Current SARS cases in East China:

The current number and type of SARS cases in East China as of May 9 are as follow:

• Shanghai: five probable and 12 suspected cases. Shanghai had it first SARS death on May 8; the victim was the elderly man who was the father of the first confirmed case in Shanghai.
• Jiangsu: five probable and 22 suspected cases.
• Zhejiang: four probable and four suspected cases.
• Anhui: nine probable and 11 suspected cases.

Updated Quarantine Measures in Shanghai:

As of May 12, US-based business people traveling to Shanghai are not required to quarantine if they have no SARS symptoms even if they have first traveled to a "SARS case area." However, asymptomatic visitors (i.e. non-Shanghai residents) from a "SARS case area" must report to local authorities upon arrival and should undergo daily health checks at the place of their temporary residence for two weeks. A "SARS case area" certainly includes most of China, but the Shanghai regulations are ambiguous with respect to travelers from the United States. Furthermore, if anyone has had contact with a suspected SARS patient, the authorities may require quarantine. Finally, the new measures reiterate that anyone who breaks a recommended quarantine and is later found to have spread the SARS virus can be subject to criminal prosecution.

American citizens living in Shanghai should be aware that due to the SARS situation in China, the Shanghai City Government continues to strongly discourage residents from traveling outside the city, and to aggressively monitor the health status of returning residents and visitors. As follow up to its April 23 eight-point “Notice on Strengthening the Work on SARS Prevention and Control” (also known as the “Eight Orders”), the Shanghai City Government on May 9 issued 20 additional implementing regulations on the prevention and containment of SARS.

The new measures provide greater detail on the implementation of the rules contained in the April 23 notice, and represent a tightening of travel and quarantine restrictions in Shanghai. The new measures stipulate that all people returning to or visiting Shanghai must have their body temperatures checked and must completely fill out health declaration forms. This includes air passengers arriving from overseas, who will have their temperatures taken either in-flight, or on the ground upon arrival, but before disembarking. If a person is found with a fever or other SARS-like symptoms, the person will be isolated temporarily and sent to a hospital for observation. The new measures also stipulate that asymptomatic Shanghai residents (including people living and working in Shanghai on a long-term basis) returning from a SARS case area should undergo a two-week quarantine period at their residence or at a location designated by community authorities. Asymptomatic visitors (i.e. non-Shanghai residents) from a SARS case area must report to local authorities upon arrival and should undergo daily health checks at the place of their temporary residence for two weeks.

The new measures eliminate some, but not all, of the ambiguity about how a “SARS case area” is defined by saying that overseas SARS areas will be defined according to World Health Organization (WHO) information. Shanghai authorities have not yet made clear whether this means the WHO list of all countries with SARS cases, or the much more limited list of regions with recent local transmission of SARS. For domestic areas, Shanghai will use a list of Chinese provinces and municipalities updated daily by the central-level Ministry of Health and available at http://www.moh.gov.cn. As of May 9, only a handful of China’s provinces, municipalities, and autonomous regions were not included on the Ministry of Health’s list of SARS case areas.

Despite the greater clarity provided by the new measures in some areas, it is very likely implementation will be uneven and inconsistent across various districts, neighborhoods, work units, and government agencies, adding to the ambiguity and uncertainty inherent in the regulations themselves. Finally, the new measures reiterate that anyone who breaks a recommended quarantine and is later found to have spread the SARS virus can be subject to criminal prosecution.

Situation in Nanjing: American citizens should also be aware that other jurisdictions in East China are adopting similar quarantine and other measures to discourage travel and prevent the further spread of SARS. The Nanjing City Government, for example, has recently adopted very strict policies that have led to the quarantine of approximately 9,000 city residents. These rules have been verbally related to the U.S. Consulate, and apparently stipulate that all people, both Nanjing residents and visitors, arriving in the city from a SARS-affected area (including Beijing, Guangzhou, Inner Mongolia, Shanxi, Tianjin, Hong Kong, and Taiwan) will be subject to a mandatory 14-day quarantine at designated quarantine centers. Further, visitors and residents traveling from other locations who are showing SARS symptoms will also be quarantined. If a probable or suspected case appears in a residential development, the entire residential development may be placed under quarantine.

In light of these new and existing measures in Shanghai, Nanjing and other cities in East China, American citizens contemplating travel away from their home jurisdictions should be aware of the likelihood that they will be subject to potentially numerous body temperature and other health checks while traveling and upon return home. They may also be requested by local officials to be quarantined for a two-week period, either at their place of destination or upon their return home.