Exclusive SARS Report: Six Degrees of SARS: Of Politics, Greed, and Plagues

Toogood Reports ^ | 11 April 2003 | Nicholas Stix

[mrustow]

It's time I went to my favorite shopping district, Manhattan's Chinatown, and picked up some "donta" (Chinese egg custard), fresh seafood, and roast duck for my family. But going there could potentially kill us all.

Since I don't live in China, Hanoi, Toronto or Singapore, I may sound paranoid. And yet, I'll take that chance. The majority of Chinatown's inhabitants hail from China's Guangdong Province, which is Ground Zero for "SARS" – Severe Acute Respiratory Syndrome, often erroneously described as "pneumonia" or "atypical pneumonia." Illegal Chinese immigrants constantly arrive in Chinatown, largely from Guangdong Province. People also constantly travel between Chinatown and China's Hong Kong, which is near Guangdong, and which has been so badly hit by SARS, that its schools have all been shut down, and 15 separate high-rise housing complexes – i.e., 15 entire neighborhoods – quarantined.

Thanks to Chinese negligence, we can now play Six Degrees of SARS, which has brought the world together. The outbreak spread 'round the world, from Hong Kong's Metropole Hotel. Chinese Prof. Liu Jianjun, who had just been treating SARS patients in Guangdong Province, checked in on February 21, and infected ten other hotel guests. Prof. Jianjun stayed on the ninth floor, as did all but two of the hotel guests he infected. Those guests in turn either traveled on to Hanoi, Singapore, Toronto, Ireland and the U.S., or were transported to local Hong Kong hospitals, where they spread the SARS microbe.

A New Typhoid Mary?

Many of the Metropole Hotel guests who spread the SARS virus have been called "super-infectors" or "superspreaders." This dramatic description has not been terribly helpful, since as scientists have pointed out, every pandemic is spread in part by super-infectors, and because most people infected by SARS did not necessarily come into contact with any super-infectors.

Esther Mok, the former flight attendant who became infected in the Metropole Hotel, and who with two other guests brought SARS to Singapore, has been unfairly compared to "Typhoid Mary" Mallon (1870?-1938).

Mary Mallon was a New York cook who, as Allen J. Share writes in the Encyclopedia of New York City, between circa 1904 and 1915 caused a series of outbreaks of typhoid fever, the last of them at Sloane Hospital for Women. Share writes that, "In all she was implicated in forty-seven cases of typhoid fever and three deaths," without herself becoming ill. In 1910, health authorities released Mallon after a three-year hospital confinement, after she promised to stop working as a cook, and to report regularly to them. But Mallon disappeared, and continued working as a cook, often under assumed names. And so, from 1915 on, she was forced to live out her days a prisoner in Riverside Hospital on The Bronx' North Brother Island.

Unlike Mary Mallon, Esther Mok nearly died from SARS.

When Esther Mok took ill, family and friends visited her, and became ill in turn. Her parents and pastor all succumbed to SARS. Singapore's Health Minister Lim Hng Kiang recently condemned Mok, saying, "Esther Mok infected the whole lot of us."

Unfortunately, much like "Typhoid Mary" Mallon, Esther Mok is now a prisoner in a hospital room, and the 26-year-old woman may be condemned to life as a leper in the small island republic of four million citizens.

Tons of Cure Won't Suffice

Investigators still don't know what SARS is, or its source, but they do know that it is a pandemic, spreading like wildfire around the globe. A virulent microbe, which spreads through droplets and possibly the even more dangerous airborne transmission, SARS chews up and spits out ordinary people and health-care providers alike. Early optimism that SARS responded to a treatment regimen of antivirals and/or corticosteroids has proven premature. American scientists are developing a vaccine, but it might take as many as five years to develop – if it even works.

In the case of SARS, the old adage holds true: An ounce of prevention is worth a pound of cure.

At press time Wednesday, the WHO listed 2722 SARS cases worldwide, including 106 deaths in 17 countries. In addition to mainland China (1280, most of which are in Guangdong) and China's semi-autonomous city, Hong Kong (970), the hardest-hit places are Singapore (118), the U.S. (149 cases in 30 states), Vietnam (62, almost all in Hanoi) and Canada (94, mostly in Toronto).

Since the WHO numbers are based on fatally flawed information, however, they are of limited value.

Considering how many times the Chinese have been caught lying, I wouldn't be surprised if China had ten or even one hundred times as many SARS cases as its officials claim. For instance, late last week, came word that Chinese health care workers had reported that the SARS count for Beijing was 50, not five, as had been reported, and media reports maintained that SARS was spreading beyond Guangdong and Beijing, though the Chinese government and the WHO had not, to my knowledge, cited either development. We'll be returning to the matter of the Chinese.

Note too that aside from problems with the veracity of Chinese officials, the WHO numbers are extremely conservative. As of Tuesday, Canada listed 138 "suspected" cases, in addition to the 94 "probable" cases that the WHO lists.

Initially, German and Chinese researchers believed a paramyxovirus, which also causes the mumps and the measles, to have caused SARS. Based largely on work announced by UCSF microbiologist Joseph DeRisi on March 23, however, the CDC and WHO are now over "90 percent" sure, respectively, that SARS is a form of the coronavirus, a family of viruses which in one form often causes the common cold. But this is a coronavirus unlike any previously seen, and may work in tandem with another type of virus. Conversely, the Chinese counterpart to our CDC (which has the same name), is "80 percent" sure that SARS was caused by three of the four forms of chlamydia virus, including one which also causes the sexually transmitted disease of the same name.

(In spite of all the lies the Chinese have told, there is no apparent reason for them to lie, in pinpointing chlamydia viruses rather than a coronavirus as the cause of SARS. Hence, the coronation of Joseph deRisi by CDC chief Julie Gerberding notwithstanding, I prefer to wait and see, before submitting to any of the SARS theories presently in circulation.)

Some scientists believe that the microbes were initially passed from animals, in the form Avian Infectious Bronchitis Virus (IBV), to humans. A French virologist and M.D. quipped that if SARS derived from IBV, it is a "revenge of the chickens." However, just as theories of SARS' character vary, depending on location, so too do theories of its transmission. Many theories usually mean little knowledge.

In Hong Kong, for instance, local authorities now claim that the virus spread within the large, Amoy Gardens housing complex, via backed up toilets (the virus is present in patients' excrement) and contaminated cockroaches. Amoy Gardens residents then visited residents in other housing complexes. At present, 15 housing complexes in Hong Kong are under quarantine.

Conversely, some scientists have suggested that the virus may have been genetically altered.

A skeptical correspondent who has been following the SARS outbreak since the beginning, wrote on Wednesday from Hong Kong,

"It is very worrying, that the no report has been forthcoming. It seems that nobody in Govt. has learnt, silence begets panic.

"Reporting openly 'on going investigations' is much better than saying nothing, the absence of official word has allowed the media to speculate, naming every possible source as the Amoy [gardens] Block E problem.

"Over the last 2 weeks of govt. quiet examination, the media have accused animals, pets, roaches, the drainage, the lift, letter boxes, etc.

"The Govt. silence, following wild media speculation has meant that pets have been dumped."

Note that not everyone who comes into contact with SARS becomes ill, and that of those who do become ill, 4 percent die of the illness, depending on location. (Admittedly, the foregoing is based on shaky numbers.) SARS has largely killed the elderly, and those who were already ill, and whose immune systems were thus compromised.

For an historical frame of reference regarding pandemics, note that in 1918-19, during World War I, 21.6 million people around the world died from a "Spanish influenza" outbreak, including over 500,000 Americans – 195,000 of whom died in the month of November, 1918 alone. And that was before the era of commercial air travel.

During the current pandemic, perhaps unsurprisingly, the island-republic of Singapore, already notorious for its draconian system of criminal justice, was long the only country so far to take proper public health precautions. And yet, last week, Singapore suffered a major setback, when 29 health-care workers at Singapore General Hospital (SGH), where no patients had been diagnosed with SARS, were suddenly hit with the illness on the same day. The situation at SGH is indicative not of the weakness of taking strong measures, but rather of the Pandora's Box nature of a pandemic.

On Wednesday, Malaysia banned all visitors – and even SARS-infected Malaysians – from entering the country from mainland China. All nations should have taken such measures – regarding Hong Kong, as well – in mid-March. In calling the Malaysian measure "Draconian," Reuters reporters Jalil Hamid and Benjamin Kang Lim exposed their ignorance of, or hostility toward sound public health practices.

The China Syndrome

Whether the SARS microbe initially passed naturally from poultry to farmers, or via some more sinister method, the Chinese government turned what could have been a limited, local epidemic, into a pandemic. Chinese officials' responses have alternated between silence and lies. And when they get caught in a lie, eventually they concede it ... and then tell a new, revised lie.

Chinese authorities realized in November that they had an outbreak on their hands in Guangdong, a densely populated province of 86.4 million people. Tried-and-true public health methods required tracing each patient's contacts; quarantining affected individuals, buildings, and neighborhoods; placing patients in isolation, and having health care providers don protective gear; and shutting down all travel, except for deliveries of food and medicine, in and out of the affected region. Instead of employing such procedures, Chinese officials censored all discussion of the outbreak, apparently based on the theory that if they ignored it, it would go away. In early February, they permitted the Chinese media to report on SARS for one week, before reimposing SARS silence.

For almost the entire month of March, Chinese officials stopped updating the SARS census, except for Hong Kong. Prior to April 3, Beijing even barred the WHO from visiting Guangdong's provincial capital, Guangzhou (the city formerly known as Canton). According to Reuters last Friday, Chinese officials were still stonewalling WHO officials. And on Saturday, Elisabeth Rosenthal and Lawrence K. Altman reported in the New York Times, that health care workers in Beijing reported there were more than fifty cases of SARS in the capital, while official Chinese reports to the WHO remained stuck at 12.

And as we shall see, things have since gotten much worse in Beijing.

Hence, few observers take seriously Chinese officials' SARS numbers, or their claims that the outbreak is receding, notwithstanding the apology last Friday by Chinese CDC chief Li Liming, for withholding information for so long.

Liming's apology has to be put into the proper context. On the one hand, consider the report the previous day by the New York Times' Lawrence K. Altman and Erik Eckholm, that Chinese officials – particularly Minister of Health Zhang Wenkang – were irate over foreign advisories against traveling not only to China in general, but even over travelers avoiding Guangdong Province and Hong Kong. According to Altman and Eckholm, Minister Zhang said, "What we have done is to give timely notice about the pneumonia, in accordance with our national conditions and law."

"Mr. Zhang also said that international curbs on travel to China were unnecessary because the outbreak of the disease was 'under effective control' and the number of cases was declining. 'It is safe to come to China to live, work and attend conferences,' he said."

China has lost millions of dollars due to cancelled tourism and conventions, and her officials appear to be putting the nation's pocketbook before the public health.

After Chinese Minister of Health Zhang and CDC chief Liming's respective mea culpas, both were caught lying yet again. On Tuesday, Time magazine's Susan Jakes reported on a signed statement by veteran Dr. Jiang Yanyong, of People's Liberation Army General Hospital 301, had made for Time, insisting that at least 72 SARS patients, of whom nine had died, were either presently or had been treated in two Beijing hospitals. At PLA 302, an "old man" infected ten doctors and nurses in the two days he spent in the hospital, before dying. The dead man's widow was then admitted to PLA 302, and died shortly thereafter. Dr. Jiang reported being told by colleagues, that PLA 309 is "treating 60 SARS patients and that seven patients have died of SARS." And on April 6, Dr. Jiang reported that PLA 302 had admitted five SARS patients from the police. Part of Dr. Jiang's statement follows.

"On April 3rd, China's Minister of Health announced to the press that the Chinese government was already diligently dealing with the problem of SARS, and that the spread of the disease was already under control. He said that Beijing had 12 SARS cases and that three had died of the disease. I couldn't believe what I was hearing. The next day when I went to the hospital all the doctors and nurses who had seen Zhang's statement were furious. As a doctor who cares about people's lives and health, I have a responsibility to aid international and local efforts to prevent the spread of SARS."

Dr. Jiang noted that Chinese authorities did not want health care providers blabbing the truth about SARS in Beijing, in part because of two political congresses that were taking place in the capital.

And yet, it is not only totalitarian apparatchiks who seek to softpedal or even to denigrate SARS coverage. Even as the New York Times published multiple stories on Tuesday reporting that no nation had been able to arrest the outbreak, "as clusters of new cases appeared in several countries," on the Times op-ed page, Philip Bowring complained of "irrational fear out of proportion to the danger," and that "The statistics of the disease ... scarcely suggest the need for the restrictions being imposed on travelers, which are slowing trade and hurting tourism around East Asia." Uncritically echoing Chinese government figures, Bowring insisted that the public was being irrationally panicky about a disease that, after all, had killed fewer people than, say, "dengue fever and encephalitis in the Southeast Asian tourist havens of Thailand and Malaysia."

I hope that Philip Bowring, who writes for the International Herald Tribune, receives awards from Southeast Asian governments and chambers of commerce, since otherwise his little exercise in head-in-the-sand boosterism was for nothing.

But the Chinese have not been alone, in putting greed before the public health. Swiss authorities appeared to be doing the right thing, in barring participation at a big annual watch and jewelry expo held simultaneously in Basel and Zurich last week, to Southeast Asian businesses. When the Swiss announced, however, that Southeast Asian TOURISTS from the same countries were permitted to attend, it became clear that public health was the last thing on the Swiss' minds. While foolishly risking an outbreak in Switzerland, the Swiss greedily sought to exploit the situation, in order to cut Southeast Asian businesses out of sales, while banking Southeast Asian tourists' money.

U.S. Practices Also Far from Ideal

U.S. officials also leave much to be desired, having gradually corrupted public health procedures that took generations and millions of deaths to develop. Public practices have also been harmed in the name of "civil rights." Political advocates who are ignorant or indifferent to public health procedures, and who see in such measures threats to the privileges and financial interests of their favored groups, have fought them tooth and nail.

In the late 19th and early 20th century, immigrants were examined for contagious diseases such as TB by doctors at all U.S. ports of entry. Immigrants who proved to be sick, were either rejected entry or quarantined. Today, no such measures are in place, and immigrant activists have fought against any health-based immigration limitations, even on foreigners stricken with full-blown AIDS.

Meanwhile, after World War II, tourist travel into the U.S. steadily grew. And today, diseases are smuggled into the country with millions of illegal immigrants, who cross the Mexican or Canadian border, or who come here on tourist or student visas.

The AIDS lobby has also crippled public health procedures. Activists insisted on standard public health procedures (contact tracing, quarantining, focusing on the target group) being dropped in the case of HIV infection. The CDC caved in to the activists, resulting in thousands of preventable deaths.

Last Friday, the White House finally put SARS on a list of highly contagious diseases for which public health officials have the power to quarantine people (a list on which AIDS was never placed). And yet, with airports still open in Southeast Asia, and our airports still accepting flights from China (including Hong Kong), Singapore, and Vietnam without examining all arrivals, the numbers can only rise.

On the same day, New York Sen. Chuck Schumer (D), announced that there was no danger in visiting Chinatown. Many Chinatown businesses have been in trouble since before 911, when the Transit Authority shut down its main East Side subway station, at Grand Street, for renovations. The station may not reopen for years. That silly, silly man surely told himself that he was just helping his constituents.

Seeing Schumer, I was reminded of Jaws. In spite of their knowledge that a shark is devouring swimmers, in order to protect the summer tourist business, the town worthies in fictional "Amity" announce that the water is safe. Only this was no movie.

The U.S. government may have no power over regimes such as Beijing's, but the more foreign incompetence we are faced with, the more stringent our domestic measures must be.

And so, as I wait for our public officials to stop playing politics, with apologies to the people of Chinatown, I won't be coming around for a very long time.

To comment on this article or express your opinion directly to the author, you are invited to e-mail Nicholas at adddda@earthlink.net .

[FrogMom]

What I'm reading from scientists these days, is that the mortality rate is more like 10-20%.

I agree. My numbers are too high by a zero, but it's still 54 million that would die. I still think it'll be worse than that if they don't move quickly and quarantine EVERY suspected case until ruled out.

[DannyTN]

"SARS is under control! SARS has peaked! We have defeated SARS!"

[mrustow]

I had to smile. Normally, Baghdad Bob makes me laugh, but under the circumstances ... The craziest thing is, that "responsible" officials in Canada today sound just like Bob.