# 2544
Note: Today's blog is a bit of a ramble - starting out with a book review, and then morphing into a story about newshounds and odd news items on the net.
I'll try to connect the dots, however, before I'm through.
This weekend I'm reading The China Syndrome: The True Story of the 21st Century's First Great Epidemic by Karl Taro Greenfeld. Although I'm only about half-way through the book, I can recommend it highly.
The book not only chronicles the emergence of SARS, and the initial cover up by Chinese Authorities, it gives us wonderful profiles of many of the genuine heroes of the SARS epidemic.
People like Guan Yi, Zhong Nanshan, and Malik Peiris. Names that many who follow the bird flu story are certainly familiar with. This book is worth reading even just for the insight it gives on these people.
A brief profile of Guan Yi and Malik Peiris, by the same author, appeared in Asia Time Magazine in 2006.
But of course, the main focus of the book is the SARS outbreak, and how it became the first global epidemic of the 21st century.
One of the earliest signs that something was wrong came from reports that vinegar sales had gone through the roof in some towns in China, and that local pharmacies were seeing a run on antibiotics and other medicines.
The Chinese often will boil vinegar in their homes in the belief that it is protective against respiratory diseases. While rumors of `something' going on in China reached Hong Kong late in the year, along with reports of surging sales of vinegar, there was no `official' confirmation of anything amiss.
Early on in the SARS outbreak, a few newspapers even printed official `denials' that any epidemic, or unusual disease outbreak, was ongoing.
As an example, on January 4th, 2003 the Heyuen Daily printed an article on the front page by Li Jianhua, entitled : EPIDEMIC IS ONLY A RUMOR.
The first half of the story explained how there was no epidemic, and that there was no need to buy up medicines, or to panic.
The second half, a bit surprisingly, went as far as to mention patients that were hospitalized with what was called `atypical pneumonia' - described as a common non-communicable disease brought on by the changing weather. It was not, however, an epidemic.
One can't help but feel that the reporter was trying to `telegraph' a message to the public that something was wrong, even though it was couched in the wording of a politically acceptable denial.
This report came out more than six weeks after the first cases began appearing in Guangdong Province, South China.
Amazingly, even after Chinese officials knew they had a serious problem on their hands, they failed to inform the world medical community - or even their own hospitals on the mainland, or in Hong Kong.
Newspapers were forbidden to mention the outbreaks for fear it would put a damper on the Chinese New Year's celebration and cause panic. The outbreak was classified as a `state secret'.
This veil of secrecy would mean that it would be another two months before the WHO (World Health Organization) would have enough information to issue the first global alert on SARS (March 12th, 2003).
By then, more than 1,000 people would have been infected, and more than 100 had died. SARS had, by that time, escaped the confines of mainland China and was showing up in Vietnam and in Hong Kong.
This initial reluctance to admit that there was a problem ultimately led to the disease making its way around the world, and infecting more than 8,000 people. More than 800 of whom died.
Since then, we've been assured that this sort of lapse would never happen again. That China had learned a difficult lesson, and had mended their ways.
Perhaps.
Of course the slow-motion disclosure over the past few months by Chinese officials about their melamine tainted milk is less than reassuring in this regard. Old habits, it seems, die hard.
And the Chinese press is no less government controlled today, than it was in 2003. It ranks 167th out of 173 countries in `freedom of the press', as rated by Reporters Without Borders.
So it is hard to say whether we really would hear, early on, about any serious outbreak of infectious disease within China's borders. Many observers fear we would not. At least, not through official channels.
The same could be said for a number of other nations around the world. China is certainly not the only country with a history of holding information close to the vest, or of suppressing freedom of the press.
It is for this reason that the newshounds on the Internet flu forums devote a good deal of their time combing the foreign press, looking for tidbits that might provide some early indication of a problem. Scanning for another anomaly - like the spike in vinegar sales - or reports of mystery ailments, that would herald an outbreak somewhere in the world.
ProMed mail, a service of ISID (International Society of Infectious Diseases), and Global ARGUS at Georgetown University, are just two of a growing number of groups that monitor the media for signs of epidemics or social disruptions that might signify an outbreak.
As bad as SARS was, it was easier to contain than an influenza pandemic would be. If a novel influenza virus got as much of a jump as SARS did, it would be impossible to stop.
And so we watch, and listen, and try to make sense of often difficult to decipher - and sometimes seemingly unrelated - pieces of information.
We peer through a dense fog made up of diverse languages, distance, and political and editorial filtering - and we try to analyze what may, or may not, be happening in remote areas of the world.
It isn't an easy job. And the results are often messy, and inconclusive.
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To give my readers an idea of the difficulty involved in deciphering these news accounts, I have two examples that appeared this weekend in the Chinese press. (Hat tip Florida1 on Flutrackers)
Neither of these stories likely signifies anything ominous. They are simply data points that would have to be added to a good deal more corroborating information before we would consider them particularly relevant.
But each has been duly noted, and archived on the flu forums, and will be available to compare to other stories from the same region, should they appear.
The first story is about an exceptionally realistic looking `drill', held in Sichuan Province, China to dispose of animal carcasses during a major epidemic.
As you will no doubt notice, the machine translation of the original Chinese article leaves a bit to be desired. The vagaries of these translations leave many of them ambiguous and open to interpretation.
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Figure: Sichuan Province to carry out the disposal of sudden major animal epidemic emergency drill
Animal epidemic prevention personnel on the scene after the killing of "sick duck" with the group of ducks and sound processing. China made Yao pan
December 12, animal husbandry and food bureau of Sichuan Province, Sichuan Province Animal Epidemic Prevention Station supervision, Meishan City, Dong Poqu and animal husbandry bureau of animal husbandry and veterinary bureau, the city of Meishan in the United Dongpo Qu million in the town of White Horse Village held a "major emergency in Sichuan Province Disposal of animal disease emergency drill ".
I found from the activities of local villagers raised a large number of duck deaths occurred, the diagnosis of suspected highly pathogenic avian influenza, rapid disposal of the epidemic, the fight against the whole process.
Through activities at all levels to further improve the province's animal epidemic prevention personnel supervise the disposal of highly pathogenic avian influenza and other major animal epidemic.
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This second story seems to be an official reassurance that there are no SARS or Bird Flu cases in Shenzhen, China. This is probably just a routine `filler' story, printed because this is the time of year that concerns mount over a return of SARS or bird flu.
Still a denial of bird flu or SARS cases does capture one's attention. Shenzhen was at the epicenter of the SARS outbreak in 2002.
No one in our city bird flu cases
Newspaper reporter and then Xu Jiao Li-Juan Jiang-party correspondent reported that the city of CDC influenza surveillance network analysis show that our city is currently unexplained pneumonia and influenza monitoring network did not find anything unusual in our city were no cases of bird flu.
At present, bird flu is a high rate. City CDC stepped up SARS and bird flu monitoring.
This year in October, November, the city of cases of influenza-like level of activity at a lower level than in the third quarter dropped significantly.
December 1 to 7, flu-like cases had increased slightly, with similar levels of monitoring over the years.
In addition, in the fourth quarter of this year's influenza virus isolation and the rate of influenza outbreak than the previous number of significant decline, indicating that our city for the 2008 Summer influenza peak is over.
City CDC experts reminded the public that as a result of seasonal changes caused by temperature fluctuations, making a variety of common respiratory pathogens has increased the probability of infection, influenza vaccination is the prevention of influenza complications and the most convenient, economical and effective measures.
The public should also develop good health habits, not smoking, washing hands frequently and avoid over exertion to increase the outdoor activities to enhance physical exercise; should avoid contact with animals, birds, poultry as little as possible to the market.
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These two stories will be added to a dozen more like them, gathered from all over the world, by hard working newshounds this weekend. They will be examined, and debated, and watched for a week or two - to see if anything develops.
Most of the time, nothing comes of them. They signify nothing of importance, and they get filed away for future researchers, and largely forgotten.
But sometimes they do give us a heads up.
It was just about this time last year when the newshounds first picked up on the early reports of human H5N1 infections in Pakistan. The flu forums had it, and were discussing it, days before the mainstream press caught wind of it.
One of the lessons we can take from The China Syndrome is that rumors of an outbreak did manage to emerge out of a tightly controlled society, despite limitations placed on the press. As cell phones, SMS, and Internet connections proliferate - even in repressive countries - the ability to hide an outbreak for very long diminishes.
Whether it is picked up by Georgetown University, or ProMed, or the volunteer newshounds on the various flu forums, or some other news gathering and filtering enterprise - I fully expect that the first word of the next great epidemic will be heard on the Internet - probably buried in some obscure news story from China, or Laos, or Myanmar - or perhaps posted anonymously by a visitor to one of the flu forums or blogs.
The good news is, there are scores of people working diligently to try to find and properly interpret this information. With luck, we won't be blind-sided again.
For more information on how the newshounds work, see my essay Newshounds: They Cover The Pandemic Front.
