Since the way Chinese public health officials traditionally save face is by covering their ass, when I hear things like this I don’t automatically believe it:
“With initial efforts of containment, actually we not only reduced the impact of the first wave to China, but we also won time for us to prepare the vaccine” now being given to China’s people, [Chen Zhu, China's health minister] said in an interview during the Havana meeting of the Global Forum for Health Research.
After the swine flu first appeared in Mexico last spring, China put Mexican visitors ? and people from other countries who had set foot in Mexico ? in weeklong quarantines and monitored them for the virus, whether or not they seemed sick.
Chinese authorities also isolated entire planeloads of international visitors if someone on board experienced flulike symptoms. They pulled passengers off trains and blocked access to villages if someone got sick after coming into contact with a foreigner.
Such measures are easier to impose in an authoritarian state. They sparked protests around the world, but when asked if they were successful, Chen said: “Exactly, very successful, exactly.”
“We are confident the situation is under control,” he said. (AP via Chicago Tribune)
While the New York Times China correspondent Edward Wong seem to find these assertions credible, others (including us) aren’t quite so credulous:
Health experts say extraordinary measures against swine flu ? most notably quarantines imposed by China, where entire planeloads of passengers were isolated if one traveler had symptoms ? have failed to contain the disease.
Despite initially declaring success, Beijing now acknowledges its swine flu outbreak is much larger than official numbers show.
China’s official count of nearly 70,000 reported illnesses with 53 deaths is dwarfed by estimates of millions of cases with nearly 4,000 deaths in the United States, a nation with about a third of China’s population. (Maria Cheng, AP via Google News)
Earlier we put up a detailed post about a tour group outbreak of swine flu where all of China’s containment measures failed miserably. The Chinese have a terrible record on leveling with the world on disease outbreaks — their cover-up of SARS is exhibit one — so there is more than some suspicion the Draconian swine flu measures were as much about show as about public health (this is something all governments do, including the US). And now China’s alleged transparency on swine flu is being questioned by the same specialist who helped blow the whistle on his government during the SARS outbreak:
Zhong Nanshan of Guangzhou Institute of Respiratory Diseases in southern China, called into question the official number of deaths from H1N1, telling the Southern Metropolis Daily newspaper that the quoted figure of 53 was too low. ?I just don?t believe that there have been 53 H1N1 deaths nationwide,? he said.
While many have pointed out that limitations on testing capacity have led to an underreporting, Zhong suggested that some hospitals were intentionally not testing those who died from pneumonia for H1N1.
His words carry weight because he shot to fame during the Sudden [sic] Acute Respiratory Syndrome (SARS) outbreak in 2003 for quickly recognizing and reacting to the threat posed by the new virus while government officials around the country tried to cover it up. (David Cyranoski, Nature blog The Great Beyond)
China has a sorry record on bird flu as well. While we tend to think of authoritarian central governments as all-powerful, they are often unable to control what goes on in far flung provinces at or beyond the periphery of their reach (we see the same thing in US federal agencies where regions often act autonomously against the orders of the headquarters). It would not be surprising to find that many deaths have been covered up or just ignored in provincial hospitals. There could be all sorts of motives for this, none of them praiseworthy.
Katherine Todrys and Joe Amon of Human Rights Watch have pointed to another factor that might be making the toll from swine flu less visible in China:
Worldwide, far more people migrate within than across borders, and although internal migrants do not risk a loss of citizenship, they frequently confront significant social, financial and health consequences, as well as a loss of rights. The recent global financial crisis has exacerbated the vulnerability internal migrants face in realizing their rights to health care generally and to antiretroviral therapy in particular. For example, in countries such as China and Russia, internal migrants who lack official residence status are often ineligible to receive public health services and may be increasingly unable to afford private care. (Todrys and Amon, Commentary in Globalization and Health, Human Rights Watch)
There are vast numbers of internal migrants in China and it is likely many of them have very little or no access to health care. They die unattended and perhaps buried unrecorded.
Unlike China’s health minister, I an not confident swine flu is under control in China. At least no more confident than I am that Sarah Palin is an expert on energy policy.