The return of the H7N9 case chart timeline...

Click on image to enlarge.
Please note, this chart is based on publicly available data and its completeness
suffers accordingly. It is provided as a guide only. Each black line (y-axis;
FluTracker's case numbering is used for comparability) represents a single, laboratory-confirmed
H7N9 patients' journey through time (the bottom, x-axis).  Data on patient discharge dates were
particular patchy in 2013 and I have yet to update what is available onto this chart (please ignore the terminal coloured dots for now)

...and its associated headaches.

This is a chart the really relies on complete data to be of full use.

I just had a look at the 2013 chart...you can find it here... which was last updated 02.06.2013. It's clear from that figure that detail on when H7N9 cases leave hospital was pretty scarce at the end of the first outbreak; or I couldn't find it. There has been a tally described in the past - around 86 cases discharged I think - but which cases is largely unclear.

So you can see that a lot of the 2013 patient's timelines trail off into infinity. By now those ill people would have been discharged or are part of the fatal cases list. Interesting that that link above describes a case that was hospitalized for 67-days, before succumbing.

Today I began the next case timeline chart for 2014. It's still a work in progress as I have yet to trawl through the cases to see which have been described as discharged (some definitely have) and I have not yet included those cases who were not admitted because illness was mild or without any obvious signs of disease at all.

As you can see from the new chart of 82 cases with a date of illness onset of 01-Jan-2014 or later (you'll need to click on it to appreciate the detail), the number of fatal cases, to date, is much lower tan it was in 2013's first wave of H7N9 infections.

It would not be surprising to find that most cases remain hospitalized in 2014 as the majority have been initially described as critical, severe or serious in this second round. I wonder how the contacts of these case are faring?

I will try to flesh this out in the coming weeks. Hopefully we remain as red dot-free as we are now.

Middle East respiratory syndrome coronavirus (MERS-CoV) update to timeline of key events....

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Feel free to use this graphic. Simply cite this blog and Dr Ian M. Mackay.

An update to my main website's MERS-CoV timeline now including the countries that have hosted their "own" cases along the top - and when the first case most likely occurred.

I'm doing a little updating across the board actually - hence the graphics!

Anything you'd like to see recorded on this timeline that I've missed?

As always, these graphics are cobbled together from various sources including public and the scientific literature. They do not represent the views or interpretations of any institution but the one in my head. They are compiled with all care and the best of intentions but may not be as comprehensive as data from the primary public health sources in the countries that are mentioned on my websites.

H7N9 median time between events: the story of average disease

Click on image to enlarge.
From Clinical Findings in 111 Cases of Influenza A (H7N9) Virus Infection, Gao et al, Volume No 368, Page No. 2277-85. Copyright © (2013) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.

This is a supplementary figure from the New England Journal of Medicine article entitled "Clinical Findings in 111 Cases of Influenza A (H7N9) Virus Infection" published May 2013 by Gao and colleagues working at a host of Chinese institutions around Eastern China.

It presents key median times between virus acquisition through to death among 62 influenza A(H7N9) virus-infected patients.

It struck me as a very clear way of summarizing the timeline to death among those with this outcome ascribed to infection by H7N9 earlier in 2013.

It is noteworthy that the median time for antiviral therapy to commence was 7-days, ostensibly too late to have an effect on severe infection and disease....but then a definite diagnosis took 8-days on average so antiviral treatment would have to have been commenced without lab confirmation, in order to be most effective. 

It seems that quite a few H7N9 patients present to at least 2 facilities once they become symptomatic. From the figure above, antiviral treatment is usually started at the second, tertiary care facility. Could it be started earlier?

This really stresses the key role of the first Doctor an H7N9 patient presents to, an event which itself occurs 48-hours after symptoms develop. The high end of when antiviral treatment needs to be administered to have its greatest impact.