Much of the United States is mesmerized by the belligerent squawks from North Korea's Kim Jong-un and the volatile tension straddling the Korean peninsula, but I'm more concerned about what is happening in China right now and the troubling trickle of news on a new bird flu strain H7N9.
At least 16 people have been infected, patients who were widely distributed through the geographic enormity that is China, and already six have died. But what makes this small cluster of flu cases unusual is its timing - we usually see flu outbreaks emerging in the fall and winter months and we are just now breaking into the month of April - and that this type of flu strain is not known to infect humans.
H7N9 seems to be following a well established pattern of other emerging viruses: originating in east Asia, the infection appears to have a tentative association with wet markets and butchering, and is of zoonotic or animal origin. We've seen this situation previously with Nipah virus in Malaysia infected pigs and slaughterhouse employees and with SARS and its birth in the wet markets of Guangdong Province in China.
Laurie Garret masterfully crafts an unnerving story, of unknown unknowns regarding these human flu cases and the potential linkage between the thousands of pigs and fowl carcasses that clogged Chinese waterways in March.
Here's how it would happen. Children playing along an urban river bank would spot hundreds of grotesque, bloated pig carcasses bobbing downstream. Hundreds of miles away, angry citizens would protest the rising stench from piles of dead ducks and swans, their rotting bodies collecting by the thousands along river banks. And three unrelated individuals would stagger into three different hospitals, gasping for air. Two would quickly die of severe pneumonia and the third would lay in critical condition in an intensive care unit for many days. Government officials would announce that a previously unknown virus had sickened three people, at least, and killed two of them. And while the world was left to wonder how the pigs, ducks, swans, and people might be connected, the World Health Organization would release deliberately terse statements, offering little insight.
By the end of March, at least 20,000 pig carcasses and tens of thousands of ducks and swans had washed upon riverbanks that stretch from the Lake Qinghai area all the way to the East China Sea -- a distance roughly equivalent to the span between Miami and Boston. Nobody knows how many more thousands of birds and pigs have died, but gone uncounted as farmers buried or burned the carcasses to avoid reprimands from authorities.
We are very early into this developing scenario and this spate of cases could fizzle into just a blip in the news cycle and on the infectious disease radar. You should read Maryn McKenna's reasoned and calm analysis here and to devour a slew of delicious infectious disease geek resources at the tail end of her article.
The point I want to make here is a reminder of how closely intertwined the lives of humans are with the lives of the animals we breed and eat. Not many of us raise pigs in the backyard or hear the cock's crow in the morning and it's easy to forget that for thousands of years we have lived in close proximity to our poultry and livestock.
But this is still the case in developing nations and particularly those with industries reliant on raising and butchering animals for the global market as well as people supporting a family with their hens and chicks. It is these people and places that are at most risk of emerging zoonotic infections like H7N9 and they require careful surveillance and monitoring of the health and well-being of both people and animals. Remember: catching a novel disease from an animal is the rule not the exception.
Resources The most important link I can give you: "The New Bird Flu, And How To Read The News About It
" from Maryn McKenna. A timeline of events
from Laurie Garret's article "Is This a Pandemic?" in the short news cycle of H7N9. Her article can be accessed here
. Shanghai will be temporarily closing its live poultry markets
on Saturday due to fears of a spreading H7N9 .
