Senior Resident, Massey College, University of Toronto
CEO, Health Strategy Innovation Cell
Adjunct Lecturer, Dalla Lana School of Public Health Policy
Adjunct Professor, Institute for Health Policy, Management & Evaluation
Adjunct Professor, Ryerson University School of Health Services Management
The RIWI data tracker ran in all parts of China from Sunday April 14th at 22:49 to Monday April 15th at 19:50 China Standard Time.
The findings were based on The RIWI Corporation’s patented, privacy-compliant and peer-reviewed data algorithms and technology that reach Internet users with equal random probability in any targeted region of the Internet-enabled world. Through the patented process of someone making a manual type-in error in the browser bar (URL bar, or navigation bar) on any browser on any Web-enabled device, such as a tablet or desktop; and thereafter stumbling upon the thousands of random, rotating so-called ‘non-sense’ domain names on any top-level or country-specific domain (e.g., in this case, the top-level country domain is .cn) where RIWI Nano-Surveys™ are hosted, respondents were asked, in Mandarin, very short, rapid questions with low-latency and the replies were immediately and automatically tallied and geo-segmented on multiple RIWI servers, which then link IP-based respondents to privacy-compliant identifiers. RIWI software ensures that respondents can only answer once, that no Internet ‘bots’ can spam the question pages, and that all respondents are real, human respondents.
For this project, the questions (in Mandarin) were: “Do you know someone who has contracted the new Avian Flu in your local area?” “What is your age?” “What is your gender?” The data were segmented according to Province and city. The first question was deliberately phrased to allow public health leaders to move scarce resources to affected areas based on the assumption that a growing awareness of contagion in an area precedes actual deaths. If there are areas where awareness is high, this could be an early signal that there are more deaths looming, especially when the incubation period for this particular strain appears to be 5-7 days.
Almost 30,000 – 29,136 “fresh” Internet users (i.e. that is, people who do not ‘opt in’ to incentivized survey panels or regularly take surveys) – were randomly exposed to the questions over 20 hours. At 24.08%, this response rate eclipses typical response rates to panel-based Internet surveys (ranging from 4.7% for personalized approaches, and 2.2% for a generic approach using panels). Scholarly literature on this topic concurs that a first-time “fresh” responder (not on a panel) to a survey provides more reliable replies than does a practiced, incented responder who has previously been through many Internet surveys.
Our data findings are below.
The red-highlighted cities are Chinese cities where, as compared to their Census (2010) population, the level of contagion awareness statistically exceeds the expected level of awareness. These cities, as explained below in the analysis, tend to be those where H7N9 deaths have been reported. This analysis is based on the Chi Square Test of Independence at the 0.05 level of significance.
Removing outliers (notably, six cities, Zhejiang, Shanghai, Jiangsu, Guangdong, Fujian, and Beijing) where Internet penetration is at least two standard deviations above the mean, a regression analysis and correlation coefficient (below) illustrates that our data are geographically representative of the Chinese data (applying 2010 Chinese census data, the most recent publicly available for all cities measured).
By way of comparison, the H5N1 bird flu strain killed at least 371 people in Asia and Africa over the past ten years. Moreover, in 2009, the H1N1 flu virus caused the first influenza pandemic in over forty years.
This article provides an early view of how the current H7N9 bird flu appears to be spreading. Due to the emergency nature of this possible pandemic, we chose not to pursue publication in traditional research journals, even so-called ‘fast-track’ publications, since the importance of releasing the data immediately is essential.
Knowledge of apparent bird flu in the local areas of the major cities provides a clue as to where additional public health services may be needed in the near future. In addition to the H7N9 virus spreading from birds to humans, it is unknown at this time whether there is, in fact, human-to-human spread. Moreover, the prevalence of bird flu in the local area naturally depends on the 5 to 7 day incubation period of the virus.
While it is acknowledged that the RIWI Nano-Survey™ data shown here were collected from Internet users who were only informed indirectly or by hearsay that someone in their local area had apparent bird flu, the data do provide a basis for a possible epidemic, as based on the rapid spread of the self-reported information. The very high response rate (24.08%) far exceeds that of other Internet surveys, suggesting an intense relevancy of interest in the subject matter, another signal of the urgency of this matter in the minds of average Chinese citizens.