律删除。

2、有关境外报道我国出现任何传染病疫情的内容一律删除。注：不论境外境内，所有媒体关于传染病疫情（以往众所周知得不包含在内，如非典等）的新报道一律先删除，事后听通知。
2005-9-25

有关浙江临海兴建豪华校舍之事一律不报道！
2005-9-22

25日新华社将发布关于“网站清理整顿的通稿”，不要转发，不要议论。有关此内容发现一律删除！
2005-9-20

近日一河南人在王府井劫持出租车杀害司机撞伤几人之事，一律暂不报道。
2005-9-10

1.不再报道关于北大学生柳剑锋出走之事。已有内容撤除，论坛不讨论。

2.新华社对外稿关于中国天主教负责人答记者问一律不得转载。
2005-9-2

监管时如遇《山东临沂计划生育调查手记》一文立即删除！

These translated directives were first posted by Rogier Creemers on China Copyright and Media on November 11, 2012 (here).

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Post tags: 17th Party Congress, Beijing, Beijing Internet Instructions, censorship, Censorship Vault, Chen Guangcheng, Chongqing, Directives from the Ministry of Truth, epidemics, Foreign Propaganda Office, Fuzhou, Guangdong, Harbin, Henan, Internet censorship, Korla, Liaoning, linyi, Liu Jianfeng, Ministry of Truth, National People's Congress, netizens, NPC, Panyu, Peking University, SARS, Shandong, Sichuan, Taishi, Wang Binyu, wangfujing, Xinhua, Xinjiang, Zhang Chunxian, Zhejiang, Zhuhai
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Zhang, born in November 1946, is a native of Tai’an, Liaoning province. He became a member of the Political Bureau of the CPC Central Committee in 2002 and began serving as vice premier of the State Council, China’s Cabinet, from 2008.

Zhang had previously served as Party chief in Jilin, Zhejiang and Guangdong provinces, respectively, between 1995 and 2007.

BBC News profiled Zhang among the eight Chinese leaders it flagged as “faces to watch” ahead of this month’s National People’s Congress, and pointed out that he came under fire as party secretary of Guangdong when the government was slow to respond to the SARS crisis that broke out in the province in 2003. Most recently, Zhang presided over the relief effort and investigation following the high-speed rail disaster in eastern Zhejiang’s Wenzhou.

Bloomberg Businesweek has more on Zhang’s background - he graduted from North Korea’s Kim Il Sung University with an economics degree – and the decision to install him as the new head of Chongqing’s government:

Zhang, a 65-year-old native of northeastern Liaoning province, rose to prominence under former President Jiang Zemin. He is in charge of areas including industrial production, transport and energy, according to the official Xinhua News Agency. He also meets foreign business leaders, including International Business Machines Corp. (IBM) Chief Executive Officer Virginia Rometty, who met him last month in China’s leadership compound in central Beijing.

The choice of Zhang to replace Bo, whose removal was the strongest rebuke of a Politburo member in at least five years, is a signal that China’s leadership trusts him to take a difficult job. Zhang has been mentioned by analysts including Li Cheng at Washington’s Brookings Insitution as a candidate for the Politburo Standing Committee, the group, now with nine people, that exercises supreme authority in China. The party is set to pick a new standing committee later this year.

“In terms of economic policy and most likely any political reform he’s not known as a reform-oriented person, but has a reputation of being very steady wherever he serves,” said Victor Shih, a political economist at Northwestern University in Evanston, Illinois. “Part of the reason why he has been assigned to Chongqing is that he will provide relatively steady leadership to a city in turmoil.”

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Post tags: Bo Xilai, Chongqing, National People's Congress, SARS, zhang dejiang
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According to the police, the person, surnamed Liu, used the website he operates to spreadrumors on Feb 19 that SARS infections had occurred in Baoding-based PLA 252 Hospital inorder to boost the website’s traffic.

On Sunday, local authorities decided to punish Liu by sentencing him to spend two years in alabor education institution, the report said.

The Ministry of Health published an online note on Feb 25 to clarify that the infections in the hospital were actually caused by adenovirus type 55. The note said there has been no reportof any fatal or critical cases.

Reuters reported that Lin spread the rumors in a bid to improve traffic, according to the announcement by the Baoding public security bureau.

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Post tags: hebei, rumors, SARS
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That contender is Vice Premier Wang Qishan, a face most familiar to those in Washington as the leading figure on the Chinese side of the Strategic and Economic Dialogue. Back home, Wang is known as a competent manager with a wealth of experience in the financial sector, having served in the central bank and headed the China Construction Bank. He has also earned a reputation as something of a “crisis defuser” — both dealing with the SARS outbreak as Beijing mayor and playing an important role in shaping China’s response to the economic crisis. Wang’s engagement with top US officials also earns him credibility as something of a statesman. As for his aspirations, one wonders what lay behind his decision to give an extended interview to the US media, a rarity for top Chinese officials (see: Wen Jiabao and Fareed Zakaria). Was he advertising his capabilities to Beijing by holding court with Tim Geithner on a serious show like Charlie Rose?

On the flip side, did the heir apparent fall from grace? Not exactly. Li arguably still has the best shot of becoming premier, given that he’s President Hu Jintao’s close ally and protégé. But questions are surfacing about his managerial capabilities and experience, given the challenging economic transition that Beijing hopes to engineer. Such doubts are not entirely Li’s fault. He was dealt some of the toughest portfolios in the Politburo — namely, food safety and social housing. But it will be up to Li to prove his opponents (who argue that his achievements are few) wrong.

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Post tags: Beijing, china construction bank, Hu Jintao, Li Keqiang, SARS, succession, Wang Qishan, Wen Jiabao
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The translation under review here was made by Andrew Clark, a non-academic, with acknowledged help from two Chinese consultants who prefer anonymity. It seems to me to be very well and sensitively done. Clark has supplied over 400 endnotes explaining the book’s many cultural references, from Chinese gift-giving protocol to Russian folk songs. He has kept close to the author’s unadorned colloquial style of Chinese, and has supplied an eloquent three-page preface of his own.

Clark told me that when he asked Hu Fayun for a thumbnail description of Such Is This World@sars.come the author replied: “It’s about the internet.” The novel is actually about much more than that, but I see his point.

The story covers a year in the life of the principal character, a fortysomething Chinese widow named Ru Yan. It commences in the Fall of 2002, as her son prepares to depart for graduate school in France. He leaves Ru Yan his computer, teaches her how to use email and the internet, and directs her to a website called Midlife that includes a forum for parents of overseas students. The narrative then broadens out into several political, historical, and human themes; but the internet is humming away in the background, when not actually on the page, and drives key parts of the action.

The e-book version of Such Is This World@sars.come can be downloaded at Ragged Banner Press. Read additional reviews of the book via CDT.

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Post tags: book reviews, Hu Fayun, SARS
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As you might or might not have guessed from the stupid title, the main plot arc revolves around the SARS outbreak, which Ru Yan gets an early handle on because a family member of hers in the south has come down with the mysterious disease. Eager to warn her new friends on the internet, she posts about SARS on the forum, and people who remember the SARS outbreak can probably guess how things go from there. Her posts are deleted, she receives odd threats, others step in to her defense, and ultimately a war of sorts breaks out. Political agendas are being pushed on both sides, but Ru Yan doesn’t see herself as political at all, she simply thinks people ought to be warned about the disease.

Against this backdrop, Ru Yan’s offline life is expanding. A coworker has introduced her to the city’s most eligible bachelor, who happens to be a high official in charge of public health. And a meet-up of internet friends offline has connected her with Damo and his circle of intellectuals, which now includes as CASS professor, an overworked lawyer, and several overseas Chinese.

There are several conversations about China’s future and overseas Chinese in the book that I think should be required reading for the entire comments section of this blog. In fact, the book as a whole contains honest and open political discussions of the sort that are far too lacking these days whether we’re talking about China or any other country. By setting these arguments as mostly between friends, Hu is able to portray both perspectives fairly and honestly, although it is clear where his own feelings lie.

Read also a review of the book from Peking Duck.

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Post tags: book reviews, Hu Fayun, SARS
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