New Flu Cases Rise in Shadow of SARS

The death of a 38-year-old chef in Zhejiang from a new strain of bird flu has brought the number of reported fatalities to three, following news on Sunday of two earlier deaths in Shanghai. Ten H7N9 cases have now been confirmed, while a businessman is reported to have died from a separate flu strain in Hunan. Amid uncertainty and distrust of official information, rumors and speculation have become rife, about both unreported cases and possible (though unlikely) links to the armada of dead pigs that descended on Shanghai last month. The cases have also prompted vigorous stock market trading as investors look to cash in, and official warnings against sacrificing chickens to ancestors on Tomb-Sweeping Day. From Josh Chin at China Real Time Report:

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 scientist studying the virus’s genetic makeup.

In marked contrast with their opaque handling of the 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 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 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 , 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.”