Quarantined in Korea ( About H1N1)- An Excerpt

Quarantined in Korea - An Excerpt

A group of teachers quarantined in southern Seoul say that the overall mood in the group is good, but raised concern that conditions there may actually be putting their health more at risk. "Generally spirits are high here, we're out in the sun getting a tan. 'Outbreak' is playing on the TV, which is pretty surreal," said D, an English teacher from the United States. The teachers requested anonymity due to their employment situation.

The teachers have been taken to the facility after staying in the same conference as a person who later developed the H1N1 form of influenza A. However, some of them had not even been in the center at the same time as the first patient.

They are being kept in the same conference center, and quarantine will continue for seven days after the last reported infection. Since new infections are reported every day, the quarantine looks likely to continue for some time.

Meanwhile the detainees are passing the time by exercising on the balcony, watching films and DVDs and reading. Several have maintained blogs about their experiences.

"There are conference rooms on the ground floor that had projectors, so at first we hooked up our laptops and had movie nights," D said. "But they closed off the first floor and we had to stop."

That might not sound much like quarantine, and that might be the problem.

While the level of segregation has effectively separated the group from the outside world, not much has been done to prevent transmission within it.

While authorities have repeatedly asked detainees to stay in their rooms, little has been done to enforce it. People in the center say they are able to move within the complex, and that some things that would have helped encourage segregation have not been done.

The detainees have no access to outgoing phone lines, although internal phones are in each room. The internet has been off from their rooms and the only online access is from communal areas, meaning that those without cell phones would have to use communal areas to communicate with their families. People quarantined say authorities have not allowed them the chance to contact their families or embassies in any other way.

Air conditioning was kept off until Wednesday, leading many to cool off on the communal balcony.

Detainees have been told not to smoke, but complaints have been made that those smoking in their rooms have been reprimanded, while smokers in communal areas had not. One detainee said they had been promised nicotine patches but not given any.

Others say that the authorities have been lax on basic hygiene.

"When there have been confirmed patients, some people have been moved into their beds but the sheets haven't been changed," said D.

Another detainee, G, said that cleanliness had not been well-maintained.

"They are not removing the trash. They decided that it needed special treatment because of the infection risk, but since then they haven't done anything," she said Tuesday morning.

"Water was coming out of the garbage all over the floor. The bathrooms haven't been cleaned since we got there.

"We're running out of paper towels, running out of soap and we're running out of toilet paper."

Cleaning and restocking was eventually done at around 4 o'clock that afternoon.

"We had a guy posting adverts on all the doors make it to the third floor before some people playing Mahjong told him he shouldn't be there," said D. "It's like a Benny Hill sitcom at times."

Health officials say they have been kept together for their own convenience, and the consensus is that the facilities are not generally unpleasant.

"My current situation is rather comfortable. Since I have symptoms, I have my own room. It's a large comfortable space, except that the air conditioners don't work. So it can be a bit warm in here, even with windows open." said B, another teacher in quarantine. "The staff here has been very nice and very professional, especially considering their unfamiliarity with this kind of situation."

But others say communication has been an issue. Some people were told that they would be going for tests, only to be taken to quarantine with nothing but the clothes on their back. No tests were done.

"I was told I was just going to have a test. Then the doctor told me I had to go to a testing center, and then I was brought here," G explained.

"I had a friend bring and drop off a suitcase as soon as I got here," she said.

She expressed frustration at the lack of communication early on. "The information changes constantly, and I think what makes us most upset is that they told us not to contact our embassies and that they did not contact them."

Those in charge of the facility deny telling them this.

However, the teachers say that things are slowly improving. Communication has improved between the authorities and detainees. DVDs, books and teacher training materials have been provided. Cleaning has been done regularly since Tuesday.

A group of expats have made visits to the center, although they did not enter the quarantine area. They brought books, food and other supplies.

"It's wonderful to have that support from the Korean expat community and I think that a lot of people are looking for that recognition," said D.

Among those visiting was Benjamin Wagner, an American lawyer who teaches International law at Kyung Hee University Law School. He said the teachers appeared to be treated well and that xenophobia did not seem to be a big factor in the quarantine.

"I went there for specifically that reason and ... there didn't seem to be any bias in the quarantine," said Wagner, who spoke to six of the teachers. "It's true that some Koreans got to go home, but some foreigners got to go home as well."

"Unfortunately, there does appear to have been some negligent medical treatment in the quarantine process, which may have led to some people contracting the disease who wouldn't have otherwise. Korea is playing a catch-up game with quarantine expertise, but it needs to make sure that proper WHO procedures are being followed."

Sixty-five people were originally quarantined, although many have been removed after developing suspected symptoms of swine flu. But questions remain about how those 65 people were chosen. Those detained had only been given basic airport-type tests, and held regardless of the outcome.

All foreign teachers that attended the group have been quarantined. Health officials say some Koreans who were at the conference have been quarantined at home.

Health officials say the teachers were detained because they had stayed together in the conference center. This seems to be an attempt to follow the WHO guidelines about households who experience infections - essentially treating the whole group as one household.

Some say that that was an unnecessarily broad method of selection. Others would have preferred to be quarantined at home.

At issue is a separate group who did not attend the conference, but were brought on Saturday to the same facility for a conference the following week.

One teacher The Korea Herald spoke to said he had not met the other teachers before being quarantined.

Some feel that they have been put at additional risk by the quarantine.

"Initially, people were handing out together and socializing, although those with symptoms were kept in their own rooms, even from the start. However, people did intermingle, playing cards, talking, etc.," said B, who was confirmed as having swine flu on Tuesday.

"I arrived symptom free, but quickly developed symptoms by the end of the first day. The short incubation time - 1-5 days - with this particular virus makes it likely many of those who got sick, caught the virus after arriving here, but that's just speculation on my part."

"There was a lot of misinformation and one thing I felt is that if I was not at risk of swine flu I definitely was after we were taken back to the center," said G.

"It just implies that our health was not that important."

According to the Health Ministry, 22 of Korea's 32 cases of H1N1 were in foreign teachers as of yesterday afternoon. The sharp emphasis on this aspect has upset some in the wider community of foreign English teachers. Some have been asked to take tests despite not having left the country in the last six months.

But B warns that limiting such inquiries to foreign teachers may miss important cases.

"This isn't a foreigner disease. I was exposed to sick Koreans. This is a traveler disease. Any person who travels or is around those who do ought to be cautious."

By Paul Kerry ( 2009.05.29)

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New flu "unstoppable", WHO says, calls for vaccine
Mon Jul 13, 2009 7:48pm EDT


By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - Saying the new H1N1 virus is "unstoppable", the World Health Organization gave drug makers a full go-ahead to manufacture vaccines against the pandemic influenza strain on Monday and said healthcare workers should be the first to get one.

Every country will need to vaccinate citizens against the swine flu virus and must choose who else would get priority after nurses, doctors and technicians, said Dr. Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research.

Several reports showed the new virus attacks people differently than seasonal flu -- affecting younger people, the severely obese and seemingly healthy adults, and causing disease deep in the lungs.

Kieny briefed reporters on the findings of the WHO's Strategic Advisory Group of Experts on Immunization, or SAGE. "The committee recognized that the H1N1 pandemic ... is unstoppable and therefore that all countries need access to vaccine," Kieney said.

"The SAGE recognized first that healthcare workers should be immunized in all countries in order to retain a functional health system as the virus evolves," she added.

After that, each country should decide who is next in line, based on the virus's unusual behavior.

Seasonal influenza is deadly enough -- each year it is involved in 250,000 to 500,000 deaths globally. But most are the elderly or those with some kind of chronic disease that makes them more vulnerable to flu, such as asthma.

ELDERLY ADVANTAGE

The elderly seem to have some extra immunity to this new H1N1, which is a mixture of two swine viruses, one of which also contains genetic material from birds and humans. It is a very distant cousin of the H1N1 virus that caused the 1918 pandemic that killed 50 million to 100 million people.

A study published in the journal Nature on Monday confirmed that the blood of people born before 1920 carries antibodies to the 1918 strain, suggesting their immune systems remember a childhood infection.

The work by Dr. Yoshihiro Kawaoka also supports other studies that this new H1N1 strain does not stay in the nose and throat, as do most seasonal viruses.

"The H1N1 virus replicates significantly better in the lungs," Kawaoka said. Other studies have also shown it can cause gastrointestinal effects, and that it targets people not usually thought of as being at high risk.

"Obesity has been observed to be one of the risk factors for more severe reaction to H1N1" -- something never before seen, Kieny added. It is not clear if obese people may have undiagnosed health problems that make them susceptible, or if obesity in and of itself is a risk.

On Friday, a team at the U.S. Centers for Disease Control and Prevention and the University of Michigan reported that nine out of 10 patients treated in an intensive care unit there were obese. They also had unusual symptoms such as blood clots in the lungs and multiple organ failure.

None have recovered and three died.

The CDC estimates at least a million people are infected in the United States alone and clinics everywhere are advised not to test each and every patient, so keeping an accurate count of cases will be impossible. The United States has documented 211 deaths and WHO counted 429 early last week.

Kieny said WHO would also work to get better viruses for companies from which to make vaccines. She said the strains that had been distributed did not grow very well in chicken eggs -- used to make all flu vaccines.

One exception -- AstraZeneca's MedImmune unit makes a live virus vaccine that is squirted up the nose and it is easier to produce, Kieny said.

WHO said countries should continue with their normal vaccination programs against seasonal flu. Kieny said the seasonal H3N2 strain was also very active now in the southern hemisphere's winter.

Sanofi-Aventis, Novartis, Baxter, Schering-Plough's Nobilon, GlaxoSmithKline, Solvay, CSL and AstraZeneca's MedImmune are among those working on flu vaccines.

(Editing by Philip Barbara)