Sara, from Finland, has been coughing during the night again – her “Beijing Cough” is back. The symptoms are identical to those of six months earlier: a cough, but no sign of a cold.
Not many real Beijingers have heard of the Beijing Cough, but the name is in common use among foreign visitors to the city. They think it’s due to a failure to acclimatise – you get it when you arrive, and it clears up when you leave, a bit like Delhi Belly.
Before arriving in Beijing, and particularly while the city was hosting the Olympic Games, Sara and her boyfriend Harry had seen plenty of reports on Beijing’s air quality. China’s capital has been working to deal with air pollution – Du Shaozhong, formerly deputy at the Beijing Environmental Bureau, told Southern Weekend that the city had shut down or upgraded over 60,000 boilers of one sort or another since 1998.
In 10 years, the number of days on which sulphur-dioxide levels breached regulations during the 134-day period when Beijing’s central heating systems operate fell from 106 to nine.
On arriving in Beijing in April 2011, Sara was ready to “be a smoker for a year”. But to her delight, they suffered no symptoms in their first few months. Then Sara got an ear infection, which lasted six weeks, after going for a long run outside. And by March the following year, she was coughing for 10 or more minutes during the night, “like a chain smoker”.
Harry blamed the Beijing Cough. They moved apartment and bought a Swedish air filtration unit – but things didn’t improve.
Harry decided the best cure was a return to Finland. In July 2012, Sara flew home, and a month later her symptoms had gone. Harry looked up monitoring data for 2011: “At its worst, PM2.5 levels in Helsinki were 27 micrograms per cubic metre, and the average is under 10. In Beijing, it’s over 80. And that’s why we reacted as we did: we’re used to very clean air.”
In August, Sara went back to China, and her Beijing Cough returned as well. She went to the doctor.
In Finland, the doctors had struggled to find a cause for her cough. But the doctor in Beijing had more relevant experience. She asked Sara if she suffered similarly in Finland, if she’d always lived in the same apartment in Beijing and how close it was to busy streets. “Then she asked me if I wore a mask, if I exercised outside, if I went for long walks before sleeping, and if I had an air purifier. I think she was wondering if it was the air.” Sara recalls.
On hearing that Sara was taking aspirin for sensitive skin and had suffered a six-week ear infection. The doctor made her diagnosis: her skin was sensitive to particulate matter, and this was affecting her ear, nose and throat. The coughing was due to the dirt in her nose travelling down into her throat as she slept.
The hospital irrigated her nose and throat and prescribed Sara allergy medicine. A week later her symptoms eased. “The doctor said the main thing was to wear a mask and avoid exercising outdoors.” She always wears a mask now.
A term coined by foreigners
Harry can’t recall the first time he heard of the Beijing Cough, but the phrase seems to have been coined by a foreigner. Many foreigners have joked about it on their blogs: “I've become That Annoying Person clutching her stomach coughing in your subway car, coughing at the restaurant table next to you, coughing and interrupting your conversation,” blogged one New Yorker in 2009.
In January 2008, British doctor Richard Smith visited Beijing, and afterwards wrote a case presentation detailing the hour-by-hour progress of his Beijing Cough. “A spasm [of coughing] might last 90 seconds… A spasm might come every 10 minutes. I didn't feel ill, and I didn't cough up anything. My throat did feel irritated, but I didn't have what I would call a sore throat.”
In fact, the term can be traced all the way back to 1990.
The earliest reference Southern Weekend could find was from the September 1990 edition of The Rotarian, in a report citing an article on air pollution: “Once primarily an urban phenomenon in industrial countries, air pollution has spread worldwide… In greater Athens…the number of deaths rises six-fold on heavily polluted days. In Hungary, the government ascribes one in 17 deaths to air pollution. In Beijing, air pollution-related respiratory distress is so common that it has been dubbed the ‘Beijing Cough’.”
The author of the report was Hilary F French, who in January 1990 was working at the environmental research outfit Worldwatch Institute. On December 26 last year she told Southern Weekend: “That was the first time I’d used the phrase, but I’d seen it in the news – I hadn’t been to China myself then.”
Use of the term started expanding in academic circles. In 2002, political economy book Rich Democracies said that “the air in its urban areas often has an acrid, sulfurous odor, and the ‘Beijing Cough’ is heard everywhere.”
In more popular prose, the phrase quickly caught on too – just like Peking Duck, the Beijing Cough was often covered in guide books. In 2003’s Culture Shock: Beijing at Your Door, tourists were warned that “many people complain of ‘Beijing Cough’… it’s a sporadic, dry cough or tickle in the throat that lasts from December through April. As far as we know there is no way to prevent or cure ‘Beijing Cough’.”
The term appeared more frequently online, peaking during the 2008 Beijing Olympics.
Beijingers catch the Beijing Cough
Gradually, Chinese people too came to hear the term. In 2006, Liao Kang complained on his blog that since returning to China from his teaching job in California he had suffered from a cough. His friends said he had been pampered by the pure American air – and was now suffering from the Beijing Cough.
On December 5, 2011, Beijing’s visibility was at its lowest for the year. The air quality index at the Chegongzhuang monitoring station was 236. (Photo: Wang Yikun)
But for most Chinese people it has stayed an unfamiliar phrase. A search for the Chinese translation of the phrase brings up few results. Many environmental monitoring staff, respiratory doctors, environmental health experts, and even Du Shaozhong himself, deny knowledge of it. Only Fan Xiaochuan, a professor of public health at Peking University, has used the term in public, at a press conference – and he heard it from a foreign friend.
“It isn’t a medical term, or a scientific one, it has no definition or specific symptoms, it was made up by foreigners. Winter in Beijing is dry and that can cause coughs – there are reasons of both climate and pollution,” says Liu Youning, head of the PLA General Hospital’s Respiratory Disease Institute. “It’s a folk term – we never diagnose a Beijing cough or a Shanghai cough.”
Despite the dismissals, Chinese people have still taken to the term.
Huang Wei, a deputy researcher at Peking University’s Environment and Health Research Centre, only heard it recently. “Three or four American friends have used it with me since the summer of 2012. They were surprised I hadn’t heard it, as I research the link between air pollution and health.” She was sceptical at first, but then it made sense: she had lived in the US for 12 years, and started to get winter coughs after returning to Beijing.
People who arrive in Beijing from other Chinese cities often have the same complaint too. Yoga coach Liu Jia spent time in Guangxi province, south China, in 2011, setting up a new studio. It was only when she returned to Beijing that she realised she hadn’t been aware of the problem before. Yoga involves deep breathing and so requires clean air, and Liu spent a month finding the right air purifier and monitor.
Harry thinks Beijing residents are constantly coughing: taxi drivers cough; when they walk through their apartment complex they can hear the sound of coughing from the windows. He can’t understand why they don’t talk about it more. “Are Beijingers used to everyone coughing, or have they just not noticed?”
Sara recalls a magazine survey which asked 225 Chinese and foreigners what “the worst thing about Beijing” was. Of the foreigners, 75% said air quality – but only 28% of Chinese people gave the same answer, with 33% choosing transportation and others opting for high rents and inflation.
Urgent treatment needed
Most Beijingers only realised the dangers of particulate pollution in 2011, during the controversy over reporting of PM2.5 levels. Li Tianjian sells Yuanda brand air purifiers – and he saw sales rocket that year. Meanwhile, Wang Jun and Zhang Bin have 800,000 users for their mobile phone software providing nationwide air-quality index information.
That controversy also spurred the Beijing government to make dealing with PM2.5 pollution a priority for 2012. On June 1 the city issued the first standard limiting particulate emissions from diesel fuel. Plans for dealing with air pollution during the 12th Five Year Plan period issued in December aim to see PM2.5 levels drop by 15% in Beijing – as opposed to 5% in other key regions.
But there is little chance of a Beijing resident heading to the hospital over a sore throat. At most, they might buy a little medicine. “The costs aren’t enough for my employer to reimburse, so I’d have to pay myself, and you have to queue, take time off, and I’d lose my attendance bonus,” says one interviewee.
And what long-term impact does air pollution actually have on health? “The best way to research this is a cohort study, tracking health over the long-term. But in China this is only happening in Wuhan, where they’ve only just started,” says Huang Wei. “It takes over a decade to do and needs hundreds of millions in funding – it’s just not happening in China currently.” She thinks the Beijing Cough phenomenon is another reason why air pollution must be dealt with: “Normal people are affected, not just susceptible populations.”
In April this year, Harry will return to the fresh air of Finland. “Our parents’ generation experienced air pollution, but we’ve enjoyed clear air.” Forty years ago, Helsinki’s heating was fuelled by coal, and the buildings were coated in soot. Harry says his time in Beijing has taught him something: “When I go back, the first thing I’ll do is tell my friends to treasure the clean air. They never think about it or discuss it, they just think it’s natural. They don’t realise how many people here in Beijing dream of air like that.”
Originally published inSouthern Weekend, January 3, 2013.