Taiwan | Random Analytica

February 19, 2014

Random Analytics: H7N9 by Employment (to 250 confirmed)

The Avian Influenza A(H7N9) continues its steady attrition. According to Flutrackers there have been 358-cases of H7N9. With Wave 1 (45) and Wave 2 (32) fatality counts as confirmed by Xinhua my unofficial fatality total stands at 77 (a Case Fatality Rate of 21.5%).

While updating the most recent case details to my personal H7N9 Db today, a 29-year old female from Changsha, Hunan I noticed that we had reached an interesting milestone. Of the 358-cases thus far I have now been able to confirm 250 of their job titles.

Let’s look at the data to data.

Looking at the Job Titles we still find that the leading data item (occupation) is Farmer (35.6%), then Retired (24.4%) then the two paediatric titles of Primary School (5-12) and Child (0-4) with a combined total of 21 (8.4%). I’ve now been able to record 40 different titles with the top half accounting for 61.2% of the entire data, the bottom half just 8.6% and unknown 30.2%.

Some further points of interest:

In Wave 1 (to case #136) Farmers represented 28/136 of all cases (20.6%). Currently in Wave 2 there have been 222 cases of which 61 were Farmers (27.5%);
The current average age of the H7N9 impacted Farmer is 62-years while the average age of all H7N9 victim is 54.5-years;
The average age of a H7N9 Retiree is 70.4;
In Wave 1 Paediatric cases (0-15) represented 7/136 of all cases (5.1%). Currently in Wave 2 there have been 15-cases (6.8%) which shows a slight increase;

When we role all the Job Titles into a Job Family the top-3 groups are Non-Participatory (26.5% comprising children, retirees and the unemployed), Farming, Fishing & Forestry (25.4%) and then Food Preparation & Serving (5.3% including catering, chef/cook, food sales, live poultry trade & market vendor).

Of interest:

The first two groups have remained largely unchanged in 2014 but the Food Preparation & Servicing group has been steadily declining in recent weeks (down from 6.9% recorded on the 1^st February);
Only one Healthcare Practitioner (an ER Surgeon from Shanghai) has been recorded;
Along with the single Healthcare Practitioner recorded, no Healthcare Support (Enrolled Nurses, Vet Assistants or Orderlies) or Protective Services (Police, Ambulance, Fire & Wildlife Rangers) have yet been recorded equating to just 0.3% of all cases. A marked contrast to MERS which as Ian M. Mackay noted on 5 February 2014 Health Care Workers accounted for 18% of all cases and 2.7% of all deaths;
The average age of all H7N9 victims without a job title is 57.

Last chart is a look at some main Job Titles in a running total. I’ve included child cases up to the age of 15-years in response to some of Ian M. Mackay’s concerns about an increasing paediatric count.

Given that those unknown job titles cases have an average of 57-years I believe that Retirees are somewhat underreported but given the older age of Chinese farmers it’s hard to estimate a breakdown without some local knowledge (of which I don’t possess).

FINAL THOUGHTS

Without wishing for more H7N9 cases I’ll plan for another employment update as I confirm the first 300 Job Titles.

There is a lot of interesting data in the first 250 Job Titles that I have been able to confirm. I only wish we had some more clarification on the almost 1/3^rd of missing data items.

I’ll continue to scrabble for information as it comes in. Public sourced journals with detailed case studies are excellent sources and I am sure we will be seeing some of the Wave 2 case studies in coming weeks and months.

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February 1, 2014

Random Analytics: H7N9 More Employment Graphs (to 31 Jan 2014)

The Avian Influenza A(H7N9) continues its steady attrition. According to CIDRAP there have been 277-cases of H7N9 with the fatality count standing unofficially at 61 (a Case Fatality Rate of 22%).

Earlier in the week I posted some analytics looking at the case list employment data. Subsequently I’ve been involved in a rolling tweet-up with Ian Mackay, A biologist and Potrblog.com on some of those findings. Some of that discussion has caused me to further reflect on the data I presented.

Reflection then turned into action (and some updated/revised charts plus one new one!).

The first chart is very similar to the H7N9 incidences by Job Title previously released with the exception that I have updated a number of Job Titles to align with the Chinese data (i.e. amended Maid (Expat) to Domestic Helper) but also to better reflect actual real world situations. Thus School Age (5-17) has been split into both Primary and High School age groups.

The current chart reflects Job Title data in 204 of 277 cases (73.7% of all data inputs). The two predominant employment types continue to be either a Farmer (33.8%) or Retired (27.5%). Farming job titles are up slightly and Retired job titles are down slightly from data released earlier in the week.

Some further points of interest and conjecture:

In Wave 1 (to case #136) Farmers represented 28 out of all 136 of all cases (20.6%). Currently in Wave 2 the following 141 cases had 41 Farmers (29.1%);
The current average age of the H7N9 impacted farmer is 61.9-years. More than 5.1-years over the average age of all those impacted by the virus, which probably demonstrates an ageing issue for Chinese agriculture; and
The average age of the H7N9 retiree is 71.3. How good is the Chinese economy, its medical system and its infrastructure compared to barely three decades ago?

Before I go on to my next three charts I want to discuss the importance of job titles. During my tweet discussions this week I brought up the issue of the differentials between a small cropping and a pig farmer. Everyone agreed with the issue but, by chance, I found a great example as I was completing my data updates today.

Via CIDRAP reported (29 Jan 2014). Seven new H7N9 cases, plus family cluster, reported. Detail:

The family cluster reported today involves three people from Zhejiang province, a 49-year-old man, his wife, and their 23-year-old daughter, according to a report from Xinhua, China’s state news agency. All three cases were previously reported. The man’s infection, which ultimately proved fatal, was confirmed on Jan 20. His daughter got sick 3 days after taking her father to the hospital, and she is in serious condition. The man’s wife’s infection was confirmed on Jan 27, and her illness is mild, according to Xinhua. Media reports in China yesterday, citing officials from China’s Center for Disease Control and Prevention, said the parents are from Xiaoshan and worked as vegetable dealers in a live-bird market before they got sick and that their daughter had worked at the market for a short time, the South China Morning Post, an English-language newspaper based in Hong Kong, reported today.

That detail might have made me change my job title for the parents to a Market Vendor, yet I suspect they are a small cropping family (who as first reported are ‘Farmers’) who also ran a small vegetable stall in a local poultry market (thus a secondary occupation of ‘Market Vendor’/’Vegetable Dealers’). Their daughter who also became ill was first reported as ‘Staff’ potentially equating to her role as running their market stall.

For all the conjecture that I put forward they might have caught H7N9 from wild birds at their vegetable farm, rather than the poultry market.

The second chart looks at employment by Job Family (see previous H7N9 employment related blog for methodology). Unlike the previous post about Job Families I thought it important to include the unknown data inputs which have been relatively unchanged since the commencement of the outbreak in February 2013. The largest groups are represented by Non-Participatory (27.4% comprising children, retirees, students and the unemployed), followed by unknown employments (26.4% or more than one in four) finally followed by Farming, Fishing & Forestry (25.6%). After those two groups Food Preparation & Serving (6.9% including catering, chef/cook, food sales, live poultry trade, market vendor) and Production, Factory & Food Processing (2.5% comprising butcher, factory worker, poultry abattoir, sheet-metal worker and stone processor). Those five groups equate to 88.8% of all cases.

The final chart asks the question. Has the recent spike in H7N9 cases been over represented by farmers?

Short answer is No.

The above chart displays acquisition by employment type (at onset) with four main groups represented: Farmer, Retired, All Other Known Employments and those that are currently unknown.

Two key months dominate. April 2013 and January 2014. By the end of April Farmers represented 19.7% of cases, currently they have increased by more than 5-points to 24.9% while Retired have reduced from 31.8% to 20.2%. Farmers moving from one in five to one in four H7N9 cases is still a reasonable movement but a trend has (not yet) been proven.

Let us give it one or two more months…

Stay safe, stay healthy and continue to make good choices.

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January 27, 2014

Random Analytics: H7N9 by Employment/Zhejiang Age Pyramid (to 26 Jan 2014)

This week (ending 26 January 2014) the Avian Influenza A(H7N9) has been busy. According to CIDRAP at least 45-cases have been reported during the past seven days alone, topping the busiest weeks of the disease in its first wave (approximately April 2013). As of today 245-cases of H7N9 have been reported with an unofficial fatality count of 57 (a Case Fatality Rate of 23.3%).

As someone who has practiced Workforce Planning for a decade or more I am always interested in what people do. One item I have noticed over the past ten months of amateur epidemiology is that health researchers are also interested in what you do, especially where your work (or lack thereof) puts you at risk or directly in harms-way of disease or death.

Here are some more H7N9 charts looking first at employment then an age chart concentrating on Zhejiang Province which hit 100-cases as of today.

The first chart looks only at the Job Title announced via a medical facility, Chinese media or via an online journal or study (the latter being my preferred). Over the past ten-months I have been able to populate my Job Title data in 179 out of 245 cases (or 73.1% of all H7N9 cases). The two predominant employment types are either a Farmer (30.7%) or Retired (28.5%). Potentially this proves the theory that exposure to live birds either in a farm setting or purchasing birds from live markets (as many retirees are understood to do) might increase your chances of catching H7N9. After Live Poultry Trade (5.0%) the breakdowns become less than 2.8% shared amongst 35 further job titles. Couple of interesting points:

The average age of farmers infected by H7N9 is 61.0 whereas the current average age of victims is 55.7;
Foreign workers (or even tourists) only make up three (1.7%) of the cases. One businessman from Taiwan, one foreign driver and one Indonesian maid based out of Hong Kong;
There were five unemployed people confirmed in the first wave up to mid-April. The last person confirmed as unemployed was case number #101 with onset 16 April 2013. Does that mean that the unemployed are not catching the disease anymore OR that those without employment are part of the 26.9% of cases without a notifiable job title?
There has been only one confirmed medical staff employment type to have caught H7N9 and to have subsequently died. The case of Dr. Zhang Xiaodong, a 31-year-old surgeon from Shanghai has raised alarms but reflects 0.6% of known job titles and 0.4% of all H7N9 cases to date. When you compare this against MERS-CoV, especially in Saudi Arabia which has seen multiple cases and deaths amongst its healthcare practitioners you can only but commend the Chinese authorities and medical fraternity;
Not trying to stir up trouble but I noted that the Japanese Journal of Infectious Diseases refers to Chinese Farmers as ‘Peasants’ (see page 558 Laboratory Diagnosis and Epidemiology of Avian Influenza A (H7N9) Virus Infection in Humans in Nanchang City, China).

The second chart looks at employment by Job Family (see appended note for methodology). In this we see that the largest groups are represented by Non-Participatory (38.0% comprising retirees, children and the unemployed) closely followed by Farming, Fishing & Forestry (31.8%). After those two groups Food Preparation & Serving (9.5% including food sales, catering, market vendor, chef/cook & live poultry trade) and Production, Factory & Food Processing (factory worker, butcher, poultry abattoir, sheet metal worker and stone processor) equate to 82.7% of all cases. As per my comment in the previous chart this aligns reasonably well with the theory that the disease is spread through the contact with poultry.

Note 1: Often Workforce Planners will use a layered methodology of employment groups with job title as the most granular level up to Job Families. The purpose of this is to split the job titles into logical and practical segments to allow deeper workforce analysis to occur. A job family is a grouping of similar jobs at the highest level that usually consists of several job functions. In Australia I would use the Australian and New Zealand Standard Classification of Occupations or ANZSCO but given I have a choice I’ve opted to use the much more logical Bureau of Labor Statistics Occupation Employment Statistics.

Note 2: I created two groups outside of the BLS methodology. The first was ‘Non-Participatory’ to align with those people unemployed or no longer participating in the labour market. The second was ‘Other’ which reflects job titles such as ‘Worker’, ‘Company Employee’ or ‘Staff’.

As Ian M. Mackay pointed out in his latest Virology Down Under update Zhejiang H7N9 cases hit 100 today. Last chart is a look at the age pyramid for Zhejiang. A quick comparison shows that of male onsets is slightly lower than the total average (61% for Zhejiang, 70.2% overall) although the average age of 57.5 is slightly higher than the 55.7 H7N9 average. This is reflected in the age pyramid with has no Zhejiang cases in the lowest four cohorts and 59% of cases between the ages of 50 – 74. For a comparison against the first 226-cases see: Random Analytics: H7N9 Age Pyramid and Average Age (to 22 Jan 2014).

As always, stay safe, stay healthy and make good choices.

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January 22, 2014

Random Analytics: H7N9 Age Pyramid and Average Age (to 22 Jan 2014)

The very recent death of Dr. Zhang Xiaodong, a 31-year-old surgeon at the Shanghai Pudong New Area People’s Hospital and a number of younger sufferers has raised the spectre that the Avian Influenza A(H7N9) might be morphing into something more deadly in 2014 (as compared to 2013) and only if you listen to mainstream media which is often too quick to push the panic button.

Knowing the go-to people on this subject I thought I’d do some reading.

Via his excellent Virology Down Under blog Ian Mackay, PhD (with the Australian Infectious Diseases Research Centre at the University of Queensland) wrote a piece about this very subject just last week. H7N9 age with time: is a younger adult demographic emerging this time around? Excerpt:

This is a big graphic – sorry for that – but I thought it best to show the distribution of age bands (this is updated from the paper I co-authored recently with Joseph Dudley) alongside the shifting age in total numbers and proportion of cases each week. The data are all publicly sourced and verified against the WHO and scientific literature whenever possible and of course, against FluTrackers excellent case list.

The chart below (click on it to enlarge and see much more clearly) then some comments underneath. Keep the previous sex/week chart in mind (it’s trend has not changed much with the latest cases; these charts also result from a question from CIDRAP’s Lisa Schnirring last Saturday) when looking at this. Is any effect seen below due to the increased female representation?

I’m quite an admirer of Ian’s work, especially those graphs looking at accumulation/epidemiological data. I couldn’t help but notice that his Age Band chart uses a standard 2D column graph rather than a 2-way bar graph as used by demographers. I thought the use of that methodology along with a graph showing the decline in average age since October 2013 might be a better illustration of his very sound reasoning.

So, to add emphasis to Ian’s article I spent last night updating my H7N9 data, untouched since early December and did a couple of new graphs up to and including case number #216 (sourced from FluTrackers).

The first graph is an age pyramid (otherwise known as a beehive graph) commonly used by demographers and health experts to map population and mortality distributions. As you can see by using this methodology I’ve been able to bring the population groupings to just 5-year intervals which highlights the continued concentration of male onsets (70.2%). Of interest also are the aged cohorts with the highest percentile of cases with 55 – 59 (21-male/5-female/12.1%), 65-69 (19-male/5-female/11.2%) and 50-54 (13-male/10-female/10.7%). These three groups alone make up more than a third of all H7N9 onsets to date.

The second chart shows the average age of all onsets since case number #2 through to case number #216 (minus one case which does not come with age data). Interestingly, the first two victims were aged 87 and 27, thus the average age from those two was 57 which is in the variable range of the virus through its entire 11-month history. As you can see from the coloured section which represents all onsets from October 2013 (effectively, the second wave of H7N9) the average (or mean) age has reduced by approximately two-years. According to my data, the average age for onsets for wave 1 was 57.0 while currently for wave 2 it sits at 52.7.

For the record I am by day a post graduate student and a Workforce Planner. In terms of medical knowledge at best I am a keen amateur epidemiologist who gained an interest in the subject having worked in an Operating Room Suites as an Anaesthetic Secretary a decade ago.

I hope this small piece and further blogs during 2014 (time permitting) adds to the H7N9 discussion be it by an additional or improved data point, analytic or infographic.

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October 15, 2013

QuikStats: Avian Influenza A(H7N9) Autumn 2013

H7N9 in China “is still present and there is still a great deal not yet understood about this H7N9 virus. Other influenza viruses that circulate in poultry often decrease dramatically during the summer months, only to reappear later in the year during cold season. Also, many low pathogenic influenza viruses in poultry have transformed into highly pathogenic viruses.” (Hiroyuki Konuma, FAO regional representative for Asia and the Pacific, 18^th September 2013)

***** Please note that this infographic of the Avian Influenza A(H7N9) was updated with public source information to 1200hrs 3 December 2013 EST. There will be no more infographic updates for this post *****

After 80-days in the wilderness and with the world’s pandemic attention more focussed on the Middle East the H7N9 virus has popped up again.

When H7N9 was daily news the eye of the storm was concentrated on the provinces of Zhejiang and Jiangsu and the municipality of Shanghai. As the daily case numbers declined after April the movement of the virus seemed to deploy outward at a snail’s pace. In fact the previous four case onsets to this one were Jiangxi (East China), Beijing (North China), Hebei (North China) and in Huizhou, Guangdong (South Central China) barely a 100-kilometres from Hong Kong.

After two cases were reported in the middle of summer H7N9 has backtracked returning to more familiar hunting grounds in Zhejiang half-way through the northern hemisphere autumn striking down a relatively young man, aged just 35 (according to my data the average age prior to this case was 57).

Cause like all good mysteries just as we think H7N9 is gone, it pops up again.

As my calendar permits I’ll keep the infographic updated as new information comes to hand through the autumn months. Here is a look at the first infographic I produced with the 137th case presenting in Zhejiang on the 8th October 2013.

Acknowledgements: Data for this infographic was sourced largely from CIDRAP, H5N1, FluTrackers and the WHO. Background reading supplied mainly via Pandemic Information News, Ian at Virology Down Under and Helen Branswell.

Updates

15 Oct 2013 (via CIDRAP): Chinese man hospitalized with severe H7N9 flu;
23 Oct 2013 (via CIDRAP): News Scan for Oct 24, 2013;
6 Nov 2013 (via CIDRAP): China reports two new H7N9 cases;
3 Dec 2013 (via H5N1): Hong Kong: Human H7N9 case confirmed and A few more details about the new Zhejiang H7N9 case;

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August 13, 2013

Random Analytics: H7N9 (August 2013)

***** Please note that the infographics/charts of the Avian Influenza A(H7N9) virus presented were updated with public source information to 0001hrs 13 August 2013 CET/EST *****

Infographic Details

The recent confirmation of a H7N9 case in Huizhou, Guangdong Province was the inspiration for this month’s infographic.

During the month of July there were two confirmed cases of H7N9. The first case, with a 10 July onset occurred in Langfang with a dispersed population of around 3.9-million located just 60-kilometres from the heart of Beijing and its 20.7-million residents. The more recent case with onset 27 July was in Huizhou, with its 4.6-million citizens and just 100-kilometres from Hong Kong (population 7.1-million).

After a brief sojourn this variant has decided to randomly strike at two locations within a relatively easy drive to two extremely connected and globally linked population centres. Just these four cities alone are more than 50% more populated than the entire land mass of Australia and 1.8-million more than Canada.

The other point that I wanted to make was to highlight the temporal pattern which now has six-months of data confirmed. Since April, where 70.6% of the current onsets were recorded, only four cases (two in May, none in June and two in July) have occurred.

The Northern hemisphere summer has not killed of H7N9 although it is quiet.

The fact that H7N9 has cropped up again near global cities is pure downside risk. The fact that it is occurring during the Northern hemisphere summer is additional risk. The fact that we only have a half year of temporal data available for this emerging disease means we don’t yet have a full picture of what risk we face as we commence the colder seasons.

Autumn is upon us and Winter is Coming.

Cases by Region (including Taiwan)

There have been 135-cases reported in China, 44 of which have resulted in death. Although transported by commercial aeroplane from Jiangsu there is one case reported in Taiwan who has subsequently recovered. For the record my case numbers include the single asymptomatic cases from Beijing. The most recent onset confirmation occurred 27 July in Guangdong, the first known case from that province. The last fatality confirmation via Xinhua was reported on the 12^th August.

To date 32.4% of all known cases have been fatal. For context the Case Fatality Rate of SARS was 10.9%.

The World Health Organisation confirmed that to 11 August there were 87 patient discharges (the National Health and Family Planning Commission has been doing monthly updates on the 10^th of each month but the August press release is still pending). This equates to a Case Recovery Rate of 64% (with every chance for a slight improvement as there are still four patients receiving treatment). Asymptomatic cases remain at one (0.7%).

Cases by Job Title

As a Workforce Planner I am always fascinated by how disease interacts with our employment or our daily activities. This is potentially relevant in understanding how H7N9 transfers as only one case can be scientifically linked to a person-to-person transfer, although there is strong evidence to suggest at least three family clusters.

With 42.2% of cases in the 65+ cohort the greatest job title is that of retirement. Of the 106 confirmed occupations 37-cases (34.9%) are attributed to retirees who are more likely to visit traditional bird markets and potentially are more involved in food preparation at home, both with greater associated risks. I make a small point that food preparation is traditionally more likely to be done by women and there are only seven females (just 18.9%) who are ‘retired’ in my data, thus exposure to bird markets might be a greater factor in exposure.

Farmers account for 27-cases (25.5%). Given that most Chinese agriculture is still small cropping with additional poultry (chicken, ducks, geese etc.) and other livestock the high proportion is not that surprising given that it is an avian influenza.

From there the break-downs by employment don’t offer much in terms of vector assistance, outside those such as market vendors or poultry transporters that have daily exposure to feather and fowl.

It still seems that although your employment might marginally increase your exposure to H7N9 your just as likely to catch the disease by preparing a chook for the table or living within proximity of a bird market.

Recent Health Analytics Blogs: Random Analytics: Hendra! & Random Analytics: Ebola (2013)!

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Acknowledgements: Thanks first and foremost to FluTrackers and the great work you do. For good journalism on this topic I follow Helen Branswell and CIDRAP. If you are interested in getting a daily feed on H7N9 (and other related topics) then I would recommend Crawford Killian’s H5N1 site. If you like more detailed analysis of H7N9 (and other viruses) then I would point you to my fellow Queenslander Dr Ian M Mackay and his recently revamped Virology Down Under blog.

Lastly, thanks to George R.R Martin and his wonderful ‘A Song of Fire and Ice’ epic for the borrowed line (books only, I don’t do ‘A Game of Thrones’ HBO series).

Update (14/08/2013)

Updated the main infographic and Cases by Region after a Hebei fatality was confirmed. Some minor tweaking of article after a review of the published material confirmed a further 5 patient releases. Added Helen Branswell & CIDRAP to my acknowledgements and can’t say why I didn’t do this in the first case.

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May 23, 2013

Random Analytics: H7N9 Infographics (to 22 Jul 2013)

***** Please note that the infographics/charts of the Avian Influenza A(H7N9) virus presented were updated with public source information to 0001hrs 21 Jul 2013 CET/EST *****

Infographic Details

There have been 134-cases reported in China, 43 of which have resulted in death. Although originating in Jiangsu there is one case reported in Taiwan without loss of life (my case numbers include known asymptomatic cases). The most recent onset confirmation occurred on 10 July in Hebei Province. The previous onset confirmation was 59-days previously from Beijing. The last fatality confirmation was on the 26 July via Xinhua.

To date 31.9% of all known cases have been fatal, close to a 1/3^rd of all cases. For context the Case Fatality Rate of SARS was 10.9%.

The Ministry of Health and Chinese media confirmed that to 10 July there were 85 patient discharges which equates to a Case Recovery Rate of 63% (with every chance for a slight improvement). Asymptomatic cases remain at one (0.7%).

Cases by Region (including Taiwan)

The case numbers presented here are correct to 20 July 2013 and include 135 known H7N9 victims. Although there have been 43 confirmed deaths to date I have only been able to verify 31 case fatalities. A recent Jiangsu study noted eight deaths to the 27 May (only four have been confirmed via a case fatality notification). Shanghai’s high Case Fatality Rate includes 16 confirmed case fatalities, the latest update via Xinhua was released 26 June.

Note: This infographic was created using Tableau Public.

Thoughts by Crawford Kilian

It’s one thing to analyse data and to draw a picture from it but you get real impact when you have more than analytical inputs to go by. Crawford Kilian’s comments and local knowledge via his H5N1 blog were just too good to not include in this piece. Here are his thoughts:

“The map in Shane’s post is a reminder that this weekend’s case is an outlier, geographically as well as seasonally. Hebei province almost surrounds Beijing, and if memory serves, that’s where the father of Beijing’s first case purchased the birds he hoped to sell in the capital.

Langfang, the city where the 61-year-old woman contracted H7N9, is no rural backwater. Wikipedia tells us that it has a total population of 3.85 million. An hour’s drive southeast of the Beijing airport, it’s part of the Beijing-Tianjin corridor, with no fewer than 30 universities and an economy based on computer technology. Another city in the corridor is Tangshan, which in 1976 suffered a catastrophic earthquake that effectively ended the Maoist regime and paved the way for over 30 years of explosive economic growth that changed the world.

My point is that the poor woman in critical condition in Chaoyang Hospital is not some faceless nonentity; she’s a real live human being, as real as everyone living between, say, New York and Boston or Seattle and Vancouver, or Riyadh and Jeddah. If she dies it will be a real death, not just a pixel or two winking out on a screen.

She does have some advantages, including a medical system primed and ready for her (imagine the panic if an H7N9 case turned up in Los Angeles or London). But she is still just a real human being. Statistically she may be one of the unluckiest people on the planet, but she’s a real person with a name and a family, and that is why we should all care about her fate.”

Final Thoughts

With infinite patience I’ve been awaiting the final case details of the H7N9 outbreak that commenced in mid-February and looked to have quietly disappeared in late April. Chinese and World Health Organisation media sources, so free with basic information at the start of the outbreak went quiet as the cases of H7N9 decreased. At the same time cases of Middle East Respiratory Syndrome (MERS-COV) increased with a seemingly higher Case Fatality Rate (CFR), multiple source countries and scratchy reporting diluting attention from the much diminished H7N9.

Humanity has a great capacity for curiosity but it also can as easily get side-tracked or bored and lose focus on events if they move back into the shadows.

H7N9 hasn’t gone away and the latest onset, during the Northern Hemisphere Summer is a timely reminder.

Note: Bored with flublogia? Read my updated analysis and analytics of Ebola Random Analytics: Ebola (2013)!

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Note: If you are interested in getting a daily feed on this and other interesting related topics (such as the MERS-COV outbreak) then I would recommend you follow Crawford Kilian or read his H5N1 blog. If you are interested in more detailed analysis of H7N9 (and other viruses) from a medico rather than an analyst then I would recommend my fellow Queenslander Dr Ian M Mackay and his Virology Down Under blog.

Update (28/05/2013)

Updated main infographic with four additional recoveries and one confirmed death as reported by Xinhua.

Update (29/05/2013)

Updated main infographic and Map with additional Beijing case as reported by Xinhua.

Update (15/06/2013)

Updated main infographic with additional two deaths and one recovery as reported by Xinhua.

Update (21/07/2013)

Updated main infographic & map with additional case as reported by CHP and H5N1.

Update (22/07/2013)

Updated map with additional four verified Jiangsu fatalities via CIDRAP update.

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May 12, 2013

Random Analytics: H7N9 Infographics (to 15 May 2013)

***** Please note that the infographics/charts of the Avian Influenza A(H7N9) virus presented were updated with public source information to 0001hrs 16 May 2013 CET/EST *****

Infographic Details

Between 12 – 16 May there have been no new reported cases of H7N9 and a drip feed of case and fatality details. To date the totals for China are 131-cases including 36-deaths and Taiwan 1-case without loss of life. Two deaths were confirmed on 13 May without details and the first confirmed fatality from Hunan was reported on 15 May. Note that all totals include asymptomatic cases.

To date 27.3% of all known cases have been fatal, or more than one in every four afflicted by H7N9. For context the Case Fatality Rate of SARS was 10.9%.

The Ministry of Health and Chinese media confirmed that to 15 May there have been 61 patient discharges (46.2%). Asymptomatic cases remain at one (0.8%).

The most recent fatality (with details) reported by the Chinese media was on the 15^th May 2013 via Xinhua.

Cases by Region (including Taiwan)

Along with a decline in cases there has been a drip-feed of case details that have flowed through during the week. Note: I have two confirmed deaths that I cannot add as the province has not been disclosed.

The last confirmed onset that I could see has moved from Fujian to Jiangxi and it’s more than a week old in the regional extremities of the outbreak. Shanghai, the region which hosted the outbreak in mid-April announced during the week that it had not had a confirmed case in more than 20-days and was in the process of dismantling its emergency level response to H7N9.

Note: I have created this infographic using Tableau Public software which can be viewed here.

Cases by Job-Title

Here is another look at the cases by employment.

Given that more than 44% of cases were in patients over the age of 65 it’s no surprise that 35 (28.8%) of job titles are ‘Retired’.

To tenuously back the avian link the next largest job title was ‘Farmer’ with 26 confirmed at 19.7% of all cases. If you include those job-titles with linkages to farming, poultry production and food preparation that number would increase to 38 making it the most dominant employment type at 28.8%.

Of the 31 unknown job titles, 12 (9.1%) are represented by people over the age of 65, thus would predominately fall into the ‘Retired’ or ‘Farming’ employment types depending on whether they are rural or urban based.

Note: My previous post on H7N9 can be found at Random Analytics: H7N9 Infographic (to 8 May 2013)

Updates (13/05/2013)

Confirmed two additional job titles (1x Builder and Farmer) so updated both the infographic and Cases by Job-Title.

Updates (14/05/2013)

Updated the main infographic after a further 2 fatalities and 15 recoveries were confirmed via Xinhua.

Updates (16/05/2013)

Updated the main infographic and Cases by Region map after a fatality was confirmed via Xinhua and a further four recoveries were announced via CCTV News. The most recent Xinhua announced fatality link was also updated.

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May 9, 2013

Random Analytics: H7N9 Infographics (to 8 May 2013)

***** Please note that the infographics/charts of the Avian Influenza A(H7N9) virus presented were updated with public source information to 0001hrs 9 May 2013 CET/EST *****

Infographic Details

In the past 48-hours of reporting there has been one new case of H7N9 and one retrospective fatality. This brings the total for China to 131-cases including 32-deaths and Taiwan to 1-case without loss of life. Note that all totals include asymptomatic cases.

To date 24.2% of all known cases have been fatal. For context the Case Fatality Rate of SARS was 10.9%.

The Ministry of Health also confirmed that to 6 May there were 42 discharges. That keeps the recovered total to 42 (31.8%) and asymptomatic cases at one (0.8%).

The most recent fatality (with details) reported by the Chinese media was on the 3^rd May 2013 via Xinhua.

Economic Impacts of H7N9: Direct Costs and The Poultry Industry

According to the World Bank, China’s Gross Domestic Product hit $7.318-trillion USD in 2011, making it the second largest economy on the globe. Back in 1982 China had a GDP of $203-million, a mere 1/36^th of its current size, thus an economy that has doubled in size more than six times.

Last year China’s economy grew by 7.9%, the weakest result since 1999 and below expectations.

The first quarter of this year was expected to see growth rates return to 8% or greater. This would be driven by internal consumer consumption over exports. However the first quarter of 2013 disappointed with GDP growing by 7.7%, again under expectations.

Although the avian influenza A(H7N9) virus is not the reason the Chinese economy has been soft it is a contributing factor. Some considerations when considering direct costs:

Effecting flu controls on the human and fowl populations such as the additional ¥303M ($48.6M USD) which was put up by the Chinese Ministry of Finance in late April;
Subsidizing the poultry industry as it struggles with the outbreak, like the ¥90M ($14.6M) from the Beijing Municipal Bureau of Agriculture again in late April;
Additional medical costs and insurance for regional populations costed to the Ministry of Finance, and;
One of the biggest direct costs of the H7N9 outbreak is the loss suffered by the poultry industry. By mid-April that agriculture component stated that it has lost approximately ¥10Bn ($1.6Bn USD) as chicken consumption halved and chicken/egg prices collapsed.

If the figures are not overstated then the impact to the first and second quarter GDP figures would be at a cost of between 0.1 and 0.15% with a work-in-progress cost to the economy of between 0.2 – 0.3% over the calendar year. Although future poultry losses would not be of that magnitude (as the poultry industry ramps down production and concentrates on protecting its breeding stocks) that number will still likely increase to some degree over the coming months. The standalone poultry industry losses to mid-April alone could account for the 0.3% minimum underperformance of the Chinese economy.

Looking at this from a different angle there is also currently an unrealised loss in terms of the overall chicken population value.

In brief, the Chinese chicken population in 2009 was 4,680,000,000. Here’s a great infographic via The Economist:

Prior to the outbreak becoming known in China the national average broiler price (chickens raised purely for meat production) was ¥9.37 (source: Beijing Shennong Kexin Agribusiness Consulting). At publication date the average price of broilers across Liaoning, Shandong, Henan, Hebei and Jiangsu was just ¥4.07 (source: www.chinafarming.com), effectively a 56% reduction. Eggs have had a similar price decline and broiler chicks around 75% as agribusiness pends new stock purchasing and waits out the virus .

Now I know that not all chickens are broilers (being an owner of nine-chickens and a rooster myself) but with a huge appetite for chicken which is on-hold and an approximate 10-week lifespan of broilers the short-term price impacts of such a decline are a huge drag on first and second quarter Chinese GDP growth numbers.

Another consideration: Taking the 2009 chicken population number of 4,680,000,000 as a base, the bulk of chickens across the country would now be worth, on average, ¥5 less. Thus the national stock, minus protected and virus free breeders could be worth as much as ¥23.4Bn (approx. $3.74Bn USD) less than it was two months ago. If not for other inputs (such as an increase in vegetable prices against the gains in chicken import prices) then the possible impact on GDP could be doubled or even tripled.

In summary, the impacts of the current H7N9 outbreak on the economy are still short-term. Prices always recover when there is a market but by the time the virus passes and confidence returns to the poultry industry the national stock will have decreased, poultry producers have gone out of business and outside of imports the industry will take at least 3-months to re-stock. This will drive up prices in the short-term and those direct impacts will flow through the economy.

Much like the medical unknowns still in play the economic impacts can only be forecast.

Unlike the medical impacts which are tracked on a daily basis and could disappear overnight the negative economic impacts of the virus could be sustained for many months.

Note: My previous post on H7N9 can be found at Random Analytics: H7N9 Infographic (to 6 May 2013)

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Update: (30/07/2013)

World Poultry published an article on 29 Jul 2013 stating that:

“The total losses of poultry-related companies all over the country up until the end of June exceeded 600 billion yuan ($92.2 billion) since the first case of H7N9 virus was discovered by the authorities at the end of March, according to the latest statistics from the National Poultry Industry Association.”

In my article I envisaged that the loss for the first and second quarters of Chinese GDP would be between 0.1 and 0.15%. The National Poultry Industry Association total would equal 1.26%. Industry bodies tend to overstate the loss in a crisis so I am still confident in my original forecast but happy that the first numbers to be discussed fell well within a reasonable range of error.

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May 6, 2013

Random Analytics: H7N9 Infographics (to 6 May 2013)

***** Please note that the infographics/charts of the Avian Influenza A(H7N9) virus presented were updated with public source information to 0001hrs 7 May 2013 CET/EST *****

Infographic Details

In the past 24-hours of reporting there has been one new (retrospective) case of H7N9 and confirmation via the Chinese Ministry of Health 4 additional fatalities. This brings the total for China to 130-cases including 31-deaths and Taiwan to 1-case without loss of life. Note that all totals include asymptomatic cases.

To date 23.7% of all known cases have been fatal (an increase of 2.9% from yesterday’s data). For context the Case Fatality Rate of SARS was 10.9%.

The Ministry of Health also confirmed that to 6 May there were 42 discharges. With that update the recovered total now moves to 42 (32.1%). Asymptomatic cases remain at one (0.8%).

The most recent fatality reported by Chinese media was on the 3^rd May 2013 via Xinhua.

Cases by Region (including Taiwan) to 6 May 2013

I usually don’t repeat the second infographic from one night to the next, however some data came in via the Chinese Ministry of Health which included four new deaths confirmed by province (although not down to case level at this stage). Two additional fatalities were reported in Jiangsu and one each in Zhejiang and Anhui.

Although recoveries have been revised upwards I cannot confirm to case level the details of 14-cases and 5-cases cannot be confirmed to province or municipality level.

Two other changes with this infographic. The first is a colour scale to reflect the number of cases in each region. Secondly, I have created this infographic using the excellent Tableau Public software which can be viewed here. (Note: I have no commercial or personal relationship with Tableau).

Note: My previous post on H7N9 can be found at Random Analytics: H7N9 Infographic (to 5 May 2013)

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