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Hong Kong Confirms First Human Case of Bird Flu (reuters.com)
134 points by wikiburner on Dec 3, 2013 | hide | past | web | favorite | 42 comments

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/

I would also like to recommend World war Z. cuz a zombie plague is much more dangerous than flu

PhD Epidemiologist: I wouldn't. I love zombies, and I love zombies in Epidemiology, but I wouldn't exactly hold World War Z as a great example of pandemics in action. Especially not the movie.

I'm pretty sure the parent was being sarcastic.

I never can tell these days.

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


You may be interested in 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

Glad you think so ;)

There was also a BBC documentary called "Pandemic" which was pretty good, with more relatable characters than Contagion had in my opinion.

For a much more fun depiction, try Outbreak (1995) [1]

[1] http://www.imdb.com/title/tt0114069/

That's exactly what I thought of when I read this title. That movie give my friend a panic attack.

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

[1] http://www.npr.org/blogs/health/2013/11/26/247379604/2009-fl....   

[2] http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...

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

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

[5] https://www.federalregister.gov/articles/2013/11/25/2013-281...

Edit: spelling

Being in Hong Kong and having lived through the SARS era, I'm happy when someone brings us back to reality and doesn't play the OMG-we'll-all-gonna-die scenario.

In the case of SARS, even though it killed more people in Hong Kong than anywhere else -many of them doctors and nurses-, the secondary effects of the disease affected everyone here: travel to Hong Kong stopped, the economy tanked, companies and shops closed and people lost their livelihood, no-one wanted to invest, everyone was afraid.

We should always be careful with the headlines.

>Being in Hong Kong and having lived through the SARS era, I'm happy when someone brings us back to reality and doesn't play the OMG-we'll-all-gonna-die scenario.

I couldn't agree more. Even SARS, concerning as it was when its pathology was unknown, was associated with fewer deaths in Hong Kong than influenza during the same year.

>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.


> 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.

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.

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#...

Transmitability source: http://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H7N9#...

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

How they do it: http://www.google.org/flutrends/about/how.html

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

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

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.

I guess NSA could run a much, much more accurate version of such service.

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

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".


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.")

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!!)


This is about bird flu, which is a virus, not bacteria, and has nothing to do with antibiotics.

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

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

Pandemic strains of influenza are noted for, among other things, their tendency to utterly ignore the routine seasonal patterns of flu. See: The 2009 pandemic, which kicked off in late spring, when the major wave of seasonal influenza is on the way out, if not over entirely.

It's also a lot harder to create vaccines for, as a virus that kills poultry doesn't work well with existing production methods that almost exclusively involve poultry eggs.

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.

> 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.

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

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

I was talking about my own rules being a resident of the PRC. If you live outside the PRC, you can probably follow more lax rules to stay alive.

It should be noted that transmissibility and virulence (your chance of dying) aren't particularly correlated, if at all, so while you don't want to get this, there's nothing yet to suggest wide-scale person to person transmission.

Indeed, there's some evidence to suggest avian strains of influenza (vs. pig strains) have a little bit of a disadvantage when it comes to kicking off pandemics.

Also, early mortality estimates are super unstable.

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...

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

Has anyone else noticed a pattern here?

Holy shit, it's happening...

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."

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

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