
Hong Kong Confirms First Human Case of Bird Flu - wikiburner
http://www.reuters.com/article/2013/12/02/us-hongkong-birdflu-idUSBRE9B10MA20131202
======
bjz_
For an chillingly realistic depiction of how a worldwide pandemic could
unfold, I'd highly recommend watching the film Contagion (2011)[1]. For all
those who complain governments and scientists overreacting to new flu strains,
I would prefer that than the alternative - doing too little and being swamped
by an uncontrollable virus.

[1]
[http://www.imdb.com/title/tt1598778/](http://www.imdb.com/title/tt1598778/)

~~~
creativityland
Will have to give this a watch. Not sure how realistic but Plague Inc is not
bad for an iPhone/iPad game.

[http://www.ndemiccreations.com/en/](http://www.ndemiccreations.com/en/)

~~~
draugadrotten
You may be interested in
[https://www.moocdemic.com/](https://www.moocdemic.com/) which is a global
simulated outbreak, playable on iPhone and android phones.

The games goes together with the online MOOC "Epidemics - the Dynamics of
Infectious Diseases"
[https://www.coursera.org/course/epidemics](https://www.coursera.org/course/epidemics)

------
Anon84
A few comments based on my experience working with these things back in 2009
[0]

1\. Yes, this thing has a mortality rate of 30%. What that means is that out
of all _detected_ cases 30% of the people have died. The keyword here is
detected. At this stage, and without a massive surveillance plan looking for
specifically for serological evidence of the virus, authorities are only aware
of a tiny fraction of the actual cases (the most severe) which tend to skew
the mortality rate. The actual mortality rate for the 2009 H1N1 has just now
been reevaluated with more accurate data and techniques [1, 2]

2\. So far it doesn't seems to have crossed the threshold to be able to spread
quickly from person to person. Doing that will imply a few more mutations that
will likely make it less aggressive and deadly (it's hard to spread if you
kill your host too quickly).

3\. Better than watching Contagion to get an idea of what a spread looks like
at a global scale is to watch [3] which is an accurate representation of the
H1N1 spreade in 2009. Each edge you see represents the (likely) first infected
person traveling from an infected to an uninflected city. You can play with
the (client) software we used for these simulations over at [4]

4\. Attempts to use real time proxy data like mentions in Twitter and searches
in Google to monitor the spread of infectious diseases haven't really been
very successful. Google flu trends had some early success but it seems to be
breaking down recently. As usual Twitter seems to be much better at predicting
the past than the future. In fact the CDC has recently launched a competition
to try and do just this [5]

5\. In summary, don't panic. Much smarter people than myself are keeping an
eye on this and it's likely not as bad as the link baity headlines would have
you believe.

[0] I worked directly with the official surveillance data and used it to model
And forecast the worldwide spread of the virus. We were actually able to
predict (and publish) the epidemic peak for dozens of countries I'm advance
You can access all the relevant publications here:
[http://www.bgoncalves.com/publications.html](http://www.bgoncalves.com/publications.html)

[1]
[http://www.npr.org/blogs/health/2013/11/26/247379604/2009-fl...](http://www.npr.org/blogs/health/2013/11/26/247379604/2009-flu-
pandemic-was-10-times-more-deadly-than-previously-thought).

[2]
[http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...](http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001558)

[3]
[http://m.youtube.com/watch?v=YAf1aXCvvdU](http://m.youtube.com/watch?v=YAf1aXCvvdU)

[4] [http://www.gleamviz.org/simulator/](http://www.gleamviz.org/simulator/)

[5]
[https://www.federalregister.gov/articles/2013/11/25/2013-281...](https://www.federalregister.gov/articles/2013/11/25/2013-28198/announcement-
of-requirements-and-registration-for-the-predict-the-influenza-season-
challenge)

Edit: spelling

~~~
feral
>2\. So far it doesn't seems to have crossed the threshold to be able to
spread quickly from person to person. Doing that will imply a few more
mutations that will likely make it less aggressive and deadly (it's hard to
spread if you kill your host too quickly).

I've done some epidemiology, but I'm not a biologist. I don't understand your
line of reasoning there. I suspect it stems from a logical mix-up, but its not
detailed enough to say for sure.

I understand that if a disease kills its host, before it can infect more
people, then it will 'burn itself out' and fail to spread. Therefore, _all
other things being equal_ , a disease that kills more slowly, or kills less,
will spread more.

However, that does _not_ mean that a disease must become less aggressive and
deadly to spread quickly from person to person - or even has pressure to.

We can use the terminology of compartmental epidemiology modelling to make
this clearer:

\- The rate which describes how contagious the disease is, between an infected
person, and a non-infected person: 'B' (beta).

\- The rate a which someone infected becomes non-infective (recovered or
dead): 'v'.

\- Lets also talk about the mortality rate, the % of infected people who
become dead, rather than recovered.

You say:

>(it's hard to spread if you kill your host too quickly).

I interpret that as a statement about 'v': you are saying that if the disease
kills too quickly, it won't spread too fast.

That's true - if 'v' is much shorter than a normal flu - let's say its
minutes, as an illustrative unrealistic extreme - then clearly even a very
contagious disease (high Beta) will burn itself out.

However:

> So far it doesn't seems to have crossed the threshold to be able to spread
> quickly from person to person.

That is a statement about 'B'.

You imply that it is necessary, or likely, that 'v' changes as 'B' increases.

But what reason do you have to think that?

There's no reason to think that a disease couldn't have a normal 'v' (couple
of weeks; but even a couple of days would probably still be incredibly
dangerous), but a really high 'B' and a really high mortality rate, if we are
very unlucky.

The mutation of the disease isn't guided, or intelligent; it doesn't care if
it reaches equilibrium with its host population, or kills us all.

The evolutionary pressure on the disease to become less lethal is a
populations-of-diseases level pressure (i.e. the specific disease will die, if
it kills all humans); whereas the evolutionary pressure to spread more applies
at the level of individual members of this specific disease (which is normally
how we think about evolutionary pressures).

Why think there's a casual link from the former to the latter? I believe your
argument mixes the two up, leading to a faulty conclusion, and an unwarranted
assumption of an extra safety factor.

I've seen a number of people working in the area of epidemiology make what I
think is this mistake, and I'd like to know whether I'm missing something or
they are.

~~~
Anon84
I'm a physicist, so very much not a biologist or epidemiologist. You should
definitely take what follows with a pound of two of salt.

You are correct, of course. I might have tried to say too much in a single
sentence, I did say "likely make it less agressive" because that's what
usually happens with the flu (even true for the 1918 Spanish flu). Of course,
this is not a requirement, and you have the example of Smallpox with a 30%
mortality rate and an R0=B/v in your notation of around 5 (flu is usually
~1.2-1.5).

There's usually a problem in terms of notation and confusion when moving from
"intra-host" populations to "inter-host" populations. Starting with intra-
host, a "good" quasi-species argument for why this is likely is:

If you assume that mortality is one of the dimensions of the high dimensional
"genetic vector" space and person to person transmissibility another, by
randomly exploring the space through mutations and reproducing the mutations
that produce more offspring you are likely to move away from the "high
mortality" area unless that's somehow important for viral survival. Any virus
that is able to keep the host alive for longer with have more time to explore
it's genetic space for longer to find the region where it is able to spread
more easily and will also likely generate hosts with higher viral load leading
to easier inter-host transmission. Or, as you say,

 _a disease that kills more slowly, or kills less, will spread more_.

It's not easy to talk about these things just considering Beta because Beta
hides many factors, such has number of contacts, probability of exposing
another person to the virus, host viral load (which affects how many virions a
person is in contact with), etc...

A simpler and perhaps not completely correct way of saying this is that "it's
hard to spread if you kill your host too quickly" because you have less time
to generate a high viral load, less generations between transmissions to look
for beneficial mutations, etc...

As an extreme example, you have HIV which has a generation time of a few hours
and a huge mutation rate, so each few hours your immune system has to deal
with a "new" virus until it can no longer cope. As I've heard several people
say, HIV wins the war by losing every battle.

------
alexeisadeski3
With an estimated mortality around 30%, I wouldn't want to catch this bug.

Fortunately, it doesn't seem to spread human-human particularly well - yet.

Mortality source:
[http://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H7N9#...](http://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H7N9#Mortality)

Transmitability source:
[http://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H7N9#...](http://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H7N9#Human_to_human_transfer_of_virus)

------
AmVess
Google Flu trends (near real time updates):
[http://www.google.org/flutrends/](http://www.google.org/flutrends/)

How they do it:
[http://www.google.org/flutrends/about/how.html](http://www.google.org/flutrends/about/how.html)

~~~
lwf
Google's predictions of flu trends haven't been accurate recently:
[http://commonhealth.wbur.org/2013/01/google-flu-trends-
cdc](http://commonhealth.wbur.org/2013/01/google-flu-trends-cdc)

~~~
AmVess
I see the point of the article, but it is dated January 13, 2013...which isn't
recent.

~~~
Fomite
That would have been last flu season, which is about as recent as evaluations
of flu surveillance systems get.

Also, I saw a presentation given at an infectious disease conference...less
than a month ago. Google Flu Trends appears to _really_ break down at small
spatial scales, like a single city. Unfortunately, Google is also super opaque
about how it works, so it's hard to tune.

------
alanho
misleading title, it's first case in Hong Kong but not first case in whole
world

~~~
dredmorbius
I'd argue "unclear" rather than "misleading". H7N9 had previously been
confined to the Chinese mainland.

Inclusion of an "its" would help: "Hong Kong reports _its_ first human case of
bird flu".

[http://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H7N9](http://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H7N9)

------
thaumasiotes
Huh, I assumed this had happened some time ago. The hong kong airport PA
system has been pumping out warnings about bird flu since september at least.
("Do not touch birds while in Hong Kong. If you get a cough, inform the
appropriate authorities.")

~~~
dmgd
I was there for a few days at the beginning of July and they had those
warnings then too (plus a body heat scanner, which was a little bit
disconcerting because I was very warm at that point!!)

------
CalRobert
I was just thinking I could go for another viewing of The Seventh Seal.

------
Kilo-byte
it's the usual flu season people, no need to fear this thing

~~~
seanmcdirmid
This flu is a bit worse than the standard one; you have a 3/10 chance of
dying. As always, stay away from live birds...no pet chickens...think twice
about buying that parrot.

~~~
ars
> As always, stay away from live birds...no pet chickens...think twice about
> buying that parrot.

What? No!

This virus doesn't just magically show up in a bird, the bird has to catch it
from another bird.

Stay away from large flocks, sure. But home pets? No problem at all.

~~~
panacea
Don't live/eat/sleep in close proximity to fowl pens.

~~~
Crito
Have you ever smelled a chicken? That is good advice regardless.

------
sirkneeland
Has there been any observed correlation between public hysteria over disease
outbreaks and lower airline ticket prices? I'd love to scoop up a cheap ticket
for the Rugby 7s...

------
blahbl4hblahtoo
Is it time for the media to go pant shitting crazy about epidemics again?
Seriously?

Has anyone else noticed a pattern here?

------
nether
Holy shit, it's happening...

~~~
Houshalter
Your comment adds nothing to the discussion and is severely exaggerating
what's likely to happen.

That said, I'm imagining the small possibility that people of the future look
back on this comment going like "this guy knew and everyone ignored him."

~~~
ZoF
Haha, we were so quick to dismiss him, if only we'd known.

