Why quarantine is the best policy
By Chen Ching-chih 陳清池
Published on TaipeiTimes
http://www.taipeitimes.com/News/edit/archives/2005/01/26/2003221041
Wednesday, Jan 26, 2005,Page 8

On Jan. 15, Taiwan and China reached an agreement allowing direct charter flights across the Taiwan Strait during next month's Lunar New Year holidays. It is quite likely that direct trade, transport and postal ties -- the "three links" -- might soon follow.
Under these circumstances, the need to pay greater attention to China's threat to Taiwan's security is obvious.

In addition to military security, one must think in terms of health security: the health threat that China has historically posed to its neighbors, particularly Taiwan, must be seriously considered.

The 2002-2003 global outbreak of SARS, which resulted in the deaths of 774 people (including 43 in Taiwan), was a disease that originated in China, and experts have warned that it will not be the last.

Nowhere is the flu virus more likely to mutate the way the SARS virus has than in China, where crowded conditions prevail, traditional farming practices pack pigs, birds and people close together, and locals consume exotic wild animals.

Indeed, "China is the perfect breeding ground for new viruses," German virologist Christoph Scholtissek has said.

In addition, judging from China's long history of epidemics, public health officials must take the warning seriously and be prepared for more diseases to emerge from China.
Dating back to the 12th century BC, Chinese oracle-bone scripts have mentioned the existence of pestilence.

With their propensity for keeping records, the Chinese from the 3rd century BC began recording the occurrence of epidemics in some detail.

One can thus have a pretty reliable idea about the frequency of epidemics that have had an impact on China over the last 2,200 years.

According to a checklist of epidemics in China, two major outbreaks occurred: the first in 243BC and the second in 48BC.

In the succeeding centuries, as China became more urbanized, an average of seven epidemics were recorded each century until the 14th century, when 20 epidemics were recorded.

Another 20 epidemics then ravaged China in the 15th century. The number doubled to 41, then 38, 39 and 39 again for each of the centuries after that. On average this represented one outbreak every two-and-a-half years.

Infectious diseases did not and do not respect borders. Trade, war and other means of cross-border contact facilitated the spread of disease across the world.

Three examples, one each from the 14th, 19th and 20th centuries, should suffice in demonstrating how major epidemics that appeared to have originated in China not only caused enormous loss of life within China but also beyond its borders.

First, let us cite what many historians believe to be the most devastating epidemic in recorded history.

In the 13th and 14th centuries, Mongol movements across previously isolated locations probably brought the bubonic plague to the Eurasian steppe for the first time.
Plague-infected fleas and rats served as carriers and passed on the deadly bacteria to humans.

The 14th-century pandemic first invaded China in 1331. This plague coincided with native Chinese resistance against Mongol domination, climaxing in the overthrow of the Mongols and the establishment of a new Chinese dynasty, the Ming, in 1368.

William McNeill, the noted historian of plagues, writes, "The combination of war and pestilence wreaked havoc on China's population. The best estimates show a decrease from 123 million in about 1200 to a mere 65 million in 1393, a generation after the final expulsion of the Mongols from China."

The plague then traveled west along the trade routes of Eurasia before reaching the Crimea in 1346, when the disease broke out among the armies of a Mongol general laying siege to the trading city of Caffa.

From there the infected fleas, rats and humans boarded ships bound for Mediterranean seaports from where the disease proceeded to penetrate almost all of Europe.

This bubonic plague, known as the Black Death, decimated the European population.
The best estimate of plague-related mortality between 1346 and 1350 in Europe is about 25 million people, or one-third of the total population.

Even then, the plague did not disappear from China and Europe after its first massive attack in the mid-14th century, and would return to haunt the peoples of Eurasia thereafter.

Second, outbreaks of plague continued to occur in various parts of the Chinese interior in the 19th century without attracting much attention from the outside world.

This was the case until 1894, when the disease reached Canton and Hong Kong and affected the Western settlements in those ports.

Within a decade of its arrival in Hong Kong, important seaports of the world experienced outbreaks of the dreaded disease. In Bombay alone, for example, some 6 million people had died of the disease within a decade of its arrival there.

The third and final case is the early 20th-century Spanish influenza pandemic that spread worldwide from 1918; it claimed between 20 million and 100 million lives, most of them 20 to 40-year-olds.

In the US, 675,000 people were killed, while in India 18.5 million lives were reportedly lost.

According to Washington Post reporter David Brown's book Killer Virus, "Some experts believe the flu virus came from China -- the birthplace of many flu strains," although it was first detected in soldiers in early March 1918 at Camp Funston, in Kansas, "simply because of better surveillance and record-keeping."

Due to its geographical proximity and increased Chinese immigration from the late 17th century, Taiwan in particular could not escape the influence of the epidemics occurring on the other side of the Taiwan Strait.

British Customs reports, for example, mention an outbreak of plague in northern Taiwan in 1888. About 2,000 people died from the disease; the city of Taipei was hit particularly hard, with 200 dying every day during the peak of the epidemic.

Though contact with China was reduced significantly after Japan annexed Taiwan in 1895, the plague continued to find its way to Taiwan from Amoy. In all, during the first two decades of Japanese colonial rule in Taiwan, over 30,100 were infected and 24,100 died.

Following Japan's defeat in 1945, Taiwan was protected from outbreaks in China due to complete separation from China during the Cold War.

Since the late 1980s, however, Taiwan has opened its door to indirect contact with China by way of Hong Kong.

Particularly in the last decade, trade and cultural exchanges as well as tourist visits to China have increased drastically. Such increased contact laid the ground for the SARS virus that greatly troubled the people of Taiwan in 2002.

Lessons can and should be learned from the history of epidemics in China and Taiwan, as well as from the difficult fight against the SARS epidemic.

The only effective way to shield Taiwan completely from Chinese epidemics is to sever all ties with China, including Hong Kong.

In an age of globalization, however, this does not seem possible or even practical.

On the other hand, if another SARS-like crisis is to be avoided in Taiwan, it is absolutely vital that nonessential contacts with China be minimized and closely managed.

China is too close for comfort. For the sake of Taiwan's health and security, direct air and sea links with China should be avoided if at all possible.

In addition, Taiwan must have a closely considered contingency plan before another SARS-like crisis strikes the nation.

Taiwan's health is the responsibility of the government, but it is also the responsibility of the Taiwanese people as well.

Chen Ching-chih is professor emeritus of history at the Southern Illinois University at Edwardsville.