H7N9 Bird Flu Reaches Beijing

Xinhua reported on Saturday that a seven-year-old girl has become China’s 44th confirmed H7N9 sufferer, and the first in Beijing.

The child is being treated at the Ditan Hospital, and is in stable condition, Zhong Dongbo, deputy director of the 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 . “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 virus’ gene sequencing and samples with the ’s global research centers and providing timely updates of new infections and deaths. During the 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 , 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 . “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 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 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.