China: SARS and the Politics of Silence

The Chinese Plague

SARS Quarantine - China
A patient, quarantined at the Xiaotangshan SARS hospital on the outskirts of Beijing, peers outside, May 7, 2003 (Photo: Frederic J. Brown/AFP).

In mid-2001, a Hong Kong magazine ran a front-page story about how the world’s next flu pandemic would hatch in southern China and infect the rest of the world via Hong Kong. The story espoused the theory that the Spanish flu of 1918, which eventually claimed 20 million lives, had leapt from pigs to humans in southern China and traveled with Chinese laborers to the trenches of  World War I. It was no more than a theory, but on two crucial counts the magazine was deadly accurate: The two other killer pandemics of the last century, which killed about 2 million people, sprang out of China, and so will the next.

In February 2003, 18 months after the article appeared, shops in the southern Chinese city of Guangzhou experienced a run on vinegar. The traditional New Year celebrations had just begun, and most of China’s 1.36 billion people were either en route to their hometowns or already with their families enjoying the longest and most anticipated holiday season of the year. Vinegar does not usually play a part in Chinese New Year. But it is a traditional fumigant used by Chinese in times of plague. If the world had been watching, alarm bells might have rung.

Instead, Spring Festival, as the Chinese call the lunar New Year, was celebrated as usual, with a massive countrywide exodus—more than 130 million trips by train, nearly 9 million by air, a staggering 1.9 billion on the roads. For a deadly pathogen looking to hitch a ride, conditions were perfect. What’s more, the Chinese authorities knew it.

On Nov. 16, a businessman had checked into a hospital in Foshan, a city close to the Hong Kong border, with a mysterious strain of pneumonia. Two weeks later, in the drab, industrial city of Heyuan 200 kilometers away, staff at the Municipal Hospital began to get sick and die. On Jan. 3, the Heyuan News ran a brief story denying the existence of an “epidemic virus,” urging local residents not to panic. It was the first media reference, and the last for more than a month, to a disease that had appeared from nowhere in southern China. Two months later, it would reach Hong Kong, and the world would come to know it as severe acute respiratory syndrome, or SARS.

As China unbuttoned for the New Year holidays, Liu Jianlun, a 64-year-old doctor, was working round-the-clock at Guangzhou’s Sun Yat-sen Memorial Hospital. His problems had begun when a seafood salesman was wheeled into the hospital on Feb. 1 with a high fever. He was barely able to breathe. Within two weeks neither could 45 other people in the hospital.

As they started dying, hospital staff began calling the salesman “Du Wang,” the “Poison King.” His coughs were like biological bombs, and the infection they spread was unlike any flu virus Liu had seen. He worried that he was witnessing the birth of a new epidemic, and that the authorities were turning a blind eye to it.

Concerned that news of the disease might cause panic and affect foreign investment and the tourism industry, government leaders declared a news blackout. As with previous outbreaks of new strains of the flu, Chinese officials hoped this one would burn out and retreat to wherever it had come from before the world noticed.

If Liu Jianlun had been working at an Australian hospital and thought the government was ignoring the birth of a new life-threatening disease, he would probably have gone to the press. In China, such a move would have spelled the end of his career. It would also have been a waste of time.

The Chinese media were already aware of the emerging epidemic, but journalists could do nothing but watch until Feb. 11, when Guangdong provincial health officials held a belated news conference. A disease called “atypical pneumonia” had sickened 305 people and killed five but was now under control, they said. Among the brief flurry of articles that appeared in the provincial press was an interview with a local academic who accused the government of incompetence. The result: a second media blackout that lasted until March.

Shortly after the Feb. 11 press conference, Liu was invited to a family wedding in Hong Kong. He was feeling unwell, but he put it down to overwork. He’d taken precautions against catching atypical pneumonia and didn’t want to miss the wedding.

On Feb. 21, Liu checked into Room 911 of the Metropole, a sprawling three-star hotel complete with Chinese banquet restaurants and karaoke pubs in the heart of Kowloon, Hong Kong. But the next morning he was too sick to attend the wedding. He left the hotel and walked five minutes down Waterloo Road to the Kwong Wah Hospital, where he told medical staff, “Lock me up. Don’t touch me. I have contracted a very virulent disease.”

It was too late, and Liu probably knew it. His disease had already spread mysteriously in the hospital he worked at. It had begun to spread at the Metropole Hotel, too. Somehow—perhaps in the lift, perhaps in the corridor, nobody knows—he infected seven other people staying on the same floor. They traveled to Canada, Singapore, and Vietnam. Two of them were dead within three weeks.

The onset of SARS might be marked by a violent headache, or it might be marked by chills, diarrhea and agonizing pain in the joints. Within days liquid fills the lungs, making it impossible to breathe. Some patients’ livers and kidneys start to malfunction, and their blood stops clotting properly. Victims often lose consciousness for days and have to be kept alive on a respirator. The death rate may be as high as 10 percent. Survivors are gaunt, enfeebled, some partially paralyzed.

The Kwong Wah medical staff knew none of this, however, and did not move Liu into isolation until his condition became life threatening. Within a month of his arrival, 70 medical staff and 17 medical students at the hospital were struck down. Liu died on March 4.

If ever an example of the difference between Hong Kong and China were needed, their handling of the threat of disease is it. When 18 people contracted the bird flu in Hong Kong in 1997 and six of them died, the government went straight to the source of the problem and slaughtered every chicken in the territory, all 1.4 million of them. When SARS broke out in Guangdong province, the government chose to keep it quiet. It was a mistake that would not only endanger the world’s health and economy but also undermine the credibility of the Chinese government itself.

Even in a country as closely kept under wraps as China, the truth has a way of coming out. On the evening of April 3, Jiang Yanyong, a 72-year-old semiretired surgeon, was watching TV at his home in Beijing. That night the news featured a spot in which China’s health minister, Zhang Wenkang, announced that China’s capital had just 12 cases of SARS. Jiang couldn’t believe his ears.

Jiang was a former head of surgery at Beijing’s Military Hospital 301 and still did regular work there. How, he wondered, could the minister tell the world Beijing had only 12 cases of SARS when he knew for a fact there were 50 in his hospital alone? “I simply couldn’t believe what I was seeing,” he wrote in an e-mail the next day to the state-run television station CCTV-4. “All the doctors and nurses who saw yesterday’s news were furious.”

The state TV channel’s reaction was predictable: silence. But when the
e-mail made it to the hands of the foreign media, allegations were soon circling the world. WHO, which had bought the government’s line that the epidemic was under control, demanded access to Beijing’s military hospitals. Within a fortnight, the government upped its Beijing SARS statistics tenfold; three days later, the numbers were doubled again.

The Chinese government’s hold on power is guaranteed by its ability to deliver economic results. As panic spreads and business grinds to a standstill, that will be hard to do. In the meantime, its incompetence in dealing with the outbreak in Guangdong has allowed SARS to jet around the world.

Already epidemiologists are warning that if SARS is “the big one”—a fast-mutating virus that proves resistant to antibiotics—it will soon outstrip AIDS as a world health problem. Even if it is not, Guangdong’s viral incubator has hatched a terrifying warning of the threat that China poses to the health of the world.

Last Monday, speaking at a press conference in Bangkok, David Heymann, executive director of communicable diseases at  WHO, admitted that “China will make or break this disease.” The unanswered question—as outbreaks outside China are contained by efficient health-care systems and the sharing of information—is not just whether this disease will make or break China, but if the big one will make or break the world as we know it.