In the Chinese case, as scientific research and historical records have suggested, restricting travel had very little influence in stopping the spread of the disease (WHO, 2009a), and by the middle of May many countries (including the United States and Singapore) had scaled down their response measures after learning more about the virus. Instead of adopting a WHO-recommended mitigation-based strategy focusing on “minimizing the impact of the virus through the rapid identification of cases and providing patients with appropriate medical care” (ibid.), China stepped up its efforts to contain the spread of H1N1, and beginning on June 3 the government lowered the criteria for “normal” body temperature from 37.5 to 37° C, so that anyone with a temperature of 98.6° F or higher was subject to further tests.
There is a larger issue involved here, in the sense that stringent government intervention measures, such as those applied during the SARS outbreak, and subsequently repeated during the H1N1 outbreak, have not proven decisive in bringing the epidemic under control, suggesting that there is no reason to believe that the intrusive border control and quarantine measures were as effective as the Chinese government has claimed. In one recent study, in fact, it was shown that only 37.4 percent of the confirmed cases in China were identified through the strict border control and quarantine measures, with more than 60 percent of the cases identified through self-reporting (Huang, 2010, p. 144).
The available data suggest, in fact, that aggressive government intervention, by contrib- uting to the delayed spread of H1N1 in the spring/summer 2009 (Fig. 3), was at least partly responsible for the dramatic increase in the number of cases in the fall of that year. Instead reducing the total number of H1N1 cases in China, the government’s actions may simply have “pushed” the cases that should have appeared in the spring and summer to the fall. In countries that switched to a mitigation-oriented strategy in time, the vaccine access problems would have been alleviated by the buildup of natural immunity in the population (as a larger percentage of the population was exposed to the mild virus in the spring). This was clearly not the case in China: the limited availability of vaccine not only failed to act as a “firewall” in the spread of H1N1, it also simul- taneously had the unintended effect of leaving a larger percentage of people unexposed to the virus prior to the fall, even though at this time the strain of the virus remained relatively mild.
There is also increasing evidence to suggest that the seemingly lower mortality level from H1N1 in China was a result of deliberate concealment and underreporting. By imposing such strict quarantine measures, the state effectively created an environment where doctors and patients were driven to lie about the disease (Galbreath, 2009). According to a document issued by the Ministry of Health (dated October 24, 2009), cases of H1N1 fatality could only be determined by provincial health authorities. Because health care workers were not allowed to confirm H1N1 deaths without approval, it is possible that many deaths were not confirmed or reported. Political intervention at higher levels made the situation even worse.
https://www.tandfonline.com/doi/pdf/...-7216.51.2.162