Saturday, May 30, 2009

Some concerns on some people's concerns on Korea's quarantine

A new meme has been developing in the K-blogosphere lately that (1) Koreans are overreacting to swine flu (H1N1) and, more recently, that (2) "foreigners" and specifically English teachers are being targeted as dangerous vectors of H1N1.

I've already addressed the severity of Meme #1 in this post, particularly toward the bottom, but here are some highlights: This bout of swine flu has a 0.7% mortality rate: one out of 140 confirmed cases have died. That is some seven to ten times higher than "regular" influenza, and it tends to go after younger people (e.g., those under 50). At the beginning of a major travel season, having reasonable — even though somewhat invasive — safeguards in place (self-quarantining of people who have traveled abroad, regular health readings like temperature, avoiding public places when possible) may be what keeps this at a manageable hum instead of a full-blown pandemic. In terms of how these things go, this may be just the beginning, especially since pandemic flu tends to come in waves:
Scientists think the spring swine flu epidemic may be a "herald wave" of what's to come. In 1918, a milder wave of flu cases occurred in late winter and early spring, before the deadly pandemic surge in the fall of that year. In 1957, Asian flu was causing unremarkable illness in China, before landing on American soil for the summer outbreaks and a severe winter season.

Simonsen has studied past pandemics and says that a pattern of multiple waves is common to all of them also. The 1957 pandemic flu had three waves in the U.S. over five years, with a large number of deaths in the winters of 1959 and 1962. The 1968 pandemic flu had two waves in the British Isles over consecutive years, with 15% of the total number of deaths occurring in winter 1968 and the remaining 85% in winter 1969.
And while we're at it, let's not forget that Korea is by no means the only country where people are taking this seriously. Next-door neighbor Japan had wholesale cancellation of schools completely unaffected by the virus, for example.

As some have pointed out, this is 70 out of every 1000 reported cases, and there may be many unreported cases that don't result in fatality, with some estimates about ten to twelve times higher than the official number in the US. Mortality is deaths (numerator) over population (denominator), and if you had a denominator that was actually higher if we added unreported cases, then the mortality rate would be lower.

But there are several caveats of that logic to consider, especially if we are going to compare this swine flu outbreak to "regular" flu. Deaths from "regular" flu include deaths where the flu was a contributing factor and not necessarily the direct cause of death, particularly among the elderly who make up 90% of all "regular" flu deaths, which raises the numerator in "regular" flu deaths and makes the mortality rate higher.

But this swine flu outbreak is affecting younger people, particularly those born after 1957 when there was an outbreak with a similar strain. So if we were to compare under-50 mortality from "regular" flu with under-50 mortality from this swine flu, we can see it's a much more virulent strain, with the rough ten-times-more-severe ratio holding true.

In other words, this swine flu is not something to trifle with.

Swine flu naysayers (i.e., those who brush this off as akin to just "regular" flu) have also cited the differences in health care systems in Mexico and the US as evidence that this year's swine flu is not so serious. Even Wikipedia warns of the dangers of comparing a country like the US with that of Mexico:
Epidemiologists cautioned that the number of cases reported in the early days of an outbreak can be very inaccurate and deceptive due to several causes, among them selection bias, media bias, and incorrect reporting by governments. This could also be due to authorities in different countries looking at different population groups, many poor, which may in part explain higher mortality rates in countries such as Mexico. Furthermore, countries with poor health care systems and older laboratory facilities may take longer to identify or report cases.
This argument basically boils down to this: Swine flu is not so deadly if you don't count all the deaths. Yes, in Mexico the poor and uninsured made up many of the deaths due to H1N1, but in the US, the 36,000 deaths per year from "regular" flu occur in a country where tens of millions are uninsured and where even the elderly under Medicare lack the resources and support network to get adequate medical care (these are severe shortcomings in the US).

In other words, it's disingenuous to point out the deaths of all the poor people in Mexico who died from swine flu while not citing the very significant effects of poverty and lack of resources in all the "regular" flu deaths in the US with which swine flu is compared.

Again, this swine flu is not something to trifle with.

We have the first wave of a significantly more virulent form of influenza against which most of the population does not have any immunity (or prior exposure) and we are about to begin a major travel season after already seeing how air transportation and transit has been a key way in which it has colonized.

This is not the regular flu. What we need to do is curtail its spread as much as possible until a reliable and safe vaccine is available and administered.

And now I'm going to repeat what I've said many times before about how the public often sees public health: Public health people are called incompetent for their failures and chicken little when they're successful. If an outbreak occurs despite the attempts to stop it at the airports and the schools and elsewhere, the public health specialists will be criticized and derided, but if no outbreak occurs, we'll have people going on and on about how they overreacted to the flu.

And, dayum, was that a long intro to what was supposed to be a fisking of Roboseyo's Korea Herald piece on the quarantining of fifty English teachers last week, so I'll try to keep that short and sweet.
The quarantining of more than 50 English teachers last week was the subject of a great deal of interest and concern in the expat community.
I'm going to stop right here and point out that a key aspect of this is that this discussion and concern is in the expat community, as Rob says. While this was just one of dozens of stories in the media that an average Korean might see on any give day this past week, it was a highly scrutinized and heavily focused-on topic of expats. This is relevant to Rob's characterization later on.
There are several reasons for concern, first because many English teachers work with children, and many small and not-so-small children have not yet learned to cover their mouths when they cough, or to wash their hands properly. This means both teachers and students are at risk: diseases spread easily in schools.
Okay, there's a bit of a logical leap here: No kids in the schools have been infected yet, but their tendency not to cover their mouths when they cough or wash their hands properly might cause the teachers to get infected. Well, yeah, this would be true if swine flu had already infected some of the kids, but that hasn't happened yet. Point taken: diseases spread easily in schools so we want to keep it out of the schools (hence Japan's "overreaction" by closing thousands of unaffected schools).
However, another point of concern for many foreigners in Korea is whether Swine Flu is beginning to be portrayed as a "Foreigner Disease."
See, this is where the difference between the average Korean's perception and that of the K-blog-reading expat comes into play (more on this to come)...
The Joongang Daily published an article with the headline "Foreign English Teachers Epicenter of New Flu Cases."

Now, it is a matter of pure fact that a large number of the virus-infected in Korea are foreign English teachers. That's undeniable. However, some of us are concerned as well, that if English teachers are portrayed as the primary disease carriers, it will have two side-effects that are bad for everyone.

The first side-effect is bad for Koreans. If Koreans read an article saying "Foreign Teachers Epicenter of New Flu Cases," from a news source they trust, there is a chance that they will decide, "Well, I don't spend time around foreigners, so I'm fine." That false sense of security might cause some to neglect safety precautions recommended by the World Health Organization to prevent disease transmission.
As I mentioned on Rob's own blog and in this post, the Korean media is describing each Korean case in detail:
국내에서 신종 인플루엔자 A(H1N1) 환자 2명이 또 발생해 확진환자가 35명으로 늘었다.

보건복지가족부 중앙인플루엔자대책본부는 미국에서 입국한 유학생을 포함, 한국여성 2명이 신종 플루에 감염된 것으로 확인됐다고 29일 밝혔다. 이들은 각각 20세 유학생과 48세 미국 거주자로 전해졌다.

20세 유학생은 지난 24일 미국에서 입국했으며 다음날 증세가 나타나 27일 보건소에 의심증상을 신고했으며 이날 최종 확진됐다. 48세 환자도 미국에서 25일 입국한 뒤 27일 증상이 나타났고, 바로 의료기관에 신고했다.
The one-third or so that have not been English teachers have been described in detail: Koreans of whatever age, usually coming back from abroad. Along with foreigners arriving from abroad, Koreans returning from abroad have been focused on in the public information as people who need to be careful upon returning (and such information is exactly why some have gone to get checked after becoming sick).

The Korean media is NOT saying this is just foreigners. That is a K-blog conceit that does not stand up when one looks at the reports on the actual H1N1 cases. But Rob's article makes the underlying assumption that Koreans will not typically read about all the cases of Koreans being infected, and that is simply not the case.

Most any Korean in Korea who follows this story enough to know about the group of teachers quarantined would also have read about the infected Koreans, whose age and mode of transmission are pretty clearly stated. The danger, if there is any, is not that people will think "Oh, I don't know any foreigners, so I'm okay," but that they will think, "Oh, I don't know anyone who has come back from abroad, so I'm okay."
Believing H1N1 is a foreigners' problem actually increases the risk that Koreans will catch the disease.Koreans may believe that H1N1 is a problem (currently) coming from abroad, but that's very different from saying it's a foreigners' problem. Again, your assumptions about Koreans reading/hearing only about foreign cases is inaccurate and therefore your conclusion is faulty.
When SARS appeared in Asia, many Koreans believed kimchi kept SARS out of Korea, but again, I hope Koreans will not rely on kimchi alone to protect them: a friend quoted a Kenny Rogers song to me, "Trust in God but lock your door," and I answered, "Eat kimchi, but wash your hands with soap."Boy, that kimchi-prevents-SARS idea really gets a lot of mileage. I've heard it said by expats far more than I've ever heard it said by Koreans, and most of the times I've heard it said by Koreans it was said in jest, like eating spinach would turn you into Popeye. I'm going to have to gather some quantifiable evidence to see how widespread (or not) this supposed meme actually is, or rather, how widely it is actually believed.
The other, more insidious worry that some foreigners have is that this situation will spread the attitude that foreign English teachers are the source of diseases: Many foreign teachers around Korea have described being asked to take a health check, despite experiencing no symptoms, and not having traveled outside of Korea for a long time.
I'm not sure where these places are that English teachers were asked to do these things, so I can not scrutinize their acts or Rob's description of them, but it should be noted that people can be carriers and even transmitters before they realize they are sick, and people who gather in places with a large number of other people who may recently have traveled from abroad (say, people who party in Hongdae or Itaewon) may have increased risk. We're at the stage now where people might be getting it from other people who did the traveling.
If they were personal friends of someone who is now in quarantine, they ought to go to a health clinic out of their own duty toward the community's public safety. If a school decides it is the safest choice to send all their teachers, Korean and foreign, to a clinic for a health check, that is a very prudent thing to do: Everyone spending time around kids is at risk. However, comment boards online are reporting foreigners being asked to submit to unwarranted health checks and being asked to prove that they are disease-free, in a "guilty until proven innocent" manner that makes it seem like they are being singled out as disease carriers.
Again, I do not know which places he's referring to, but even the much derided regulations from Avalon English described regulations for both foreign and Korean employees.
If the swine flu scare convinces Korea to be more health conscious, to be more careful about hand washing and sanitation at schools and restaurants, to stay home from work when they are sick, so as not to spread diseases, that is a great thing. However, if the health scare is used as an excuse to put suspicion on foreign English teachers and create or reinforce an image of foreigners as disease carriers (while Koreans are unconcerned), this could develop into an unhealthy pattern of fear and suspicion toward foreigners: Such things do not belong in an advanced society like Korea.
Again, what the K-blogs (and apparently Dave's ESL) are saying about this and what average Koreans would read about this are two very different things. Look, I'm not saying there is no xenophobia in Korea, but I'd rather deal with it where it really exists. But it really seems like a lot of expats are hellbent on turning Koreans into the whitey-hating bogeyman, looking for xenophobia and xenophobic/racist motives in almost every action in Korea.

As I talked about here, that constant whining about The Man is a sure way to keep wallowing in self-pity and never get anywhere. Especially when you end up convincing yourself of made-up sh¡t that is only true in your own head and in the K-blog/Dave's ESL echo chamber. Years from now, they'll still be talking about the xenophobic quarantine of teachers in 2009.
It is the responsibility of Korea's media to provide fair information to the people of Korea, instructing them as to the true risks of the disease in a level-headed way, and describing how each Korean can help prevent its spread, without playing on people's worst fears, manipulating people's emotions with yellow journalism, and shifting blame onto outsiders and scapegoats.
And Rob, you don't know that they aren't. An article based on very faulty assumptions, applauded by the K-blog readers as having "nailed it" because they are all listening to the same incestuous amplification of the same K-blogs.

(And lest anyone think I am bagging on Rob unfairly, I actually think he's a pretty good guy and this is why I'm laying into him on this. He should know better.)


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