We are one family

When the world is concentrating her effect to contain H7N9 in Mainland China, we have another earthquake in SiChuan province on 20 April 2013 which harmed more than ten thousand Chinese with many casualties. I was driving back to my office the next day while listening to the talk on this topic in Radio Hong Kong. Among words of sympathy towards the victims, they were some who complained about the corrupted bureaucracy in Mainland which deter their donations to the victims.

The earthquake, China’s worst in three years, occurred at 8:02 am on 20 April 2013 in Lushan county near Ya’an city and the epicentre had a depth of 12km. Most of the deaths were concentrated in Lushan, where water and electricity were cut off. Pictures on Chinese news sites showed toppled buildings and people in bloodied bandages being treated in tents outside the hospital, which appeared only lightly damaged.

Ya’an is a city of 1.5 million people and is considered one of the birthplaces of Chinese tea culture. It is also the home to one of China’s main centres for protecting the giant panda.

It is a pity to see once again our motherland being disrupted by natural disaster. As a doctor, we should have a caring heart to give our helping hands to those in need especially so in our motherland. It is indeed saddening to see that such helping hands from Hong Kong to the victims are jeopardized by corrupted system in Mainland China. Whether the filibustering measures taken by some legislators to deter the Government’s intended donation of HK$100 million to the victims is righteous or not, we should not refrain from helping those in need as we all come from the same family.

As regards H7N9 pandemic, the health authority in Mainland China is more clever and transparent nowadays. From the way that news reporting day after day since its first occurrence on 19.2.2013, I am sure there are not much to hide in the pandemic status of the North Eastern part of China.

In order to protect the health of the community, we immediately met with the Centre for Health Protection (CHP) on 16.4.2013 to understand the new developments of the H7N9 and at the same time announced to the media to persuade our colleagues to get prepared for the spread of H7N9 from the North. (Please refer to page 9 of this Bulletin)

In view of the threat from Avian Influenza Pandemic, your Council is desirous to update the Guidelines on Avian Influenza Pandemic awaiting confirmation of the contents from CHP and the Hospital Authority (HA) for our members. Most of the revision would be in Annex 2: Guide to Doctors on Use of Antiviral Agents since the virus particle is not H5N1 but H7N9 this time which has lower mortality in birds than humans. Up till now, the mortality in infected human beings is high, around 20%. Its difference from H5N1 is its short duration, around 4 days, to develop into serious pneumonia which is life threatening.

So far, Tamiflu and Relenza are said to be only effective in these patients. Up till now, there is no definite human to human transmission. Even the first case imported into Taiwan from Jiangsu is proved not to be by human to human transmission. However we should stay alert for such Avian Flu attack by first of all stocking up PPE for at least one month and even stocking up some Tamiflu or Relenza. The Government advised our doctors not to treat suspected cases but to (1) report to CHP and to (2) refer to regional hospital in HA and further to (3) report to the HKDU secretariat for case follow up if required. So Prepare, Protect and Detect are the 3 keywords for you in this stage of the pandemic. Tamiflu or Relenza are reserved only for prophylaxis treatment of clinic staff if there turns out to be a confirmed case from the clinic.

According to CHP at 25.4.2013, a total of 109 laboratory confirmed cases of human infection with influenza A (H7N9) virus has been recorded in Mainland: 42 cases (including 6 deaths) in Zhejiang Province, 33 cases (including 12 deaths) in Shanghai Municipality, 24 cases (including 4 deaths) in Jiangsu Province, 4 cases in Henan Province, 4 cases in Anhui Province (including 1 death), one case in Shandong Province and one case in Beijing Municipality.

Moreover, an imported case from Jiangsu Province was recorded in Taiwan affecting a 53-year-old man who returned from Jiangsu Province to Taiwan on 9 April.

According to experts, most of the patients with confirmed H7N9 infection were considered to be at increased risk for complications from influenza owing to age (<5 years or 65 years) or the presence of certain underlying medical conditions. Among 82 confirmed cases of human infection with avian influenza A (H7N9) virus as of 17 April, the median age was 63 years (range, 2 to 89) and 73% were male. Infected poultry and poultry contaminated environment are suspected to be the likely source of infection in human.

In two family clusters, non sustained limited human-to-human transmission of H7N9 virus could not be ruled out. In view of the latest best available evidence, the longest incubation period of human infection with avian influenza A (H7N9) virus has been revised from 7 days to 10 days and the epidemiological criteria of the reporting criteria has been revised to exposure to conditions as listed on pages 8 of this Bulletin within 10 days prior to symptom onset.

We can hardly fight against the Avian Flu Pandemic without all the information updated by close networking with Mainland China. Only with our common dream of building a safer and wealthier China can we achieve such goal.

Dr. Yeung Chiu Fat Henry

25.4.2013