Commentary: While China Stonewalled (SARS)

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Commentary: While China Stonewalled

In Hong Kong, officials are scrubbing down taxicabs and elevators, handing out face masks by the fistful, and quarantining an entire apartment block. Singapore is canceling conventions and keeping 1,500 potential disease-carriers under virtual house arrest. In San Jose, Calif., authorities held 139 people on board a jet from Tokyo for two hours after five people showed symptoms of severe acute respiratory syndrome (SARS), even though they turned out not to have the disease.

But in China -- ground zero for the bug that is spooking so many -- you would have hardly known anything was seriously amiss. It wasn't until February, three months after the first SARS cases were identified, that China admitted there was an outbreak. Then for a month after that, Chinese authorities assured the world all was under control. And for more than a week, seven World Health Organization experts cooled their heels in Beijing when the government refused to let them visit Guangdong province, where SARS first surfaced.

Finally, after a global outcry, China drew back the curtain a bit on Apr. 2, giving the WHO team the green light to travel. Beijing also sharply boosted its figures on SARS, saying that 1,190 people had contracted the disease and 46 had died. Still, China's hush-hush attitude early in the crisis may have contributed to the global outbreak. "We may have lost some valuable time in putting in strategies of containment," says Dr. Margaret A. Hamburg, co-chair of a U.S. Institute of Medicine committee studying emerging microbial threats.

In the future, such stonewalling could be an even bigger problem for the international community. The warm, humid climate of southern China, with millions of people living in close proximity to pigs, chickens, and goats, makes it the world's leading incubator for new viruses. The flu outbreaks of 1919, 1958, and 1969 -- which killed millions worldwide -- all emerged from the region. Also, the explosion of air travel in an increasingly borderless world means that disease can traverse the globe with blinding speed.

China's lack of transparency isn't the only weakness exposed by the SARS crisis. Although scientists around the world quickly collaborated to identify the virus, the public policy response was less effective. Hong Kong authorities waited more than a month to quarantine people exposed to the bug -- losing an opportunity to keep SARS from travelling the globe. Some say the WHO was too slow in warning people not to travel to infected countries. And as the disease has spread, it has become clear that the pharmaceutical industry must dramatically step up research to find more effective antiviral drugs.

Health officials the world over should conduct a thorough post-mortem of the spread of SARS, for it may be only a dress rehearsal for far more devastating epidemics to come. The virus' swift spread underscores concerns that the world remains unprepared for an outbreak of some more contagious virus that doesn't respond to available treatments. For three centuries, new influenza epidemics have occurred once every four decades on average. "Another will surely come," says Australian flu research pioneer W. Graeme Laver. "If it's a real killer, the world is going to have a major problem."

China, though, will have to do the deepest soul-searching. To be sure, Beijing may have had its reasons for downplaying the extent of the problem: Word of a harrowing new epidemic could scare away foreign garment, toy, and electronics buyers whose orders are vital to manufacturing, and Communist Party leaders likely did not want anything to distract them from the National People's Congress in March.

But now that China has become such an essential part of the global economy, Beijing has a responsibility to be open about its health problems -- and let the international community participate in finding solutions. The Chinese have managed an amazing transition from a closed society to a dynamic, near-market economy. A new candor about public health would leave them stronger, not weaker.

By Pete Engardio and Bruce Einhorn

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