H1N1: Lessons in how to protect and not protect public health

On my trip to Taiwan I was reminded of one of the striking disconnects between the US and Asia in dealing with the H1N1 virus. Asia had been devastated economically only a few years earlier by the SARS epidemic and so acted promptly to try protecting its citizens by screening arriving passengers and quarantining those with fevers (and sometimes the passengers who unfortunately sat nearby). The idea is simple, if you are sick, you should not be interacting with citizens until you are less likely to spread infection. Of course, screening before the passenger got on the plane would have been better but it was a step towards protecting public health. Quarantines have existed in the US before - quarantine law began in Colonial America to combat smallpox and isolation facilities were at every port of entry up until about 40 years ago.

In the last year, when I arrived in China, Singapore, Thailand and Taiwan they all measured the temperature for arriving passengers non-invasively using temperature screens. While the Center for Disease Control (CDC) was vigilant in tracking the progress of the virus, there were no restrictions placed on travel and little action was taken to limit the risk of infection. Given that the US was the country with the most cases and deaths globally it is a reflection on our society that we chose to not screen incoming passengers.

The United States’ decision to not screen its outbound or inbound passengers reflects the national values and how America balances national health with economic expediency. Other countries risked sacrificing short term tourism and international business opportunities in order to minimize the chance of transmission. The United States chose to neither minimize further internal risk of transmission by screening and quarantining incoming passengers, nor to protect other countries from receiving infected visitors.