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William A. Haseltine interviews an American who was quarantined in Shanghai after returning from Europe

corona-virus

William Haseltine (WH): Thank you for your time. I understand that you and your wife were released from quarantine in Shanghai the day before yesterday. I appreciate you taking the time to tell your story. It will be fascinating and instructive to all around the world who may be facing a similar circumstance. It is a rare opportunity to learn about it first-hand. Let’s start from the beginning. I understand your request to remain anonymous as I publish this interview.

Traveler (TL): Thank you, Bill. We were in Europe and we were flying back via Frankfort, flying out on the 28th of February, landing on the 29th back to Shanghai. At that time, Europe was not treated as a hot zone in China. We were screened on arrival. We walked through infrared temperature checks when we walked through the airport, filled out forms specifying where we had been for the last fourteen days, picked up our suitcases, and left. When we got back to the apartment, we were met by the staff and asked us to self-isolate.

WH: Did they know you had returned from abroad?

TL: Yes, they knew we had come from abroad.

WH: Did you tell them, or did they already know?

TL: I told them. They did not know, but they asked.

WH: Please describe how control of entry and exit works where you live.

TL: We live in a fairly large complex. To enter the complex, you normally walk past a place where they take your temperature. However, that day we came in through the underground garage with our luggage, so they did not take our temperature. It actually was not until the next day when I went downstairs to pick up laundry that the person at the front desk knew I had not been around for two weeks. He said where have you been? I said we had been traveling. They said you got to do self-isolation.

WH: So the first time you had an interaction that said you have to do something was the person at the front desk of your housing complex who told you that, because you had been traveling abroad, you had to do self-isolation.

TL: Correct

WH: What kind of authority does that person have?

TL: I am not sure. I mean, they look authoritative.

WH: But from your point of view, up until that time it was just like a desk clerk or was it more than that?

TL: Yes. It is important to understand there are three levels of isolation.

The first level is self-isolation which means you stay home, you take your temperature, your record your temperature on an app and you are asked not to go out more than necessary. You may leave to buy groceries and other necessities. You can go out for walks, but you are supposed to be cautious. That is the base level.

The middle level is home quarantine. In home quarantine you remain in your apartment, but you are not allowed to go out at all. You still use the app to record your temperature and the indicators. Food and other necessities are delivered. They bring them outside your door, knock, and run away. Then you open the door to your apartment and bring it in.

The highest level is controlled quarantine. In controlled quarantine you are relocated to a hotel. I will describe that in a minute, but let me describe the app everyone uses today.

The app is a WeChat add on. The app is provided by the city. It has many features. It is in Chinese. I do not know what it all says, but I do know how to get into it far enough to do two things. One is to find my QR code. Your personal QR code is color green, orange or red. Mine is now green I am happy to say because I am successfully beyond quarantine. Wherever you go people ask to see your QR code, in stores, restaurants or even if you are going to Peete’s for coffee. They want to make sure your QR code is green. I know how to find my QR code. I also know how to go into the page to enter your temperature.

WH: How do you order food under home quarantine?

TL: There is a whole industry of food delivery services her in China. You go online, pick the restaurants, order what you want from the restaurants and they deliver within thirty minutes and you pay with WeChat. The biggest one is called Neituan. The second biggest one is called Elene. For people who do not speak Chinese, Shanghai has one called Sherpa.

They are all similar. They bring the food to the front gate. They are not allowed to enter the apartment complex. There is a receiving station by the front gate, tables and shelves to store food that is being delivered. Everybody is having food delivered. Normally, when you order food from these services, the delivery service would bring it to your front door. Not now. Since the outbreak, delivery people cannot enter the apartment complex. When they arrive, they call to tell you your food has arrived. If you are in home quarantine, you are not allowed to go down and pick it up. Someone from your apartment building will bring it up to you.

WH: How often must you enter your temperature every day?

TL: Twice a day for anyone in self isolation or home quarantine. If you are not in self isolation, reporting your temperature is not required.

WH: What time of day?

TL: In controlled quarantine, 8:00 AM and 1:00 PM. If you are in self isolation, you pick the times. You must do it at the same time every day.

WH: How long were you in self-isolation after you returned?

TL: For two days.

WH: Then?

TL: We began receiving official calls. First from the local CDC (center for disease control), then from the city CDC, then from the district CDC. Finally, we received a call from the police. They said, “You guys were on flight x. We are sorry to report that one of your fellow passengers has tested positive for the coronavirus.”. We returned on Saturday, and the call from the police came in on Tuesday.

TL: The police told us that we would have to finish our fourteen-day period in controlled quarantine at a hotel. We asked, “are you sure? Is that really necessary?” We checked with the American consulate. They said, “Yes. You must comply.”

The City CDC gave us a more detailed explanation. They told us, “You were seat x and the passenger in question was in seat y.” “But we were far from that passenger” I said. He was in coach and we were in business class. “That does not matter, you must comply. Our rules state that being in the same plane counts as contact. You could have bumped into each other while waiting in line getting on or off the plane.”

WH: What happened next?

TL: The City CDC said, “Pack your bags. We are going to come by tomorrow morning at 11AM and bring you to the hotel.” The next morning, they came with a van.

WH: Wednesday morning?

TL: Yes. A person came to the front gate wearing a mask. Everybody wears masks now all the time when they go out.

WH: What kind of masks? HEPA filtered masks?

TL: Just one of those surgical masks. They serve a signal that they are not going to cough droplets at you, not to protect themselves.

WH: Gloves?

TL: I do not remember if the person who came to our door was wearing gloves. The driver probably was wearing gloves. The driver was wearing a hazmat suit wearing an N95 mask.

WH: There was a van waiting for you downstairs at 11AM?

WH: Two suitcases?

TL: We each took one large suitcase and I also had a backpack full of computer equipment.

WH: Then what?

TL: They drove us to a hotel. According to TripAdvisor, it is number 711 out of 4,801 hotels in China. It is a three-star hotel.

WH: Did they take over the entire hotel?

TL: Yes. They took over the whole hotel.

When we arrived, there was another person in a hazmat suit waiting for us. It was not like checking into a hotel. There is someone sitting behind several card tables spread out with many forms. He explained what we were supposed to do. We asked if we could room together. They say no. No exceptions. I said, “You know I don’t speak Chinese.” “No problem.” She replied.

They put us two rooms apart on the same floor. They gave us detailed instruction forms. Mine were in English. They explained, “You are in complete quarantine. You are not allowed to leave the room. Meals will be delivered to your door three times a day, at 8:00 AM, 12 noon and 6:00 PM. We will knock on the door or ring the bell. Wait at least thirty seconds until they have a chance to get away. Only then can you open the door, retrieve the food, and close the door quickly.”

WH: Did they leave the food on a tray on the floor?

TL: No, on a stand.

WH: Did you choose the food? What about dietary restrictions?

TL: Yeah, I explained I do not eat pork. They said, ‘Okay, well we will do our best to accommodate that.’

WH: But other than that did they give you a choice?

TL: No. There was not a menu.

WH: How was the food?

TL: I would call it high school cafeteria food. It was edible, but Chinese. But that is not how we subsisted. We could still order food via Neituan or Elene and have it delivered to the hotel. You pick the restaurant, order it, and have it delivered.

WH: Did they continue to deliver the standard food regardless of whether or not you ordered your own food?

TL: Yes. We usually ate the breakfast they served. Otherwise we had two meals at lunch and two at dinner. Our friends sent care packages as well.

WH: Were you allowed to visit your wife while under quarantine?

TL: No. Not at all. Not once. We communicated via Zoom on our computers. We set up video conferencing. We shared the experience together. We could chat together all the time.

WH: How many rooms were there in that hotel and do you think it was full?

TL: I would say the hotel was probably ninety percent full. There were about seventy rooms altogether on five floors.We were told to report our temperature before eating breakfast. I would call the staff downstairs to report my temperature.

WH: Did you also enter your temperature on the WeChat app?

TL: No, I had to call it down.

WH: How did you take your temperature? Did they give you a thermometer?

TL: Axillary thermometer, the least precise way!

WH: Under your armpit, right?

TL: Exactly.

WH: Did they give you the thermometer?

TL: Yes. They provided the thermometer and disinfectants. When we checked in, I had to show that I could read the thermometer accurately. I had to take my temperature and then read the thermometer, then hand it over so they could verify it.

WH: Were you ever tested for coronavirus?

TL: No.

WH: No tests, no test ever?

TL: No tests. I asked why. The answer: ‘There problem is a problem. There are no false positives, but there are a zillion false negatives. If you test negative it does not mean you are negative. Therefore, everyone exposed must remain under controlled quartile for the full fourteen days. they still want you to spend fourteen days in quarantine from contact.’

WH: Who is explaining that to you?

TL: I do not remember. That might have been from the consulate.

WH: The US consulate? Did no official person from Shanghai explain that to you?

TL: I do not remember. It is possible that they explained it to my wife.

WH: Okay.

TL: Ok. I remember now. It was our mutual friend who runs a hospital here in Shangahi that explained that to me.

WH: What did you do for exercise?

TL: So I have an app on my phone called Fitbod which allows you to do a simple body weight workout. I used 1.5 liter bottles of water as dumbbells.

WH: I have done that before. I also used a heavy briefcase or small suitcase.

TL: Whatever works.

WH: Sit ups, crunches?

TL: Pushups, lunges, squats, curls with the water bottles.

WH: Am I correct– You and your wife were in controlled quarantine for 11 days?

TL: 11 days. That is correct. You might actually appreciate one of the funnier moments of this whole experience. When we checked in, a woman handed me a very tiny bottle of shampoo, tiny bottle of shower soap and a couple of bars of soap and showed me how to wash my hands properly. And then she hands me a blue bucket and a little bottle disinfectant tablets. She says, in English, “This is for toilets.” My eyes grow wide in horror trying to figure out what she is asking me. I see she realizes what I am thinking and she bursts into laughter and she says, ‘No, no, no, no, no, no. I do not want you to use bucket as a toilet, but want I want you to do is dissolve the tablets in water in bucket, then dump the mixture into the toilet before you flush.’

WH: Was that only for feces or was it for everything?

TL: Everything. Everything.

WH: Everything? Does that mean every time you had to pee you had to add water to your bucket and add a disinfectant and pour it into the toilet before you flush?

TL: You’ve got it.

WH: How much water? How big is the bucket?

TL: One liter for piss and two liters for more.

WH: How many pills for each?

TL: Six and twelve. Anytime you run out of tablets, they will send up another jar. They are taking it very seriously.

WH: Did you ever interact with another person for eleven days?

TL: Only one or two people in hazmat suits at a time who came at 9:00AM to collect the garbage and to spray Lysol all over the room. These were my sole source of human interaction. I became very fond of these guys.

WH: Two guys?

TL: One or two guys, yes.

WH: Was there anything worth noting that occurred over those eleven days?

TL: I taught classes. I was elected chair of the board of a local organization in Shanghai. There was a lot of interaction with the outside world. The thing is, you build routines—waking up, working out, each meal, the hazmat cleaning crew, taking your temperature, chatting with my wife, taking a nap

WH: Did you have a TV?

TL: They had TV, but I did not actually watch TV. I turned it on once. It was all Chinese stations. But they did have movies, they had American movies, but I had actually too much going on to watch any.

WH: Do you know if anybody in your hotel actually was infected?

TL: I have no idea. The first few days there was somebody in the room between my wife and me who had a pretty nasty cough, it sounded like a barking dog. That was disconcerting. The first day we were diligently reading about whether the virus could be passed through hotel room walls.

WH: Did someone water your plants or take care of pets at home?

TL: Luckily no pets. I have a black thumb for plants. I had already killed all of our plants, so we did not have any living ones left.

When we returned home, the neighborhood management committee person brought us flowers, which was a very nice welcome home gift. Oh, I still got this piece of paper which I can read to you. On the third day, International Women’s Day, my wife was given flowers.

WH: Has it since calmed down in Shanghai? Is your life back to normal?

TL: Yes.

WH: So you can go shopping, you can go to the movies, you can go wherever you want.

TL: Not movies. Restaurants, shopping yes. But there are three things I would say that are noticeably different. Everybody is wearing masks.

WH: You too?

TL: Sure. It is considered rude not to wear a mask because that is how you tell people, do not worry if I cough, I am just coughing on myself. If you are walking around without a mask on, people will give you dirty looks. Also everywhere you go, when you go into the mall or into a restaurant, they are taking your temperature,

WH: Using an infrared gun?

TL: They have got infrared. On entering a mall you walk along a little path and there is a big TV screen. You see yourself and a bunch of people walking by and the TV screen shows your temperature. It does not slow you down. When you enter a restaurant, they aim the infrared gun at your wrist. They will tell you your temperature. Hand sanitizer. It is everywhere.

WH: What are the general conditions in the city? Can you go to work? Can you go to your office?

TL: I can. Office workers are going to the office. I would say half are working from home. Yesterday and today I stayed and worked from home. I will probably go into work tomorrow. But there are not a lot of people around.

WH: What is open or what is closed?

TL: Stores are open, factories are open, offices are open, shopping malls are open, restaurants are open. Grocery stores never closed. Gathering spots, schools, movie theaters, athletic places, gyms, any place where you have more than fifty people, are all closed. Shanghai Disney has reopened.

WH: Is there a limit to the people who enter Disney?

TL: Yes. All the Apple stores are open.

WH: Do they limit the number of people that come into a store?

TL: Yes. They only allow a certain number of people to be inside at any one time.

WH: Does that mean there is a line outside?

TL: Yes.

WH: How long are the lines?

TL: I have not seen any lines.

WH: Who pays for controlled quarantine? It must be expensive. Hotel room for two weeks, meals, monitoring, cleaning service?

TL: They just announced a change in policy. It was entirely free for us. As of today, people who are in hotel quarantine, have to pay for the room and the food.

WH: What happens if you cannot pay?

TL: Presumably they will help you.

WH: You have to pay because they think it is your fault?

TL: No, but they have to cover their costs.

WH: How would you describe your emotional experience.

TL: Before the quarantine, the experience was quite terrifying to me. I thought of quarantine as somehow a lot of very, very sick people locked up together. It was sort of like a solitary confinement sort of metaphor. You are cut off in some sense from the world.

Now after having lived through that experience in the age of the internet with continuous video conferencing, it is very different from what I thought it would be. I did not feel cut off from the world. The care packages really helped. So too did video conferencing and working remotely. I felt isolated in the sense that I was not in same room as anybody else, but I did not feel cutoff.

WH: Did you feel it was the right thing to do? Did you feel cared for?

TL: I felt very well cared for actually. The staff at the hotel, everybody was super nice.

WH: Did you feel it was appropriate?

TL: I do not know. You are the virologist Bill.

WH: What did you feel? Were you resentful, were you resigned?

TL: Not resentful. I was resigned. By the time this happened to us, we knew what had and was happening in Wuhan. People were starting to hear about the problems in Northern Italy. The vocabulary of flattening the curve was out there. It seemed like good citizenship to me. I felt like it was bad luck to have been on the same plane with that guy.

WH: It could have been a man or woman.

TL: It was a man. Apparently, he had been a worker in a restaurant in Italy who was returning home to China via Frankfurt.

WH: Are people worried that the epidemic may flare up again sparked by people who return home?

TL: Well, the number of cases now in China are absolutely tiny. There have not been more than two cases per week over the last six weeks. All cases here are imported, people who came in from overseas. Given that is the situation, it seems reasonable to be careful and to isolate people who come here on planes from overseas. Honestly, I feel very, very safe here.

WH: What about the university? Will everything be okay with virtual education?

TL: Well, it has actually worked better than I thought. Virtual education is not perfect. It is not as good as live education. However, in some ways it is as good or even better. If I had free choice, I would prefer to be teaching live. For a teacher it is really exhausting to be staring at a screen. You have to concentrate even harder when you are teaching. That is not so nice for the faculty. As for the students, they miss all the kinesthetic communication that goes on in a classroom. That is not as successful when mediated by a screen. You can individualize interactions better virtually. You can do more asynchronous things. The faculty has been fantastic. They have really jumped in and done what they have to. There is a lot more discussion among the faculty about pedagogy than there has ever before.

WH: I do not want to take more of your time. You have been extremely generous and this is a fascinating story.

TL: If you have a minute what is life like in New York?

WH: All the restaurants, theaters, museums, and every place people can gather is closed. The subway is opened. Schools are closed. The economic hit is going to be massive.

TL: Do you think it is appropriate?

WH: I can’t answer that question easily as we do not know how widespread the infection is. Our government seems to be one of the worst prepared to deal with the epidemic. We are simply flying blind. In that case extreme measures are likely justified. But what a pity it has come to that. Testing has just not been done on any scale. As we speak, even doctors cannot get a hold of tests they need to test their patients. Hundreds of nurses are in some kind of quarantine because they were exposed but do not know if they are infected. Things are really badly messed up starting from the White House on down. It has just been a terrible mess. Because no one really knows what is happening, people are being asked to shelter in place.

TL: That is the state in the nation of France now.

WH: Yes. Like Italy and Spain too. That is what happens when you do not test. That is the only thing you can do. It is not a matter of democracy. It my opinion it is the difference between good and bad leadership.

TL: Yeah. Look at South Korea. South Korea has had amazing results. And they had a serious outbreak. But they tested everybody in sight.

WH: They did not test everybody. They did contact tracing. Much better and more efficient than testing everybody.

TL: That is right. But they tested 230,000 people and they did contract tracing to do it.

WH: Thank you again.

TL: One final word. On third day of quarantine, when I received an unexpected package of kiwi fruit, coffee, and tea from the Shanghai Municipal Foreign Affairs Office. The package came with a note in poorly translated English that read,

“My dear friend, the inconvenience for the time being, it is for the health of you, of me, and of everybody. So thank you for everything. Quarantine against virus is no isolation of warm hearts. We are right here with you.”

(William A Haseltine is Chair and President, ACCESS Health International)

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