Sunday, February 11, 2007

In the Season of SARS


Back in early 2003, when I was living in Hong Kong, I got an e-mail from a friend and former colleague regretting that he had to cancel a planned trip to Hong Kong. “It’s that pneumonia thing,” he said.

Pneumonia thing? What pneumonia thing? I wondered. What is he talking about?

I was vaguely aware that some hospital in Kowloon had reported a few cases of what the newspapers were calling “atypical pneumonia”, but why this should be the cause to cancel a trip or why it should even have impinged on the consciousness of somebody living half-way around the world was a puzzle.

Not long afterward I flew to Japan and was away from Hong Kong for about three weeks. When I returned to the SAR (Special Administrative Region), I found a city that had been utterly transformed by SARS.

For by that time the “pneumonia thing” had acquired a name: Severe Acute Respiratory Syndrome.

A fellow traveler in the season of SARS was Karl Taro Greenfeld, then the editor of TIME Asia in Hong Kong. He has written a compelling narrative about the SARS outbreak, China Syndrome: The 21st Century’s First Great Epidemic (Penguin Books, 442 pages).

Greenfeld begins his story considerably earlier than the time I first became aware of it by exploring the fetid menagerie of caged animals, snakes, badgers, civet cats and other exotic ingredients of the “Wild Flavor” restaurants and slums of southern China, that great incubator of diseases.

People had begun showing up in Guangzhou hospitals with similar symptoms: high fever, coughing, clouded x-rays. They did not seem to respond to antibiotics, the usual way to treat respiratory ailments.

“As anecdotal reports of unexplained respiratory ailments filtered back across the border [with Hong Kong] , influenza experts perked up and local virologists began to suspect that an influenza outbreak might be afoot,” he writes.

SARS found its way into Hong Kong by way of a Chinese doctor, who, though feeling poorly, nevertheless traveled to the territory and checked into the Metropole Hotel in Kowloon, spewing his infection to the other guests.

In a similar fashion the disease spread to Vietnam, Canada and other parts of China. But health officials really understood they were under siege when SARS spread through Amoy Gardens. It is hard to overestimate the fear that this caused. Amoy Garden is a typical lower-middle class high rise apartment complex in Kowloon.

There are a thousand like it throughout Hong Kong. If SARS could race through this building infecting hundreds and killing dozens in a matter of days, no place in Hong Kong was safe. Why this dreaded scenario was not repeated in other complexes is one of the mysteries of SARS.

But, of course, it was in China that SARS had its greatest impact. Chinese officials deliberately stonewalled, obfuscated and lied. Reports of the disease that might have helped slow the spread to other cities were quashed, Reporters were told what not to report.

China’s authorities were loath to admit that an outbreak of unknown severity was racing through the country at a delicate time when the country was undergoing a leadership change. Greenfeld quotes one doctor as saying, “What mattered more? The Party Congress or a few doctors?”

Then surprisingly, the Chinese leadership did a complete about-turn. Rather than downplay the disease, they publicly acknowledged it and took measures to halt its spread.

President Hu Jintao decided that the issue gave him “the populist sheen that could lubricate his ascension to real power,” Greenfeld writes. He visited hospitals, and labs. He flew to “ground zero”, Guangzhou, to conduct a personal inspection.

“Hu had made a brilliant political calculation; he would personally take over the anti-SARS campaign making it a centerpiece of his inchoate administration and using it as a wedge to consolidate power.” .

It was as if a dam had burst. The number of acknowledged cases in Beijing tripled, quadrupled overnight. The news media covered the story 24/7. Special awards were made to health care workers – “Heros of SARS.” A Beijinger could have his temperature taken a dozen times a day.

Like all good medical narratives, China Syndrome is something of a detective story. Greenfeld gives plenty of space to the virologists who decoded the virus that caused SARS, not to mention his own TIME correspondents who “bombed” Beijing hospitals – that is, walked through the front door and asked nurses point blank whether they had any SARS cases.

Yet for all of its virtues China Syndrome already has a kind of dated quality to it. After all, SARS burned itself out in a few months – nobody really knows why. Was it all that temperature-taking in Beijing, the culling of tens of thousands of civet cats in Shenzhen, a change in climate, luck?

On the scale of the world’s deadliest plagues, the 21st century’s “first great epidemic” didn’t quite live up to its billing. Fewer than 10,000 people were infected; fewer than 1,000 died of the disease. Not exactly the Black Death.

SARS never impinged strongly on the English-speaking world. Only a handful of cases were reported in North America. Most of the world’s attention was diverted by the invasion of Iraq, which took place almost simultaneously.

Hong Kong may have been the world’s only media market where another story actually competed for attention with Iraq. But then we had our own nightly body count on the local news.

Moreover, the hope and expectation that SARS and Hu Jintao’s response would usher in a new era of openness in China proved to be fleeting, a promise unfulfilled, as China’s authorities have since moved to assert their authority over the media.

Even today we learn that a Chinese doctor, Gao Yaojie, acclaimed for helping fight the spread of AIDS, and coming into conflict with the authorities for doing it, is under house arrest and denied permission to travel to the US to accept an award for her work.

Yet those of us who lived through the season of SARS will never forget it. If nothing else it had demonstrated how fast a strange new disease could take hold and spread far and wide in this globalized age of air travel. The century’s first great epidemic was a bullet dodged. But it will not be the last.


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