Detail Infection / Transmission / Treatment Timeline For The Most Recent H7N9 Infection

H7N9 Patient: Liu
Age:35
Sex: Male

October 2-3:

Liu walked and Hitch-Hiked from Shaoxing to Ningbo and back.
There are indications of torrential rain, flooding, dead pigs, and food shortages along his route, especially in the city of Yuyao  http://gaosanshiyiban.blog.edu.cn/2013/830384.html  and http://bbs.tianya.cn/post-funinfo-4681055-1.shtml   A few days later this same area was hit by Typhoon Fitow.

Updated 10/28/13 to add:  We suspect that  contaminated  drinking water was a possible H7N9 infection vector for this patient. Given his "hike" through the flood zone, and the reports of floating dead animals, including water fowl, it is likely that Mr Liu ingested water which was contaminated with  flood / storm runoff water.

October 3:

Liu is back in Shaoxing, where it is reported he got a rather harsh foot massage.

October 3-6:

Period of overseas travel?

Liu's whereabout are not reported, however it has been reported that he traveled overseas (到外地旅游) prior to symptom onset. http://news.163.com/13/1016/02/9B99EO9F00014Q4P.html. This period would have him returning from overseas travel just prior to Typhoon Fitow coming ashore on Oct 7th.

Noon October 6th:

Liu is reported to have had hearty lunch with his friends at a  Shaoxing restaurant where he ordered chicken, duck and two beers.

Morning October 7th. 

Liu woke up ill with a fever in his company's provided dormitory. He reportedly felt dizzy, hungry, and began vomiting after trying to eat; followed by sweating and "more serious symptoms"

Evening October 7th.

Typhoon Fitow comes ashore approx 1pm local time.
A coworker saw how sick Liu was and went to a nearby pharmacy to pick him up some "anti inflammatory" medicine

October 8th.

Liu went to a local clinic where he was ostensibly diagnosed with a bacterial cold and given cold remedies

October 9-10th

Liu is in the clinic and receiving intravenous saline solution.  At this point, it seems as if he is being treated for severe food poisoning. 

It is possible that Liu was infected with H7N9 while at this clinc.  One wonders how packed this local clinic was with typhoon victims.

October 11th

In the afternoon after receiving more intravenous fluid, Liu feels shortness of breath. The doctors immediately escalate his case, and by 5pm he was transfered to a better equipped hospital. At 6pm Liu calls his brother and asks him come. The brother reports Liu  seemed clear headed, but his speaking was laborious and he was panting.

At the emergency room, Liu refuses to go to the ICU to be placed on a ventilator, ostensibly for financial reasons. By 9:40pm Liu is placed in coma via sedation, and finally taken to the ICU where he is placed on a ventilator.

October 12th

Liu is placed on the Critically Ill list

October 13th

Liu's condition had not improved, and by evening time regional CDC staff was brought in for sampling.
Liu is treated twice with Tamiflu

October 14th @23:00

Liu's has tested positive for H7N9 infection.

October 15th

Liu is moved into isolation, negative pressure room, and is considered for "artificial liver treatment"

Sources:
http://news.sina.com.cn/c/p/2013-10-16/033428443428.shtml
http://zt-hzrb.hangzhou.com.cn/system/2013/10/16/012585096.shtml