Doctor traveling with fellows quarantined 7 days in Hong Kong after H1N1 exposure

He spent 2 days on a hospital infectious disease ward and then was confined to a camp.

At the height of recent worldwide concern over the spread of influenza A, H1N1, a U.S. orthopedic surgeon was quarantined in a hospital and camp in Hong Kong for 7 days after a passenger on his overseas flight developed H1N1, or swine flu.

One day after arriving in Hong Kong, health authorities contacted Alvin H. Crawford, MD, FACS, an Orthopedics Today Editorial Board section editor, to alert him a situation was developing related to a sick passenger on his flight.

Extra caution

“The Asian countries are in sort of a heightened state of alert because of their previous experience with SARS,” he told Orthopedics Today after returning from his trip.

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Crawford was traveling to Asia to mentor three spine surgeons considered to be the best and brightest of the Scoliosis Research Society (SRS) candidate members. They were participating in the SRS Traveling Fellowship Program, a trip that included stops in Hong Kong, Beijing, Tokyo, Singapore and Seoul.

Part of his journey involved a Detroit-to-Tokyo flight, prior to landing in Hong Kong.

“I was made aware in Hong Kong there was a passenger on the flight from Detroit to Tokyo who had come down with swine flu,” Crawford said.

They told him the three-row rule was in effect and he was not seated within three rows of the ill person. He then lectured at the Chinese University and had taken an excursion and came in contact with many people.

Crawford felt his risk of contracting or spreading H1N1 was low, but later Hong Kong health authorities told him a passenger sitting in front of him also developed H1N1.

Although he did not have a fever or other symptoms, the Hong Kong authorities made him aware that he would have to undergo an examination and testing, he said. He was taken to Princess Margaret Hospital and kept in isolation on the infectious disease ward for 2 days under observation, undergoing testing and starting a course of Tamiflu (oseltamivir phosphate, Roche). All of Crawford’s tests came back negative; however, that was not the resolution of the issue. He was confined and his young traveling companions continued on their trip to Beijing without him.

Quarantine camp

He was then transferred to a camp near the mainland China border for the remainder of his quarantine, where he was assigned a bungalow, was required to wear a mask, picked up his meals at a canteen, and was observed to ensure he took his flu medication daily. Socialization with others quarantined at the camp was discouraged.

He spent his time there cruising the Internet, reading everything he could find and practicing the clarinet.

Crawford contacted the U.S. State Department and a colleague in Hong Kong — a friend of the Minister of Health — for assistance, but those efforts failed to shorten his quarantine time.

Upon release 5 days later, he received a certificate stating he had been quarantined and treated for H1N1, but even with that Crawford was concerned he might get stopped when he flew to Japan to connect with the traveling fellows because 10-day quarantines were in effect there. His choices were to risk further quarantine in Japan, if another passenger came down with the flu, or head back to Cincinnati.

“I elected to re-join the group,” he said. “I went to Tokyo and met up with the group and encountered no further problems,” Crawford said.

The traveling fellows told him one hospital they were scheduled to visit in Beijing and another in Hong Kong were closed to foreign visitors due to the H1N1 situation.

Crawford, who ran a hospital orthopedic department for 28 years, feels he probably has a greater appreciation for how these kinds of administrative issues impact the practice of medicine.

“I knew there was possibly little risk in terms of contamination, but realized it was a government decision made on a bureaucratic level. Once you mentally process and resolve that, it becomes a little easier,” he said. “The H1N1 story is by no means over and its worldwide impact has yet to be determined.”

Crawford’s chief concern during his ordeal remained his responsibility to mentor the fellows and introduce them to key people at each stop of the trip.

“Fortunately, only one leg of the trip was interrupted.”

For more information:

• Alvin H. Crawford, MD, can be reached at Cincinnati Children’s Hospital Medical Center, Division of Pediatric Orthopaedic Surgery, 3333 Burnet Ave., Building C, MLC #2017, Cincinnati, OH 45229-3026; 513-636-4787; e-mail: alvin.crawford@cchmc.org.