Authorities in China are tightening quarantine rules and urging citizens overseas to put off trips home as the country reports more cases of incoming travellers with coronavirus.
The rise in imported cases poses another challenge for Beijing’s efforts to contain a deadly contagion that appeared to be out of control outside China.
On Tuesday, health officials in eastern Zhejiang confirmed seven new cases of the coronavirus, all of whom were Chinese nationals returning from Italy to Qingtian county in the province’s southeast.
Of the seven, six travelled with a 31-year-old woman who was confirmed as infected on Monday. Identified by her surname Wang, she worked as a waitress in a restaurant in Bergamo, a city in the Lombardy region of northern Italy.
Wang flew to China with her husband, a younger brother and four colleagues from Milan through Moscow before arriving in Shanghai and travelling by road to Qingtian on Saturday.
The seventh was a 34-year-old colleague of Wang’s, who took a separate flight from Milan to Frankfurt on Friday before flying to Shanghai.
A doctor at a hospital in Qingtian told news website Caixin that the eight decided to return to China because business had taken a hit from the coronavirus outbreak in Italy. Zhejiang health authorities said they had traced 39 people who had close contact with Wang and wanted to find more passengers who took the same flight.
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On Tuesday, Shanghai health authorities said 71 people who had contact with the eight travellers to Qingtian were in quarantine.
In a letter to people living abroad, the Qingtian county government said that it was best that they stayed where they were.
Qingtian is home to about 330,000 Chinese migrants in Europe, and about 100,000 of them were in Italy. Local government officials told Caixin that more than 100 had returned from Italy since what has become Europe’s worst outbreak started.
“[People] travelling home could not only be exposed to risks of infection during the trip and bring enormous pressure to their hometown’s effort to contain the outbreak, but [they could] also endanger the health and safety of families and people in the county,” the letter said.
“Please make sure to inform families, particularly those residing abroad or having travel history to infected countries over the past 14 days, not to come home without careful consideration.”
Those who returned should notify the authorities and must quarantine themselves for 14 days, the letter added.
The surge in imported cases came as China, after weeks of tight controls on internal movement, reported a fall in the number of new cases while the number of infections reported abroad, particularly in South Korea, Italy and Iran, exploded.
High-profile incoming cases have been reported since the weekend. Among them was an employee of a Chinese state-owned company who tested positive in Shenzhen on Saturday after flying from Britain. That day, health authorities in northwestern Ningxia Hui autonomous region and in Beijing each reported two infections imported from Iran.
Local governments in China have since ramped up preventive measures. Shanghai requires everyone entering the city from countries with “relatively serious virus conditions” to quarantine themselves for 14 days. That followed a similar decision by authorities in southern Guangdong province.
In addition to quarantine rules, Beijing also demanded that overseas residents who arrived back in China must register and report to community health officials, a process that also involves daily monitoring of their temperature.
China’s capital also set a 14-day quarantine period for visitors from South Korea, Italy, Iran and Japan, including Chinese nationals.
In Dandong, a city in northeastern Liaoning province near the border with North Korea, the local government said all visitors who arrived on or after February 12 would have to undergo health tests, while those who arrived on or after February 28 would be tested at designated hotels where they would be quarantined if found to be infected.
Analysts said that pressure on local governments could increase as more citizens overseas planned to return home for annual festivals and commemorations.
Some may be planning trips back for the grave-sweeping festival, which this year falls on April 5.
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“This is not an easy issue. There will be more and more severely affected countries in the coming weeks,” said Hitoshi Oshitani, a professor in virology at Tohoku University in northern Japan.
“There needs to be a long-term strategy to contain all new transmission chains. We are also considering this in Japan.”
Observers said that it would not be feasible for China to regulate the return of all nationals from overseas, especially when Italy showed that restrictions were not completely effective.
“Probably a better approach is to focus on identifying infections locally with broad use of laboratory testing for outpatients as well as inpatients,” said Benjamin Cowling, head of epidemiology and biostatistics at the University of Hong Kong.
“Sustaining the same strength of containment measures for another six-to-12 months may not be feasible, and we will need to think about more sustainable measures to curb transmission.”
Flemming Konradsen, director of the school of global health at the University of Copenhagen in Denmark, said many countries were recommending that citizens who returned from high-risk areas should regularly check themselves for signs and symptoms of coronavirus, seek advice from medical staff if in doubt, be extra observant about hygiene, and quarantine themselves for 14 days after travelling from areas of high risk.
“It is very important to communicate to Chinese nationals staying overseas to seek medical advice, via a mobile phone etc, from local authorities if they feel the slightest symptoms before embarking on a trip back to China,” he said.
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