The irresponsibility of the Chinese government in combating an outbreak of bird flu in Yushu in northwestern Qinghai is almost incomprehensible. Rather than cooperate with international health officials to determine the extent and seriousness of the flare up of the disease, Chinese bureaucrats closed off that part of the country to all foreigners. What happened next could have come out of a monk’s account of epidemic disease from the middle ages:

When natives living further from the area made a trip to the farming community, they discovered that it had “vanished” together with 3 of its surrounding villages. Only some ruins, blocks from collapsed walls, remained. Apparently, the farms and villages had been flattened and there were signs that they had been razed.

It is believed that some inhabitants from those 3 villages were workers in the farm. Around 200 people were estimated to have inhabited or worked in those 3 villages and the farm. There whereabouts are, as yet, unknown.

The above translation of a boxun report suggest that three villages were razed in response to unrest linked to a forced bird flu quarantine in Yushu in northwestern Qinghai in China. China has imposed news blackouts and arrested reporters in the past, so verifiable news from the area is difficult to obtain.

If true, the razing of villages and disappearance of 200 people may point to other, more serious problems. Has the epidemic spread to humans and the Chinese government doesn’t want anyone to know?

This is from a translated page on a Chinese message board. It is completely unconfirmed but at the least, it demonstrates what happens in a society when the free flow of information is impeded by government:

News outside of China however, points toward a virulent strain of H5N1 linked to Qinghai Lake has killed ducks and geese in several areas of southern Siberia in Russia as well as the adjacent region in Kazakhstan. There are now reports of five suspected cases of H5N1 in Kazakhstan linked to infected geese, suggesting many similar cases would be possible in Qingahi and Xinjiang provinces in China, where there have been three outbreaks linked to migratory birds and all involved dead geese.

Although it is possible that the ability to infect humans has been recently acquired, boxun reports in May and June described human fatalities in the Qinghai Lake region. In addition, several strains of H5N1 capable of infecting humans were also described.

The news blackout in China as well as additional suspect cases in neighboring Sichuan province which may be spreading further south to Yunnan province has suggested that a raging H5N1 pandemic in China is being covered-up.

The fact that the government has prevented international officials from visiting the province is extremely troubling. It suggests that the bird flu epidemic is out of control in one and perhaps two provinces.

The avian flu outbreak at Lake Qinghai was first identified by Chinese wildlife officials at the end of April. Initially it was confined to a small islet in the huge salt lake, where geese suddenly began to act spasmodically, then to collapse and die. By mid-May it had spread through the lake’s entire avian population, killing thousands of birds. An ornithologist called it “the biggest and most extensively mortal avian influenza event ever seen in wild birds.”

Chinese scientists, meanwhile, were horrified by the virulence of the new strain: when mice were infected they died even quicker than when injected with “genotype Z,” the fearsome H5N1 variant currently killing farmers and their children in Vietnam.

Yi Guan, leader of a famed team of avian flu researchers who have been fighting the pandemic menace since 1997, complained to the British Guardian newspaper in July about the lackadaisical response of Chinese authorities to the unprecedented biological conflagration at Lake Qinghai.

“They have taken almost no action to control this outbreak. They should have asked for international support. These birds will go to India and Bangladesh and there they will meet birds that come from Europe.” Yi Guan called for the creation of an international task force to monitor the wild bird pandemic, as well as the relaxation of rules that prevent the free movement of foreign scientists to outbreak zones in China.

In fact, as mentioned above, thanks to the inaction of Chinese officials, the pandemic has spread to Siberia:

Russia said on Tuesday an outbreak of bird flu in Chelyabinsk was dangerous to humans, as teams of sanitary workers destroyed birds in Siberia in an attempt to prevent the westward spread of the deadly virus.

The H5N1 strain of bird flu is behind the outbreak in Chelyabinsk, a city in the Ural mountains, the Emergencies Ministry said in a statement.

It said no cases among humans have been confirmed in Russia.

“Measures are being taken to prevent the spreading of the infection among domestic birds and to exclude the possibility of the infection moving to humans,” the statement added.

Russia is battling to contain a bird flu outbreak, which top health officials say has killed more than 11,000 birds countrywide and could spread westwards to Europe, the Middle East and Africa.

So what are the chances of avian flu morphing into a strain that can be transmitted human to human? According to Science Magazine, 100%:

The new US Health and Human Services Secretary Mike Leavitt told the Associated Press in early August that an influenza pandemic was now an “absolute certainty”, echoing repeated warnings from the WHO that it was “inevitable”. Likewise, Science magazine observed that expert opinion held the odds of a global outbreak as “100%”.

In the same grim spirit, the British media revealed that officials were scouring the country for suitable sites for mass mortuaries, based on official fears that avian flu could kill as many as 700,000 Britons. The Blair government is already conducting emergency simulations of a pandemic outbreak (“Operation Arctic Sea”) and is reported to have readied “Cobra” – a cabinet-level working group that coordinates government responses to national emergencies, like the recent London bombings, from a secret war room in Whitehall – to deal with an avian flu crisis.

According to the Centers for Disease Control, bird flu is now “endemic” to fowl in Southeast Asia. In other words, no local eradication efforts will be able to stem the tide of disease as it makes its way across the continent of Asia. Also according to the CDC, the bug is mutating to the point where it’s becoming easier to infect mammals as well as developing a resistance to some anti-viral medication:

New research suggests that currently circulating strains of H5 viruses are becoming more capable of causing disease (pathogenic) for mammals than earlier H5 viruses and are becoming more widespread in birds in the region. One study found that ducks infected with H5N1 are now shedding more virus for longer periods of time without showing any symptoms of illness. This has implications for the role of ducks in transmitting disease to other birds and possibly to humans as well. Additionally, other findings have documented H5 infection among pigs in China and H5 infection in felines (experimental infection in housecats in the Netherlands and isolation of H5N1 viruses from infected tigers and leopards in Thailand ), suggesting that cats could host or transmit the infection. These finding are particularly worrisome in light of the fact that reassortment of avian influenza genomes is most likely to occur when these viruses demonstrate a capacity to infect multiple species, as is now the case in Asia.

So where would the “tipping point” occur? There have already been 17 cases of known human to human contact, most of those occurring in Viet Nam. And recently, there was a scare in Indonesia as three people died of bird flu who lived in the same house:

There is also a question as to whether those 3 victims were exposed to the source at the same time or whether one of them was the index case and transmitted the virus to the other close family members sharing the same genetic susceptibility to the virus. As we know, the 2nd case showed symptoms 10-11 days after the 1st, the 3rd case a few days later: an unusual incubation period for avian influenza if they were exposed at the same time. My hypothesis is that they were grossly exposed to a (so far unknown) source, possibly repeatedly. Alternatively, one victim could have become a new infection source for the others who have similar genetic susceptibility.

Some health professionals point to Viet Nam as a possible starting point for the pandemic. But Viet Nam has been tremendously cooperative with international health officials in cataloging and studying the virus.

Not so China. This report was from July 20 in the Washington Post:

World Health Organization officials and other international health organizations have asked the Chinese government for details about three outbreaks in the remote western provinces of Qinghai and Xinjiang. In seeking to head off a potential human pandemic, international health experts said they require samples of the bird flu virus, analyses of its genetic makeup and specifics about the extent of the infection and efforts to contain it.

“It is a matter of urgency,” said Julie Hall, coordinator of communicable diseases in WHO’s China office. “It is an outbreak of potential international importance. We’re looking for China to share the information as quickly as possible and as much as possible.”

While Chinese authorities allowed a team of investigators from WHO and the U.N. Food and Agriculture Organization to visit Qinghai last month, the government has yet to respond to a June 17 request by international health experts to travel to Xinjiang, U.N. officials said. The Chinese officials, saying the infection in Xinjiang has been contained, have given no indication they will authorize the trip.

U.N. officials and independent scientists said they were reluctant to publicly discuss their frustrations with China for fear the government would shut them out of the country. But officials and researchers said they were dismayed with the government’s secrecy, especially after China ran afoul of international agencies for its response to the SARS epidemic that began in 2002. China’s health minister was fired after the government acknowledged it covered up the SARS outbreak.

Viet Nam apparently learned its lesson from the SARS outbreak and have provided all the cooperation that the WHO has asked of them. But the Chinese government is suffering what can perhaps best be described as a hangover from the secretive society created by Mao and brutally enforced by Deng Xiaoping. Despite all the economic reforms, China still has a long way to go before becoming a grown up and responsible member of the international community.

Given this mindset, it’s entirely possible that the first cases of human to human transmission by casual contact could occur in China – it could occur and we wouldn’t realize it until it had already spread to other countries. By then it would be too late. Given the fact that we live in an age where international travel is commonplace, bird flu could be in half a dozen countries before the world would be able to react.

Glenn Reynolds for one, is still being cautious about pushing the panic button. I love Glenn Reynolds to death but for God’s sake Mr. Instapundit! When people whose job it is to calm us down start talking about “inevitable” pandemics with “100%” certainty, isn’t about time to hit the red button and raise the alarm? The government should be mobilizing every information source they have access to and start getting the word out now. There are steps people can take to minimize the risk of catching the bug. Those measures should be pounded home on every news channel every day from here on out.

Time may be running out. And most of us have done precious little to protect ourselves.