Transpacificflyer

The health crisis has been expected and was warned of repeatedly by public health officials in North America, Japan, Hong Kong, and the EU for several years. It has been an annual topic of concern at the public health congresses, with warnings that we would see another SARS like event in the region. I appreciate that one must not give way to doom and gloom and must stay positive, but here's something to keep in mind;

1. Parts of Asia including mainland China are currently experiencing some of the worst air pollution in years. Much of Thailand has people choking for air and primary schools closed. Some parts of Vietnam are just as bad. Thailand has 100+ agricultural fires raging, Cambodia 900+ as the respective governments refuse to stop field burning. What this means is that a large portion of the region's population is already subject to respiratory distress. An infection which damages the lungs further will have a devastating impact.

2. Western health systems are short staffed or at full capacity as it is. An event no worse than the previous SARS event could cause some health systems to slowly meltdown. There is no way the UK NHS or Canada's hospital system could cope with a surge of 10%+ in the ERs.

3. As was pointed out, more people are traveling then ever before. Mainland Chinese are an important source of tourism for Cambodia and Thailand. Considering the past conduct of Thai and Cambodian officials, it is not unreasonable to expect that they will do their utmost to protect their tourist revenue and to keep the Chinese visitors coming. Bangkok is a major airline hub and IMO presents a risk. The use of temperature monitoring is not particularly effective due to the incubation period of the illness. If the scanners are anything like the magical bomb detectors the army purchased some years ago, then it's in large part for show, to reassure the public,

4. The world has more conflicts than ever before. Health care workers cannot even vaccinate against polio in rural Pakistan without being killed, so consider the implications if the illness spreads to vulnerable regions.

5. Don't assume that this illness will demonstrate the same type of mortality outcome as previous outbreaks. The MERS crisis illustrates this point. It was unexpected that MERS would have a 50% fatality outcome. It was also unexpected that Older males with diabetes would over present in the fatalities.

The odds are only good if decisive action is taken. We live in a world where profits and political goals can squash public health needs. The Chinese government has a history of concealing data and of not being transparent. The end result is that information from China is unreliable. Airlines will try and keep their routes open as long as possible although a curtailment of Chinese air traffic might be the salvation some airlines could use.

Voluntary compliance and mainland China are not compatible. This was demonstrated by the measures the world had to force upon China during the SARS crisis. Human beings are selfish creatures. People will still try and circumvent the travel ban in place and bribery is a way of life in China.I expect that politically connected people or those who can pay will avoid the quarantine.

China had the strict measures imposed on it. The world was threatening to cut off trade and air travel unless China acted. It is an accepted fact that the Chinese government initially covered up SARS and was unco-operative. Today, the Chinese government has acted faster and allegations of dishonesty are not being made. However, there was a delay and a reluctance to provide complete data. Every foreign public official I have heard quoted so far, from the EU, to Japan to the USA has said in polite diplomatic words that they do not accept the Chinese government's estimate of patients. Governments are being discrete and measured in public statements in order to avoid the idiocy that accompanied the SARS outbreak. I recall the cases of ignorant fools refusing to patronize Asian owned business or overtly discriminating against Asians on the assumption that they were infected. The last thing we need is an accompanying outbreak of stupidity.

Another unpleasant part of the reality is that the Chinese government and its representatives are not held in high regard by other countries public health officials . This is due to ongoing allegations of spying and/or theft of intellectual assets. An illustration of this was the panicked revoking of access for two researchers with mainland Chinese origins and their mainland students to Canada's only Level 4 virology facility last July. It's not politically correct to raise the issue, but there are legitimate concerns. It's also a case of "we told you so, and you wouldn't listen".City codes? Seriously? The rules you reference either do not exist, and when they do, are not enforced unless an important person makes the complaint. As for people complying with rules, a quick read of expat forums (e.g. thaivisaforum) will provide a long list of examples of angry old men whinging about restrictions on agricultural products and how they circumvent the rules to bring in their sausage or cheese etc.

If I was a contingency planner at an airline, I would be pulling up the contingency plans now. The western airlines cannot compel their employees to work the Chinese routes if there is a legitimate concern for health safety. They are not there yet, but another week or two of increased cases and they will have to act. The Zika crisis disrupted leisure travel to LATAM and the Caribbean for a year, with some significant drops in traffic. Personally, I would be ok with a suspension of air traffic to China for a couple weeks. It might impress upon the mainland government that it needs to change its practices.