Reports From China
Point To Major
H5N1 Coverup
From Patricia Doyle, PhD
Outbreak Cover-Up?
The website that first broke news of the Sars virus in China is now warning of a bird flu epidemic that has claimed more than 100 lives, but can it be believed.
By Chris Taylor
South China Morning Post
A US-based Chinese-language news website known as Boxun, or "Abundant News", has riveted the online medical community over the past month with a series of reports from China's Qinghai province about an alleged bird flu cover-up. One report - said to be leaked by a Chinese official - claimed that 121 people were dead from avian influenza, or H5N1.
China has denied the claims, but for anyone who follows both Chinese-language underground news agencies and the medical organisations that obsessively monitor emerging viruses, the Boxun reports and the international online response to them recalls early 2003, when news emerged of a killer virus in Guangdong. The virus was Sars, which became a menace overnight after a Boxun report interrupted a long media clampdown by Beijing.
Boxun's Sars story was translated into English and repeated by ProMED-mail, an online reporting system that keeps subscribers informed of outbreaks of new diseases. Now Boxun is either leading the pack again, or leading it astray - and Boxun's founder doesn't rule out the latter. Nevertheless, ProMED picked up the story once again and the world's online community of virus watchers has been discussing it since.
"We've been following the reports very closely for several weeks," said Peter Cordingley, a public information officer for the WHO Regional Office for the Western Pacific in Manila. "We have no independent confirmation of them."
Boxun's founder, who goes by the pseudonym of Wei Shi and describes himself as a businessman, said from the US that he could not verify the web-posted stories from Qinghai that Boxun had run.
Nor could he vouch for the alleged whistleblower's credentials. All Boxun's non-secondary source reports are posted anonymously. But he said he hoped that by putting the stories in the public domain, somebody would prove them true or false.
"We put out the stories like these and on Sars because we believe anything like this can happen in China," he said. "The government doesn't want to confirm anything."
Mr Cordingley said the WHO was wary of Boxun, because it was seen as a "dissident website", adding: "Some of the stuff they publish has a political agenda."
According to Wei, Boxun runs a broad range of news from secondary sources including state-controlled Xinhua items, which count for the majority of China news content. He said that he and his team of US-based volunteers had no political affiliations. "People in China cannot express themselves freely, and Boxun is an opportunity for alternative points of view to be expressed," he said.
But even if Boxun does have a political agenda, when it comes to the threat avian influenza poses to world health, alternative views - if they are really coming from the ground level - must be taken into consideration as an alternative to China's state-controlled media.
One of the posts on the website includes the only known photographs of the dead bar-headed geese at Qinghai Lake that sparked the controversy. Wei is convinced the photographs are authentic.
One grainy, wide-angled shot shows a sandy foreground with what seem to be masses of lifeless birds stretching away to a sliver of a turquoise lake under an arching blue sky. If the anonymous poster of the pictures is to be believed, the birds are bar-headed geese struck down by H5N1 at the end of their 1,000km migration from the northern plains of India to China's remote western Qinghai.
The photographs were posted on May 24, one day after the Chinese authorities told official media that wild geese were dying of H5N1 in Qinghai, marking China's first outbreak of avian influenza since last August.
It was news that generated great interest in scientific circles. The report ended a nine-month clean bill of health in a nation that is home to about 13 billion poultry. But more importantly it was evidence that H5N1, a scourge to domestic birds in Asia, was now killing wild species of birds. This suggested a possible mutation in the virus that simultaneously made it much more mobile and a greater threat to other species, including humans.
Boxun confirmed that threat the day after the Xinhua report, with an anonymous story headlined: "Acute bird flu in Qinghai leads to multiple deaths, officials impose news blackout and strict prevention." The report, which was datelined Xining - Qinghai's provincial capital, claimed that "large-scale deaths of birds" began in early April, and that tight monitoring of the news had kept it from the outside world.
"In mid-April, the phenomenon of widespread infection of humans, domestic animals, etc. appeared ... but because the area is so sparsely populated, the large extent of the infection of humans and domestic animals was not readily apparent," the report said.
The alleged deaths later came to include six Chinese tourists, who reportedly contracted bird flu during the May Day holiday week. The report named three of the dead tourists as from Sichuan province: Li Tianlei, male and Dai Jing, female, both from Chengdu, and Li Tianhai, male, from Chongqing.
A report the next day stepped up the charges, claiming that an official leak had revealed 121 people had died of bird flu. Of those, 11 were health workers, the report said.
"At present, Chinese officials are still maintaining their position that as of yet there are no human infections and have increased the suppression of news," the website said. According to sources the report does not name, about 1,300 people were quarantined, but it was not reported where.
On May 25, a report provides a list of 18 villages with a total of a 120 deaths. It also provides some unscientific musings on whether the disease was pure H5N1, or a new viral concoction, before concluding "it is definitely contagious".
One of the few western media outlets to publicise the reports has been Henry Niman, founder and president of Recombinomics Inc - a private viral gene and predictive viral change research centre - posted English translations of the reports as they appeared, using Alta Vista's Babelfish translator.
Some reports are touching, such as one dated May 26. After complaining about news restrictions on China's media, the writer says: "The reports of the past few days have been made by the nine of us from around Gangcha county and Qilian county, because we wanted to really understand the avian influenza situation in Qinghai. We came disguised as tourists to carry out on-the-spot interviews ... only by coming to this place can you realise just how poor China can be. Anyone with a conscience would shed tears."
The reports end abruptly - and have not resumed - on June 5, with a report on the website the same day announcing that eight of the nine had been arrested. The ninth, according to Boxun, was cut off mid-transmission and has not been heard of since. The first eight names, ages, places of birth and place and time of arrest were all provided.
Mr Cordingley gave the WHO's official response to the reports: "We have been assured by China's Ministry of Health that there have been no human deaths from the bird flu, and we have no reason to disbelieve them."
But Dr Niman is less certain. "It's pretty clear that H5N1 is more abundant now, and yet we had no reports [from China] between August last year and Qinghai," he said. "In other words, they got through the whole season without any outbreaks, and that seems suspect.
"There was one ProMED-mail report from Fujian [in April this year] that said that there was an outbreak in domestic geese, and the striking thing about that report is that the animals were not even being tested."
Wei Shi, of Boxun, may hope that unverified reports on his website will prompt reporters and health officials to do the footwork required to prove or disprove them, but it has taken the WHO until this week to get approval from the central government to go to Qinghai. That's about six weeks since the May 4 date provided by Xinhua for the mass deaths of bar-headed geese at Qinghai Lake.
There are now many unanswered questions. Mr Cordingley said the WHO was now in Qinghai with a team that also comprised the Chinese Ministry of Health and the Ministry of Agriculture. Perhaps they will discover that migratory geese infected with H5N1 became sick at the end of a grueling 1,000km journey and died.
Perhaps the WHO will see evidence that the authorities moved in and mopped up afterwards, cleared away the carcasses and keeping some specimens for analysis.
But perhaps something else happened. After all, the WHO visit comes less than a week after Xinhua vaguely reported the first-ever "joint medical and logistic support exercise" between the mainland's army and air force, including "on-the-spot treatment, field hygiene and epidemic prevention".
If Boxun, ProMED-mail and the Sars experience can teach us anything, it is that every detail counts. In the case of a possible human-to-human transmissible and a H5N1 pandemic, too much is at stake to demand anything less.



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