A/H1N1 flu — erroneously known as swine flu — is a strain of influenza that first appeared in Mexico in April 2009 and quickly spread around the world. As of April 2010, A/H1N1 flu had reached 212 country and territories and killed an estimated 17,700 people. The World Health Organization (WHO) said it would take at least a couple years to come up with sound casualty numbers.

The first domestic case in China of the A/H1N1 flu — erroneously known as swine flu — was in Guangzhou in May 2009. The 24-year-old woman who tested positive for the disease is believed to have contacted it from a Chinese-American man who came to her photo studio not long after arriving on China from New York, Other cases has been reported before that but they all had contacted the disease overseas. The first reported case of the disease was a 30-year-old student just back from the United States were he caught it. Immediately after he was discovered 349 people who had come in contact with him were quarantined.

The first death in China from the A/H1N1 flu was in Tibet in October 2009. The second and third were in Qinghai and Xinjiang, A woman from coast Zhejiang Province who initially was said have died from it, it turned out, was electrocuted in a hospital shower. After being informed of the her death, 50 relatives of the dead woman stormed the hospital and threw rocks.

As of December 2009, 648 deaths has been reported. By then the disease was spreading into rural areas and there were concerns about a major outbreak during lunar New Year. One survey found that half of Chinese didn’t want to get a A/N1H1 vaccine over concerns about its safety.

A/H1N1 flu seemed to peak in China in late 2009, with 5,000 new three days in mid November pushing the total to more than 59,000. As of late November 2010, only 53 deaths had been attributed to A/H1N1 flu.

Zhong Nashan, a respected doctor involved with uncovering the extent of the SARS epidemic, told the Southern Metropolis that he believed the A/N1H1 death figures were too good to be true and guessed local governments were under-reporting or concealing case and many A/H1N1 deaths had been misdiagnosed as something else. Beijing vowed to punish anyone involved in covering up A/H1N1 deaths.

In November 2009, it was reported that two dogs in Beijing and four pigs in Heleongjiang Province had come down with the A/H1N1 flu. The animals are believed to have contacted the disease from humans.

Websites and Sources: Center for Disease Control on China CDC World Health Organization on China who.int/countries/chn ; Wikipedia article on Public Health in China Wikipedia Rare Diseases in China , Lancet Article thelancet.com ; Flu in China flu.org.cn ; Paper on Flu and Ducks ncbi.nlm.nih.gov ; CDC on Bird Flu cdc.gov/flu/avian

Chinese Plan Against A/H1N1 Flu

China also began administering a vaccine for swine flu in early September, the first country to do so. Foreign officials said China demonstrated an unusual openness to sharing information about A/H1N1 with its citizens and other governments, in contrast to its secretive approach to the near pandemic of severe acute respiratory syndrome, or SARS, a few years ago. [Source: Edward Wong, New York Times, November 11, 2009]

Chinese and Western officials say Chinese leaders put in place a comprehensive plan for a pandemic outbreak after the disastrous experience of SARS. This includes, at least in the first stages, some of the stringent quarantine measures of the SARS era, but also emphasizes educating the population about the disease: A red banner hanging from the balcony of a rural school building here in Guangdong Province says: A/H1N1 flu is preventable, controllable and curable, and not terrifying.

The government was so anxious to stay ahead of A/H1N1 that officials decided in June to start developing a vaccine even though testing kits for measuring the dosage of the agent in the experimental vaccines had not arrived from the W.H.O., said Zhao Kai, a virologist who advises the government. It was an unusual step, but on September 5 China became the first country to declare that it had discovered a vaccine, and by late October it had produced nearly 53 million doses.

China’s Tough Measure Against A/H1N1 Flu

As of August, 56 million people had been screened for flulike symptoms at China’s borders, said Feng Zijian, director of the emergency office of the Chinese Center for Disease Control and Prevention. Feng said he did not know the number of travelers who had been quarantined. The United States Embassy in Beijing said that 2,046 American citizens had been quarantined by the end of October, with 215 of those testing positive for A/H1N1. [Source: Edward Wong, New York Times, November 11, 2009]

Local authorities canceled school classes at the slightest hint of the disease and ordered students and teachers to stay home.

Quarantines of entire school groups from overseas ignited outrage in the home countries and led some American officials to complain to the Chinese government. The State Department implicitly criticized the Chinese policies by issuing travel warnings on the quarantine procedures.

One of the most extreme cases took place in July, when a group of 65 students and seven chaperons from St. Mary’s School in Oregon was quarantined twice, once in Beijing and once in Henan Province. The first time came after a girl pulled aside at the airport tested positive for A/H1N1. Then in Henan, a boy running a high fever also tested positive, leading to a second quarantine session. During that time, a dozen students tested positive for A/H1N1. Most of the students and chaperons flew back to the United States on July 31, having spent 12 of 17 days of their trip in quarantine.

China was virtually alone in taking such harsh measures. At the time, it seemed extreme, and it seemed restrictive, because I had never experienced an infectious disease outbreak, said Scott Dewing, director of technology at the Oregon school and one of the trip chaperons.

A/H1N1 Flu Quarantines in China

The disease entered China despite severe Communist-Party countermeasures to keep it out, namely the quarantining of people — including foreigners — who displayed symptoms — even slight temperatures or runny noses — or who came in contact with people that had symptoms of the disease. In Beijing, most of 650 people quarantined in April and May 2009 were identified at the city’s airport where passengers with fevers were identified using a thermal forehead scanner. China acted so aggressively in part to avoid a repeat of what happened during the SARS crisis in 2003.

Dozens of U.S., high school students were quarantined in Yichang on the Yangtze River after several students came down with the disease. An Australian lacrosse team spent five days in isolation after one player tested positive after arriving in the country. An American whose temperature was 98.9 degrees F, a mere 0.3 degrees above normal, was taken off a plane, placed in an ambulance and rushed to a quarantine facility where forced to spend three days separated from his family in small single room, enduring checks by doctors in biohazard suits and meals pushed through a small hole in a door even though he didn’t have the flu. He told the Washington Post, “It’s really weird to interact with people who are completely covered, It’s strange not to see anybody’s face. Being there so long, I was freaking out a little. What if I do have swine flu — Am I ever going to see my wife, my family, my friends again. That was the worst.”

About 150 Mexicans were put under strict quarantine even though most showed no symptoms and had not come in contact with anyone with the disease. In some cases they had not been to Mexico for months and seem to have been quarantined simply because they were Mexicans. The Mexican government chartered a plane to repatriated 136 Mexican nationals who has been held incommunicado. One of them told AP, “There were soldiers who won’t let us past the gate. This is like a kidnaping for us.”

Mexico is the country where the disease originated and more than 50 people died. China banned direct flights from Mexico and stopped imports of Mexican pork and sent a plane to Mexico to pick up Chinese tourists stranded by the flight ban. Mexico accused China of discrimination and called the confinement measures “unacceptable” and “without foundation” and advised its citizens not to travel to China.

China’s Tough Measure Against A/H1N1 Flu Appear Effective

Chinese and foreign health officials insisted their strict measures helped slow the spread of the disease in the world’s most populous country. China did a much better job than India in combatting the disease, . Like China, India has more than a billion people, many living in poor, rural conditions, and was exposed to the virus after it had been diagnosed in the West. The Indian Health Ministry has reported 505 deaths as mid November 2009. The United States, where the virus was spreading even before it was diagnosed in the spring, has reported more than two million cases and about 4,000 deaths in a population of 300 million. [Source: Edward Wong, New York Times, November 11, 2009]

“I think there were a variety of measures put in place by different countries, and it’s difficult to say what worked best and what didn’t, but China’s has worked very well, I think,” said Michael O’Leary, the director of the Beijing office of the World Health Organization.

If these strict measures had not been taken, and if there had been a sudden outbreak of the disease, there would have been a huge panic among the Chinese population, Feng said. Although there were many criticisms from outside, people should understand China’s considerations.

But Feng and Dr. O’Leary also say that the social and financial costs of China’s tough measures will have to be evaluated to see whether they were worth the benefits. And it is unclear how decisive those actions were in slowing the transmission of A/H1N1 — the summer heat in much of China was likely a critical factor in slowing the spread, and most schools were out of session at the time.

Image Sources: Landsberger Posters http://www.iisg.nl/~landsberger/, Environmental News

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

Last updated July 2011

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