China’s H7N9 flu outbreak had claimed 6 lives by Saturday, with the number of confirmed cases rising to 16. With the discovery of the virus among live poultry on sale at Shanghai markets, over 20,536 chickens, ducks, geese and pigeons were culled overnight on Thursday, with more to follow as authorities try to contain the disease. At The Wall Street Journal, Josh Chin and Betsy McKay summed up recent developments:
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:
— 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.”