Effect Measure

China shocks Captain Renault

The latest chapter in the Chinese Disease Cover-up Follies involves a just published report in the New England Journal of Medicine by eight Chinese doctors reporting the genetic sequences of an H5N1 case that occurred in November of 2003. Old news. Except China didn’t officially report its first case until two years later, November 2005. Just as the first issues of the journal were reaching NEJM’s subscribers, were notified that one or more of the authors wished to withdraw the paper. Too bad. Too late.

Meanwhile, the World Health Organization is expressing shock at the reporting lapse and demanding further details.

A spokesperson for the WHO’s China office said officials will be seeking answers from the Chinese Ministry of Health about the discrepancy.

“I think it’s safe to say that we will be asking for more information on this in the wake of the publication of this letter by the eight scientists,” Roy Wadia said from Beijing.

“We would certainly want much more information as to exactly what happened, who this case was, what the possible source of infection was, where he was infected, the treatment — all the standard questions.

“There is information that needs to be shed on this by the Ministry of Health and we will be asking for that.” (Helen Branswell, Canadian Press)

All we need now is Claude Rains, as Captain Renault in Casablanca:

Rick: How can you close me up? On what grounds?

Captain Renault: I’m shocked, shocked to find that gambling is going on in here!
[a croupier hands Renault a pile of money]

Croupier: Your winnings, sir.

Captain Renault: [sotto voce] Oh, thank you very much.


Captain Renault: Everybody out at once!

Yes, we are all shocked China has not been completely transparent about the bird flu cases everyone in the world knew they had, but wouldn’t admit to:

Influenza experts outside China have long believed the country has hidden or missed human cases of H5N1. To date the country has reported 19 cases to the WHO; 12 of those people have died.

“They were just so noticeable by their absence,” influenza virologist Earl Brown of the University of Ottawa said of China’s contention through 2004 and most of 2005 that it had found no human cases of the often fatal disease.


The worrisome H5N1 virus was first isolated from a goose in the southern Chinese province of Guangdong in 1996 and is believed to have spread widely throughout the country’s vast expanses.

When country after country in Asia reported outbreaks in domestic poultry in late 2003 and early 2004, China maintained an official silence, insisting it was free of the virus.

“I think they were probably part of it (the outbreak) and they didn’t look hard or they didn’t tell us when they found stuff,” Brown said.


Flu watchers aren’t surprised that China had cases as early as 2003. In fact, outside China it has been widely assumed, given that three people from Hong Kong became infected with the virus during a visit to Fujian province in February 2003.

But those cases — only two were confirmed as one died without being tested — were shoved off the world’s radar screens within days. That’s because SARS exploded in the intensive care wards of hospitals across Asia and in Toronto.

“It’s clear that (H5N1) cases were occurring in China before they were reported and likely have occurred since — and were not reported,” infectious disease expert Dr. Michael Osterholm said when told of the letter. (Branswell, CP)

This blog’s IP has been banned in China so we won’t offend the Chinese authorities when we say, “What a bunch of dumb peckerheads.” [NB: A peckerhead is not a type of bird.]


  1. #1 anon
    June 22, 2006

    how do we know, that the request to remove the letter
    was too late ? Can this be verified ?
    The Chinese obviously didn’t think it
    was too late. It could be NEJM’s policy to
    get the letter printed, although it wasn’t really
    too late…
    Did the Chinese comment on this ?
    You wrote it was a “report” but I read it was
    a “letter”. Is a scientific article about the case
    expected to follow ? Was this being planned and now
    cancelled ?

  2. #2 revere
    June 22, 2006

    anon: It is a scientific report in the Letters section. Letters in the NEJM are reviewed (I know this because I’ve published there). Many Letters in NEJM contain scientific data. It is a fast track way to publish some things if they are very short. This one had clinical data.

    Withdrawal was too late for two reasons. It had already gone out to the NEJM’s First Class subscribers (it was in the mail by at least a couple of days by the time the withdrawal request was tendered) and therefore officially published; and you can’t just “withdraw” a published paper. You have to retract it, and that requires all the authors to do it and state a reason. The request for withdrawal came without any explanation.

  3. #3 Trina Bashore
    June 22, 2006


    You all should be able to come up with some fowl language for this situation.

    Maybe they were – to chicken sh** to come forward.

  4. #4 revere
    June 22, 2006

    Trina: My theory is they are a bunch of turkeys.

  5. #5 Tom DVM
    June 22, 2006

    I’m sure the Chinese authorities are shaking in their boots now that our ‘gutless wonder’ the WHO is on the case.

    “…the World Health Organization is expressing shock at the reporting lapse and demanding further details.”

    This is a surprise? Where are the cases from 1990-1996.

    Revere, why not do an expose on Foot and Mouth disease in China? China has been and continues to cover-up an outbreak that has been going on for more than a decade…and isn’t that funny, just showed up as an outbreak of unknown origin in Vietnam…sound familiar.

    The WHO’s inability to deal with China on any issue with any authority pretty much ensures that we will have at least one pandemic within the next two years.

  6. #6 Marissa
    June 22, 2006

    Oh Casablanca… one of my favorite movies! And Claude Rains and Humphrey B are so cute. But seriously… I would not be surprised if there were several cases of H5N1 admixed with the SARS cases.

  7. #7 Trina Bashore
    June 22, 2006

    Or perchance, we should thank the egg-cellent peep-le for cracking this wide open.

    Sorry for venting my defense mech. of dire humor(?) about this but … this has scary implications. Wasn’t the story that this jumped from civet cats (the coronavirus)? So does this mean that H9N2 is a likely precursor of H5N1, or not? If H9N2 was in circulation with H5N1 was the N2, carrying the stalk deletions in the N in the same places? Are the two historically in different areas of the N?

    Is that N2 holding traits in common with North or South America?

  8. #8 revere
    June 22, 2006

    Marissa: You may be right about the SARS and H5N1 cases (since is an example). SARS was first thought to be H5N1 by WHO.

    Trina: H9 has alpha 2,6 recognizing HA and Webster worries a lot about it as a pandemic virus. Since we don’t know what causes virulence, if it were primarily a function of the other segments of H5N1 and there was compatibility between those segments and H9, a reassortant between H5N1 and H9N2 would be bad news. The spread of H5N1 into areas where there was previously H9N2 (e.g., the middle east) is something people are keeping an eye on.

  9. #9 anon
    June 22, 2006

    from NEJM webpage:
    (Editor’s note: The Journal has received a brief communication from the authors of “Fatal Infection with Influenza A (H5N1) Virus in China,” asking that their letter be withdrawn. We have received no further explanation, and the letter has already been published in this week’s issue. We are investigating the situation.)

    So, both the authors and the editor refer to it as a “letter”. And not a “published paper which you can’t just withdraw”. And they don’t say when they received the
    request for withdrawal.And the situation seems to be unclear enough to require investigation.
    If some US-organizatioon had requested the withdrawal
    with similar timing, do you think NEJM had complied ?

    I would also be interested to hear, how the letter was transmitted in the first place and who and why requested the withdrawal.

  10. #10 LG
    June 22, 2006

    Anon: I had already *received* my copy of NEJM by the time the withdrawal request was put in to the journal. There’s just no way you can withdraw it at that point.

  11. #11 revere
    June 22, 2006

    anon: A Letter in the NEJM is a particular kind of communication. This is similar to the use in The Lancet and other places. It is reviewed prior to publication.

    I don’t think country of origin has any bearing here. Once something is in the literature then removing it becomes a problem. A good journal like NEJM doesn’t just “disappear” a paper. There is a process, regardless of authors. If the authors wish to publish a retraction or issue a correction the journal considers it. It is not material these are Chinese authors.

  12. #12 Lisa the GP
    June 22, 2006

    A letter in a scientific journal isn’t always of the ‘letters to the editor’ type, which are generally reactions to articles that have been printed. Often they are short preliminary results of important early results from research, which the authors wish to publicise quickly, either to make sure they’re on the map as the first to make the observation, or because the information is urgently needed by the community.

  13. #13 M. Randolph Kruger
    June 22, 2006

    Dear China,

    Thanks for holding the bird flu conference in December it was so very nice of you to ask the west for 9 billion dollars so you could pay your poultry farmers off, just so they could grow new endemically sick birds in and on endemically infected grounds and coops. We also want to thank you for your witholding of sequences, information and oh by the way what happened to those 6500 people that were sent up country and never seen again? Did you forget to tell us about those cases too or was it just another one of those Chinese oversights? So many people, so many to repress and torture. Where in Hell is my little red book?

    We have in America been sleeping with the enemy, but for a change the entire world just got screwed. And it only cost us 9 billion ? Thats about 1.50 per person on the planet. Really cheap whores you guys are.

    In a world that is poised to take the hit of human history in a pandemic environment we can only wonder why that out of a population of several billion people that are being controlled by less than 25,000 elite Communists that they allow this to continue. No guns? Then, “Why not try rocks”? Its an interesting question because if everyone in Beijing simply threw a rock at the head office, the pile would be several hundred feet deep and you would be dead. You might be anyways soon as you have used the Guadong province as the bird flu petting zoo at the expense of the entire planet and you were CLEARLY trying to develop a vaccine for it. Does it surprise anyone that you just popped up with a 73% effective vaccine. Well it likely is too little to late you rice propelled motor scooters. Your repressionist attitudes and the use of human vaccines on poultry may have given this crap a pathway to humanity and likely rendered anything we can do to nil.

    All of this is for what is good old capitalism on the world scale and putting the jack boot on the neck of your people in country. Hey, we have some libs who will send you Dick Cheney for training camps. I would hate to see him go, but for 9 billion he might clear his calendar for a month.

    To cut to the chase and just to say it, “Boys, you have finally gone far enough. You made the biggest mistake in the history of the world and that my friends is that you have made me mad. Your second mistake is that you lied about it and now third you likely are going to be responsible for the sickening and deaths of billions which may include my friends and family. Thats strike 3 boys and in this game you are out.”

    It amazes me that only 5 people in the ChiCom world had the cajoonies to take your Joeseph Stalin world and stick it so far up your butts that they are going to have to have it surgically removed. Its a nice little kick in the giants knee and I wish that say 2 or 3 billion ought to do it right now too. Death of a thousand kicks. Those guys need a Nobel and not for vaccine. Nope they have gone miles today to preserve world peace. My first inclination is to haul your asses into the UN Security Council and ask you to explain this revelation. On the other hand you will veto anything that we want to do and you are already trying to veto the families of the “responsible parties” for the press release. You will of course just say it was a mistake, an error, a…….next label please.

    It wasnt an oversight, nor was it anything other than a bunch of jerks on the Pacific side trying to cover their collective asses just like we try to cover ours here in the US. Why not just renounce Communism? At least the people will get to bitch about it as they die of ARD associated with Bird Flu and they might only imprison you rather than string you up as they did Mussolini. Better than that. I would have you down without a mask hauling bed pans out of the local SARS/H5N1 wards.

    Be glad I am not in charge. I would have an embargo on you so fast it would make you think that I was in charge of the Titanic. Sometimes you DO have to go down with the ship. This might be one that I would tie you to the helm with lots of made in China chain, that was formerly of course made in the USA.

    Stern warning boys. You had better start ponying up the sequences, the information and report them as fast as the crap drops out of one of those two legged superturkey feathers and flu carriers produce it. Else you might be staring down the barrel really fast. You might not be able to understand the words, “Justifiable Homicide'” but in America, we invented them.

    Have a nice day.

  14. #14 tan06
    June 22, 2006

    Since we have between us and China ‘the great fire wall’, how can we get information about the fate from now on about Qing-Yu Zhu, M.D.; E-DeQuin, M.D.; Wei Wang, M.D.; Jun Yu, Ph.D.; Bo-Hua Liu, Ph.D.; Yi Hu, Ph.D.; Jian-Fei Hu, Ph.D.; and Wu-Chun Cao; M.D., Ph.D. in China, who all contributed to this letter?
    For I am greatly admiring their courage to send this to the NEJM, and I read the full text of the article, and it has some implications on developing an effective vaccine against the H5N1 virus, when we consider their published appendix with phylogenetic analyses of representative H5N1 viruses.
    Are you already studying on it, Henry Niman?

    The government of China could prevent any damageing effects to their position by wholeheartedly and freely admitting it was very hard by 2003 to detect H5N1, and that from 2005 on they’ve had the wisdom to be transparent on H5N1 reporting and surveillance procedures.
    Everyone would accept their explanation.

    So let the concomiting action to withdraw this letter be just some hesitant acting-out from some scientists who are not yet used to this new policy of the China government. Please.

    Better halfway turned from failure than totally gone wrong at the end (or how does such a saying go in English)?

  15. #15 Marissa
    June 22, 2006

    Revere: do you remember anything about H9N2 prevalence, virulence and outbreaks during the last 10 years or so?

    Trina: Yes, the immediate SARScoV was civets, but the ultimate repository was Chinese horseshoe bats.

    I would think the South Korean debacle over cloning should have told the Chinese what not to do. Hello, Will Robinson! Danger!

  16. #16 Grace RN
    June 22, 2006

    China is getting so very good at proferring and thenquickly taking back; perhaps glue should be put on one’s hands when receiving their papers…

  17. #17 ipmat
    June 22, 2006

    Doctors Qing-Yu Zhu, E-De Qin, Wei Wang, Jun Yu, Bo-Hua Liu, Yi Hu, Jian-Fei Hu, and Wu-Chun Cao:

    I would like to express my appreciation for both the work you have done investigating an infectious disease which is a threat to us all, and your willingness to quickly release findings to a venue with wide accessibility to scientists and lay people worldwide. Given competing interests both within and outside the scientific community, this is not always easy to do. For this reason, I admire people like yourselves and Ilaria Capua for setting an example by taking a stand on openness in such an important area.

    In your case, I realize the potential repercussions could be much greater than for most. The initial decision to send the letter to the New England Journal of Medicine can not have been easy. I fear that your attempt to retract your letter means some person or group inside China is applying pressure to some or all of you. I sincerely hope that you all remain both well and free to continue your work.

  18. #18 M. Randolph Kruger
    June 22, 2006


    Our Chinese friends who produced the letter are going to need some cover and that can be provided with a simple email request. Hit Senator Frists office at


    Now please keep the rants to a zero here and stay focused. We are literally interceding to keep these guys alive. I am hearing from my friends in the university in HK that these guys are not only out on the limb, they sawed it off behind them and they knew it when they did it. They didnt do it for political gain, they did it because they are just about like us and they know the difference between right and wrong. They are possibly looking at life in prison… or worse. .

    The guys who ran Boxun.com that alerted the world to the SARS outbreak are currently in prison for the rest of their lives for “releasing” information that was ” incorrect ” to the press. We all now know that this was B.S. and everyone of these guys put it out on the line to let the world know. The PLA I can assure you is not a group to screw with. Time to let the ChiComs know that this is unacceptable in todays world.

    Please, just a quick email asking for the Senator to take action to ensure these guys dont end up on the Chinese dissident heap. No rants or anything political. Send that to the other in boxes.

    They knew when they did it that there could be no retraction. Oh, they’ll say that it was a mistake but over there they round people up and they are not heard from again. A quick letter from the Senator to the Chinese, or a push to the State Department will prevent them from being removed from their posts. It might also keep them and their families alive. They cant dissapear if a Senator starts asking questions about Dr. So and so.

    It might also force the Chinese to release a lot more information as they acquiesce to the will of the world. The WHO also has one more chance as well to restore themselves and bring the issue to the UN Security Council if they cant get the right answers. No more damned politics. This stuff is starting to get legs and its going to start taking a lot of people with it.

    Send the email. Be brief and concise. Dont rant. Get the message across that you want something done!

  19. #20 Thinlina
    June 22, 2006

    Adding here just the first lines of the news:

    “www.chinaview.cn 2006-02-14 08:26:16
    BEIJING, Feb. 14 — Infectious diseases in 2005 killed almost double the number of the previous year, and authorities warned that the true figure might have been under-reported. —“

  20. #21 M. Randolph Kruger
    June 22, 2006


    I saw something like that for Vietnam too. Hell, they didnt get rid of H5. They just quit classifying it as such. They just call it viral pneumonia and let it go. At the height of the H5N1 outbreak they were seeing 15 cases a day… Did someone flip the switch or did they stop everyone from reporting it.

    I am a firm believer that they will “announce” bird flu when every country reports that they have it in their borders, or nearly every country. The reasons for this are economic and if they call Pan 4 many businesses have already made plans to repatriate their workers from around the world. Everyone will start pulling their economic horns in and a worldwide recession will begin. Think about what will happen after 4 months of pandemic and then poof drop 300 million on their likely misguided 3% model of 1918 out of the purchasing picture. Man its going to be tough and tougher for each million or two of the population that this stuff smokes for the people that are left.

    We can only deal with whats in front of us with this stuff. There is not enough money on this planet to take care of bird flu and the lead time could be ten years even if there were.

    So we just deal with it.

  21. #22 Thinlina
    June 22, 2006

    Sent a message to

    Please come along, people! 🙂

  22. #23 Aileen
    June 22, 2006

    Sent a message to

  23. #24 Thinlina
    June 22, 2006

    The population of Finland is about 5,2 million people. In the year 2003 there were about 3350 reported infection related deaths according to this article (in Finnish) http://www.terveysportti.fi/terveyskirjasto/tk.koti?p_artikkeli=sae07000 .

    If the infection death rate in China (population about 1,3 billion) were the same – which it isn’t due to health care infrastructure differences between the two countries – there would have been about 830 000 deaths due to infections in China before. After this news that the infection death rate would have been doubled, there could be at least 1,6 million infection related deaths last year. And this figure is counted based on Finland’s reported numbers. In Finland almost everyone has access to antibiotics when needed.

  24. #25 Rod
    June 22, 2006

    Sent a brief message to Ken.

  25. #26 tan06
    June 23, 2006

    You can also send a mail to the Chinese ambassy in your country. As many political influencers as possible.

  26. #27 caia
    June 23, 2006

    Randolph: Is there a particular reason you chose Frist and/or this particular staffer? I’m thinking I might have better luck emailing my own Senator, unless there’s a good reason to do otherwise.

    Revere: You may have been implying this with your Casablanca reference, but I think the WHO’s response is exactly right: play ignorant and upset. They can’t very well roll their eyes and say “duh,” even if it was common knowledge that the Chinese had previous (and probably the first) human cases. What the Chinese doctors did (which, go them) was give WHO, other countries, and interested parties the cover and the justification to demand the answers publicly that have so far been only asked for privately.

    If I’m not mistaken, you’ve said before that we will need to rely on this kind of self-sacrificing breaking of the rules for the public good, as we did with SARS. (If it wasn’t you, it was Crawford, and I hope you won’t mind me getting you confused looking back months.) It’s reassuring to see this happen again – such heroes are necessary, and usually under-appreciated.

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