Vent: It isn't just China - Lack of openness by public health officials endangers us all!

[alert]

Most of the regular visitors to FT know that the People's Republic of China (PRC) has a bad reputation for being less than honest about disease outbreaks. As far as I am aware, this started with their cover-up of the SARS outbreak in 2002-2003. People started dying of SARS in November 2002 in Guangdong, and the government of the PRC covered it up. The only word release was when a Dr. Cunnion sent ProMED an email in February 2003 blowing the lid off the story, leading to the ProMED post:

http://www.promedmail.org/direct.php?id=20030210.0357

For his efforts, he was hailed as a hero and actually received an award (http://www.promedmail.org/aboutus/awards/) from ProMED. Others in China, such as Jiang Yangyong, who revealed local SARS outbreaks in China were also viewed as heroes by the international community.

Fast forward to Spring 2009, when the H1N1 virus emerges in North America. Most of us know the official story. The CDC discovers several cases in California and Texas, and simultaneously Mexico reports a severe respiratory outbreak of unknown origin that turns out to be swine flu as well. By April 24, 2009, all the pieces come together, and the H1N1 Pandemic is revealed. Very few people outside of FluTrackers know the real story of what happened leading up to the release of this information. Around April 15, 2009, word began to leak out in the mainstream Mexican media about a woman who died of atypical pneumonia in Oaxaca, in which no identifiable pathogens were detected. Mexican mainstream news tried to dismiss this as the result of a seasonal pathogen. This prompted a local newspaper called the Diario Despertar de Oaxaca sent reporters undercover into a quarantined hospital masquerading as nurses. For details of what they did, see:

http://www.flutrackers.com/forum/showthread.php?p=352661

They broke the story of additional cases and deaths, and infections in HCW, which implied H2H spread. We picked up the story on the 17th here:

http://www.flutrackers.com/forum/showthread.php?t=99635

leading to one of the longest threads in FT history. I joined FT only because of their work. I had attempted to furiously send their articles to ProMED, and when I couldn't get sufficient response, I posted them here. No English language site other than FT posted anything on this outbreak until Canada issued a travel alert on the 22nd, even though the CDC was clearly aware of the spread. No US source posted until the 24th. For their work, endangering their lives, these people got no praise or awards, and their site (www.diariodespertar.com.mx) was taken offline shortly afterward and has remained offline since. IMO, it is only because of their efforts that everyone recognized the 2009 Pandemic.

Why does this matter now? Because as in 2009, the CDC has been detecting a novel influenza in the United States, this time called trH3N2. We have a forum on it:

http://www.flutrackers.com/forum/forumdisplay.php?f=2614

As was the case with H1N1 prior to April 24, 2009, the CDC is insisting that no ongoing, efficient transmission of this virus is occurring. But today, we now have evidence that the CDC has been aware since December 15, 2011 of a 23 person cluster of ILI over several weeks containing 2 confirmed trH3N2 cases:

http://www.flutrackers.com/forum/showthread.php?t=178476

strongly implying ongoing transmission of this virus. This time, we did not get an inside release. It is not hard for me to imagine the parents of one of the children, or perhaps a daycare worker getting on a blog and posting this. If they had, I'm sure one of us would have found this. To me, what is occurring now with trH3N2 is very similiar to what happened in April 2009, but without the efforts of the Diario reporters.

The difference of course, is also the HIPAA law. If someone had released this information, they likely could have gone to jail. If I did find a blogger claiming to be a nurse treating a cluster of trH3N2 cases, could I post it without risk of arrest? I'm not so sure. While many FT members have come forward and now post under their real names, the main reason I do not is my role in exposing the 2009 outbreak.

Would we have had a declared pandemic in 2009 without those reporters? Maybe not. Given the poor response and likely cover-up of trH3N2 clusters, I can imagine that wiout the efforts of those reporters, the US might never have admitted the truth about H1N1, and we might not have had a declared pandemic until much later. It is conceivable to me that we could have gone for several months misdiagnosing cases as seasonal flu and trying to find swine links, much as we have done the past few months with trH3N2.

I hate to admit it, and I hope I am wrong, but it really looks like the CDC now is engaged in the same kind of cover-up behavior that we slammed the PRC for in 2003, and that they may have been trying to attempt prior to April 24, 2009. And just as in 2003 and 2009, lack of openness by the public health officials endangers us all.

 

[Giuseppe]

Re: Vent: It isn't just China - Lack of openness by public health officials endangers us all!

The problem with government statements, updates, press releases is that normally these pieces of news are intended for calming down people fear, possibly spreading much more fear than the earlier, causative event.

This is only an apparent paradox.

Often, public health authorities around the world simply have not information about a specific event and thus they have to lie; the important thing to do is to make lies as credible as possible.

On the other hand, the inefficient government tends to say that all things are under control, whereas people in the community are well aware of the contrary.

Amidst this fog of war, we are struggling to see some lights into the frames, obscured often in a tight fume curtain.

In the wording of a text, in the punctuation, in sparsely information provided there is always someting true.

We have - over all - to avoid the bias: China is not a democracy; well, this may be true according some westerner opinionists (if you see the Greece situation, the fictional democratic regime there is doing so many damages to the citizens then a closeted N Korea like regime). But it is an immense country and the most populated entity in the world. With megacities with tens of millions of inhabitants it is nearly impossible to obscure a mass casualties event such as an epidemic caused by an enhanced transmissibility H5N1 strain.

Conversely, democracies seem to be much more strict in 'sensible' or 'strategic' issues information dissemination.

Our biased vision may cause dangerous distractions on the real scope of an event.

 

[JimO]

Re: Vent: It isn't just China - Lack of openness by public health officials endangers us all!

Although fiction, one line in Contagion brought it all home for me. The military officer from Homeland Security stated that they didn't want "anyone to know until everyone knows". I am sure that many in government fear widespread panic far more than they fear the disease itself. A severe pandemic accompanied by panic and resulting lawless behavior could ultimately bring down a government, especially where there has been decades of underlying discontent. I would be willing to bet that most Chinese politicians and communist party officials wouldn't even care if 10% pf the population died, as long as it wasn't accompanied by social unrest that would threaten the government.

I would condense the situation in China down to this: A totalitarian government + widespread devaluation of human life + a communistic philosophy of the good of the nation (or the party) outweighs the good of individuals = suppression of information + protection of the state at the expense of the citizens or outsiders + harsh response to any dissent or unapproved release of information.

The Chinese government has a completely different world view than we do and in their world view, if it suits their interests, they see nothing wrong in withholding disease information, even if the result could be a severe pandemic. People today forget that many regimes throughout history have placed the highest priority on self preservation. There have been many regimes who would gladly have used the spread of disease as a passive weapon to weaken their enemies. Who's to say that the Chinese don't hold the same view? Perhaps their motives are even more sinister than simply lack of concern for the health of their own people or for outsiders.

Other public-health agencies, such as the CDC, have probably fallen into the "fear of panic" trap. Now that the real possibility exists that a serious pandemic could kill many people, they are facing the reality of dealing not just with prevention and cure of the disease, but with the accompanying social consequences. It wouldn't be the first time a government agency in the U.S. withheld important information to avoid widespread panic. I don't know what the best approach would be, but I have to believe that, ultimately, being open with the public will result in fewer problems than withholding information that will eventually be made public. Yes, there might be some short-term panic, but I am sure it would be different than what would happen if people found out what was going on and discovered that it was being covered up.

I think that it is important to note that since the CDC was placed under Homeland Security, which is closely affiliated with the military and the military's way of dealing with information, it has been less forthcoming with information. The military is accustomed to carefully controlling the information releases to civilians or even average soldiers during a crisis, so it doesn't surprise me that all the agencies under Homeland Security would adopt this "need to know" mentality. It makes their job easier. Thank God for the FOIA.

 

[Giuseppe]

Re: Vent: It isn't just China - Lack of openness by public health officials endangers us all!

I think that the first step needed to understand a situation or a behaviour is the respect due to the subject we are analyzing, in this case, China, its people, its political and institutional background.

 

[alert]

Re: Vent: It isn't just China - Lack of openness by public health officials endangers us all!

It isn't China that is the problem here. It appears that the US CDC is not being fully open about what it knows about trH3N2 transmission in the United States, as evidenced by the fact that it didn't mention the 21 additional contacts with ILI until an accidental release in a California report recently, more than two weeks later. If you look closely at how H1N1 was revealed, it isn't out of the question that they may have been trying to cover it up until the Diario broke everything wide open.

When it is China pulling a cover-up, the whistleblowers are heroes. Now that it is someone else...

And Jim, you're exactly right. The truth will come out eventually, and it might not look good.

 

[curiosity]

Re: Vent: It isn't just China - Lack of openness by public health officials endangers us all!

Maybe the motive is less sinister.

Maybe they are trying to prevent being convicted of "oversensationalizing" the event as they were by the media re: H1N1.

There was no way to tell the 2009 H1N1 would be as mild as it was (granted it was significant to those of us who pay attention to the finer details) and the media crucified them for spreading alarm and fear for something that kills so few people - compared to cancer, heart attacks, guns, etc... or worse, for trying to vaccinate persons against the new virus in the "all natural" world when the threat didn't present itself as significantly as 1918.

Perhaps the concern with H3N2v is that they want to know a little more about the virus's virility before they begin informing the public - before they begin suffering the consequences of the international "don't go to USA" propaganda (similar to the Mexico H1N1 event), before the media begins to oversensationalize then blast the incident as "scare tactics". Besides, Sanje Gupta of CNN already put his life on the line by going to Mexico City with his bag of tamiflu - just in case he came down with H1N1. I mean, really, what could he possibly do now to show his bravery and courage in the face of infectious disease.

The background work is being done - preparing specimins for possible vaccine manufacturing, calling on State Health Departments to be more vigilant in lab detection, administering guidance for the treatment of persons ill with H3N2v. The difference is the public as a whole is not receiving the "possible" picture. Remember that the potential cases have not yet been confirmed as truly having the H3N2v - there is only a possibility - and with all of the respiratory viruses circulating - there is no absolute reason to assume those cases ARE H3N2v.

I admit, I am surprised the information that has been released has only been released via the "Have You Heard" section and think they are downplaying the incident - but I think the motives are in response to the most recent event and it's outcome.

 

[Vibrant62]

Re: Vent: It isn't just China - Lack of openness by public health officials endangers us all!

I think I tend to agree with Curiosity on this one for THIS event only.

The powers that be are between a rock and a hard place in many regards i.e 'damned if they do, and damned if they dont', and yet I also agree with Alert that such actions and lack of information could (for a pandemic that turns out to be severe) compromise the health and safety of us all.

The answer is and must be that its 'all about balance' where communications are in line with the known and expected risks of the potential outbreak. If this standpoint is taken, then behaviour that is anything less than transparent e.g. in relation to H5N1 would be disgraceful... but biding time to see if what could well be a mild pandemic or a severe flu, and in how many people ... is that a bad thing? After all, this a virus that is sufficiently similar to ones that have infected us before PROVIDED THAT in the background the correct steps and isolation and control steps ARE being taken.

After the furore in political circles over pH1N1 and the massive expense that followed for what turned out to be a fairly mild virus (in terms of the numbers killed - many who caught it have never been so ill and as we know, there were disproportinate numbers of deaths in the young and healthy) ... but as a result there has been backlashes in multiple directions with serious impacts all over the world; reductions in pandemic preparedness funding being one of them.

We here are well informed and many of us have specialist skills from our working lives; but many reporters and especially politicians are not. Look how many reporters and politicians do not understand that H5N1 flu and pH1N1 swine flu are and were different viruses.

I am glad that I am not the one in the hot seat having to make such decisions; life is never so cut and dried and there is always a large grey area in decision making.

 

[Gert van der Hoek]

Re: Vent: It isn't just China - Lack of openness by public health officials endangers us all!

Many studies have shown: health and disease are related to power, economic development, poverty and inequality.

Most things governments do - in any way, in any field - are related to health.

Health is politics and politics is health.

So don´t be surprised if you are interested in public health, you will see all things beautifull and all things ugly, in every human society.

Including heroic acts and including lies.

 

[curiosity]

Re: Vent: It isn't just China - Lack of openness by public health officials endangers us all!

It may also be the information that is being shared is just enough ... specific to this event.

We know there is a novel virus - H3N2v.

Based on multiple location detections, in my opinion, the virus IS spreading human to human.

If the case in Marin, CA pans out as an H3N2v case also then that further reinforces my opinion.

What would change about the event response or the public perception if the information was widely distributed that a cluster of persons in West Virginia might have been infected?

Would the release of information be any different if the virus were not only novel but was also causing severe morbidity and mortality in the US? (perhaps similar to the increased, unusual pneumonia mortalities in Mexico City in 2009?) My opinion is - absolutely.

Once the CDC could confirm the two cases in the US were related to the novel influenza in Mexico, they hit the media with a huge volume of information - the healthcare industry was inundated with information and guidance.

The CDC didn't inform the public of the novel virus detection in Mexico prior to the US cases, but would there have been any change in the disease progression or outcome knowing the novel virus existed prior to entering the US?

Influenza is an illness that, in a novel outbreak setting where all humans are susceptible to the disease and the disease has adapted to humans, will not be contained - unless it kills ALL infected people faster than they can spread it. There isn't any amount of quarantine or isolation that will prevent the disease's spread by the time it is detected - and only some social changes will slow it down. Culling the chickens, for example, hasn't stopped H5N1 - and hopefully the CDC isn't making plans for an "Andromeda Strain" response (but if they were, I would put money on the likeliness they will NOT communicate that information!)

I think even a confirmed H2H spread of H5N1 of a large scale will not stop the cars, planes, boats, etc... Thus my last question is: What will prior information regarding how large the outbreak is or how many people have been infected change about the event response and public perception to a real influenza disaster?