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Every time his phone rings and echoes around his vast temporary office at the national Center for Disease Prevention and Control (CDC), Li Qun’s heart misses a beat. Every time he prays it is not another reported case of the A(H1N1) influenza.
Last Monday, it was. An Italian tourist in the Tibet autonomous region was suspected of having contracted the virus.
By 11 pm that night, Li, the team leader for the CDC’s emergency response team, had briefed six experts in epidemiology and booked them on the next flight to Lhasa, which landed at 3:30 pm the next day.
The response team, made up of 67 trained professionals in various fields, is on call 24 hours a day and Li spends a great deal of his time on the phone trying to persuade more people to get involved and help ease their increasing workload.
As of last Friday, the Chinese mainland had five confirmed cases of the virus, all brought in from flu-affected regions. The Italian woman was diagnosed last Wednesday to be just suffering from seasonal flu and she and her tour group were able to continue their sightseeing in Tibet.
It is a far cry from the United States, with its far smaller population, excellent health facilities and generally well-educated public. By last Friday, a total of 5,710 people there had contracted human H1N1 cases across 48 states. Eight people have died yet the US does not impose routine quarantining or have a consistent policy approach to deal with the outbreak.
Last Monday was the fifth time Li had dispatched a team in response to a report of a H1N1 case. On arrival the experts must investigate, diagnose and treat symptoms, as well as make a speedy judgment as to risk of a potential outbreak for the top health authority.
However, the remoteness of the Tibet region posed an extra challenge. “Many of our experts were first-timers in Tibet. But our local CDC colleagues were well prepared,” said Li.
Such a fast reaction to public health incidents is a result of the lessons learned from the SARS outbreak in 2003.
“We are better prepared than during the SARS period,” said Li. “That outbreak happened all of a sudden; the people, resources and information system were not ready.”
Since SARS, the country has invested heavily in disease control measures, such as a sophisticated Web-linked information sharing system for the CDC, and built an extensive emergency plan and emergency reaction law, as well as creating new departments within the health authority.
Added to this, prevention has also been boosted by the public awareness. “Society shows more understanding of the public health sector, which creates a very good environment,” said Li.
During SARS, the battle to contain the deadly virus was dubbed the “people’s war”.
As with that outbreak, the CDC has again divided its fight against the epidemic in China on to two battlefields: The nation’s borders and the nation’s monitoring system.
For the former, quarantine measures at airports, shipping ports and train stations are designed to delay the spread and win more time for research — as Zeng Guang, head of epidemiology for the CDC, explains: “Find one case and isolate close contacts to cut off the origin of the infection” — while, for the latter, the ever-expanding CDC network, along with 170 hospitals and 24 laboratories, provide earlier diagnosis and treatment.
In terms of confirmed cases so far, Zeng said the number in China was only the tip of the iceberg, but urged the public not to worry as the strain was considered mild. He said the outbreak had spread over a month or so when “the world was off-guard”.
After having experienced the SARS epidemic in 2003, the recent outbreak has led to several questions over the handling of the latest crisis by China. Should the country act aggressively? Is the nation’s reaction effective or exaggerated?
“China has reached a very good balance in effective control and social cost,” said Xue Lan, dean of the public policy and management school at Tsinghua University in Beijing. “The health and quarantine authorities are very nervous and on high alert. But life and the economy have not been disrupted.”
World leaders acknowledge the H1N1 virus is spreading fast but its severity has been relatively low compared with other flu strains. However, China’s strategy of quarantine at borders, quick reaction to suspected cases and information briefing have proved very effective.
“Over-reaction is a waste of resources,” continued Xue. “There is no set standard across the world. The standards vary nation to nation.”
For China, a densely-populated country of 1.3 billion people with a less developed health system, a pandemic would come at a tremendous cost.
Dr Hans Troedsson, the World Health Organization (WHO)’s representative in China, said the mainland’s response to the virus had been well handled, explaining: “Right after we informed the Ministry of Health about the outbreak in North America, China activated its national pandemic preparedness and response plan.”
He said China had increased surveillance to identify suspected cases, informed health staff nationwide to investigate and report any possible signs of the telltale symptoms and launched campaigns to tell the public how to protect themselves from the virus.
As part of its proactive response, China established eight working groups made up of experts from the CDC, Ministry of Health and General Administration of Quality Supervision, Inspection and Quarantine, as well as ministries of agriculture, foreign affairs, science and technology.
It has been hailed as crucial step in ensuring a coordinated response to the outbreak.
The weak link, however, has again proved to be the monitoring and tracking of the nation’s vast mobile population.
When a student returning to Shangdong province by train after flying to Beijing from Canada called a local CDC to tell them he had a terrible fever, he became the mainland’s second confirmed case of the H1N1 flu.
But even though health workers rushed to meet him from the train, not one person who shared his carriage was tested for the virus. It was left to the local authority to trace all his fellow passengers to quell any potential danger.
Also, during the first wave of panic over the outbreak, some Mexican citizens traveling to China complained of being quarantined simply because of their passport.
Gustavo Carrillo, a Mexican businessman quarantined at the Guomen Hotel in Beijing this month, told China Daily: “This is more than just caution. I feel discriminated against.”
Carrillo was escorted straight to a quarantine site upon landing at Beijing on a Continental Airlines flight from New York after he showed his Mexican passport.
However, the authority later relaxed its isolation policy when more details on the virus became available, with passengers on a flight with the third confirmed patient not even tested because the sufferer’s latent period had occurred after she got off the plane.
“The system reacts with the epidemic and is very flexible,” explained Xue, who said that because of its 1.3 billion population and densely populated cities, what China did to prevent the spread will have important repercussions for the rest of the world.
However, the tighter prevention measures and strict quarantine practice have been hotly debated among the public and the media in China.
After front-page stories on the outbreak for nearly a month, the public has been naturally concerned with how the government measures will affect their lives, while the media, probing further into the potential pandemic, has questioned whether the measures have really worked.
This may explain why several blogs written by quarantined patients, such as Zhong Shuang, have attracted millions of hits on the Internet.
From photographs of fruit juggling displays to explicit details of the tests they must endure, the bloggers have given their readers a firsthand account of where the hundreds of yuan being spent by central government each day to prevent the spread of the H1N1 flu is going.
Associated Press writer Will Weissert last Monday also joined in the debate when he and his Chilean wife were quarantined in Shanghai after arriving following a stopover in Cancun, Mexico. The Cuba-based reporter, who said he had no contact with a suspected or confirmed flu patient, was forced to miss his friend’s wedding because of the measures.
“The public read about the people in quarantine because they wanted to know how it all works and how they are treated,” Zhong told China Daily. A marketing director for a software company, whose six-day enforced stay in a remote Beijing hotel ended on May 16, said the people she was quarantined with were treated well and believed the government was trying to avoid the worst case scenario.
However, Mexican businessman Gustavo Carrillo disagreed. Even though the Guomen recruited extra cleaning staff, and offered Western meals and English newspapers, he told China Daily he felt he had been “under-treated in a deserted hotel”.
“Chinese or foreign, nobody likes to be quarantined, to have their liberty removed,” said Xue at Tsinghua University. “But the Chinese public are more vigilant over the outbreak of disease after the suffocating SARS experience.”
