China takes hard line against swine flu

BEIJING — Before the plane even lands, the flight attendants pass out influenza forms. Coughing lately? Fever? Contact with anyone with flu-like symptoms?

You walk past Chinese customs officials — most wearing medical face masks — and pass under thermal-imaging cameras. The cameras scan for fever, and possibly flu.

While the U.S. prepares for an H1N1 pandemic in the fall, China is acting like it's already under way.

"We are taking all precautions we can," said Wang Shuai, a deputy director at the Chinese Ministry of Foreign Affairs. "We have 1.3 billion people, so public health is a great priority."

So far, some 2,000 Americans have been detained by the Chinese on suspicions that they were infected or exposed to swine flu. They include business travelers, schoolchildren and even Mayor Ray Nagin of New Orleans, who was quarantined for five days.

Jonathan Metzl, a Kansas City native and psychiatry professor at the University of Michigan Medical School, was held for a week in June after someone on his flight to Shanghai came down with the flu. He was housed in a formerly abandoned hotel reopened as a government quarantine facility.

Metzl and fellow "guests" weren't allowed out of their rooms. His Chinese guardians were polite, although there were bugs and occasional mice. He feels China instead could focus on controlling the spread of the disease among its own population.

Health self-defense

But Metzl doesn't question China's right to protect itself. "The Chinese have been through SARS, they've been through avian flu, so I think their tolerance for these quarantines is a lot higher than ours," he said.

The Chinese government so far has reported more than 2,800 cases of H1N1 — but no deaths — on the mainland; the first being a Chinese student returning home from the University of Missouri. Hong Kong officials report 10,000 cases and four deaths.

H1N1 already has killed 522 in the United States. The Centers for Disease Control no longer reports the number of cases, but estimates nearly 8,000 people have been hospitalized because of the virus.

Many U.S. public-health experts believe aggressive quarantines such as China's serve little purpose, although governors have the right to quarantine areas in a public-health emergency.

But it's premature to even discuss the possibility, said Kit Wagar, a spokesman for the Missouri Health Department. "There's absolutely no reason to do anything like that," he said. "There are ways to limit the spread of it, and that's what we're focusing on."

Checking the temperature of every visitor to a country isn't likely to do much to prevent H1N1, either, according to Michael Cooperstock, an infectious-disease specialist at the University of Missouri.

"The virus is so contagious and so widespread," he said. "Trying to identify people as they come into the country isn't going to work because plenty of people would be incubating without showing any symptoms."

Instead, voluntary quarantine of those already sick is the goal, with health officials urging anyone feeling ill to stay home from work or school.

Hit hard by SARS

China implemented its more aggressive approach after learning about epidemics the hard way.

SARS, or severe acute respiratory syndrome, appeared in southern Guangdong province in 2002. Within months it spread to 37 countries and killed 774 people.

The epidemic ravaged the Asian economy, devastated tourism and foreign investment, costing the economies of Southeast Asia an estimated $18 billion and pushing Hong Kong into recession.

In the aftermath, Asian governments were sharply criticized for their slow response. Officials seem determined to head off any criticism this time.

Hong Kong authorities quarantined a hotel in May after a foreign guest tested positive for H1N1. But once it became obvious the virus wasn't as lethal as early reports indicated, and that the virus was already circulating, officials dropped the idea of additional quarantines.

High vigilance continues on the mainland. Two weeks ago, the 375-room Shangri La hotel in the northern city of Hohhot was quarantined after a Japanese man tested positive for H1N1. Police cordoned off the lobby, and those with reservations were told to find another hotel.

On the streets of Beijing and Hong Kong, face masks are a familiar sight. Signs on the subway warn people to cover their mouths when they cough. Hand-sanitizer dispensers are common in many buildings.

China plans to manufacture 65 million doses of vaccine by year's end.

So far, H1N1 hasn't proven much more dangerous than seasonal flu strains. But as in the U.S., officials in Beijing and Hong Kong worry the swine-flu virus could return this winter with a vengeance.

"What we're concerned about is how it will mutate," Hong Kong Chief Secretary Henry Tang said. "There's the fear that H1N1 and H5N1 (bird flu) could mix into a much more dangerous strain."