Routine Branswell

Routine flu reporting from Helen Branswell means "superb." What makes her the top flu reporter is her precision, wide range of important contacts, knowledge of the subject and reliability.

All of these are on display in her recent article for Canadian Press on the latest announcement by China that there has been another bird flu death there.

Chinese authorities announced another human case of H5N1 avian flu Sunday, a man from the southern Chinese province of Guangdong who fell ill Feb. 22 and died March 2.

The case came to light amid warnings from the World Health Organization that other human cases may be going undetected in the world's most populous country.

In an interview from Beijing, the WHO's senior person in China paused when asked if he felt there was more human disease in the country than Chinese authorities are admitting.

"It's very conceivable that there are more cases," said Dr. Henk Bekedam, the WHO's representative for China.

"But we do not have the impression, at least from the central ministry, that they are hiding information from the outside world." (Helen Branswell, Canadian Press)

In the first five lines of this piece we learn that WHO's person in China thinks there are probably more cases not detected and that if cases are being hidden it isn't at the level of the central ministry (presumably the Ministry of Health). Plenty of wiggle room here and Branswell heard it.

Every line of this article is packed with information. For example:

When suspected human cases have cropped up in other countries, the WHO has required testing by a external laboratory before it officially confirms a case. But to date China has not agreed to send out its specimens for independent testing. And the WHO has accepted positive tests from China as confirmation of H5N1 infection.

Many outside the country are skeptical of whether China is reporting the full extent of its H5N1 problem. The country's deeply engrained tradition of secrecy - evidenced by its attempts to cover up the emergence of SARS in 2003 - is fuelling a belief that China's problems are more extensive than the country is willing to admit.

There are also suspicions that Chinese officials choose strategic moments at which to announce new cases. Last weekend, when world media attention was focused on the discovery of Europe's first outbreak of H5N1 in domestic poultry - at a turkey farm in Ain, France - Chinese authorities announced two additional human cases. They became a footnote to the coverage of Europe's spreading H5N1 problem.

Branswell questioned Bekedam on these prevalent suspicions and he acknowledged he was aware of them. She reports him as saying he believes the problem, however, is China's inability to detect cases in its huge population spread out over a huge territory. But we hear also some vagueness, with Bekedam expressing himself in terms of "impressions" and invoking his regular contact with the Ministry. He clearly has some reservations:

Unlike other jurisdictions, where suspected human cases are quickly reported - and often just as quickly dismissed - Chinese authorities do not report until confirmatory testing is completed.

Bekedam said the WHO doesn't object to that system, so long as there are no hints of human-to-human transmission among the people being investigated.

"As long as you're talking about sporadic cases, we have no problem that you inform us at the moment that they have been properly confirmed," he said he has told Chinese authorities.

"But if there are other close contacts who are also sick, then we would like to be informed. And we need to be informed."

We know from other reporting that WHO's relationship with China's Ministry of Agriculture is not as good as with the Ministry of Health (see Nick Zamiska's terrific reporting in the Wall Street Journal noted in this post). Bekedam expressed concerns that WHO was no longer getting notice of widespread poultry die-offs. Perhaps the bird vaccination program was allowing infective birds to remain healthy and go undetected, he speculated. But something seemed amiss:

"So somehow the animal surveillance system is not picking up the sick poultry. And that is of concern," Bekedam said.

He noted that none of China's 14 human cases - Sunday's announcement would make that 15 - were from areas where outbreaks in poultry had been reported. Investigation after the fact uncovered evidence of sick birds in at least eight of the cases.

Recent statements from Chinese officials lay the blame for the virus's spread on infected migratory birds. On Friday, the country's Vice-Premier Hui Liangyu warned that when the spring migration begins poultry outbreaks and human cases could soar in China.

Bekedam suggested his Chinese counterparts may be focusing too much attention on the wrong facet of the problem.

"We . . . still feel that there has been a relative over-emphasis on what's happening up in the air," he said . . . .

This is interesting as evidence of WHO's step away from the migratory bird emphasis. One wonders if they have additional information calling that thesis into question or whether they are only reiterating a belief that poultry movements and endemic cases are not being given their due. This is one of the few things Branswell's article doesn't tell us.

It's just another day at the office for Helen Branswell. This is what flu reporting should be like but seldom is. Kudos (once again).