Pandemics show no respect for borders

Posted July 15, 2009, at 7:07 p.m.

When I arrived in China late last month, the hazmat-suited public officials who met my plane had the same question for each passenger: “Have you had contact with pigs?” The officials took our temperatures, and then we were free to pass through customs and go on our way.

As a physician who had come to Shanghai to lecture at a Chinese medical school, I found it interesting to witness firsthand China’s public health response to the H1N1 virus. The process seemed like overkill, and it had debatable public health benefits, but it didn’t inconvenience me terribly. Or so I thought at the time.

The next evening, I returned from dinner to find two white-coated public health workers waiting for me in the lobby of my hotel. Apparently, a passenger three rows in front and five seats across from me on the flight had tested positive for H1N1. I was given 30 minutes to pack my belongings. When I returned with my bags, I noticed that the hotel staff stood in the corner of the suddenly cleared lobby wearing surgical masks. “I have no symptoms whatsoever,” I tried to explain, but the siren of the ambulance that sped to the front of the hotel drowned out my protestations. The back door opened to reveal three fellow American passengers from my flight. I climbed in, and we drove two hours in darkness.

At 3 a.m., we arrived at a rural motel complex. Each of us was assigned to a single room and handed a letter. “Ladies and Gentlemen, I hope you have had a good trip to China,” it read without a hint of irony. “In order to combat H1N1 you will stay at the Fengxian Medical Observation and execution institution for these special days. Stay at your observation room, no come out of your room. This temporary separation is for your family and friends’ happiness and health. You will find quality services here. Have a nice time at this special moment.”

The Chinese media have reported that travelers placed in quarantine are being held at five-star hotels, but if this is true, then the star system is in need of revision. Imagine a Motel 6 next to a chicken farm in the middle of a field. Then imagine that it had been left abandoned for a year before receiving a quick cleaning and sani-tizing and a lot of new security features. The rugs in my room were frayed, and wallpaper peeled from the walls. Mosquitoes abounded. Each room boasted a door alarm that sounded upon opening, and a metal containment fence and police sentries ringed the complex.

I was told that 10 ambulances worked through the night to bring in people from my flight. On my wing of the complex, there were three businessmen, a photographer and her two children, an engineer, a banker and many others. In the days that followed, we were joined by people from other flights. We couldn’t leave our rooms, so we passed much of the time standing in our doorways, talking across the empty corridors about the mice, the heat, the food, the missed opportunities and especially the isolation.

After several days, our frustrations erupted in a series of impromptu rebellions. We attempted to march en masse to the guard station to present our demands: hallway aerobics classes, dinner delivered from a Shanghai steakhouse, better conditions. Each time, the guards eventually coaxed us back into our rooms, and little changed.

Twice daily, three-person medical teams, draped from head to toe in infection-control gowns, caps, goggles, gloves, shoe covers and face masks, visited us to check for fever. Not one of us was ever sick or symptomatic.

After seven days, we were told once again to pack our things. Quarantine-clad observers ushered our haggard group outside and handed each of us a final letter as we waited for chartered buses. “In order to protect public health and keep H1N1 flu from spreading,” it read, “we have kept you here for 5-day medical observation.”

So is China’s aggressive approach, which has quarantined thousands of Americans and others, the proper way to protect its population from the new flu?

No. Pandemics are serious matters, and quarantines have proved effective in combating the world’s most serious contagions, from SARS in the 21st century to the influenza pandemic of 1918. It’s understandable that China, which was hit very hard by SARS, would be particularly wary of a new epidemic. But the kind of con-finement I experienced flies in the face of established notions of international public health. Quarantine is expensive, and public health needs are many. Most other countries have moved away from quarantine as a means of combating H1N1, in large part because while the virus may yet mutate into a killer infection, it is not consid-ered deadly at present.

The U.S. government recently issued a travel advisory warning travelers about the Chinese government’s H1N1 containment efforts, saying there have been reports of “unsuitable quarantine conditions.” The internment may have kept us away from Chinese citizens, but it left us vulnerable to getting sick from our quarantine con-ditions. We were psychologically isolated and disoriented.

China’s quarantine policy also has an unpleasant whiff of xenophobia. Chinese passengers were allowed to stay in their homes during the quarantine period instead of being confined to the high-security quarters the rest of us shared. The setup promoted the narrative that H1N1 was being spread by “foreigners.” Quarantined businessmen told me they’d had contracts canceled by their Chinese colleagues, and my Shanghai hotel informed me that my room rate would be triple what it had been if I wished to return.

Many countries — the U.S. included — have tended to see viral illness as coming from “outside,” only to learn that pandemics show little respect for national borders in a globalized world. Chinese health authorities need to wake up to this lesson and develop China’s ongoing H1N1 response in concert with, rather than in rejection of, international norms.

Jonathan M. Metzl is a professor of psychiatry and women’s studies and directs the Program in Culture, Health and Medicine at the University of Michigan.

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