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April 11, 2013: 38 H7N9 cases, ten deaths.  

As of 9:50 AM EDT, China's H7N9 cases have jumped to 38, with 10 deaths. Overnight, five new cases were reported, along with one death.  So we appear to be settling into a bit of a routine here, with a handful of new cases being reported, and an occasional death.

There still are not enough cases to determine a Case Fatality Rate without panicking everyone, but it is clear that this virus is a killer.  The new cases are of people who are very, very sick, and are admitted and tested and confirmed and (hopefully) isolated.

When I worked for an IBM business partner, one of the axioms I learned there was:  You Don't Know What You Don't Know.  And we don't know several things.

First, a Chinese report states that of some 700+ chickens culled at Shanghai wet markets, only 20 tested positive for H7N9. Crawford Killian covers this nicely in his blog, The Silence of the Chickens. You cannot detect what isn't there. Shanghai authorities just took 111,000 birds out of the public diet for a nonexistent problem. Of course, they had to do this:  It is Standard Operating Procedure for killing off a pandemic candidate virus.  See Dr. Margaret Chan's decision in 1997 when a human-to-human H5N1 threatened the entire world in Hong Kong. 

The cases are being found without organizing human testing.  No H7N9 rapid test exists.  Expensive and time-consuming reverse-PCR tests need to know what they are looking for.  Needless to say, H7N9 reagents were the last things anyone was expecting to stock.  So today's press release from the Chinese version of the CDC is welcome news:

Testing reagents for the avian influenza A/H7N9 virus have been distributed by China CDC to all influenza network laboratories of 31 provinces across China. As of 8 April 2013, a total of 160,000 Real-time PCR reagents have been delivered to make all areas capable of detecting human infections with avian influenza A/H7N9 virus.

The Chinese now have the tools necessary to get proactive and get ahead their arms around the scope of this new virus. We simply do not know how many Chinese have been infected; how many have truly died; and how transmissible this virus has become.

Yesterday also brought us the controversial story of Chinese scientists who theorize, in remarkable candidness and lack of censorship, that this new flu may mutate 8 times faster than normal viruses.  THis conclusion was reached by looking at two H7N9 strains spaced some two weeks apart.  Specifically, there were nine changes in the hemagglutinin  over that two-week period.  from this, the scientists concluded the virus was capable of massive, sweeping mutations in a shortened period of time. 

I wonder if our CDC got tipped off on this pending story and that is why they decided the most prudent thing to do was open its EOC at level 2. 

I am also reminded of the forthcoming animated film Epic; specifically, the upcoming trailer.  Click on this link and forward to 2:08.  Perhaps if this virus can mutate so quickly, it can mutate to the life expectancy of this fruit fly?  We can hope so.

UPDATE:  Flutrackers is reporting two Hong Kong residents are being monitored.  This is not new and has already happened.  We should get answers quickly.

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