A SHANGHAI infectious diseases expert dropped everything to be the sole doctor supervising
the return flight home carrying 98 Chinese stranded in the swine flu epicenter of Mexico,
Cai Wenjun reports.

The traditional role of doctors treating illness and alleviating pain changes dramatically at the outbreak of infectious disease when they transform into warriors defending the front line against epidemics.

The doctor defender role has been highlighted in China in two significant cases - more recently the global swine flu outbreak and, six years ago, the nightmare outbreak of SARS in 2003.

Dr Lu Hongzhou, an infectious diseases expert at swine flu treatment hospital, Shanghai Public Health Clinical Center, has been involved in the defence of both outbreaks.

Lu could not get any closer to the front line in the current outbreak than being the sole medical expert supervising the return flight home of 98 Chinese stranded in the swine flu epicenter of Mexico.

He talked about his experiences of both outbreaks on release last week from a seven-day quarantine with the passengers he shepherded home at a hotel in Shanghai's Pudong New Area.

He came to the interview last weekend from a meeting with health ministry officials on the prevention and control of AIDS, another key role of this leading infectious diseases expert who won a Shanghai Science and Technology Progress Award and a Silver Award, the highest honor for local medical staff, for bacterial research.

Lu, a member of Shanghai's expert panel for swine flu control and prevention, was directed by the Ministry of Health to supervise the China Southern Airlines rescue mission back to China.

"After Hong Kong reported Asia's first swine flu case, both the city and state health authorities activated a high alert status on the disease," said Lu.

"The experience in supervising the flight from Mexico to China will stay with me for the rest of my life," said the 43-year-old Anhui Province native.

It all started on the morning of May 2 when Lu got an emergency order from the Ministry of Health to supervise a trip to bring the stranded Chinese back from Mexico.

He took his laptop and all his information about swine flu directly to the airport without returning home.

His flight arrived in Guangzhou in the afternoon where he worked with airline authorities and the crew to develop an in-flight strategy for swine flu prevention and control.

He told the flight crew what preventive measures should be used and how to protect themselves by wearing masks, gloves and using disinfectant.

"I designed a seat map to ensure that no single passenger should sit close to another," he said. "Since the swine flu virus can spread through infected people's coughs and sneezes, I directed that all passengers have dinner in turn. While one passenger was eating, all people sitting around him must wear masks."

Lu's biggest concern was how to deal with people starting to develop flu-like symptoms on board.

"I had prepared 10 protective outfits. Anyone with symptoms had to wear the outfit and sit in the designated area, the rear three rows, set aside for sick people and their close contacts," Lu said. "Fortunately, none developed suspicious syndromes during the entire trip."

All Lu's pre-planning was carried out to the letter with the cooperation of all passengers and the crew. But what he couldn't control was the weather.

The flight left Guangzhou on the night of May 4 and landed in Mexico City to pick up 79 Chinese. However heavy fog prevented a landing in Tijuana on May 5 where more Chinese were to be collected. "The pilots tried for a landing once but they couldn't find the runway," Lu said.

The plane diverted to Los Angeles and later set off again for Tijuana to pick up another 19 passengers. It finally landed at Shanghai Pudong International Airport on the afternoon of May 6.

Lu didn't sleep during the return flight. He was busy monitoring and advising passengers, answering their questions, checking temperatures and assisting the crew.

"There was a pregnant woman and a two-year-old girl on board, so I paid extra attention to them," said Lu. "The pregnant woman was panicking about the virus getting to her unborn baby and I calmed her down by explaining the disease."

His work didn't stop after the flight landed in Shanghai.

After their conditions were checked on arrival, Lu and all passengers were immediately put into the quarantine hotel.

It wasn't until the first night in quarantine that Lu managed to call his family.

"My wife and daughter are used to me disappearing for a long time after an infectious disease outbreak," he said. "They are my strongest support," said Lu, who received cell phone messages from his 17-year-old daughter and police officer wife expressing their concern and love.

Lu said China's proactive response to the global swine flu outbreak is effective and appropriate given its high population density and lessons learned from the SARS outbreak.

"Some countries have blamed China for overreacting to the swine flu epidemic, but it had to do so to prevent a big outbreak," he said. "If a pandemic breaks out in China, the impact on people, medical staff and materials would be huge.

"As a medical professional, I knew the disease's properties and took proper protective measures against the virus on board. I was confident of not catching it," Lu said.

"But I was also quarantined and that meant that all people, no matter Chinese or foreigner, no matter doctors or ordinary passengers, undertook the same proactive measures for the sake of disease prevention and control."

His comments were echoed by a news release issued by the World Health Organization's China office early this week, claiming the best defense against the spread of influenza A (H1N1) in China is vigilance and public education.

The office acknowledged the unique challenges facing the world's most populous country.

If a pandemic breaks out, China could face tremendous demands due to the sheer size of the population, the socio-economic diversity across provinces, and the large migrant population, the WHO said.

Lu recalled his experiences when SARS broke out in 2003, when he was also designated by the Ministry of Health to guide disease prevention, control and patient treatment in affected regions.

"The SARS situation at that time was much more severe than this swine flu outbreak," Lu recalled. "It was a completely new disease at the start and resulted in big mortality rates. Swine flu is still a kind of A type flu and people have researched the virus for a long time. Many of our methods in defending swine flu came from what we learned from SARS."

He said quarantine is a very necessary method to prevent the possible virus spread. "All swine flu cases in China are imported ones now and proper quarantine can prevent transmission between humans within the community," he said.

"If we don't control the spread from the first-generation patient, the number of cases can grow quickly."

Lu reassured that swine flu is a preventable and curable disease whose mortality rate is less than 1 percent, far lower than the 9.6 percent of SARS and 61 percent of bird flu (the H5N1 virus).

"What I am worried about now is a possible second wave of A type H1N1, which is expected to hit the world in autumn," he said.

"Virus mutation is another concern. If the H5N1 and H1N1 viruses reassort, the disease will become much more severe."