Confronting New Strains of Influenza

Confronting New Strains of Influenza
China Times editorial (Taipei, Taiwan, ROC)
A Translation
April 30, 2009

In April 2009, the world was just beginning to recover from the havoc wreaked by the financial tsunami. US President Barack Obama confidently declared that signs of an economic recovery were already evident. Who knew another storm was already brewing? The World Health Organization (WHO) upgraded the epidemic caused by the H1N1 virus, a "new type of influenza," to a Level Four Alert. This may be revised at any time to a Level Five Alert. Many nations, including the Republic of China, have begun working to prevent a repeat of the panic and harm caused In 2003 by SARS (Severe Acute Respiratory Syndrome).

At the same time, we have good news. This year, 12 years later, the Republic of China government will finally acquire observer status under the name "Chinese Taipei." On May 18 it will participate in the World Health Assembly (WHA). Some people consider WHA observer status under the name "Chinese Taipei" unsatisfactory. They compare it to World Trade Organization (WTO) membership under the name "Taiwan, Penghu, Kinmen and Matsu Customs Territory." But this is nevertheless an important step in the Republic of China government's return to the international community. Especially since this new type of influenza may touch off international concerns. Taipei has been invited to the meeting. It has been presented with the opportunity to join the international dialogue on public health and the cross-border health cooperation program led by the World Health Organization (WHO). This will provide Taipei with valuable experience in public health surveillance and the prevention of enterovirus infections and Influenza epidemics. For Taipei, participation in WHA is an important breakthrough.

Participation in international organizations is one thing. But disaster prevention efforsts must not be taken lightly. A new outbreak of influenza caused by a four-year-old boy's illness on a pig farm near the US-Mexican border appears random, like the outbreak of SARS in 2003. On February 26, 2003, an American businessman who fell ill in Hanoi and was hospitalized in Hong Kong, died. This was the prelude to SARS, known as the 21st Century plague. Soon afterwards, Hong Kong, Mainland China, Vietnam, and other Asian regions reported cases of SARS.

The first SARS cases were discovered in March. Initially, health authorities believed the epidemic was under control. But in April Heping Hospital experienced a massive outbreak. Patients, health care workers, and nursing personnel were all infected. This was Taiwan's first mass infection of SARS. The public experienced widespread panic and confusion. The government classified it as a fourth category of SARS Notifiable Diseases. For the first time since 1949, hospitals, streets, and buildings were quarantined. Both the central government Director of Health and the Taipei City Director of Health were forced to step down. The "anti-SARS hero" at the time, the man who on his own initiative entered the already quarantined Heping Hospital and took command, is today's Director of Health Yeh Chin-chuan.

SARS reminded many people of what well-known sociologist Ulrich Beck calls the "risk society." Society treats individuals as units. But modern risk is globalized (Glocal Risk). Individual behavior has collective consequences. Many people believe that one reason the SARS epidemic got out of control was that the Beijing government covered it up during its outset. The global community means constant interaction. Public health is an issue that requires everyone's participation. Any one nation or region's negligence may lead to unpredictable and unfortunate consequences. On Taiwan, SARS screening and isolation measures led to widespread public discussion of ethical issues. For example, a high school student quarantined at home violated quarantine to attend a cram school class. This created a hole in the quarantine system, and widespread criticism that the high school student had "absolutely no sense of public spirit." Some Heping Hospital medical staff refused to go back to work. Then Taipei mayor Ma Ying-jeou had some harsh words for them. He said fighting SARS was akin to waging war. If health care workers refuse to work, it is akin to cowardice in the face of the enemy. He would punish them according to the "Infectious Diseases Prevention Law," and seek administrative accountability.

The SARS epidemic taught Taiwan valuable lessons about collective risk, personal responsibility, and medical ethics. The fight against SARS also helped established standard operating procedures. Three and a half months after SARS erupted on Taiwan, WHO announced Taiwan's removal from its list of SARS infected areas. During this period, 664 were infected and 73 died. Approximately 110,000 were quarantine at home. Three in ten thousand returning to Taiwan from infected areas became infected. Twelve in ten thousand who came in contact with them became infected. The incidence of SARS on Taiwan was low. But the risk of death among those infected was high.

During that period, Taipei's application for WHA observer status was rejected. Six years later, a new type of influenza led to 160 deaths in nine countries. Asia already has its first confirmed cases, in South Korea. Will it cause a global pandemic? Everyone is concerned. In addition to public health security issues, scholarly studies reveal that the economic damage caused by the epidemic on Taiwan caused a drop in consumption of over 200 billion NT. Excluding the cost of fighting SARS, the financial losses amounted to 16 billion NT. Will the new type of influenza have a similar impact on a still recovering economy? The nations of the world must work together to survive the economic and social impact of the disease. During the SARS crisis, US Secretary of Health and Human Services Tommy Thompson said pandemics remind us that public health knows no borders and is not a political issue. Without a global public health cooperation mechanism, we will not be able to control such diseases.

中時電子報
中國時報 　2009.04.30
社論－以萬全準備迎接新流感挑戰
本報訊

二 ○○九年四月，這個世界剛剛開始要從金融海嘯的肆虐中回神過來、準備迎接美國總統歐巴馬的信心喊話：「景氣已看到復甦的契機。」沒想到新風暴又成形，世界衛生組織（ＷＨＯ）已將因Ｈ１Ｎ１病毒感染所造成的「新型流感」升級為第四級警戒，並且隨時可能上修為大量流行的第五級警戒。包括台灣在內，各國已紛紛投入防疫工作，以免二○○三年ＳＡＲＳ（嚴重急性呼吸道症候群）恐慌與傷害再現。

與此同時，台灣接獲一樁好消息。叩關十二年後，台灣終於在今年以「中華台北」名義的觀察員身分，參加五月十八日舉行的「世界衛生大會」（ＷＨＡ）。或許對某些想比照世界貿易組織（ＷＴＯ）「台澎金馬關稅領域」會籍名稱的人來說，ＷＨＡ觀察員「中華台北」這個名稱不盡如人意，但是這畢竟是台灣重返國際社會所跨出的重要一步；特別是在這次新型流感可能引爆國際流行的隱憂之際，台灣此時獲邀與會，不但有機會加入國際公衛對話，參與世界衛生組織（ＷＨＯ）主導的跨國醫衛合作計畫，台灣更能在腸病毒、流感疫情監控等公共衛生及疾病預防上，提供寶貴的經驗，因此參與ＷＨＡ堪稱近年來台灣的一項重要突破。

能夠參與國際組織是一回事，但防疫抗災的努力更不可掉以輕心。這次從美墨邊境一家豬隻養殖場裡的四歲小男童生病所引發的新流感，彷彿出於一個看似輕微的偶然，一如二○○三年的ＳＡＲＳ。二○○三年二月二十六日，越南河內一位美商發病送至香港就醫後，不幸死亡，揭開了ＳＡＲＳ這個被稱為是二十一世紀人類第一場流行瘟疫的序幕；之後香港、中國大陸、越南等亞洲國家紛紛傳出了ＳＡＲＳ病例。

記得當時三月間發現第一個ＳＡＲＳ病例，起初衛生主管機關還認為疫情在控制中；四月就爆發和平醫院集體感染，病患、看護工、醫護人員先後發病，這個台灣第一次發生的ＳＡＲＳ集體感染，讓台灣進入了集體恐慌，社會氣氛大亂。政府宣布將ＳＡＲＳ列入為第四類法定傳染病，並創下自一九四九年以來，首度封院（醫院）、封街封樓、院外發燒篩檢的景況；中央和台北市的衛生首長雙雙下台。當時主動進入已遭封院的和平醫院指揮大局「抗煞英雄」就是今天的衛生署長葉金川。

ＳＡＲＳ讓很多人深刻體認到著名的社會學家貝克（Ulrich Beck）所一再提醒的「風險社會」特質：社會看似以「個人」為單位，但現代風險卻已展現出一種全球在地化的趨勢（Glocal Risk），個別行為具有集體的影響力。很多人相信，ＳＡＲＳ疫情之所以會一發不可拾，原因之一是中國大陸一開始隱瞞疫情；對交流頻繁的國際社會而言，公衛是「一個都不能少」風險連動課題，任何一個國家、地區的疏忽，都可能造成難以估計的不幸後果；而在台灣，ＳＡＲＳ的篩檢與隔離措施，也引發了公共倫理議題的高度討論，例如，某位被居家隔離的高中生跑去補習，造成防疫漏洞，引發各界責難，認為這名高中生「完全沒有公共道德意識」；此外，當時和平醫院有醫護人員不願意返回醫院工作，進行抗爭，時任台北市長的馬英九特別說了重話，強調抗煞視同作戰，醫護人員如有抗爭，即視同敵前抗命，將依《傳染病防治法》懲處，並追究行政責任。

在ＳＡＲＳ流行期間，在有關集體風險中個人的道德倫理與醫療專業等議題上，台灣上了寶貴的一課，也建立了抗煞的ＳＯＰ（標準作業模式），ＳＡＲＳ病例在台灣出現的三個半月後，ＷＨＯ宣布台灣從ＳＡＲＳ感染區除名。在此期間，台灣共有六六四個病例，其中七十三人死亡；居家隔離者共有十一萬人左右，由疫區返台者的發病率為○○三％（一萬人有三人），接觸者則有○一二％發病；ＳＡＲＳ在台灣可以說是一種獲病比例低，但是死亡風險高的疾病。

那段期間，台灣也曾申請成為ＷＨＡ觀察員未成。六年後，新型流感已在九國家造成一六○例死亡，亞洲也已在韓國出現第一起確定病例，是否會進一步造成全球大流行，世人極為憂慮；除了公共衛生安全的問題之外，從ＳＡＲＳ的經驗看來，疫情還會造成經濟損害，以台灣為例，學者研究，ＳＡＲＳ期間，台灣的消費減少了二百餘億元，不計抗煞經費，財務損失約為一六○億元，新型流感是否會對尚未恢復元氣的經濟造成新的打擊，同樣令人關切。總之，無論是疫情本身或者經濟、社會層面，各國必須通力合作才有可能度過這場猛烈的疫情危機。一如ＳＡＲＳ期間，美國衛生部長湯普森強調的：疫情讓世人警惕到，公共衛生是沒有國界的，也是非政治性的，若沒有全球公共衛生合作的機制，就無法控制疾病。