The lessons of flu blogging

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In the spring of 2005, I started a blog about H5N1 avian influenza – not because I knew anything about it, but because I didn’t. Surfing the web for news about it would, I thought, teach me something.

That it did – and much more. I soon realized that I’d stumbled into a worldwide online community that I learned to call Flublogia: a growing number of bystanders, journalists and health experts who were beginning to share information on outbreaks and a growing number of public health issues. We didn’t have to teach ourselves; we could teach one another.

Since then Flublogia has evolved into a volunteer epidemic-intelligence service, which is sometimes useful to the professionals and sometimes a nuisance. We’re useful in part because we work for free, usually every day of the week. We get wind of public-health problems and relay them via blog posts, tweets and other social media. When the professionals come to work on Monday morning, they may find next week’s agenda waiting in their Twitter feed.

And as outsiders, we’re not obliged to be politically tactful; we can blast this or that government or health agency or NGO without fear of reprisal. I suspect the professionals, sworn to silence, tolerate us as conveniently annoying to their political masters.

We operate with fewer resources than the health agencies, who can simply ask any country’s officials about a given report; we’re confined to Google, a few key lists of media links and other Flublogians.

But “confined” is probably not the right word: Google Alerts, and advanced Google search, can deliver the latest news on virtually any new outbreak or health issue. ABYZ News Links can put us on the websites of media around the world, and the Geneva Foundation for Medical Education offers a list of health ministries from Afghanistan to Zimbabwe. The tireless efforts of FluTrackers and ProMed-mail can either set off alarms or shut them down, while Twitter users spread the news (and sometimes the fake news) with amazing speed.

The fake news currently involves anti-vaccination groups and sporadic scare-tweets about Ebola patients, fresh from the Democratic Republic of Congo, somehow sneaking in from Mexico without anyone noticing. Such reports are few and effectively dealt with – often just by ignoring them.

More serious problems arise when an outbreak or other public health disaster occurs in a country that doesn’t want to report it – or lacks the means to.

I first realized this 10 years when the earthquake hit Haiti. Just out of curiosity, I started looking for Haitian online media, and could find almost nothing. That was likely as due to my own poor search skills as anything, because when cholera arrived 10 months later I did turn up some good local sources.

But official online sources were scarce. In a poor country, the government knows its people aren’t online at all, or at-best have WhatsApp on their phones. They don’t like to talk about disease outbreaks anyway, so they’re not very forthcoming. So, finding reliable information about cholera required waiting for official WHO statements. And WHO, a UN agency, was compromised because the UN was denying responsibility for importing cholera to Haiti through a contingent of Nepalese peacekeepers. (I had actually blogged about the Nepal cholera outbreak just a few weeks earlier).

It was much the same in the West African Ebola outbreak: poor countries, no infrastructure (least of all good government websites) and very little interest in telling the world what was going on. And just the other day I found that the Democratic Republic of Congo’s ministry of health website has not been updated since September 2019, a few months after the last health minister was ousted and charged with embezzling Ebola funds, in the midst of the current outbreak.

Not only poor countries maintain stony silences about their outbreaks. When Middle East Respiratory Syndrome (MERS) emerged in 2012, almost all cases originated in Saudi Arabia. Since then, the Saudis have worked hard to tell the world as little as possible about a very nasty disease. It was an embarrassment to the House of Saud for the world to see how sloppy infection control had enabled MERS to spread in hospitals among patients and healthcare workers alike.

Despite their wealth of experience, the Saudis have published very little research on the disease; it took an imported case in South Korea to trigger a flood of papers on the disease. The Koreans were more than willing to reveal the weaknesses in their healthcare system that had enabled one case to multiply into scores – many of them contracted in overcrowded emergency departments from patients who were ‘doctor shopping’.

Similarly, China announced the first cases of H7N9 bird flu very promptly; after the humiliation of the SARS cover-up, the Chinese government was determined to make amends. Again, research papers filled the internet as Chinese newspapers reported the spread of the disease.

Flublogia was tracking these outbreaks and drawing conclusions about the responses. It was tempting to lean toward conspiracy theories, especially when even WHO refused to admit the UN’s role in Haiti’s cholera, but the case for sheer incompetence is more persuasive. When a Liberian with Ebola turned up in Dallas in 2014, the local healthcare system botched it: the poor man was turned away when staff should have put him instantly into isolation, they then admitted him but allowed conditions in his room that infected two of his nurses.

Flublogia reported on these events in real time and gave them an immediacy that mainstream coverage could rarely achieve – in part because many of us were able to interpret events and draw conclusions that health officials prefer to pass over in silence.

Given the nature of social media, you would think Flublogia would have been rapidly corrupted by bots and cranks. Instead, it remained a forum for serious professionals and interested amateurs, with very few digressions into partisan politics. That has begun to change. Ever since the 1990s, a medium without margins has attracted marginal people, and such people now turn up under hashtags like #measles and #Ebola. The experts who refute them, like Dr. Peter Hotez on vaccination, take a lot of punishment. But he gives as good as he gets, and many in Flublogia now recognize nuisance tweets whose only purpose is to waste the time of those who answer them.

Looking back over 15 years and many outbreaks, I can see I have indeed educated myself – by putting myself at the feet of experts and journalists who are often as surprised as I by the latest scare. It’s not just the body count and the symptoms that they’ve taught me. It’s the response, and the long-term consequences for the survivors. I now know enough to know, like the experts, how ignorant I am.

Most importantly, Flublogia has taught me the wisdom of Dr. Rudolf Virchow’s observation, as true in the 21st century as in the 19th when he made it: “Medicine is a social science, and politics is nothing else but medicine on a large scale.”

About the author

Crawford Kilian, a journalist and retired college instructor, blogs about the politics of public health at H5N1 http://crofsblogs.typepad.com/h5n1.

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