The horror of the H7N9 strain of bird flu isn't just that it's deadly — it's killed at least 23 people, it's definitely chicken-to-human, it has a chance of "going human-to-human," and it might be on the move. Another grim reality is that China might not be telling everyone just how bad the disease has become, even as it becomes clear we don't know how to stop it: Following concerns about a SARS-like "cover up," China's Center of Disease Control has stopped publishing its figures in English, just as the first new case of H7N9 popped up in the massive Hunan province — and on the verge of mainland holiday exodus. Indeed, if Chinese health officials aren't being completely transparent about "the first truly urban influenza in history," it won't take long for the rest of the world to find out.
"The center has halted the publication of English-language figures about the spread of the disease since last Thursday," Forbes's Russell Flannery reported last night of the bizarre move by Beijing's CDC. "It didn't give a reason." Whether it's a clerical consideration or another sign of hesitance on communicating everything beyond Chinese borders, that H7N9 is lost in translation cannot hide that reports of human infection kept pouring in over the weekend — even if the total number of human cases remains confusing. According to Shanghai Daily, 115 people are infected, and 23 are dead. Forbes puts the total at 125. Other counts put the total at 121.
But those numbers may balloon as H7N9 makes its way beyond the mainland Saturday: "Hunan cases come a day after the eastern province of Fujian reported its first case and during the same week that a man in Taiwan become the first case of the flu outside mainland China," Reuters reports. Here's what the trail of those three main regions — Fujian, Jiangxi, and Hunan — looks like, with millions of human beings in between:
Jiangxi, the province in the middle, reported its first suspected case on Thursday, Xinhua reported. Regardless of where the cases started, the disease has been spotted in both directions now. And on the horizon looms a gigantic mainland exodus. "Around 4.2 million people are expected to cross to Hong Kong from Shenzhen between April 27 and May 1 to celebrate the Labor Day holiday," reports Jake Maxwell Watts at Quartz, our sister publication. Hong Kong reported its first suspected case this month which caused concern, but that turned out to be a false alarm. If you thought the first case in Taiwan was bad, 4.2 million people coming in from mainland is a lot of people, and it could mean a ripe opportunity for the disease to spread.
Meanwhile, in the labs, precious little is known about the strain. There's the good news: "Chinese scientists confirmed on Thursday that chickens had transmitted the flu to humans," reported Reuters. But that still does not explain the cases where people who didn't come in contact with poultry still caught the disease. At Foreign Policy, Laurie Garrett points to trouble:
There is a missing link. For the new virus to have acquired these key mutations, it must be infecting a mammalian species of some kind, besides human beings. It had to have picked up those mutations inside a mammalian host. But to date no infected pigs or other mammals have been found, according to the Chinese CDC.
This is a mystery. And here is another: Nearly all known bird-to-human flu jumps have occurred in rural settings, unfolding on and around farms. But not this H7N9: This may well be the first truly urban influenza in history. No infected rural flocks or farmers have been found in China. This outbreak started in one of the most modern, densely populated metropolises in the world: Shanghai.
That (scary stuff) said, a visiting team from the World Health Organization insists there exists no hard evidence sustained human-to-human transmission, even if they did call it "one of the most lethal" flu viruses ever. "One of the things we need to be concerned about is this might gain the capability of going human-to-human which up to this point has not happened and is somewhat encouraging news," Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases (NIAID) and a top U.S. virologist, told the Agence France-Presse in an interview. "But we still need to be very prepared for the eventuality of that happening."
Correction: There were reports of a H7N9 case in Hong Kong earlier this month. A seven-year-old girl showed the signs, was put in quarantine, and later tested negative. We've update the article to reflect that.