China admits Sars may spread out of control

China sacked its Health Minister and the mayor of Beijing yesterday and cancelled a week-long May Day holiday after suddenly increasing the figure for Sars cases in the capital.

Beijing has more than 700 confirmed and unconfirmed cases, ten times more than initially admitted, putting it among the communities hit hardest in the world, behind only Guangdong province and Hong Kong. Even now there are doubts whether all the figures in China have been revealed.

The government's actions come after an emergency politburo meeting on Thursday ended weeks of lies and evasions by top officials who tried to deceive World Health Organisations experts struggling to control the outbreak.

In the meantime, the sense of panic amid the Chinese population has spiralled. Public opinion surveys conducted secretly by the government have revealed a rising tide of anger. People have stopped flying on planes and public meeting places are deserted. School and university classes have been suspended. In Beijing all the main international hotels are almost empty, while most people are wearing double face masks and disinfecting their homes and offices. People have been told to eat garlic and a turnip-type vegetable as an antidote. Foreign visits have been cancelled or postponed including that of Tony Blair who was scheduled to arrive this week.

Shopkeepers are using surgical gloves and railway staff are disinfecting stations and giving passengers random temperature checks.

The growing unease was also evident in Canada, the country affected worst outside Asia, where a 14th person has died. Fears that Toronto's health system is now infected saw a leading hospital close its critical care unit after four staff members began showing symptoms.

Meanwhile, Singapore, the country with the fourth-biggest toll, shut its wholesale vegetable market and quarantined all 2,400 workers. South Korea said it was considering a ban on some blood donations. Indonesia deployed troops to help medical staff to examine returning workers and normally bustling Hong Kong was like a ghost town .

China's admission that things were far worse came from Gao Qiang, the deputy health minister, who said an investigation ordered by leaders on 15 April had revealed 339 infections, 18 deaths and 402 suspected cases in Beijing – vastly higher than the 37 cases and four deaths reported earlier. Such public sackings and public admissions of failure are extremely rare in Chinese politics where the principle of collective responsibility is normally applied "Someone had to be held accountable," said a Chinese government source.

"There is an essential difference between inaccuracy of Sars statistics and intentional cover-up of the situation of the disease," he said. China, he explained, had simply used a different system to report cases. Zhang Winking, the Health Minister, and Ming Xenon, the Beijing deputy party secretary, had repeatedly issued statements saying the position was under control and that China was safe to visit. The Health Minister said the disease was "under effective control".

On the contrary, the disease spread rapidly in the capital but to cover it up the authorities moved patients into military hospitals and did their utmost to deny access to investigators. When they did arrive, the patients were moved out of their rooms and driven around the city.

The World Heath Organisation was alerted to the crisis at China's largest transportation hub only by the courage of a military doctor, Jiang Yanyong, 71, who took the bold step of publicly revealing the number of cases he was aware of in the military hospitals.

WHO said on Wednesday there were probably as many as 200 people in Beijing infected with Sars, although the city government was then insisting that there were only 37 cases.

At least eight of China's poorer provinces, including Shanxi, Inner Mongolia and Ningxia, have reported Sars cases. Officials said hospitals in those areas may not be able to cope with contagion and the influx of patients.

The handling of the crisis has dealt China's reputation a severe blow. While the top leadership is primarily concerned at the impact on foreign invest-ment and economic growth, some observers hope it may have wider consequences. Some speculate it could be used by the incoming leadership to push for glasnost in the same way President Mikhail Gorbachev exploited the Chernobyl nuclear accident to push through changes in the former Soviet Union.

Until now, political reforms have not been on the agenda of President Hu who said in a public appearance at military research institute in Beijing yesterday he was confident of China's ability to find the methods to combat Sars.

NY Times:

New Worry for China as SARS Hits the Hinterland

By JOSEPH KAHN with ELISABETH ROSENTHAL

OHHOT, China, April 20 — Meng Chunying says she felt the beginnings of a nasty head cold on March 18. But Ms. Meng, an Air China flight attendant who often flew the Hong Kong-Beijing route, said she never made the connection with an outbreak of atypical pneumonia that she thought was under control.

A few days later, Ms. Meng, feeling listless and feverish, flew to Hohhot, the wind-swept capital of the Chinese region of Inner Mongolia, to see her family.

Though the atypical pneumonia, called severe acute respiratory syndrome or SARS, first appeared in southern China in November, local doctors did not figure out that Ms. Meng, 27, was Inner Mongolia's first case until early April. By then, Ms. Meng had infected her mother, stepfather, brother and doctor, who gave it to another patient. Ms. Meng also passed SARS to Li Ling, her husband of three months, who became one of the first people in Inner Mongolia to die of SARS.

While China, under international pressure, has admitted that the outbreak of SARS in big cities like Beijing is far worse than originally reported, it now has a problem that is potentially even more serious: the disease has spread to less developed regions in China's vast hinterland.

"We were told atypical pneumonia was finished in February," Ms. Meng said through tears at the Hohhot Hospital, where she has mostly recovered. "I never imagined that this kind of tragedy would fall on me and my family."

In recent weeks SARS has arrived in force in places like northern Inner Mongolia and northwestern Shanxi, places that lack the medical expertise and equipment to adequately treat a disease that can require weeks of intensive care.

Shanxi, a poor, parched coal mining province, has the largest outbreak outside the major cities, with considerably more than 120 cases, provincial health officials said.

Inner Mongolia has 25 cases officially, though the number of patients being treated in at least five places around the sprawling region appears to be significantly higher.

[Nationally, health officials on Monday reported 132 new cases of SARS, bringing China's total to 1,959, with 86 deaths. The government news media said the new tally included cases in six new cities or provinces since Sunday.]

China has become a society on the move, where people from the remotest provinces travel routinely for work and pleasure. But planes and trains also allow a potentially lethal virus to hitch a ride to communities where the level of health care has fallen far behind that of transportation links.

China's economic transition has brought airports to the smallest cities, but it has forced local hospitals to make do with far less government support.

"We are getting help from the authorities, but it is a terribly difficult situation," said a doctor at the Provincial People's Hospital in Taiyuan, the capital of Shanxi. The hospital had to buy and borrow a cache of ventilators for what has become the largest SARS ward in the provinces.

The rapid spread of the disease to interior regions explains why the Chinese authorities reversed themselves and canceled "golden week," a weeklong holiday starting on May 1 that officials had been promoting for months to help stoke tourism and higher consumer spending.

The disconnect between China's mobility and its medical care also shows the terrible gamble China's government made — and lost — when it suppressed information about SARS in February, apparently so that bad news would not sully the parliamentary session held in March to anoint new government leaders. Around the time that President Hu Jintao and Prime Minister Wen Jiabao were appointed to their current positions by the National People's Congress, SARS was extending its reach to at least nine provinces.

With a blackout on reporting about the disease in the government-controlled press, patients knew little. Doctors were unprepared for outbreaks, even though SARS had emerged in the southern province of Guangdong four months earlier and was raging through Hong Kong by mid-March.

"We did not even have the proper masks," said Zhang Wei, a doctor in Hohhot, describing the confusion when the first SARS cases reached Inner Mongolia. "No one had any idea how to deal with this disease. We had four people die here, one after the other, before the officials realized we had a serious problem."

In Taiyuan, an edginess hangs in the air at the ramshackle Shanxi Provincial People's Hospital, over a battle whose outcome is still uncertain. Hospital workers finger white masks as if they were rosaries.

Taxi drivers, whose red cabs boast signs proclaiming "Newly Disinfected," refuse to pick up people who emerge from the gates. Passers-by haul huge bags of medicinal herbs and plants — a concoction that the provincial government has announced can prevent SARS.

The object of the nervousness is a squat glass and concrete building that sits behind a locked fence at the very back of the hospital. It is home to several dozen patients with SARS, some sick enough to be on ventilators.

Through a large plate glass window, doctors and nurses clad in bright blue head-to-toe protective garb can be seen scurrying through the halls, the white coats that used to be the armor of their profession hanging limp by the door.

The chronically underfinanced health department had to round up expensive tools to fight SARS: large stocks of protective gear, including fancy masks that cost $3 apiece, as well as oxygen tanks and ventilators. Doctors and nurses, some quarantined in the SARS wards, work 10-hour shifts.

The first case from Taiyuan was diagnosed in early March, in a jewelry merchant who had returned from Guangzhou, the SARS epicenter. He infected close to 30 patients, including his mother and father, who both died in mid-March in a military hospital in Beijing.

Even as provincial doctors worked hard to contain the first outbreak, the virus nonetheless slipped back into the province in the lungs of other travelers.

In late March an official from the Qingxu district of Taiyuan had an oral ulcer treated at People's Liberation Army No. 301 Hospital in Beijing — a place that secretly housed SARS patients. A week later, back home in Taiyuan, he developed the disease and it began racing through the Qingxu district.

A third outbreak started after a man who collected the body of a relative who had died at Youan Hospital in Beijing returned to Shanxi and discovered he had SARS.

SARS has also begun to show up in even poorer areas, hitchhiking with sick patients like a dental resident at Provincial People's Hospital who became infected and took SARS home to the southern city of Linfen.

Some expect the problem to get worse before it gets better. Jiang Cheng, a local pharmacist, said there were far more cases than had been reported so far.

"It has already spread to other parts of the province, especially in the south," he said. "That's because it's more developed there and people travel around a lot."

As a flight attendant for Air China for six years, Ms. Meng traveled regularly to Guangzhou and Hong Kong, and she heard about the outbreak in Guangdong Province in February. But following the government's propaganda line, Air China assured employees that the outbreak was purely local and "under control."

On March 15, Ms. Meng was working on Flight 112 from Hong Kong to Beijing. Among the passengers she served that day was an elderly man who looked pale and wan and asked for water so that he could take some pills.

Hong Kong authorities in late March rushed to track down travelers on that flight after as many as nine members of a tour group took ill after flying to Beijing.

Ms. Meng first felt sick three days after the flight. She visited an Air China medical clinic, but no one warned her about SARS, she said. "We work hard and get tired all the time, so we're used to it," she said.

Had she known she had a highly infectious disease, she said, she would never have returned to Hohhot. But it was there that she developed a high fever, and there that she sought help.

She described the Huhhot Hospital as "completely unprepared," initially putting her into a room with patients who had different diseases. Only in early April did doctors diagnose her SARS.

When her husband, brothers and stepfather took ill, the hospital staff panicked and refused to treat them, Ms. Meng said, adding that the hospital manager eventually relented.

The disease had spread to health workers anyway. At the nearby Hohhot Chest Hospital, the main treatment center for lung diseases, SARS infected half a dozen medical workers. Frightened staff members refused to work, leaving the hospital critically short-handed.

Huang Qi, the deputy general manager of the chest hospital, worked day and night in the SARS ward, even wheeling dead bodies to the "peace room," or morgue. Mr. Huang was subsequently found to have SARS.

The disease has roamed far in this northern region, as far north as Hulun Buir, an area near the Russian border known for its grassy steppes.

And in the west, Li Song. a medical worker for the government-owned railroad system who was sent to Beijing for training in March, took SARS home to the remote town of Linhe. An isolation ward at Ba Meng Hospital there now houses at least 13 patients, including Mr. Li, his wife, his mother and the 21-year-old nurse who first treated them.

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Panic grips Beijing as leaders admit tenfold rise in Sars infection rates

By Jasper Becker in Beijing

New Worry for China as SARS Hits the Hinterland