It’s almost a year since the H1N1 virus, widely known as swine flu, was the feared pandemic that swept across the world. In North Korea the estimated death rate per infection is estimated as hundreds of times greater than those for South Korea. This glaring example of two extremes owes much to the medical advantage that the south has over the north. What is perhaps even more interesting is that South Korea has been able to gain a measure of infection control better than the UK. (information extrapolated from http://www.flucount.org/ ).

My first awareness of the virus was when arriving in Korea in June last year. I found that it was necessary to complete and sign a questionnaire inquiring if I had any flu-like symptoms. I must admit that I felt pretty sick, sneezing and coughing with a headache to complete the package. And seeing that questionnaire in front of me didn’t make me feel any better. I felt uncomfortable filling in every detail, especially with the words at the bottom of the form. These words warned that if your symptoms were considered serious enough you would be kept in quarantine until they subsided and you were no longer a risk.

It was a moral dilemma: do I potentially start a flu epidemic in a country which will be my home for a year or do I bite the bullet by owning up to my coughs and sneezes and then possibly being locked away in quarantine, hoping my future employer would understand. I bit the bullet and filled out the document – truthfully. After all, I wouldn’t want mass manslaughter on my hands.

I may have been hesitant about handing it in at customs, but as soon as it left my hands I was swift in my exit. But no sooner had I left one room, than I was confronted by a thermal scanner pointing at the entrance that I had just walked through and there was a guard looking at the monitor. There was no doubt in my fevered mind that he was scanning for passengers with high temperatures. I kept my head held healthfully high, staring hard at the camera, daring it to catch me out. It didn’t. So I passed through customs and, amazingly, as soon as I got some fresh air my symptoms disappeared.

In July, one month after I arrived, the country increased its alert level to ‘orange’. This was part of a four tier system: green, amber, orange and red. The alarming fact was that over 12,000 had contracted the influenza virus within a two-week period. The whole country was on high alert. People were encouraged to wear masks when commuting to work via public transport; while in public areas anti-bacterial sprays were made available for general use. The epidemic increased. By autumn, large social gatherings were either postponed or closed. In schools, it was a requirement for students to have a mask with them at all times in an attempt to prevent the epidemic spreading. A school with an infected student or students could be threatened with closure from a few days up to a fortnight. Hagwons (private academies) also adhered to a very similar regulation. My hagwon made it compulsory for teachers as well as students to wear a mask at all times inside the building. Observing these rules was somewhat frustrating, as having to teach English with a mask covering the majority of the face can make it difficult to communicate. It must also have been hard on the Korean students having to try and understand words in English. Maybe those students pronouncing certain English words in a rather muffled manner in later life will blame those masked days. However, prevention is certainly better than cure.

Reflecting on that year, I sense a major flaw in the way the whole influenza epidemic was handled in Korea. I saw very few people cover their mouth when they sneezed and coughed. The ones wearing masks carried on wearing them throughout the long day. They exhaled into them and with every breath the masks would become more contaminated. Personally, I found it very unsettling, to breathe in what my body was naturally attempting to flush out.

Currently, with the ‘alert level’ lowered for H1N1, travelling on public transport I observe individuals not covering their mouth as they shower fellow travelers with germs. Could there be some way to highlight what their coughs and sneezes are doing? Seventy years ago, during the Second World War, Britain’s Ministry of Health pushed to educate the nation by having the slogan ‘Coughs and sneezes spread diseases’. Posters were put up, with Hitler looming over a ‘nation of the sick’. While it may be hard in modern times to find a frightening hate figure such as Adolf, in Korea and around the world the same basic message still applies.

© John Brownlie 2010