Coping with the Corona Virus (SARS-CoV-2): Can Glucosamine from Shrimp, Mushrooms, or Other Sources Help Reduce the Danger of Pneumonia?

SARS-CoV-2-COVID-19-virus

Illustration of SARS-CoV-2 virion from the CDC.

Millions of people around the world are worried for China and hope there is soon a full recovery from the dreadful disease, COVID-19. Few things sounds more dreadful than being trapped in a locked-down city where thousands are infected and almost everything is shut down. Pray for the success of Wuhan in conquering this pandemic.

While I expressed my concerns about the severity of these rapidly spreading disease and the impact it is having on so many people, one acquaintance who wishes only to be known as C.T. shared with me some of her tentative findings about the impact of several factors on the death rate of pneumonia found across the world.

Her investigation examined  factors that may affect how severe pneumonia becomes in once healthy patients. I find her proposal interesting and potentially valuable enough that I’d like to invite feedback from experts to see if there is any merit to her thinking. If her work could help alleviate some of the suffering that COVID-19 is causing, and specifically decrease the mortality rate, that would be fantastic. Perhaps there’s nothing there. Intelligent feedback is what I am looking for.

Please note that I am not making any medical claims or suggesting that nutrition or nutritional supplements can directly reduce the risk of coming down with or dying from COVID-19 or pneumonia in general. I am not seeking to spread rumors about the disease (spreading rumors is strictly illegal in China, especially rumors or incorrect information about sensitive issues such as COVID-19 and its management, and I strive to abide by the regulations), but am inviting experts to review a tentative possibility that could be helpful to China and other nations.

C.T.’s hypothesis deals with the possible role of glucosamine and other aspects of nutrition in reducing the risk of pneumonia. Glucosamine is a natural material found in cartilage and in the shells of shrimp, crabs, etc. and the skeletons of marine animals. It is also present in China’s abundant and delicious mushrooms and other fungi (see “Dietary Sources” below). It is an antioxidant that our body can produce, though it is also commonly sold as a dietary supplement said to help treat osteoarthritis and reduce pain in joints (see an overview of reports on glucosamine at ScienceDirect). In what follows, I’ll add some comments to C.T.’s points and  mix a few finds from my searching with some of the things she has found.

The relationship between glucosamine and cartilage health has a reasonable basis (though for relieving pain, as the BBC reports, it’s not clear that glucosamine supplements actually do more than a good, full-strength placebo), and cartilage is present in several vital parts of the lungs, from the trachea through the bronchi. C.T.’s hypothesis is that viral disease may infect chondrocytes, cells that product cartilage, and that our own immune system in response may then attack those cells and lead to tissue damage that allows naturally present bacteria to cause severe infection. But could there be a relationship between glucosamine and pneumonia mortality? C.T. proposes a mechanism involving the SOX-9 protein and its role in driving a “cytokine storm” where dangerous cycles can lead to severe illness. She argues that dietary influences that inhibit or enhance the effect of SOX-9 (i.e., down regulate or up regulate) may help explain significant differences in pneumonia mortality among nations, with tea and perhaps pomegranate juice being likely to up regulate SOX-9 while diets high in shrimp and cartilage may provide the glucosamine that can may regulate SOX-9.  You can see her recent comments on the Coronavirus and the crisis in Wuhan in her post of Jan. 31, 2020, “My two bits about the novel coronavirus from Wuhan,” which points to her earlier post with the key information she wishes to share.

Whether or not C.T.’s proposed mechanisms and dietary considerations are correct, there are peer-reviewed studies suggesting that glucosamine can in fact reduce mortality from respiratory illness.

The scientific literature on glucosamine tends to focus on its role in cartilage formation and in alleviating problems with joints and bones. But there are some surprising finds related to other effects. Here are a few to consider (the first and fourth were pointed out by C.T. in her original work):

1. Griffith A. Bell et al., “Use of glucosamine and chondroitin in relation to mortality,” European Journal of Epidemiology, 27/8 (2012): 593-603; https://www.jstor.org/stable/23272500.

Abstract: Glucosamine and chondroitin are products commonly used by older adults in the US and Europe. There is limited evidence that they have anti-inflammatory properties, which could provide risk reduction of several diseases. However, data on their long-term health effects is lacking. To evaluate whether use of glucosamine and chondroitin are associated with cause-specific and total mortality. Participants (n = 77,510) were members of a cohort study of Washington State (US) residents aged 50-76 years who entered the cohort in 2000-2002 by completing a baseline questionnaire that included questions on glucosamine and chondroitin use. Participants were followed for mortality through 2008 (n = 5,362 deaths). Hazard ratios (HR) for death adjusted for multiple covariates were estimated using Cox models. Current (baseline) glucosamine and chondroitin use were associated with a decreased risk of total mortality compared to never use. The adjusted HR associated with current use of glucosamine (with or without chondroitin) was 0.82 (95 % CI 0.75-0.90) and 0.86 (95 % CI 0.78-0.96) for chondroitin (included in two-thirds of glucosamine supplements). Current use of glucosamine was associated with a significant decreased risk of death from cancer (HR 0.87 95 % CI 0.76-0.98) and with a large risk reduction for death from respiratory diseases (HR 0.59 95 % CI 0.41-0.83). Use of glucosamine with or without chondroitin was associated with reduced total mortality and with reductions of several broad causes of death. Although bias cannot be ruled out, these results suggest that glucosamine may provide some mortality benefit. [For links to references cited by Bell et al., see the Springer page for this article.]

2. Kun-Han Chuang et al., “Attenuation of LPS-induced Lung Inflammation by Glucosamine in Rats,” American Journal of Respiratory Cellular Molelcular Biology, 49/6 (Dec. 2013): 1110-9.

Abstract: Acute inflammation is often observed during acute lung injury (ALI) and acute respiratory distress syndrome. Glucosamine is known to act as an anti-inflammatory molecule. The effects of glucosamine on acute lung inflammation and its associated mechanisms remain unclear. The present study sought to address how glucosamine plays an anti-inflammatory role in acute lung inflammation in vivo and in vitro. Using the LPS intratracheal instillation-elicited rat lung inflammation model, we found that glucosamine attenuated pulmonary edema and polymorphonuclear leukocyte infiltration, as well as the production of TNF-α, IL-1β, cytokine-induced neutrophil chemoattractant (CINC)-1, macrophage inflammatory protein (MIP)-2, and nitric oxide (NO) in the bronchoalveolar lavage fluid (BALF) and in the cultured medium of BALF cells. The expression of TNF-α, IL-1β, IFN-γ, CINC-1, MIP-2, monocyte chemotactic protein-1, and inducible NO synthase (iNOS) in LPS-inflamed lung tissue was also suppressed by glucosamine. Using the rat alveolar epithelial cell line L2, we noted that the cytokine mixture (cytomix)-regulated production and mRNA expression of CINC-1 and MIP-2, NO production, the protein and mRNA expression of iNOS, iNOS mRNA stability, and iNOS promoter activity were all inhibited by glucosamine. Furthermore, glucosamine reduced LPS-mediated NF-κB signaling by decreasing IκB phosphorylation, p65 nuclear translocation, and NF-κB reporter activity. Overexpression of the p65 subunit restored the inhibitory action of glucosamine on cytomix-regulated NO production and iNOS expression. In conclusion, glucosamine appears to act as an anti-inflammatory molecule in LPS-induced lung inflammation, at least in part by targeting the NF-κB signaling pathway.

3. Yuh-Lin Wu et al., “Glucosamine Attenuates Cigarette Smoke-Induced Lung Inflammation by Inhibiting ROS-sensitive Inflammatory Signaling,” Free Radical Biology and Medicine, 69 (April 2014): 208-18; DOI: 10.1016/j.freeradbiomed.2014.01.026.

Abstract

Cigarette smoking causes persistent lung inflammation that is mainly regulated by redox-sensitive pathways. We have reported that cigarette smoke (CS) activates a NADPH oxidase-dependent reactive oxygen species (ROS)-sensitive AMP-activated protein kinase (AMPK) signaling pathway leading to induction of lung inflammation. Glucosamine, a dietary supplement used to treat osteoarthritis, has antioxidant and anti-inflammatory properties. However, whether glucosamine has similar beneficial effects against CS-induced lung inflammation remains unclear. Using a murine model we show that chronic CS exposure for 4 weeks increased lung levels of 4-hydroxynonenal (an oxidative stress biomarker), phospho-AMPK, and macrophage inflammatory protein 2 and induced lung inflammation; all of these CS-induced events were suppressed by chronic treatment with glucosamine. Using human bronchial epithelial cells, we demonstrate that cigarette smoke extract (CSE) sequentially activated NADPH oxidase; increased intracellular levels of ROS; activated AMPK, mitogen-activated protein kinases (MAPKs), nuclear factor-κB (NF-κB), and signal transducer and activator of transcription proteins 3 (STAT3); and induced interleukin-8 (IL-8). Additionally, using a ROS scavenger, a siRNA that targets AMPK, and various pharmacological inhibitors, we identified the signaling cascade that leads to induction of IL-8 by CSE. All these CSE-induced events were inhibited by glucosamine pretreatment. Our findings suggest a novel role for glucosamine in alleviating the oxidative stress and lung inflammation induced by chronic CS exposure in vivo and in suppressing the CSE-induced IL-8 in vitro by inhibiting both the ROS-sensitive NADPH oxidase/AMPK/MAPK signaling pathway and the downstream transcriptional factors NF-κB and STAT3.

4. Jean-Noël Gouze et al., “Exogenous glucosamine globally protects chondrocytes from the arthritogenic effects of IL-1β,” Arthritis Research and Therapy,  8 (2006), article #R173; https://doi.org/10.1186/ar2082. (PDF also available.)

Abstract

The effects of exogenous glucosamine on the biology of articular chondrocytes were determined by examining global transcription patterns under normal culture conditions and following challenge with IL-1β. Chondrocytes isolated from the cartilage of rats were cultured in several flasks either alone or in the presence of 20 mM glucosamine. Six hours later, one-half of the cultures of each group were challenged with 10 ng/ml IL-1β. Fourteen hours after this challenge, RNA was extracted from each culture individually and used to probe microarray chips corresponding to the entire rat genome. Glucosamine alone had no observable stimulatory effect on the transcription of primary cartilage matrix genes, such as aggrecan, collagen type II, or genes involved in glycosaminoglycan synthesis; however, glucosamine proved to be a potent, broad-spectrum inhibitor of IL-1β. Of the 2,813 genes whose transcription was altered by IL-1β stimulation (P < 0.0001), glucosamine significantly blocked the response in 2,055 (~73%). Glucosamine fully protected the chondrocytes from IL-1-induced expression of inflammatory cytokines, chemokines, and growth factors as well as proteins involved in prostaglandin E2 and nitric oxide synthesis. It also blocked the IL-1-induced expression of matrix-specific proteases such as MMP-3, MMP-9, MMP-10, MMP-12, and ADAMTS-1. The concentrations of IL-1 and glucosamine used in these assays were supraphysiological and were not representative of the arthritic joint following oral consumption of glucosamine. They suggest, however, that the potential benefit of glucosamine in osteoarthritis is not related to cartilage matrix biosynthesis, but is more probably related to its ability to globally inhibit the deleterious effects of IL-1β signaling. These results suggest that glucosamine, if administered effectively, may indeed have anti-arthritic properties, but primarily as an anti-inflammatory agent.

In light of these studies, there seems to be reason to believe that glucosamine may be helpful in reducing the mortality of pneumonia. If so, being prepared to have a diet with some glucosamine sources or to have some glucosamine on hand might be reasonable should COVID-19 become a serious threat in your community, or if you are traveling under conditions where you may be exposed to the SARS-CoV-2 virus. Your intelligent feedback on this is welcome — but anonymous trolling comments that I too often tolerate will be deleted here in order to increase the chance of readers finding intelligent comments that help us better understand the issues raised here.

C.T.’s Proposals on Mechanism and Diet

C.T. wrote the following a few days ago:

Hi, Jeff, I know it sounds presumptuous, but I think I figured out which environmental triggers are involved in making it so people exposed to this virus do/do not become symptomatic and how severe the symptoms are.

1) Damage to the hyaline cartilage (by the immune system targeting infected cartilage cells) is much less likely to happen where the diet contains glucosamine (in shrimp paste and cartilage), where there is no exposure to dry and cold air, and where there is not bleach being sprayed in the air (seriously, have Hubei’s bureaucrats never heard of chemical pneumonia?).

2) The cartilage cells, if damaged, think they have to rebuild the hyaline cartilage matrix and so secrete chondroitin sulphate and other cartilage matrix molecules; the gene SOX9 is very instrumental in doing this, but if it is overly active it can cause there to be too many such molecules building up in the lungs. Voila! Viral pneumonia. What gets SOX9 going? EGCG appears to “stimulate exuberant cartilage matrix secretion” (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247298/), and EGCG is THE special molecule in tea leaves. What did the poor people of Wuhan ingest in their apartment quarantines: rice, veggies, legumes, and tea–no meat or shrimp. What else affects SOX9? Turmeric (curcumin decreases SOX9 activity–lucky Thailand), Fluoride (also helps decrease SOX9 activity–lucky India), Pomegranate (increases SOX9–unlucky Iran, where they drink pomegranate juice when sick). This hypothesis holds up even in Italy, where they drink wine and coffee all the time except when they’re trying to lose weight or fight a cold–then they drink green tea. And it utterly refutes all the stupid internet trolls who were going on and on about how “Chinese people have horrible hygiene.”

C.T.’s original post on the relationship between glucosamine and mortality in pneumonia and the possible mechanisms involved is “Glucosamine to protect cartilage during influenza infection,” Petticoat Government, Feb. 5, 2018. Here is an excerpt with the key arguments she makes:

1) The flu infects chondrocytes, the cells in cartilage. They are the only cells in hyaline cartilage, which type of cartilage is coincidentally found in places–joints, rib ends, nose, larynx, trachea, bronchi–that are among the hardest hit by influenza. (https://www.britannica.com/science/cartilage)

2) Influenza-infected chondrocytes don’t seem to actually experience obvious damage until the body’s immune system goes on the attack. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC422866/; http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2567.2003.01621.x/full) [Edited 2/17/2018: Someone pointed out to me that chondrocytes are within an extracellular matrix that has no blood vessels, so other cells, including attacking immune cells, can’t reach them. I looked more into that issue and found a 2015 cartilage transplant study which found that cartilage isn’t as immune-privileged as it used to be believed it was (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522233/). I suspect that chondroblasts–the immature chondrocytes next to the blood-vessel-containing perichondrium–are the first chondrocytes which the immune system cells attack, and then due to their destruction the cartilage matrix becomes compromised; if that compromised state becomes severe enough, immune cells can then gain access to the mature chondrocytes within, as well.]

3) Cytokines are part of the immune system’s attack arsenal. The cytokine IL-1beta is a critical component of lung inflammation during infection with influenza type A H1N1. (http://onlinelibrary.wiley.com/doi/10.1002/jmv.24138/abstracthttps://www.ncbi.nlm.nih.gov/pubmed/27714503)

4) Glucosamine–a natural compound found in cartilage–happens to protect chondrocytes by being a potent inhibitor of IL-1beta. (https://link.springer.com/article/10.1186/ar2082)

5) Damaged cartilage in the trachea/bronchi could allow for more penetrating infection by viruses/bacteria that normally would not be able to do much harm and in that way make flu sufferers much more susceptible to pneumonia. Most of the people who died from the 1918 flu died because “bacteria that normally inhabit the nose and throat invaded the lungs along a pathway created when the virus destroyed the cells that line the bronchial tubes and lungs.” (https://www.nih.gov/news-events/news-releases/bacterial-pneumonia-caused-most-deaths-1918-influenza-pandemic)

6) People who take glucosamine (it’s a common supplement for arthritis) are much less likely to die of respiratory illnesses than their peers. (https://link.springer.com/article/10.1007/s10654-012-9714-6)

So if you’re worried about influenza, it might be worth it to buy some glucosamine and take it when you’re exposed to influenza so you can protect your hyaline cartilage and thus make yourself less likely to develop pneumonia….

Eat well cooked, or non-manufactured source- glucosamine rich foods (like shrimp) to help the cartilage stay strong, and stay away from tea plant and pomegranate for a second. (Pomegranates are healthy, but are rich in natural SOX9 stimulants… Which is good… But on a viral, over-production level ((what happens with this virus)) you get to much in the lungs too fast, and therefore pneumonia.)

By the way, I have worked with nearly pure EGCG as part of my consumer products research work in the past and was often surprised by how reactive it is. Dissolve a little white EGCG in water and combine with baking soda or other alkaline material and find out what strange, ugly stains you can create on materials such as tissue paper or fabrics after allowing it to sit for a few hours. It has many effects in the body, some clearly positive, but I can imagine that there are situations where this reactive material isn’t helpful. Can it play the role that C.T. suggests? I don’t know, but would like to learn more. Is it possible that giving tea to the ill might not be a good idea? I don’t know, but it may not be helping in Wuhan, though so much of what’s happening there remains opaque. If you have additional useful information, please let me know.

Dietary Sources

C.T. points to shrimp as an important dietary source of glucosamine. I should add that it appears that the glucosamine of shrimp comes from the shell, not the flesh. In Asia, many people eat the shells, or so it seems to me, especially small shrimp where the shell is quite thin and, in fried shrimp, can be tasty and easy to eat. She also mentions gristle, which is commonly consumed, especially chicken gristle. Another source may be soups in which the bones of animals have been stewed for a long period of time. Bone-rich soup, at least in China, especially when stewed long enough to create a white broth, is widely held to be very nutritious and ideal for those who are ill, and probably supplies some glucosamine. I find it delicious, too.

There are also options for vegetarians. Mushrooms contain chitin, the widespread natural polymer found in the shells of shrimp, crabs, insects, etc., and glucosamine is one of the building blocks of chitin and I believe it can be released when digested. See Tao Wu et al., “Chitin and Chitosan–Value-Added Products From Mushroom Waste,” Journal of Agricultural Food Chemistry, 52 /26 (Dec. 29, 2004): 7905-10;  DOI: 10.1021/jf0492565. Also see Pin Zhang et al., “Kinetic Models for Glucosamine Production by Acid Hydrolysis of Chitin in Five Mushrooms,” International Journal of Chemical Engineering, 2020, article ID 5084036 (2020); https://doi.org/10.1155/2020/5084036.

Unfortunately, for those in Wuhan, there are reports that the diet is now necessarily simple and thus there may be less meat (bone and cartilage included) and less shrimp than usual, so the protective effects of glucosamine, if real, may be less available than normal. C.T. worries that the combination of cold, stress, and confinement, coupled with a low-glucosamine and high-tea diet and even the occasional exposure to bleach or other harsh chemicals in the effort to kill the virus in many places might make a perfect storm for elevated pneumonia risk for those infected with the virus. If C.T.’s proposal is correct, then bringing glucosamine or glucosamine-rich foods to Wuhan and other affected areas may be a helpful step to help reduce loss of life.

One of China’s great blessings when it comes to food is the richness of its fungi, with numerous wild and domesticated mushrooms and other fungi that are so delicious. Some are far too expensive for me, but there are many varieties that are relatively inexpensive but very nutritious, especially the black wood ear fungus called mu er (literally wood ear). It’s more expensive than rice or common vegetables like carrots, onions, or cabbage, but it’s still quite cheap and has also been touted for its immune strengthening benefits. I order some much of the time when I’m in Chinese restaurants in China. Perhaps adding this to the diet of the people in Wuhan and other afflicted cities could help?

Is Glucosamine Safe for Those Allergic to Shrimp?

Finally, one important issue is whether those with seafood allergies, including shellfish allergies, should take glucosamine since it is often made from the shells of shrimp. Please consult with your physician and don’t take crazy risks based on random bloggers. However, something to consider as you discuss such matters with competent medical authorities is that several studies suggest that commercially available high-quality glucosamine may not contain the allergens that are harmful to some people. Here are a couple studies to consider:

J. Villacis et al.,  “Do Shrimp-Allergic Individuals Tolerate Shrimp-Derived Glucosamine?,”  Clinical and Experimental Allergy, 36/11 (Nov. 2006): 1457-61;  DOI: 10.1111/j.1365-2222.2006.02590.x.

Abstract

Background: There is concern that shrimp-allergic individuals may react to glucosamine-containing products as shrimp shells are a major source of glucosamine used for human consumption.

Objective: The purpose of this study was to determine whether shrimp-allergic individuals can tolerate therapeutic doses of glucosamine.

Methods: Subjects with a history of shrimp allergy were recruited and tested for both shrimp reactivity via a prick skin test and shrimp-specific IgE by an ImmunoCAP assay. Fifteen subjects with positive skin tests to shrimp and an ImmunoCAP class level of two or greater were selected for a double-blind placebo-controlled food challenge (DBPCFC) using glucosamine-chondroitin tablets containing 1,500 mg of synthetically produced (control) or shrimp-derived glucosamine. Immediate reactions, including changes in peak flow and blood pressure, and delayed reactions (up to 24 h post-challenge) via questionnaire were noted and assessed.

Results: All subjects tolerated 1,500 mg of both shrimp-derived or synthetic glucosamine without incident of an immediate hypersensitivity response. Peak flows and blood pressures remained constant, and no subject had symptoms of a delayed reaction 24 h later.

Conclusion: This study demonstrates that glucosamine supplements from specific manufacturers do not contain clinically relevant levels of shrimp allergen and therefore appear to pose no threat to shrimp-allergic individuals.

Heather C. Gray, et al., “Is glucosamine safe in patients with seafood allergy?,Jounral of Allergy and Clinical Immunology,  114/2 (August 2004) 459–460; DOI: https://doi.org/10.1016/j.jaci.2004.05.050 (PDF also available).

Excerpt:

Six subjects participated in the study. All 6 had a history consistent with a systemic reaction to shellfish. All 6 had positive skin prick test responses to shrimp, crab, lobster, or a combination of these. All 6 had negative skin test responses to the glucosamine extract (Table I) and uneventful oral challenges with glucosamine, with no change in skin, vital signs, or spirometry….

Approximately 600 patients must be recruited to ensure that the chance of rejecting an allergy rate of at least 0.5% is less than 0.05. This pilot study, which indicates that glucosamine is probably safe for patients with shellfish allergy, emphasizes the need for further investigation, with larger studies looking at different shellfish allergens and the consistency of glucosamine formulations.

Further research is needed on this issue and others raised above. If you have other information on the food safety issue or other issues raised here, please share. Thanks!

I welcome your civil, thoughtful feedback.


Other Related Resources:

Theodore M. Brasky, “Use of Glucosamine and Chondroitin and Lung Cancer Risk in the VITamins And Lifestyle (VITAL) Cohort,” Cancer Causes and Control, 22/9 (Sept. 2011): 1333-42.

Jody Braverman, “Nutritional Value of Bone Gristle,” LiveStrong.com, September 30, 2019.

 

Update, 2/28/2020: There’s one study C.T. mentioned suggesting that chondroitin, which is often combined with glucosamine in supplements, can cause pneumonia rather than prevent it, based on a single patient. See Takeshi Satomura et al., “A Case of Drug-induced Pulmonary Disease Considered to be Caused by a Supplement Containing Chondroitin,” The Journal of the Japan Society for Respiratory Endoscopy,  37/2 (2015): 214-18; DOI https://doi.org/10.18907/jjsre.37.2_214.

Abstract 

Drug-induced pulmonary disease can be caused by a variety of drugs including supplements. We examined a case of drug-induced organizing pneumonia induced by a supplement containing chondroitin. Case. An 80-year-old man had been taking supplements for knee pain since early July 2013 and subsequently developed a cough and fever. A chest radiograph demonstrated infiltrative shadows, and he was admitted to our hospital. His condition did not improved with antibiotic treatment and bronchoscopy was performed for diagnostic purposes. A transbronchial lung biopsy specimen showed organizing pneumonia, and the patient’s condition was ameliorated with steroid therapy. We established a diagnosis of drug-induced pulmonary disease based on the results of a lymphocyte stimulation test for a supplement containing chondroitin. Conclusions. We conclude that the use of supplements containing chondroitin may result in drug-induced pulmonary disease.

That single case may not be meaningful, but if you’re concerned and want more glucosamine after consulting with medical personnel, you can just use glucosamine alone or a diet with glucosamine. Chondroitin tends to me relatively more expensive anyway. Consult your physician and don’t rely on bloggers.

By |2020-02-28T13:45:51-07:00February 28th, 2020|Categories: China, Food, Health, Safety, Shanghai, Society, Surviving, Travel tips|Tags: , , , , |Comments Off on Coping with the Corona Virus (SARS-CoV-2): Can Glucosamine from Shrimp, Mushrooms, or Other Sources Help Reduce the Danger of Pneumonia?

Views on the Corona Virus Pandemic in China

As I write, I have been out of China for over 3 weeks and am past the incubation period for the dreaded Corona virus that has been sweeping China. We were away in Vietnam on a  trip just before the Chinese New Year when the pandemic started looking serious, and were able to adapt our plans to stay out of China for a while. It has become a difficult place to be, even for those fortunate enough to avoid the virus.

We hope that the unprecedented efforts to contain the Corona virus in China will bring rapid containment, but the impact of the virus will also bring hardship to millions. The complete lockdown of many large cities like Wuhan can make life very difficult.  Even in  beautiful, modern metropolises like Shanghai and Hangzhou, where relatively few cases of the virus have occurred, life can be difficult. People coming home from travel, like two American friends of mine who just returned to Shanghai from Australia, or a European friend who just got back to Hangzhou from a visit in Shanghai, are finding that strict regulations make them prisoners in their own apartment as the government requires quarantine for travelers. That’s if you are lucky enough to get home at all — my friend in Hangzhou said that she got home just one day before a ban on travelers entering the city went into effect. I don’t know how accurate that is, so I’m just reporting what she understands.

In Shanghai, people returning on Sunday and hoping to start work on Monday are in for disappointment and frustration. It may be one or two weeks before they can go back to work, depending on local rules. After that quarantine period, apartment complexes will only allow you to leave once every other day. Martial law comes with much uncertainty and some hardship, but perhaps this is needed. But hats off to those with the wisdom to have stored basics like food and other supplies to be ready for a time of trouble. People aren’t going hungry as far as I know, but it’s probably much harder to get what you might be used to now.

One man in Shanghai desperately needed to get his new passport that was sent by DHL to Shanghai, but had not been delivered to him for a number of days because DHL was largely shut down due to virus fears. It was only by going to DHL offices and “crying” for hours in front of the building that he finally got the attention of workers there who dug  into a pile of undelivered packages and found his passport, giving him time to get to the airport barely in time. Without that, he would have been in violation of Chinese law with an expired visa. You don’t want to violate visa rules!

Such accounts, though, may pale in comparison to the woes of those who are trapped in places they don’t belong, without resources and friends. Or even local Wuhan residents struggling with the challenges of living life under a lockdown with so much uncertainty, in spite of valiant efforts now to provide support and services. An American trapped in Wuhan did manage to get a seat on a plane out organized by the US government, but the problem was getting to the airport, some 30 miles away from his home. A few weeks ago that would have been easy: just take a taxi. But taxis in Wuhan have been shut down except for a handful dedicated to taking patients to the hospitals, but this requires a complex process of getting approval from the local government committees for each region of town and there’s no chance of getting a ride to the airport. With no feasible way to get to the airport, the man missed the flight and his seat was given to someone else. Fortunately, he had a second passport with Germany, and was able to get on the evacuation flight for Germany, a nation that kindly sent a bus to give German citizens rides to the airport. (Congratulation to those of you who recognize the many virtues of having a second passport. When things go crazy in your home country, it’s nice to have another option.)

In spite of China now going all out to contain the virus, there seems to be international anger toward China and the Chinese people. There are accusations that China did not act quickly enough or is not doing enough. Individual Chinese people are also experiencing blame and anger. Hotels, shops, and restaurants in some areas are turning away Chinese people. Rudeness and xenophobic hysteria abound. As I left Asia a few days ago, after a two-week virus-free exile in Vietnam before I began a business trip to the US for a research project in Minneapolis (I just love the University of Minnesota, by the way!), I read a front-page article in the New York Times on my flight from Hanoi to Seoul and was pained to see further evidence of the worldwide anger toward China. Motoko Rich’s Feb. 1-2, 2020 article, “Global Xenophobia Follows Virus.” See also MarketWatch’s “‘No Chinese allowed’: Racism and fear are now spreading along with the coronavirus” from Feb. 3.  This is a tough time to be Chinese. The video below from a Chinese man in Florence, Italy reminds us of the humanity of those facing prejudice because a virus originated in their country.

Some say there’s a deja vu sense to this virus, which is causing so much hysteria around the globe. But there’s reason for the hysteria: the virus has left China, and now has killed people elsewhere in the world, including (as of Feb. 4) Hong Kong (1 death) and Philippines (1 death), etc., etc., etc., for a total of, well, three deaths so far outside of China. But in China, nearly 500 people have died, so the death toll is on its way to reaching that of the worldwide 2009 influenza pandemic with the H1N1 virus. Well, on its way to some degree, I suppose. The H1N1 virus that started in the Americas spread worldwide and ended up killing over 200,000 people (maybe as many as 500,000). Not 200, not 500, but over 200,000.

Do you recall the the draconian measures taken by the US government to contain that virus in 2009 and 2010? And do you remember the worldwide hostility toward North Americans for that North American virus? The shunning of all things American, the refusal to allow Americans to stay in hotels or enter restaurants, the locking down of New York, Miami, and LA? The martial law, the quarantines, the months of delayed school and the crushing of the US economy? The inability to fly, travel, or even leave your apartment? My memory must be fading, because I don’t remember any of that. I remember encouragement to get flu shots then and warnings about the virus, but not the massive, painful disruption of travel, work, school, and normal life, nor escalation in anti-American sentiment.

China is responding to the crisis by locking down many cities, stranding over 60 million people, with martial-law measures in many other cities with tough regulations forcing many to be quarantined and hindering travel, work, and normal life. There is also the cessation of much public transportation or blockades on roads in and out of many cities, the shutting down of thousands of tourist attractions, delayed operations for millions of employees, delayed school for millions, and so forth. Such extreme measures to contain this virus, and yet there is still international hysteria and blame. Outside of China, two have died, a few hundred are affected. It may get much worse, but right now, it’s noting compared to seasonal bouts of influenza and nothing close to our own H1N1 pandemic that generated hardly any hysteria and resulted in a government response that was not exactly aggressive (I’m not saying it should have been — I really don’t know what should have been done). My point is, do we really need to shun China and be angry at the Chinese people for this one?

Yet the virus has unusually dangerous characteristics and may merit the extreme measures to control it. I’m not sure. But I hope we’ll keep this in perspective relative to the thousands of deaths the US experiences every flu season from related though perhaps less severe viruses. And I pray that we’ll remember China and recognize the great burdens the Chinese people are bearing, and not add to their burdens unnecessarily. Keep China and the Chinese people in your prayers, and thanks to those who are taking steps to help rather than to blame.

By |2020-02-10T12:55:17-07:00February 10th, 2020|Categories: China, Health, Safety, Shanghai, Society, Surviving, Travel tips|Tags: , |Comments Off on Views on the Corona Virus Pandemic in China

Dangerous Professions in China

Air conditioning repair in Shanghai

Air conditioning repair in Shanghai

Be grateful for some of the overlooked workers in China who put their lives on the line everyday for our benefit. The people who carry out some seemingly basic services like window washing, air conditioning repair or installation, welding, and construction are often overlooked and looked down upon because these are jobs that don’t require advanced education and may not have high salaries. Many of the people doing these jobs come to China’s big cities as migrant workers from outside provinces, and may not fit in with local society. But they deserve a great deal of respect and gratitude.  Something as seemingly mundane as an air conditioning repair may involve breathtaking skills and dangers most Westerners might not expect.

In the photo above, a daring worker has climbed out onto the ledge of our apartment building to repair a problematic air conditioner. He has a rope connected to a railing if he should fall, but I’m not sure the rope looks all that safe and wonder if the railing would hold. On a second occasion, the man came alone and I was the one holding his security line for a while. His life was in my hands for a few moments. I was humbled to realize that this good, hard-working man takes on deadly risks every day to help people have a service that he may not enjoy in his own dwelling place.

 

By |2019-11-09T17:45:10-07:00November 9th, 2019|Categories: China, Safety, Shanghai, Society|Tags: , , |Comments Off on Dangerous Professions in China

Accepting a Job in China? Some Questions to Ask (and an Exercise for English Teachers)

After nearly 8 years in China, I’ve met a lot of foreigners and heard many surprising stories of some of the challenges they face in their jobs, especially when working for Asian companies. In most cases, the employee made assumptions about their job and their employer based on their experience with Western companies. Others didn’t fully understand what was expected of them and what they would have to do. This can lead to pain, frustration, embarrassment, and financial loss. Please don’t make lots of assumptions and assume that everything will be like it is back home.

You need to ask a lot of questions! If you find yourself saying, “I’m sure it will be OK” or “I trust it will be fine,” you may have a problem. In a very foreign culture with different laws and different levels of compliance with those laws, it’s much better to be asking, “What could go wrong?” Some of the questions you might want to ask may seem a bit bizarre, such as “Do I need to bring my own mop?” It’s a fair question, though tongue-in-cheek in most cases, as explained below.

Here are some suggested questions to ask:

  • Can I see the contract(s) you want me to sign before I resign my current job and show up for work in China? Sometimes the “standard” contract your company will give you when you show up for work will be a shocker. You may find the salary you agreed upon is not what is in your contract, that the benefits that were promised are not in the contract, and that troubling provisions are in the contract, such as a rejection of many of the normal employee rights provided by China’s generous labor laws, and even a requirement that portion of your income will be withheld for some period of time and perhaps only given to you if certain goals are achieved that you may not be able to control and achieve on your own. When you ask about the benefits or other terms you have negotiated, the response may be, “Of course! But that’s just verbal. Trust us.” Realize that the HR person saying that may be totally sincere, but several years or weeks later he or she may be gone (HR turnover is intense in China) and the new person will not believe you when you bring up the verbal agreement that supposedly was made. Contracts may not always mean a lot in China, but verbal agreements with people who are no longer around mean even less.
  • Can you put that in writing? Don’t assume that any of the benefits and other terms you have negotiated will be put into writing in your contract. Be prepared for that, which is usually something that we gullible foreigners have not even imagined as a possible risk. I suggest that you insist that everything is in writing. At a minimum, have emails confirming the terms before you accept an offer and keep copies, copy other witnesses, etc., to create a paper trail, and have dated and signed printouts of those terms witnessed and notarized as a defense (get them notarized in China also, if you can, or at least signed by Chinese witnesses), but also realize that the paper trail may not do all that much for you if you don’t get those terms in the contract.
  • Will there be more than one contract to sign with potentially inconsistent, conflicting, or generally problematic terms? This is likely if you end up with a split income, as described below, or if you are a high-end employee subject to a non-compete agreement or other special terms in addition to a standard employee contract. The additional contract(s) may have terms that undermine or exacerbate portions of your basic contract, or that create serious problems in other ways. Be ready for careful analysis and outside legal guidance and recognize that you can propose alterations. The worse thing to do is say, “Well, I trust that it will be OK.” Remember, the key question is, “What could possibly go wrong?”
  • Will I have a legitimate work permit and a work visa? Sadly, many companies bring people here on a tourist visa and have them work illegally. This can get you detained, fined, and deported. If the company is not actively working to get documents needed for a visa long before you come to China, they may be planning to rely on your tourist visa, even if they promise they will get you a visa once here. Sadly, I know too many English teachers who get into awkward situations when some of the companies that bring them here don’t properly provide work visas for them. Sometimes the company tries their best but the Chinese side (a company or school) takes short cuts and put the teachers at risk. Ask lots of questions. If there is uncertainty, be sure to try out the bonus exercise I give at the end!
  • How will the taxes due to China be paid? Ex-pats are typically told that the company will handle all Chinese taxes. Make sure this is in writing. Also make sure the company will pay taxes on your full income, which leads to the next question:
  • Are you going to split my income to evade taxes? Sadly, some companies use a practice of splitting a foreign employee’s pay, with part of the salary being paid to a Chinese bank account, and another part being paid to a bank in the employee’s home country, typically using some foreign (non-Chinese) agency to wire money to the home country. That system is convenient for getting money to your home bank account, but the problem is that the employer typically doesn’t report the foreign income to China and only withholds Chinese taxes for the China income. Ex-pats generally don’t understand that taxes aren’t being paid on the foreign income when this happens, and it can be a devastating shocker to eventually learn what might have been going on and how much risk and gargantuan penalties you potentially face. There are cases where an employee in China may do genuine work for oversees entities that may justify offshore income, but you should check carefully into this matter and get legal advice before accepting split income arrangements. Do not risk getting into trouble in China, and do all you can to respect Chinese law. If you find your company is not respecting Chinese tax laws, it’s time to resign. For some good guidance, see these articles by Dan Harris at the China Law Blog: “China Expat Pay: Splitting with Hong Kong is 100% Illegal and 200% Dangerous (Part 1)” and Part 2.
  • Will you respect Chinese Labor Law or will my work contract say I have essentially no rights (e.g., no severance pay, etc.)? Some contracts say that there will be no benefits or rights except for what is mandatory under China’s labor laws. That means no severance pay, for example, and other potential disappointments.
  • When I leave, how much notice do you require? If you are asking me to give, say, three months of notice, will you respond to my resignation notice by exercising your right to terminate me with 30 days’ notice with no severance pay? Yes, this absolutely can and does happen, even for employees who have seemingly been loyal and valuable workers for many years. It’s an ugly way to treat an employee, but there are often incentives for some people in the company to lay off a certain number of people, so they might jump at the chance to turn a voluntary resignation into a lay-off that gets them credit for their own KPIs, so I’ve been told by a China expert. The employer will always retain the right to fire you with 30 days notice (some will give less and dare you to sue), so if you are asked to give more notice than that, point out that this is unfair and either change the contract to require 30 days or consider a provision that gives you compensation if they refuse to respect your advance notice and respond by giving you 30 days notice in return.
  • How much cash will I need to bring to get started with housing and everything else in China? Many people don’t understand that the company is not going to help you with housing at all or that at most they will provide some monthly stipend toward housing, but only after you have found your apartment and paid the huge fees and deposits required to get started, and then present your company with an official receipt for your first month’s rent. If you are renting, say, a 15,000 RMB/month apartment, you may have out-of-pocket expenses from paying your first month’s rent plus a deposit of two-months’ rent, plus a rental agent fee of 35% of a month’s rent, adding up to a little over 50,000 RMB, or nearly $7,400 in cash before you receive your first paycheck and long before you’ll get your first housing stipend for some portion of your monthly rent. It’s expensive to start working in China. Are you ready?
  • Will housing benefits and other benefits begin as soon as I start, or is there some minimum term of service required before they begin? Which ones actually begin on day one? And can you put that into writing? One friend relied on the promised housing stipend in selecting a nice apartment, more expensive than he might want if paying for it on his own, but only later found out that the significant housing benefit would only begin after several years of service. Ouch.
  • To begin my job in China, will you bring me through China customs in the normal legal way, or will I be smuggled in by, say, crossing a mountain along the Vietnam border? If your employer turns you over to a smuggling team and requires you to march through the jungle or scramble over a mountainous border to sneak into China, or even if you come through a legal port but are just whisked into China through a “special lane” without your documents being checked and entered into China’s system, you are entering illegally and will have a world of trouble to face, especially if your employer takes away your passport, making you almost like a slave. This usually doesn’t apply to people coming here to work for higher-end jobs that require college degrees, but often applies to those coming to be maids or “ayis,” as is the case for many women from the Philippines. They are often taken advantage of in many ways due to their lack of legal status and their fear of seeking legal protection when they are cheated or abused. Don’t enter China illegally!
  • Will my health insurance actually help if I need surgery? And will it help my family or just me? Health care is fairly inexpensive in China, unless you want care provided by Western-style clinics or hospitals. Even if you rely on less expensive local hospitals (I love Shanghai East and it’s inexpensive VIP clinic, for example), you may be disappointed with how little your corporate health insurance covers. And insurance packages usually just apply to the employee, but may offer an option to purchase a plan for your spouse or children. Learn early what you are getting, if anything.
  • Will I be required to work on Saturday and Sundays? Can you put it into writing that I will have my weekends free? Sometimes corporate leaders launch campaigns to increase productivity, or the appearance of productivity, by requiring employees to start coming in on Saturdays or weekends. That’s really hard on ex-pats who come here hoping to experience China. Hard to experience it when you are trapped in an office all week long. Those coming here to teach also often find that there are school shows and performances held on weekends that they are required to be at. Unexpected duties tend to crop up with little notice, after people have purchased plane or train tickets, or even during holidays. Keep your weekends free and try to get something in writing to that effect. Even then, you will see that big national holidays often involve turning a Saturday or Sunday into work days to add more vacation days to a holiday. This can be frustrating.
  • Will critical corporate announcements all be in Chinese? Will there be any translation help for me? Even large multinational companies will tend to have at least some important email and documents sent to employees in Chinese only, and many won’t take any pains to provide translation. If you are not a Chinese speaker, this can make life difficult. Learn Chinese, make friends with Chinese speakers who can help you, and find ways to cope.
  • What documents do I need to bring to get my work permit? The rules have evolved on this critical issue, but have long been surprising. For example, when I came in 2011, I learned that I needed to bring my ORIGINAL diploma from BYU. In the US, people often don’t care about the diploma. It’s just a pretty document that we don’t really care about, but it’s a big deal here. You may need to contact your school to get a notarized physical copy of your diploma to work in China. And there may be a number of other original documents you need: your wedding license, your birth certificate, a letter from your former employer, etc. One friend of mine is unable to get the promotion he has long deserved because the small college that issued his diploma long ago has failed and is no longer, making it impossible to get a physical diploma now. A disaster for him, I’m afraid.
  • Jeff Lindsay holding two mops

    Reporting for duty!

    Do I need to bring my own mop or broom? OK, joking, of course, but there’s a point here: sometimes wonderful sounding jobs with lofty titles turn out to be painful and rather menial. You might think you are in charge of something major, and find out that in reality you are just mopping up after someone else. The best way to prepare is to talk to people in the company or who once worked for the company to understand what the job is really likely to involve. I talked with several former and current employees before making my decision, and that was really helpful, though I still had some surprises. But many pleasant surprises as well. I’ve had a wonderful 8 years here without too much mopping, and a lot of excitement that has swept me away at times.

No matter how much you try to pin things down, understand that things tend to change rapidly in China, so be prepared to be flexible. (Also be prepared to walk away if things turn out to be really shady.) In my case, for example, I was supposed to work here for one year, and then I would be brought back to the US to be part of a US expansion team. That sounded perfect. About one year later, as I wondered why I wasn’t hearing anything about the US expansion team, I asked around and learned through the grapevine that the U.S. expansion team had been fired and no longer existed, and all plans for my return to the US had been dropped. It was a surprise, but a very fortunate one in my case because one year would not have been long enough. Whew! I’m so grateful for that unexpected change. But in Asian companies, as many ex-pats have found, you may have to ask and inquire persistently to learn of these big changes or upcoming problems because communication to employees might not be a strong point of your particular company, nor will it be one of the KPIs for HR.

“What Foreigner?” An Exercise Useful for Some English Teachers

Now, for those coming here as English teachers, one of the jobs with a relatively high risk of trouble, here’s a physical exercise that may prepare you for your day-to-day work, especially if your company is not going to arrange for a legal work visa for you before you arrive. (If they tell you that all you need is a “student visa” and that you will be a student just doing “volunteer work” as a teachers, you might need this exercise, especially if you are being paid anything and especially if you are in a more developed city like Shanghai.) It’s a fun exercise, even a game, called “What Foreigner?” It’s something you should play a lot to be prepared so when you play it here for real, you’ll be ready. It takes 3 people to play, but you can get by with only two players if one does double duty.

You are the foreigner, and you need to begin by standing in a room in your home, school, church, or other facility with multiple rooms. We’ll call that facility “the school.” That room will be “the classroom.” You will hold a textbook or other objects that help you feel like you are in the middle of teaching a class. Act like you are teaching.

Have Friend #1 and Friend #2 go to the front door of the building. Friend #1 will step outside the door and pretend to be the police while Friend #2 will stay inside and pretend to be a school administrator. Have them wait a few minutes. When Friend #1 feels ready, he or she knocks on the door. Friend #2 looks through a window, peephole, or crack to see who it is, then turns and shouts toward you, “Police!” Friend #1 comes in and then begins walking to the classroom. As soon as you hear the shout, your job is to drop everything and escape out a back door or side door before you are spotted, and then to run as fast as you can until you are far from “the school.” Meanwhile, when Friend #1 arrives in the “classroom,” he or she asks, “Where is the foreigner?” Friend #2 then tries very hard not to laugh and says, with a sense of indignation, “What foreigner?”

Did you get out in time? Whew! Congratulations! Now do it again. Best to practice now so you’ll be ready. And yes, for those who don’t get US-style humor, I am making a joke here. I do not support violation of law in China, and recommend that you do not accept illegal work in China! Those who end up teaching in questionable English programs, working illegally as teachers, end up in lots of difficult situations where they have to run or pretend to be students. If you are teaching a class for pay, you are working and need a work visa. China is increasingly rooting out these illegal operations. I suggest you don’t take risks and strive to diligently adhere to Chinese law.

Even if you do all you can to be legal and everything looks good, you may find that your company or agency has done something illegal that may affect you. For example, a couple of teachers we knew thought they were completely legal, teaching for pay with a legal work permit in Shanghai, but it turns out that a local agency had falsified their application for a work permit in order to meet Shanghai’s strict requirements and claimed that they had advanced degrees and more years of experience than they really had, which is a serious crime that can get you deported. When the US company that brought them here as teachers learned of this, they realized that the couple was in grave danger and had to rush them out of the country without even a chance to say good-bye to their students. If you can, look at the documents being submitted for your work permit and visa and make sure that nothing has been falsified.

If you are coming to China, congratulations! It’s the most exciting and wonderful place I’ve ever been. Working here has been the most exciting (though occasionally the most painful and frustrating) part of my career so far. But ask lots of questions and do all you can to be legal and to respect China’s laws.

By |2019-11-09T17:46:48-07:00April 13th, 2019|Categories: Business, Career, China, Education, Housing, Safety, Society, Surviving, Travel tips|Tags: , , , , , , , |Comments Off on Accepting a Job in China? Some Questions to Ask (and an Exercise for English Teachers)

When Cabbies Dump You

Shanghai cabThough most of my cab rides in Shanghai turn out well, occasionally something goes sour. In the heat of the moment, it’s easy to make some serious mistakes, just like I did today.

My cab ride had just begun when I pulled a beloved Chinese epic sci-fi novel from my bag to begin some precious reading time. Suddenly the cabbie saw something come in on his cell phone and turned around and told me that he was sorry, but I had to get out so he could go get another customer. Had I been better prepared, I would have said no, I’m your customer, and please take me to my destination. This might not work and sometimes could lead to a big argument or even physical fight, but I should have resisted or at least have him take me a little closer to my destination or to the nearest subway or something better than what I did, which was 1) give up easy and 2) make a dangerous and actually illegal exit in the middle of an intersection.

“Rats,” I thought, when he told me to get out. I resigned myself to his rejection, but was actually too cooperative. He was in the left lane at an intersection at a red light. There were just seconds before it would be green, so I needed to hustle. It wasn’t a busy intersection, but still, it was wrong to let him force me out there. As I hastily prepared to open the right door, I was focused on traffic coming along the right side of the car, not wanting to be hit by a motorcycle or other vehicle. This was stupid and dangerous, for I at least should have insisted that he first drive me to a safe spot.

I got out safely and he drove off. Only later would I realize that he had my beloved book, with many markings and notes, sitting unloved in the back of his car. I was only 75 pages into it, but it was a painful loss, and I had no way to reach him because he didn’t charge me for the brief ride, meaning I didn’t get a receipt.

Rule #1 of cab rides is NEVER GET OUT WITHOUT A RECEIPT. The main reason for this is in case you leave something behind, you can use the receipt to call the company and identify the driver and get your goods back in most cases. (It also is essential if you get double billed if you got the cab through WeChat, paid by cash, but then also got an automated WeChat bill.) But a corollary to that rule is if you are being booted out without a receipt, get a photo of the driver’s ID posted in the front of the cab and a photo of his license plate number in case you need that info later, either to recover lost goods or, as in this case, to also report illegal dumping. And you might as well ask for an old spare receipt (fapiao) as partial compensation for your lost time–they usually have several.

Of course, if you have your wits about you enough to get the ID and license plate, you will also be thinking about not losing goods and looking carefully before you step out of the car. But this requires being smart enough to step out of the car in a safe spot where you can take the time to slowly gather your things, check the seat carefully, and gracefully exit instead of just making a made dash to get out of an intersection while someone drives off with your book (or cell phone, wallet, passport, etc.).

Recapping, when a driver wants to dump you for another customer:

  1. Know that this is illegal and try to insist on your rights. If he won’t respect your request, take your time. Ask for an explanation. Repeat your request. Don’t feel obligated to jump out right away. No need to reward his bad behavior. But stay friendly and don’t provoke a fight.
  2. Take a photo of his ID (this will alert him that you have the power to report him, and that may change his tune on the spot). Ask for a spare fapiao as well. Make sure you have the phone number of his company. When you get out, also get a photo of the license plate and maybe of him as well (leaving a door open for a while can buy you time for this so he doesn’t speed off immediately).
  3. Take your time to gather your stuff. Don’t leave things behind! Always ask yourself: is there anything in the trunk? On the floor? Anything that could have slipped from my pockets?
  4. Never get out at an unsafe and inconvenient location. If he won’t take you to your destination, insist that he drive you forward to the next subway station or at least to an area where it might be easier to catch a cab, and make sure he takes you to a safe spot to exit.

By knowing your rights and being assertive/annoying in a calm, friendly way, you may help him realize that cabbie crime doesn’t pay, maybe making things easier for the next customer. But don’t provoke him into extreme anger. Some cabbies have assaulted passengers, so be careful. You can just roll over like I did — but don’t do it in a rush, for you are more likely to lose things and have an accident. Take your time and insist on safety.

For me, the loss is mostly recoverable, for I just ordered a new copy of the book on Amazon.cn, and will have it back in my hands tomorrow. Taxi losses can be much more painful than that, so be careful and keep your wits about you.

By |2018-11-05T04:45:26-07:00November 5th, 2018|Categories: China, Safety, Shanghai, Surviving, Travel tips|Tags: , , |Comments Off on When Cabbies Dump You

Coping with Suicidal Thoughts in Shanghai? Local English- and Chinese-Speaking Resources Can Help

Foreigners living in China can sometimes feel very isolated, which might make depression or other mental health challenges even worse. It’s important to know that if your or a loved one is struggling with suicidal thoughts or the trauma of someone else’s suicide, there are resources to help. One resource is located right here in Shanghai for English speakers: Lifeline Shanghai (China; English only), phone: (021) 62798990. If calling from outside China, use the country code of +86. For Chinese speakers, a resource is HopeLine: 4001619995 (Chinese speakers; 24/7 toll-free access within China).

According to the Lifeline Shanghai website (http://www.lifeline-shanghai.com/):

Lifeline Shanghai serves the English-speaking community with free, confidential, and anonymous emotional support via telephone 10AM to 10PM, 365 days a year. Our helpline offers an emotional support service that respects everyone’s right to be heard, understood, and cared for. Lifeline Shanghai helpline assistants are ready to listen and support, helping you to gain another perspective and connecting you with other support services as needed. Trained volunteers offer emotional support and assist you to clarify options and choices that are right for you. ​

This service is for those with a wide variety of difficulties, not just suicidal thoughts. Appears to be a valuable addition to Shanghai’s expat resources.

Since many of my friends and some of my readers in Shanghai are part of my LDS religious community (The Church of Jesus Christ of Latter-day Saints),  will also mention the excellent resources and list of external resources provided at the Church’s official page, “Suicide Prevention and Ministering Understanding and Healing from the Pain of Suicide” (https://www.lds.org/get-help/suicide/?lang=eng).

Although Shanghai is a prosperous and wonderful place, the problem of suicide is serious. Suicide rates are painfully high and is even a serious problem among children, perhaps due to the high pressure they face in school. See “Child suicides high in Shanghai” at the Christian Science Monitor (an old 2004 article). But suicide rates have been increasing in many parts of the world, including the US. Rates among young girls have actually tripled in recent years, a terrible development. See “Suicide rate triples among young girls: How can we stem the ‘silent epidemic’?,” also from the Christian Science Monitor.

If someone you know is showing signs of suicidal thoughts, take it seriously and lovingly work to support them and get help. Turning to outside expert help may be vitally important.

By |2018-08-17T17:53:13-07:00August 17th, 2018|Categories: Education, Health, Relationships, Religion, Safety, Shanghai, Society, Surviving|Tags: , , , |Comments Off on Coping with Suicidal Thoughts in Shanghai? Local English- and Chinese-Speaking Resources Can Help

A Grieving Mom in Shanghai Learns Her Son May Not Have Pancreatic Cancer After All: Misuse of the CA-19-9 Antigen Test

A few days ago a grieving mom in Shanghai, a good friend of ours, shared some tragic news with me: her teenage son had pancreatic cancer, one of the worst cancers. Her son was likely to die soon, if the doctor was correct. Only about 20% of pancreatic cancer patients live past 5 years. She was almost overcome with grief and had been crying for a couple of days. But even though she had gone to an expensive hospital that caters to foreign clients, she wasn’t sure she should trust the doctor. The mother called me to see if I knew where she could turn for help. She didn’t know that one of my sons happens to be a doctor treating cancer at a leading US clinic.

I received a photo of the lab report for the boy and sent it to my son. The physical results reported that a scan of internal organs showed no unusual problems indicative of cancer. There were no other symptoms, just a slightly elevated CA-19-9 antigen level, 45 instead of a desired maximum of 37.

My son was greatly disappointed that the doctor would create such needless panic by telling the mom that her son probably had pancreatic cancer. My son explained that the CA-19-9 test is not supposed to be used for diagnosing cancer on its own. Absent other symptoms of cancer, its predictive power for cancer is less than 1%, he said, and when he learned that the son was just a teenager, he said it’s even less likely to be pancreatic cancer because that disease is almost unheard of in young people. The mother’s grief was turned to relief.

I later found scientific publications confirming what my son had said. For example, see K. Umashankar et al., “The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: An evidence based appraisal,” Journal of Gastrointestinal Oncology, 2012 Jun; 3(2): 105–119; doi: 10.3978/j.issn.2078-6891.2011.021:

CA 19-9 serum levels have a sensitivity and specificity of 79-81% and 82-90% respectively for the diagnosis of pancreatic cancer in symptomatic patients; but are not useful as a screening marker because of low positive predictive value (0.5-0.9%).

Other articles indicate that diabetics, such as this young man, can have inflated CA-19-9 values (this applies at least for Type 2 diabetes–I’m not sure if CA-19-9 artifacts from Type 1 diabetes has been investigated), one of many possible alternative causes of elevated CA-19-9 values. Alternative causes for the elevated test result do not appear to have been  considered by the doctor who terrified a mom by declaring that it was probably pancreatic cancer. Again, the test can be useful in tracking the progress of treatment of a known cancer, but should not be used to diagnose cancer in the absence of other evidence, as in this case.




Keep this in mind when you have your physical in China. Don’t panic if a doctor reports that you might have pancreatic cancer based on a blood test result alone. Get a second opinion and understand why that value may be high, but don’t panic. Physical testing here can often include too many unnecessary tests in search of phantom problems that may be listed in your report by people who aren’t necessarily qualified to make such proclamations.

The family still needs to be cautious and follow up on the possible causes of the inflated test result, but it was only slightly elevated unlike the much higher scores that I’ve seen reported in patients who actually do have pancreatic cancer.

I am so grateful that my son was able to help bring peace to a mother who had been crying for a couple of days over the “fake news” she received from a generally good hospital. I suggest that here or anywhere else you should be open to the possibility that some doctors don’t know what they are talking about. And of course, that can apply to what I’ve said here. Do your homework, ask questions, and be cautious about what others declare.

 

By |2018-07-05T22:10:03-07:00June 17th, 2018|Categories: China, Consumers, Education, Health, Safety, Surviving|Tags: , |Comments Off on A Grieving Mom in Shanghai Learns Her Son May Not Have Pancreatic Cancer After All: Misuse of the CA-19-9 Antigen Test

Jimmer, the “Lonely Master,” Might Be Doing Better and Doing More in China than the Deseret News Thinks

In the state of Utah, Salt Lake City’s Deseret News recently carried a touching but slightly downbeat article about China’s most popular basketball player, Jimmer Fredette, the impressive star who once stunned American crowds while playing for Brigham Young University. The article is “Lonely Master: From March Madness to Shanghai, the Unlikely Journey of Jimmer Fredette” by Jesse Hyde, published March 12, 2018. It has a lot of positive things to say about Jimmer and his accomplishments in China, but the general tone of the article is that Jimmer has missed out on his US dreams and thus has settled for something painfully inferior by coming to China, a grim and gritty place. I think there’s another perspective that ought to be considered.

Yes, the CBA is a far weaker competitive field than the NBA, and yes, it is disappointing that his NBA career did not give him the opportunities and satisfaction he sought. But don’t shed too many tears for Jimmer: things might not be as grim as the article implies.

The negative picture painted of China is quite disappointing. It’s a beautiful, exciting place where Jimmer is visible and influential to millions of people in ways that would not be possible in Europe or the US. I have met Jimmer and chatted a few times but don’t know him well nor can I speak for him. But what he is doing here is remarkable and has touched many people. His goodness, his honesty, his humility, and his high standards have also helped him touch people beyond what his athletic skills alone could do. For someone who possibly may have a sense of a mission higher than personal temporal success alone, coming to China brings many opportunities to achieve greater good, while also benefiting from a shorter season and excellent pay. Win/win from my perspective. His presence in China is part of something big, at least in the minds of many of his BYU-related fans here.

One of those fans, a Communist Party official, requested a chance to meet Jimmer last year. I was honored to be part of the little gathering where introductions were made. Jimmer with his characteristic class and humility brought gifts for the Chinese men who had come — framed photos of him as keepsakes. They were thrilled. Before Jimmer showed up, one man in the small group, a business leader in charge of the large complex where we rent some beautiful space to hold LDS services, chattered excitedly about Jimmer and quoted statistics from Jimmer’s games when he was at BYU and in China. Kid in a candy shop when Jimmer arrived. The official had gifts also, a terrific album of Chinese postage stamps. It was a beautiful souvenir for each of the foreigners at this event, which I’m proudly holding in the photo below.

With typical Jimmer class, Jimmer noticed a couple of keenly interested staff members from the little cafe where we met and invited them to get their photos taken also. It was a big day for all of us.

The Deseret News article makes numerous references to the pollution of China and Jimmer’s depressing situation here. The lead paragraph suggests he can’t see much of the skyline in Shanghai due to pollution (yes, we have pollution and some days visibility is noticeably reduced, but we have a lot of beautiful days too and air quality is improving). His apartment is “empty, lonely, a place he just crashes, so devoid of personal effects….” Regarding some reminders of his wife and daughter in his apartment: “Sometimes he needs those reminders. Like when he’s in Shanxi, a gritty industrial city where the gray dust blows from the cement factories and the grime is so thick he could scribble his name on the windows of parked cars.” And when he’s in Shanghai, in spite of the wealth and good food here, “even here, the air carries a slight whiff of chemicals you can almost taste. It’s hard not to want to be somewhere else.”

At this point in reading the article, I wondered if the staff of the Deseret News have ever been in Salt Lake City during the winter months, when the winter inversion traps air in the Salt Lake Valley and leads to painfully high levels of particles, nitrogen oxide, and other pollutants? Of if they have ever been near operations of the massive copper mine that scars the Valley? Or drove through Utah County in the days when the Geneva Steel works were cranking out massive whiffs of chemicals into the air? Or if they have lived near a paper mill in the United States? Shanghai air can get smoggy and is typically worse than most places in the US, but apart from an occasional painter using oil-based paint or a vehicle burning too much oil, as in almost any city, noticeable “whiffs of chemicals” are something I generally don’t experience here, unless those chemicals include the cinnamon aromas coming from Shanghai’s amazing Cinnaswirl bakery with world-class cinnamon rolls, or from the intoxicating smells of any of the hundreds of different cuisines available in Shanghai. OK, we do have stinky tofu, which does have a noticeable smell from its unusual natural chemistry — maybe that’s what the writer encountered here. But you can just take a few steps and be free of that.

China has pollution, certainly. There are spots that are gritty or grimy, just as in America. But it’s also one of the most beautiful and exciting places to live, especially Shanghai. For me personally, my respiratory health during my nearly seven years in Shanghai has been much better than it was in the US, where I would often get bronchitis or other issues in winter. Here it’s been great and I’ve almost never had to miss work due to illness. One or two days for an injury, but my health has been terrific. Part of that is from the food, which is high in fresh produce and generally quite healthy.

Come give China a chance. It’s one of the nicest places in the world, in my opinion. Anyplace is grim when you are away from family, but with such a short playing season, we hope that Jimmer can continue to thrive here and increasingly experience the beauty and wonders of China while here.

As a reminder of the surprising beauty and sometimes even miraculous nature of life in Shanghai, here are images of one of Shanghai’s secrets: its impressive angels rising from the ground to watch over this city. May Jimmer continue to be among them.

Finally, here’s a couple views of one of Jimmer’s favorite Shanghai spots.

Shanghai Disney Castle

The Shanghai Disney Castle

 

Cinderella’s Castle.

 

 

By |2018-03-17T07:24:37-07:00March 16th, 2018|Categories: Business, Career, China, Food, Health, Photography, Relationships, Religion, Restaurants, Safety, Shanghai, Society, Surviving|Comments Off on Jimmer, the “Lonely Master,” Might Be Doing Better and Doing More in China than the Deseret News Thinks

Surviving Your Bike Ride in China

Riding a bike is one of the best ways to get around big cities in China. I have my own large Giant bike purchased new for 800 RMB, and I love it. Fast and smooth, but just one gear. That’s fine for Shanghai. Many people ride rental bikes now like Mobikes or the yellow Ofo bike that I sometimes ride (the Mobikes are just too small for me, while the Ofo brand often allows the seat to be raised high enough to make it possible for a tall guy to ride, though not comfortably). I ride my bike most days when going to work in the Hongqiao area of Shanghai. It’s often faster than a taxi and much faster than a bus. You can join the pack of crazy motorcyclists who are not impeded by traffic jams, cutting in and out of obstacles while carefully observing all relevant laws — well, most of the laws of physics, I mean.

Bike riding is fast and convenient, but there are serious dangers. Not as dangerous as a motorcycle, where the higher speed means higher risk, but that higher risk includes collisions with you on your bike, and the results can be nasty. A friend of mine just badly crushed his hand in an accident with a motorcycle while riding his bike. He will need delicate surgery. Another friend was riding across a bridge when she hit a rock and fell from her bike, badly shattering her forearm. Painful surgery and months of recovery were required, but after a year has regained nearly all of her motion. But trust me, you don’t want an accident. Understanding the dangers is critical.

One of the biggest dangers comes from motorcylces and especially their nearly silent electric version, the ebike or electric bike. They can be zooming toward you from behind and you won’t hear them coming. They can be coming in from an angle from the back or side and you won’t hear them coming, unless you listen carefully. More important than listening is looking: you need to frequently make quick glances over your shoulders, especially over your left shoulder where faster approaching vehicles are likely to be coming, but also sometimes over your right shoulder.

Vision Trumps Everything

Peripheral vision is crucial. Frequent glances over your shoulders are vital. Understand that a vehicle may suddenly approach you from any side and any angle. A motorcycle or bike may dart out from an alley or from between parked cars on the side of the road. As you approach an intersection or driveway, someone may suddenly move into your path and it will usually seem that they never even looked your way before entering traffic. It’s amazing that some of them are still alive, but natural selection can be a slow and overly random process. I certainly have not seen any evidence that natural selection has been weeding out insane motorists and cyclists over the years in China. Evolution might work well for some species, but it seems rather inactive for species on the road. Never mind, just focus on not being the one who gets weeded out.

The key is being totally alert and aware of what’s happening in front of you, at your sides, and behind you. Listen carefully for horns, bells, rattling sounds, motors, snorts, cellphone conversations, or other indications of an approaching ghost rider. Watch for signs of motion between stationary cars. Anticipate taxi doors suddenly opening, usually on the right side. Note the protruding nose of a dog getting ready to make a dash for it. Anticipate the craziness of intersections where people may cross your path from all directions. Total alertness and attention is your key to survival.

Here’s the shocking news: for enhanced safety, I’ve given up wearing my helmet. Yes, terrible of me, right? But the statistics globally don’t show that bikers who wear helmets fare better than those who don’t, and in my Shanghai experience, I’ve realized that anything that hinders my peripheral vision or my ability to quickly look over my shoulders increases my risk. Avoiding collisions and falls is the first priority, much better than falling with a touch of added protection. Helmets limit my vision and slow me down when making rapid backward glances. Sayonora.

Alertness is also needed for coping with obstacles on the road. Manhole covers may be moved and the dangerous hole not well marked. Potholes may be large. Bricks or other objects can be in your path. With the rise of rental bikes clogging sidewalks, you will sometimes find a rental bike has been abandoned on the side of the road that partially blocks a bicycle lane. Dangerous! Be  good citizen and move it out of the way, but do this by stopping gradually and with clear signaling of intent. No sudden moves!

Speaking of rental bikes, they add a lot of danger to the scene. Not just because they might be barriers, but because they have brought many new cyclists onto the roads who don’t know much about cycling and safety. And they are slow. They go at about 30-50% of my speed, in part because the wheels are small, and as a result they are constant barriers in front of me I need to weave around. But their riders often don’t ride very well, weaving back and forth as they go. So annoying. Increases the risk for everyone. Be cautious and carefully plan how you can avoid them and get past them as soon as possible. Further, bike renters will often step out onto the road with their bike without even looking at incoming traffic. So clueless. Anticipate their stupidity and be cautious when you see someone standing by a rental bike, possibly getting ready to create a pile-up on his or her first ride.

To Be Safe, Be Predictable

From my experience, a key safety tip is that you need to be predictable. Sudden turns, veering to a side, or a sudden stop can result in disaster. In China, car drivers and motorcyclists constantly forecast where others are going and then plan their sudden weaving in and out or other crazy maneuvers based on forecasting the routes of nearby vehicles. They expect you to just keep going and will time their move based on the forecast. But if you suddenly stop or turn without warning, you may end up where they are about to end up. Bang. Ugly. Notice this when you are in a taxi. Drivers are very aggressive and it all kind of works as long as people are somewhat predictable.

Hand signals aren’t common but are a good idea, especially for left turns against traffic. They aren’t going to stop for you in most cases to let you turn, but the signal lets others know what you are doing so they won’t crash into you.

When you stop, try to do it gradually. Recently I was riding along, thinking I was alone, and saw a person who was on the ground right after an accident between a bike and a motorcycle. I stopped quickly to help and then heard someone right behind me yell as he slammed the brakes of his electric motorcycle to avoid me. I was nearly taken down by that mistake. Be predictable. No sudden moves!

I hope this doesn’t deter you from riding a bike. There are dangers, but if you are alert and cautious, you can manage the risks and enjoy getting around town much faster than going on foot or with public transportation. But do realize that there are risks. Walking and public transportation have much lower risks, so weigh them as alternatives. Very few people have ever needed major surgery after a ride on the subway.

 

By |2018-01-07T19:24:24-07:00January 7th, 2018|Categories: China, Crazy, Health, Safety, Shanghai, Society, Surviving, Travel tips|Tags: , , , , , , , , , |Comments Off on Surviving Your Bike Ride in China

Milk in China: Try the Asahi Brand for Safe, Delicious Fresh Milk

Milk has been a problem for many people in China. Trust of Chinese dairies has been low after some past disasters. Large milk powder companies struggle tend to import the milk they use because of quality control problem among the numerous small dairies that provide milk to large providers. Foreigners who like to use milk tend to buy ultra-high-temperature (UHT) treated milk that does not require refrigeration until it is opened, but the flavor tends to be poor from the heat treatment and nutritional value may be lowered as well.

After struggling with various brands of UHT milk and shying away from Chinese dairies for fresh milk, I finally found a brand of fresh that impresses me: Asahi milk. This is a Japanese company using good Japanese dairy methods on their Chinese dairy. The flavor of the milk is better than anything I remember in the US and tastes like fresh milk I enjoyed in Switzerland long ago. Really delicious. A liter will cost slightly over 20 RMB, about the same price for good quality UHT cartons of milk. But so fresh and delicious. Also, I think, safe and consistent in quality.

Asahi brand whole milk: possibly China's best?v

Asahi brand whole milk: possibly China’s best?

By |2017-10-24T06:52:38-07:00January 21st, 2017|Categories: China, Consumers, Food, Health, Safety, Shopping, Surviving|Tags: , , , |2 Comments

Funny Red Beef in China: Treated with Sodium Nitrite?

I’ve noticed that beef sold in small shops in China is often a bright red color as if very fresh, maybe too fresh. It may have been sitting out for hours or days, and it is still that bright red color, never turning brown as regular beef does. We were buying beef from a local market for quite a while before it hit me that there was something odd about the color. It never turned brown until you cooked it. Finally it hit me that this beef has been treated in some way, probably with sodium nitrite or other chemicals that prevent the normal browning that occurs when beef oxidizes over time.

Some people worry that nitrites might cause cancer, especially when present in meet that is grilled or cooked at high temperature. Whether nitrites are carcinogenic or not, I don’t want chemicals being added to my beef to disguise its age and let old beef look fresh. This might be a good topic for further investigation because I don’t know for sure what is being added and who is doing the treatments, or of they are safe or not. But in the absence of assuring data, the strange absence of browning in some of the been being sold here has given me one more thing to worry about when it comes to meat in China.

Eat meat sparingly. Make sure it’s fresh and from a trustworthy source. Pork and chicken, which are sold in large quantities with high turnover, may be freshest and safest, in my opinion.

By |2017-01-06T21:12:08-07:00January 6th, 2017|Categories: China, Consumers, Food, Health, Restaurants, Safety, Shanghai, Shopping|Tags: , |Comments Off on Funny Red Beef in China: Treated with Sodium Nitrite?

Surviving Bank Theft in China: What to Do Immediately When a Thief Robs You with an ATM Machine

If you have taken my advice elsewhere on this site, your bank account is already set up to alert you by text message whenever there is activity such as an ATM withdrawal. But what do you do when you get the dreaded message that a large unauthorized withdrawal has just been made on an ATM machine somewhere in China or elsewhere? Sadly, few victims know about an important defensive action to take at that moment that will increase the odds of prevailing in court if your bank, like many banks in China, refuses to refund the money that was stolen from you.

Court? Really? Yes. Unfortunately, Chinese banks may actually accuse you, the victim, of having given your card to someone else to use in the usually distant city where the theft takes place. “How do we know you didn’t take the money out yourself, or give the card to an accomplice to take it out? You’re trying to cheat us!” The bank sometimes won’t even cooperate by providing you the recorded images or video of the person who made the illegal withdrawal, or providing other forms of information they might have that would show this was a criminal act unrelated to you. It’s up to you to prove that you are innocent, without any help from them. What to do?

My advice is simple: the moment you get notice of unauthorized activity, RUSH to the nearest ATM machine, use the ATM card for the account that was just robbed, and make a deposit, a transfer, a withdrawal, or some other action. Stare into the camera monitoring the machine and make sure your face is visible. Your goal: create a record about the location of you and your card at that moment. For extra protection, hold up a sign with your name and the date, maybe holding your photo ID near the camera, and also show your ATM card before and after the transaction (perhaps unnecessary since it will be read and recorded, but this will verify that it’s an ordinary card you are using). The point is to create a record showing that you and your card were in your neighborhood very near the time of the theft, ruling out the possibility that you or your card was in, say, the backwoods of Guizhou province at the time. With this approach, one Chinese man recently successfully overcame the ridiculous defense of his Chinese bank in court and was able to have the judge demand that the bank reimburse him in full for the large unauthorized theft from his account. Just in case, take your card to another ATM machine from a different and do this again. Maybe it helps if one of the ATM machines you visit is associated with the bank whose account was hacked. Create at least two records. In the process, have someone take a photo of you on your camera as you are holding your card (maybe cover the last couple of digits with your fingers) and do that with a background that is easily recognizable (street signs, famous landmark, etc.) and then text it to someone you trust to create an electronic record. These forms of evidence may be helpful in proving your innocence so that the bank will be held accountable for allowing someone to hack your account.

There are thieves out there who use your scanned card and stolen PIN to make bogus duplicates and suck your money out. Sometimes money gets sucked out from your account with inside help from crooked employees. However you are robbed, be ready to swiftly create evidence that can help you in court. Further, defend yourself by using your card as little as possible. Every transaction could result in your data being given to thieves. Always shield your PIN entry. But even that won’t help when an ATM machine has been hacked and is sending data to a thief. Keep lots of cash on hand and use only a few trusted ATM machines in well monitored locations like inside banks to reduce the risk of using a bad machine.

Don’t let large amounts accumulate in your accounts, either. Diversity your resources and don’t risk losing everything if a bank goes belly up, an account is hacked, or you make a ridiculous mistake like leaving your card in an ATM machine and walking away while the terminal is still actively connected to your account (I know someone that happened to, and someone stepped in and just started helping themselves to their money).

One more thing: Be sure to call the bank and report the theft as soon as you’ve created the evidence you’ll need to show where you and your card were located. Hopefully they will work with you, but if you have to sue, it will take several months and once the award is ordered by the judge, they may still drag their feet for a few months. Sigh. One of the challenges of surviving China.

By |2016-10-24T05:57:53-07:00September 24th, 2016|Categories: Business, China, Safety, Scams, Society, Surviving|Tags: , , , , , |Comments Off on Surviving Bank Theft in China: What to Do Immediately When a Thief Robs You with an ATM Machine