Why Didnt the Government Say Anything

If this situation had occurred in the United States or any other democracy, it would hardly be surprising for people's anger to be directed at the government. However, China is a nation where power is monopolized by the Communist Party. Though it is very modern in its economic policies, China's political system has a long history of being resistant to change. The system is closed and secretive, and has a dismal record regarding human rights. Protesters have been shot for criticizing the...

SARS and Developing Nations

Another ongoing worry among international health officials is that if SARS does recur, its effect in developing countries will be Should the SARS epidemic recur, it could be devastating to AIDS patients like this African man, and to others with severely weakened immune systems. Should the SARS epidemic recur, it could be devastating to AIDS patients like this African man, and to others with severely weakened immune systems. frightening. Scientists know that patients whose immune systems were...

Psychiatric Study

For people who have survived SARS, the psychological toll has been documented. In a study of 150 SARS patients in Hong Kong, it has been found that 45 suffered from psychiatric problems when they were discharged from the hospital. The problems have ranged from anxiety and mild depression to episodes of posttrau-matic stress and severe panic attacks. Some doctors suggest that the psychiatric problems may stem from a reaction to the steroids and other drugs given in the hospital, but no one is...

Frustrating Mutations

Holmes and other experts believe it is likely that an animal virus mutated, and its protein spikes changed in such a way that they could latch onto human cells. Perhaps the barbs on the spikes altered in mutation, enabling them to be more of a threat to a human host. Researchers working on mapping the virus's genetic makeup support that theory, for in twelve different laboratories, twelve genetic profiles have been noted. Researchers believe that the variety of genetic profiles is due to the...

Difficult Job for a Crisis Team

The scramble to learn about the mystery disease began in mid-March, when WHO doctors were alerted that a Toronto woman had become infected. Apparently, SARS had hopped continents. WHO issued its first global warning, alerting travelers that what appeared to be a very dangerous contagious disease had become a worldwide health threat. On March 17, 2003, WHO officials called the top epidemiologists throughout the world to form a crisis team that would tackle the problem of identifying the cause of...

Global Threat

Again, because of the lack of real information about the disease, hospitals outside of Guangdong Province were ill-equipped to deal with it. In Toronto, for example, a woman who had talked to Liu in Hong Kong became ill and died on March 5, 2003, after infecting her son and several doctors and nurses at the Toronto hospital where she was taken. When her son Tse visited the emergency room of the same hospital on March 7, staff doctors and nurses knew nothing about the disease and had no idea how...

An Impact on Baseball

Major league baseball in Toronto suffered, too. WHO's warning came just as the Toronto Blue Jays' season was getting underway, and league officials were hesitant to allow the season to go on as scheduled. Many teams who were supposed to travel to Toronto to play baseball were nervous when baseball league officials warned visiting players not to mingle with fans or sign autographs. Although baseball officials agreed that most likely the chance of a player catching SARS in Toronto was small, they...

An Official Alert

With new information that the disease had spread to Canada and other countries, WHO officials issued a global alert on March 12, 2003. With the limited amount of information it possessed, the agency warned of the new disease and urged travelers and airline crews around the world to watch for symptoms. It also recommended that doctors and nurses isolate anyone presenting symptoms that seemed suspicious and take precautions by using protective suits, gloves, and masks when treating patients. The...

Bambi and Teddy Bear Masks

More than anything else, however, it was the presence of face masks that served as a constant reminder of the threat of SARS. People rushed to medical supply stores to buy them, hoping to keep airborne germs away from their noses and mouths. In Hong Kong, stores were selling more than one thousand masks each day some people were buying hundreds at a time. When only a few were left on store shelves, shouting matches often broke out among customers. On street corners, vendors tried to capitalize...

Canada Disagrees with WHO

While Asia was hit hardest by the political and economic fallout from SARS, Canada suffered, too. Because of the outbreak in Toronto, which had infected more than 240 people, WHO added Canada to its list of global danger spots on April 23, 2003. That prompted a storm of outrage not toward Canada's leaders but the World Health Organization itself. The morning after the warning was issued, the United Nations received protests from Canada's prime minister as well as its health minister, saying...

Clean Tires and Disinfectant

Once the Chinese government realized that it was necessary to openly confront the SARS epidemic, life changed quickly for the Chinese people. Interestingly, China's authoritarian system, which has been widely criticized as repressive, proved to be very useful in fighting the epidemic. In a country where the government rules by fist, notes observer Kathy Chen, its orders to fight SARS have been carried out in spades.39 For example, the state-run media were required to run public service programs...

Cold and Empty

Because people were unsure of how SARS was spread, families had a great deal of difficulty finding funeral parlors that would accept a SARS victim's body and even those refused to hold traditional funeral services. Throughout Asia, funerals are almost always held with the body displayed, but the threat of SARS changed that. Funeral directors, worried about spreading the disease from the dead body to funeral guests, insisted on using a framed photograph of the deceased, instead. Another funeral...

Coming to the City

But it was difficult for the people in Guangdong to remain silent about SARS when it was obvious that the disease was not under control at all. In fact, there was a growing problem as some rural patients frightened because they were not getting better in their local hospitals traveled to Guangzhou, the large capital city of the province. Because of the lack of information on the disease, the large metropolitan hospitals of Guangzhou were unaware of the seriousness and highly contagious nature...

Diseases and Disorders

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Economic Disaster

Politics is not the only thing that has been affected by SARS. In SARS-stricken countries, the epidemic has had a great economic impact especially in China. Having recently won the rights to host the 2008 Olympics in Beijing, as well as the World Expo 2010 in Shanghai, Chinese economists were very pleased with the prospects for higher employment rates and rising stock prices. However, on April 2, 2003, when WHO declared Guangdong Province and Hong Kong danger zones, that optimism evaporated...

Fear Among Health Workers

While the constant worry about SARS was hard on almost everyone, it was especially troubling for health care workers. They were the ones most at risk, and in the early weeks of the disease, it was doctors and nurses in mainland China, Hong Kong, Vietnam, and Toronto who were infected more than any other group. Because of the shortage of healthy emergency workers in Toronto, Canadian physicians contacted doctors they knew in the United States and asked for help. As a result, about three hundred...

For Further Reading

Margrete Lamond, Plague and Pestilence Deadly Diseases That Changed the World. Chicago Allen & Unwin, 1997. Excellent examples of the way people have reacted to sudden, contagious diseases. Good index. P.C. Leung and E.E. Ooi, eds., SARS War Combating the Disease. Singapore World Scientific, 2003. Although much of the material is incomplete, the book does contain some helpful information on the history of emerging diseases in China. Elinor Levy, The New Killer Diseases How the Alarming...

For the Sake of the People

Much of the anger has been directed at China's new president, Hu Jintao. Hu, whose ideas are more liberal than his predecessors, had impressed many people in his first presidential speech, for he seemed more committed to honesty and openness than other leaders had been. He vowed to remember that the well-being of China's people was his most important responsibility Power must be used for the sake of the people, he urged. Material benefits must be sought in the interests of the people.65...

From Person to Person

As some researchers concentrated on the beginnings of the virus and its probable jump from animals to people, others tried to understand how it spread from person to person. At first doctors believed that for someone with SARS to infect another person required fairly close proximity, with the infected person sneezing or coughing and those droplets coming into contact with an un-infected person. However, as doctors began seeing more patients with SARS, they noticed that in all cases, the disease...

Guessing Wrong

Tissue and blood specimens were delayed, however. For one thing, autopsies are quite rare in most Asian hospitals, and doctors at first were reluctant to authorize the taking of lung tissue samples. When some hospitals were finally persuaded to begin releasing specimens, their transport to the research facilities was delayed because many international shippers refused to carry Because they have weak immune systems, ducks are breeding grounds for new viruses. Many disease-causing viruses...

Impossible to Enforce

If it is true that a wider variety of animals carries the virus, it would create a number of new problems. Since it is almost certain that the SARS virus is a crossover from an animal virus, it would mean that there were many carriers of the coronavirus that could possibly infect humans. In that case it is not merely a matter of warning consumers about one or two types of animals, but rather most of the species sold at the markets in southern Guangdong Province. It is believed that the animal...

Is the World Ready

Hong Kong is not the only place where strategies have been mapped out in the event that SARS returns. In the United States, where only a handful of confirmed cases were verified, health officials have taken inventory in various cities, making certain that there are enough respirators and other tools needed to care for victims. Many experts say that even before the SARS outbreak worldwide, the United States was already fairly organized for a large outbreak of some infectious disease. The...

It Feels like Being in Prison

Quarantine was often far different for people in Asia. Shortly after it was discovered that more than 250 residents of the large Hong Kong housing complex, the Amoy Gardens, had become infected with SARS, health officials descended on Block E of the complex and bused the 240 remaining residents to quarantine facilities. Many of the evacuees were angry, however, for they say that their temporary lodging seemed far more conducive to the spread of disease than their housing complex. The facilities...

Its the Dumbest Thing in the World

Toronto's health officials say that one lesson they learned from their experience with SARS was the woeful state of their patient-tracking system. As Toronto's outbreak worsened in April and May, the public health system was overwhelmed by the task of keeping track of thousands of people who had been exposed to the virus and were at risk of developing SARS, as well as the many people in quarantine. Because of underfunding, the public health office had to rely on a paper-based tracking system...

Learning Lessons

One of the most important aspects of the SARS crisis is that it has shown the weaknesses in the health care systems around the world. If the disease returns, as many researchers believe it will, it is important that governments and health agencies learn from the mistakes that were made during the 2003 outbreak of the disease. For one thing, it is clear that honest, prompt, accurate reporting of the disease is vital to containing it. China's coverup of its first cases directly led to the...

Life in Quarantine

Some of those in quarantine were relatives and friends of people who had developed SARS. Many spent the required two-week period (the longest time known between being exposed to the disease and showing symptoms of it) at their homes. Besides being told to take their temperatures often and to stay away from their families, they had to resist the temptation of dashing out to do an errand or see a friend. Thousands of others were put on what was called working quarantine. Most of these were health...

Many Effects

But the effects of SARS have been felt by more than the patients and their families. In hundreds of smaller ways, people all over the world had their routines altered because of the disease. Students who had planned on studying in China were told by the Centers for Disease Control to cancel their plans. One twenty-one-year-old law student from Virginia had just begun an internship in Hong Kong when the outbreak hit, and he was called home. In SARS-affected regions, businesses that rely on...

Misinformation

But it is not just medical workers who are angry at the government's secrecy. It is almost certain that thousands of Chinese people became ill, some fatally, because they were not told about the seriousness of the disease. One man says that the government had assured everyone that the risk of SARS was long over, even when health officials knew that the disease was spreading out of control. As a result of the misinformation, the man says, his wife was ill and highly contagious for days with SARS...

New Tools to Fight SARS

If or when SARS does make a comeback, scientists are banking on new tools with which to fight it. Although experts predict a vaccine will not be available until at least 2006, there are other things that could be valuable in saving lives. One would be an accurate test for SARS. Tests at the current time are not accurate unless a patient has been infected for at least twelve days. In that time, that patient will have infected dozens of other people. However, in July 2003 one Swiss drugmaker...

No Cure in Sight

But for the majority of people, a case of SARS is a very serious threat and one for which scientists have yet to find an effective cure. Treatment or prevention of the disease is an ongoing challenge, but doctors admit that there is much to be learned about the virus before cures are found. Until then, researchers hope that an existing drug for a different virus might give some relief. In Hong Kong, for example, doctors have been giving some patients a combination of steroids and an antiviral...

Organizations to Contact

Centers for Disease Control and Prevention (CDC) The CDC's goal is to promote health and quality of life by preventing and controlling disease. The organization has developed vital partnerships with public and private medical groups that can provide information and assistance to people in the United States and throughout the world. One of the CDC's functions is to investigate outbreaks of new and dangerous diseases such as SARS. 9000 Rockville Pike, Bethesda, MD 20892 www.nih.gov This...

Police and Health Officials

WHO officials are convinced that health agencies throughout the world would be wise to see how Hong Kong was able to contain the spread of SARS, given its high vulnerability to contagious diseases. It was successful, say experts, because once Hong Kong's public health department realized the danger, it began a thorough tracking of all personal contacts of each SARS patient who had been seen in a hospital there. Not only did public health workers do the tracking, but police officers helped, too....

Reminders Everywhere

Though SARS patients and others quarantined were most affected, daily life even for healthy people changed drastically during the SARS crisis in China and other Asian countries. For children in Singapore and China, it meant that school was canceled until the threat of infection had passed. For parents of very young children, it meant babysitting services, daycares, and preschools were closed, too. That presented a problem for people who had no older children or other family members to watch...

Returning to Guangdong

To find answers to the virus's beginnings, some researchers went to Guangdong Province, where the first cases of SARS occurred. Scientists noted that the first victims of the disease were people who worked in the many live animal markets throughout the province. A visit to a market just an hour south of the province's capital showed reporter Elizabeth Rosenthal a place that seemed rife with germs In hundreds of cramped stalls that stink of blood and guts, wholesale food vendors tend to...

Ripe for an Epidemic

South Africa is one of many places on the planet where impoverished people could be decimated by SARS. Many researchers at WHO were nervous about the consequences of an outbreak in India, whose 1 billion people live in the most crowded of conditions. Since scientists believe that the outbreak in Hong Kong's Amoy Gardens housing complex was caused by feces of a person with SARS, the likelihood of a major outbreak in India where only one-fourth of the citizens have toilets is very strong. Many...

SARS and the Future

On july 6, 2003, the World Health Organization announced that SARS had been contained, as no new cases of the disease had been reported anywhere in the world since June 15. Although the announcement was a relief to many people, medical experts tended to be less optimistic. For instance, some felt that the disease could easily return. Because SARS is a coronavirus, it may be seasonal like other coronaviruses such as those that cause the common cold. Michael Osterholm, director of the Center of...

Suddenly Theyre Rock Stars

The scientific community realized that the dangerous unknown coronavirus was a problem. While there are many researchers who study viruses, there were not many who specialized in coro-naviruses. One doctor says that because coronaviruses had never been a serious threat to people and were difficult to grow or study in a laboratory, the topic had become a sleepy little corner of virology.30 Far more researchers were interested in studying viruses that cause Ebola, West Nile disease, or AIDS all...

Superspreaders

Another puzzling aspect of the SARS epidemic are those people known as superspreaders those who seem to be able to infect large numbers of people. From the beginning, scientists have been baffled at how one infected person can infect ninety people, while another can be ill without spreading the virus at all. Some researchers believe that people are superspreaders because of the way they cough perhaps forcing more of the contaminated phlegm or spray from their lungs than do most patients. Others...

The Black Box or the Sunshine

Hu's supporters were very pleased by his actions. They believed that his decision to be more open about SARS would benefit the nation. Perhaps, they said, this episode forced China to turn a corner, allowing much-needed reforms. This is Hu's chance to grab the support of the people and stand up on his own, said one former party official. China can keep living in a black box, or it can live in the sunshine. If he can't take advantage of the situation and move into the sun now, then when 66 There...

The Crossroads of the World

Another lesson of the SARS crisis was how important a part Hong Kong played in the epidemic, and how vulnerable to disease the region is. Hong Kong lies at the very edge of southern China, a region that is historically where many flu viruses and The crowded streets of Hong Kong are breeding grounds for disease. The city's large population, its crowded conditions, and the number of tourists who visit annually make contagious illnesses difficult to control. The crowded streets of Hong Kong are...

The Faces of SARS

It seemed, in the early months of 2003, that the disease came out of nowhere. No one could pinpoint the first case of severe acute respiratory syndrome (SARS) it probably occurred in November 2002 but by early 2003 it was roaring through hospitals in China and other parts of Asia, as well as in Toronto, Canada, striking down hundreds of doctors and nurses as they tried to care for their patients. It was a ghastly illness one Hong Kong resident says that watching someone with SARS gasp and fight...

Trickling Down

The loss of orders for factories, as well as the loss of revenue from tourism, had what economists call a trickle-down effect to other areas of the Chinese economy. In other words, it was not simply the factory owners or the hotel and restaurant owners who made less money. In fact, the brunt of the hardship fell not on the owners, but on the millions of people who work in those businesses. In China and other Asian countries affected by SARS, the huge decrease in factory orders resulted in...

The Government Doesnt Care

Of course, in busy cities like Shanghai and Beijing the ballooning rate of infection from SARS was hard to keep secret. As more and more people learned of friends and coworkers who had become infected, it became clear to the public that they had been lied to. Many were furious with their government. It's really bad, says a relative of a SARS victim, that the government doesn't care about ordinary people's lives.60 As the disease moved into the more remote parts of China, the response was no...

The Medical Equivalent of Shock and

There are other factors that often slow work for scientists. Laboratories are exceptionally expensive places to run, and scientists are often in competition with one another to find a new medicine or vaccine that can bring in funds for research. For that reason, research facilities are rarely willing to consolidate or share information, since they view one another as rivals. And because there is no greater achievement for a scientist than discovering a pathogen or its cure, the scientists...

The Whole Region Contracts

The SARS epidemic has not only affected Chinese workers but also many foreigners who live and work in China. For example, more than 25 percent of American employees in Beijing sent their families out of the country because of the disease. One Australian bank with branch offices in Asia gave its employees in Hong Kong the option of returning to Australia and were surprised when the majority said yes. A bank officer predicted that even when SARS is no longer a threat, many of those employees may...

Trouble for Hong Kong

Mainland China has been hard hit by the economic effects of the SARS epidemic, but Hong Kong has had even worse trouble. As fear of SARS intensified, tourists canceled trips to Hong Kong, leaving the city's airport (pictured) empty and causing severe economic distress. As fear of SARS intensified, tourists canceled trips to Hong Kong, leaving the city's airport (pictured) empty and causing severe economic distress. Hong Kong, far and away the most modern part of China, had been experiencing...

Trying Out a New Tool

The next step was to find out more about this particular coro-navirus. To do that, WHO researchers sent samples of the virus to a laboratory at the University of California in San Francisco. Doctors there have a new tool called a DNA microarray, with which they can pinpoint a virus by examining a fragment of its genetic makeup. The DNA microarray contains a slide spotted with fragments from over one thousand viruses known to science. If the WHO sample has any fragments that match up with the...

Unsettling Questions

The emergence of SARS and its spread throughout the world has raised unsettling questions about contagious disease and medicine's ability to prevent it. More than ever before, researchers are eager to understand how viruses arise. How can they mutate, and why do some viruses cause so much damage to the human body, while others have only faint effects While some strides have been made in understanding the nature of the SARS virus, a great deal is left unanswered. In a world that has recently...

We Didnt Believe It

Though Chinese officials had tried to keep SARS a secret, bits and pieces of information about the disease had spread via the Internet to the World Health Organization (WHO) and the Centers for Disease Control (CDC) both international public health organizations. When WHO's Outbreak Center, which investigates any new and potentially hazardous diseases in the world, made official inquiries to China, they were told that the oubreak was a new type of flu and that the Chinese health authorities...

Were Frustrated

International health officials, however, were not convinced. One WHO representative was adamant that the stonewalling had to stop. We have clearly told the government, he said, the international community doesn't trust your figures.16 Many doctors around the world demanded more information in case SARS appeared among their citizens. In the United States, Secretary of Health and Human Services Tommy Thompson also expressed his exasperation with the Chinese government for being overly concerned...

Works Consulted

Lawrence Altman, Behind the Mask, the Fear of SARS, New York Times, June 24, 2003. -, The SARS Enigma, New York Times, June 8, 2003. Hannah Beech, Doing Battle with the Bug, Time International, April 14, 2003. -, How Bad Is It Time International, May 5, 2003. -, Regional Affair, Time International, April 28, 2003. -, Unmasking a Crisis, Time International, April 21, 2003. Keith Bradsher, Economies Sickened by a Virus, and Fear, New York Times, April 21, 2003. -, Hong Kong Tourism Battered by...

Worst in China

China remained the hardest hit by the growing epidemic, and the government continued its policy of secrecy and noncooperation with international authorities. WHO asked for permission to visit China so that doctors could review data about the first outbreak in Guangdong. The response by the Chinese was, says one WHO official, dead silence.13 The fact that their government was continuing to be secretive caused panic among the Chinese public. Villages erected barriers on the roads leading in and...

We Didnt Take Any Preventive Measures

One young nurse who became ill says that she had been looking after a patient who came to the hospital with flu-like symptoms, as well as a severe cough. The whole forty minutes she was with him he was coughing and expelling huge amounts of phlegm. This was unusual, she says, for a cough of that nature was not normally a symptom of the strains of flu she had seen. But although his illness was a mystery, the staff did not wear masks when tending to him. We didn't take any preventive measures,...

The Psychological Toll

As months went by in SARS-affected countries, many learned that there were often psychological effects on residents. In Hong Kong, for example, many people complained of feeling mentally fatigued each day. There was no comfort of routine. There were no concerts to attend, no social get-togethers with neighbors. Many people found that the sources from which they had always drawn strength were missing. For some it was religion, and there were noticeable changes in churches in Asia and Canada. In...

Notes

Quoted in James Kelly, Making News on the SARS Front, Time, May 5, 2003, p. 8. 2. Quoted in Claudia Kalb, The Mystery of SARS, Newsweek, May 5, 2003, p. 29. 3. Quoted in Kalb, The Mystery of SARS, p. 28. 4. Lily, telephone interview by author, September 18, 2003. 5. Quoted in BBC News, Eyewitness Vietnam's SARS Survivor, April 17, 2003. www.news.bbc.co.uk. 6. Quoted in BBC News, Eyewitness. 7. Quoted in Peter Wonacott, Susan V. Lawrence, and David Murphy, China Faces Up to SARS Criticism, Wall...