# 1684
On the heels of yesterday's announcement that a 22-year-old man from Hunan Province died last month from the H5N1 virus, we get word of a second outbreak among poultry in Tibet this year.
News out of China is often slow in coming . . . assuming it comes at all.
China recently ranked 163rd out of 169 nations (hat tip Crof!) in Reporter's Without Borders yearly rating of Freedom of the Press worldwide. Only Burma, Cuba, Iran, Turkmenistan, North Korea, and Eritrea were found to be more repressive.
China obviously has a bird flu problem, but you'd hardly know that from the `official reports'. With a population of 1.3 Billion, 15 times greater than Vietnam, they report only 28 human cases compared to Vietnam's 104 cases.
These numbers (if true) would suggest that the incidence of bird flu is 50 times greater in Vietnam than it is in China. That hardly seems likely.
Hong Kong, a territory with just 426 sq miles to monitor, reported 21 H5N1 infected birds discovered in 2007 (and 4 so far this year). Mainland China, with 3.5 million square miles, rarely reports on infected birds at all, yet their territory is 15,000 times greater.
Occasionally we'll hear of a small outbreak, already contained, in poultry somewhere, or even more rarely, of a human case. But that's about it.
The silence out of China is deafening.
How much of this under reporting is due to a lack of surveillance and testing, and how much is actual suppression of the news, is impossible to know.
Nor can we know the true extent of the bird flu problem in China. We can surmise, based on what other nation's in that region are experiencing, but we can't truly know.
While we watch the unfolding of avian flu events from half a world away, we do so with the somber knowledge that we are likely seeing only a fraction of the story. And of course, this problem isn't limited to just China. Many of the countries worst hit by the virus are also the least likely to be upfront about the problem.
Myanmar (ranked 164th) , Vietnam (162nd), Pakistan (152nd), India (120th), and Indonesia (100th) are all hard hit by the virus, and all rank in the bottom half of the world's freedom of the press index.
Some of this obscuring of the truth comes from a lack of surveillance or testing facilities. And much is caused by poverty and ignorance. Millions of people die every year in remote villages (or even overcrowded and poor urban areas) throughout the world without ever seeing a doctor. Detecting avian influenza cases in these regions requires a good bit of luck.
And that assumes anyone is looking.
While we earnestly report every known bird flu fatality, we actually have no idea what the real numbers are. Human cases are almost certainly under reported, we just don't know by how much.
Ship's captains plying the extreme northern and southern latitudes know that small chunks of ice poking out on the surface indicate much larger masses of ice beneath. Nine/tenths of the danger remains hidden under the surface, and out of sight.
The same is probably true for bird flu.
China confirms second bird flu outbreak in Tibet this year
www.chinaview.cn
2008-02-19 16:24:00
BEIJING, Feb. 19 (Xinhua) -- Chinese authorities have confirmed a new bird flu outbreak among poultry in Tibet, the second case of this year in the southwestern region, the Ministry of Agriculture said.
A ministry statement said that 132 poultry had died in the epidemic in a village outside the regional capital, Lhasa, since it started on Feb. 6, while another 7,698 have been culled.
The National Bird Flu Reference Laboratory confirmed the virus as a subtype of the H5N1 strain on Sunday, it said, adding that emergency measures by the local government had brought the situation under control.
The previous outbreak in Tibet, detected in the region's Gongga County on Jan. 25, killed 1,000 chicklings and ducklings and led to the culling of an additional 13,080 birds.
The Ministry of Health said on Monday that a 22-year-old man surnamed Li in the central province of Hunan had died of the virulent H5N1 strain on Jan. 24.
There have been 18 human deaths from the H5N1 strain and 28 confirmed cases of infection in China since 2003, according to World Health Organization (WHO) data.
The deadly virus is most commonly passed from sick poultry to humans through close contact. From 2003 to Feb. 15, 2008, WHO data indicate that 227 people died in 361 confirmed human cases of H5N1.
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