【09.11.11纽约时报】China’s Tough Flu Measures Appear to Be Effective

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China’s Tough Flu Measures Appear to Be Effective

By EDWARD WONG    Published: November 11, 2009

http://www.nytimes.com/2009/11/12/world/asia/12chinaflu.html?_r=1

CHANGGANG, China — Few farmers in this southern village gave much thought to the epidemic that had begun spreading rapidly in the United States early this summer until the authorities sealed its 100 residents off from the outside world for about a week. It turned out that a visitor from California had shown symptoms of the swine flu virus, or H1N1, when he arrived for a funeral.
Quarantines and medical detentions are among the aggressive measures that Chinese officials have taken to slow the transmission of H1N1, which quickly spread worldwide after being diagnosed first in North America.
To protests from around the world, China isolated entire planeloads of people entering the country if anyone on the plane exhibited flulike symptoms. Local authorities canceled school classes at the slightest hint of the disease and ordered students and teachers to stay home. China was virtually alone in taking such harsh measures, which continued throughout most of the summer.
Now, Chinese and foreign health officials say that some of those contested measures — more easily adopted by an authoritarian state — may have helped slow the spread of the disease in the world’s most populous country. China has not had to cope with a crush of cases, and it began administering a vaccine for swine flu in early September, the first country to do so.
Foreign officials also say that China demonstrated an unusual openness to sharing information about 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.
That is not to say that China has been spared. On Tuesday, Health Ministry officials reported an “explosive” growth of H1N1 on the mainland because of the onset of winter, with 5,000 new cases in the previous three days pushing the total to more than 59,000.
At least 30 people have died here after contracting H1N1.
Exact data on the virus are hard to pin down; many more cases are suspected than confirmed, and countries often use different methods to identify cases. Still, the indications in China are much more positive than those in India. 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 identified in the West. The Indian Health Ministry has reported 505 deaths.
The United States, where the virus was spreading before it was identified in the spring, has reported more than two million cases and about 4,000 deaths in a population of 300 million.
“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,” said Dr. Michael O’Leary, the director of the Beijing office of the World Health Organization.
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. Mr. 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 testing positive for H1N1.
“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,” Mr. Feng said. “Although there were many criticisms from outside, people should understand China’s considerations.”
But Mr. 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 H1N1 — the summer heat in much of China was a critical factor in slowing the spread, and most schools were out of session at the time.
Some foreign officials are still skeptical of the need for the strict quarantine measures, saying that China should have re-evaluated its policies by June, when it was apparent that the disease was not as lethal as initially feared. The State Council, China’s cabinet, did not decide to relax the quarantine policy until July.
From the beginning, the W.H.O. has said that tightening borders would not keep the disease out, and that closing borders or automatically quarantining specific groups of travelers — as China did for a brief period with holders of Mexican passports — would have no benefit.
Quarantines of entire school groups from overseas ignited outrage and led some American officials to complain to Beijing. The State Department implicitly criticized the Chinese policies by issuing travel warnings on the quarantine procedures.
In July, a group of 65 students and seven chaperons from St. Mary’s School in Medford, Ore., was quarantined twice. The first time came after a girl pulled aside at the airport in Beijing tested positive for H1N1. Then in Henan, a boy running a high fever also tested positive, leading to the second quarantine. During that time, a dozen students tested positive for 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.
“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 school and one of the trip chaperons. “Now, looking back and seeing some of the measures that are being taken now in the U.S., the Chinese measures don’t seem so extreme.”
Chinese and Western officials say that 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 taken for SARS but also emphasizes education. A red banner hanging from the balcony of a rural school building here in Guangdong Province says, “H1N1 flu is preventable, controllable and curable, and not terrifying.”
The government was so anxious to stay ahead of 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 Sept. 5 China became the first country to declare that it had developed a vaccine, and by late October it had produced nearly 53 million doses.
Li Bibo contributed research from Beijing. Keith Bradsher contributed reporting from Hong Kong.

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