Shanghai SARS Cases a State Secret (China caught in lies -- again)

Despite government pronouncements, reports of disease are still being 'sanitized' BY HANNAH BEECH / SHANGHAI

As panic about SARS spreads in hard-hit Beijing and throughout China's underdeveloped interior, Shanghai has so far appeared strangely untouched by the mystery virus. Local health officials in Shanghai on Thursday reported only two confirmed cases and 16 suspected cases, of which two are foreigners. In contrast, Beijing has reported more than 750 confirmed SARS cases. Wary that foreign investment might flee Shanghai the way it has from Hong Kong, central government officials early this week sent a directive to Shanghai municipal authorities asking city officials to continue promoting what has been touted as essentially a "SARS-free city," a vice-mayoral aide told TIME.

But is Shanghai really in the clear? Doctors in this city of 16 million have begun voicing doubts about the veracity of the government figures. Local medical staff also allege that World Health Organization experts, who are concluding a monitoring trip to Shanghai, are being shown what one doctor at the No. 6 People's Hospital describes as "a sanitized version of Shanghai's SARS problem." A doctor at the Shanghai Contagious Diseases Hospital told TIME that there are more than 30 suspected cases have been admitted to their hospital's facilities, nearly double the official suspected caseload for the whole city. He and other doctors also say that Shanghai's requirements for diagnosing SARS are much more stringent than elsewhere in the world and that if the standards used in, say, Hong Kong were applied in Shanghai, many of the suspected caseload would be shifted to confirmed cases.

At the Huashan Hospital in a leafy district of Shanghai, doctors and nurses confirmed there were seven suspected cases at their hospital, although the hospital's official press liaison says they currently have none. The patients are being kept in a makeshift isolation ward housed in a dilapidated building formerly used for hepatitis patients. Doctors and nurses were not wearing full isolation suits; many were simply wearing four or five simple surgical masks over each other. But on Wednesday, security guards waiting for possible WHO visitors were ushering foreigners to a fancy high-rise building nearby. On the 15th floor of this building, medical staff in isolation suits greeted visitors, while other staff conspicuously sprayed disinfectant around the ward. There were several newly made signs in English pointing out the "respiratory clinic" and other facilities. No such sprucing-up measures, however, had been taken at the makeshift ward where patients were actually being kept.

Meanwhile, at the No. 6 People's Hospital, director He Mengqiao formally denied that there were any suspected cases there, instead maintaining that the hospital was merely a "monitoring station." Yet just 10 minutes earlier, another doctor who mistakenly assumed a reporter was affiliated with the WHO, showed X-rays of a 14-year-old patient suspected of having the disease. He said that other students at the patient's school in Xuhui district were also running fevers and were being monitored.

Also on Wednesday, top Shanghai Communist Party officials met with local official media to discuss the city's SARS situation. The meeting was classified as "neibu," or internal, meaning that the information would not be disseminated to the public. Officials told the gathered media that Shanghai would not escape the SARS epidemic, despite previous public assurances to the contrary. The party cadres also said that the WHO had told them that the U.N. agency did not believe the government figures of only two confirmed cases. Large-scale events in the city were to be cancelled, and Shanghai's much-vaunted auto exhibition was closed early after rumors that SARS-positive patients had visited the show. The media were instructed to ramp up a SARS public education campaign, so city residents would know how to prevent the spread of the virus.

But party officials then cautioned that "Shanghai's SARS caseload was still a state secret," according to one journalist who attended the meeting. The state media was not to report any SARS statistics higher than the government-sanctioned figures, nor were Shanghai journalists allowed to interview any SARS patients or their families. "Readers are going to be very confused," complained the journalist. "On the one hand, we tell them there are almost no cases in Shanghai. On the other hand, we tell them that they must be very vigilant in avoiding the disease. But if Shanghai has barely any cases, why does the public need to be worried about SARS?"

Potentially SARS is spread on the basis of around 1 to 300.

It will be around for a very long time, including in Vietnam. [Where Thailand's first fatal case, Dr Urbani, the Italian WHO doctor who was in charge of this Region contracted the disease]

The other day Dr Manoon Leechawengwong gave a presentation about SARS to some friends of mine in Bangkok. Dr Manoon is a specialist on respiratory diseases; former Assistant Clinical Professor at Mount Sinai Teaching Hospital, NY; is Chairman of the Siriraj Foundation [Drug- resistant Tuberculosis Research Fund] and Director of the ICU of Vichayut Hospital in Bangkok.

One of my friends made some notes and here they are, verbatim:

QUOTE:

I herewith share with you my lay-man's assessment, particularly what I picked up from the questions and answers:

The virus gets into the air by a carrier sneezing or coughing, or it transmits by touching an affected area (better explained in websites such as who.int, cnn.com etc etc.)
the virus travels in big aerosol droplets that may travel 1 meter; it may (possibly, and much more dangerously) also travel in tiny invisible aerosol droplets that could travel a mile
this (corona type) virus stays alive for 3 hours; the sun's UV light probably kills the SARS virus droplets in the air instantly (as it does other coronas)
Who gets it and what chance to survive?
Anyone can get it (probably), although (probably) some may be less infectious, and others may be highly infectious.
If you are over 60, the risk of death may be 40%, young children: 1%, so age has something to do with it (probably)
(probably) the length of exposure to the virus increases the risk of contracting SARS i.e. that's why so many hospital staff picked it up.
What symptoms?
fever >38degrees; dry cough; chills; muscle ache; difficulty in breathing.
You will be REALLY sick
80-90% get hospitalised
10-20% need ICU treatment
7% need respirator
4-5% die; creeping up to 6% (probably) (this is under the best possible healthcare scenarios so far...)
Sickness may take 3-5 weeks; if you get over it you will have a good chance of being immune to SARS afterwards (probably)
What is the situation in Thailand:
(probably) we are very lucky so far - Dr Manoon thinks there is no reason to believe that statistics are being suppressed.
The bad news is: it WILL hit Thailand also, probably in big numbers, and probably : very soon.
for now we owe a lot to Dr Urbani, the Italian doctor who went to Hanoi to investigate this mysterious disease, got SARS from a patient (who died of it) then came to BKK to die himself, in isolation; because Urbani knew he had it, he went into an ICU, and told all hospital staff to wear facemasks, surgical gloves etc; Dr Manoon believes that way a rapid spread was avoided.
Most Thailand upcountry hospital doctors and nursing staff don't have proper surgical masks and may not get them in view of the shortage and increasing price.....(anyone could help by sending masks to Dr Manoon)
Dr Manoon (he did not say it, my own conclusion only...) faces a lot of obstruction from Health Ministry officials who wish to play down his awareness activities for fear of damge to Thailand's reputation and the direct economic consequences (tourism; airtravel; trade fairs and conventions; hotels + restaurants; retail i.e. store traffic; entertainment). Of course: nobody likes to see the economy go down, and that's exactly why we should act collectively to raise the awareness.
Dr Manoon is campaigning wih limited means to promote the wearing of face masks in Thailand the same as they do in Singapore (not as in HKG) i.e. if you are a carrier you MUST wear a mask; also if you have any similar syptoms of colds, influenza, coughs. Some government officials do not like this kind of "adverse" publicity!
What do we do to protect ourselves?
don't be stupid and ignorant about it
BE RESPONSIBLE by trying to prevent the spread of SARS i.e. wear a face mask when you have the virus, to prevent the spread of the aerosol droplets as much as possible
FREQUENT HAND WASHING
keep in optimal health condition, have enough sleep; dont stress! (if you don't, your immunity will be lower and this bug(ger) will have an increased chance to find it and hit you...)
Discipline yourself when you have any reason at all to be suspicious about yourself or anyone in your immediate environment: DONT TOUCH YOUR FACE (the moment you rub the SARS droplets into your eyes or nose you are sure to go down with SARS)
Have FACEMASKS ready at home, in the office, and at your childrens' class rooms
Anyone (employees, students) with any suspicious symptoms at all: quarantine yourself i.e. dont go to work/school/out and seek treatment immediately; employers and schools should set up the rules; create the awareness.
Keep uptodate, don't lower your guard!
dont travel to the worst hit areas if you can avoid it
if you must travel: wear facemasks at the airports, on the planes, and: be responsible about the potential consequences after your return

Why the sudden and major awareness unlike previous viruses?

because doctors and nurses never before died after exposure to virus patients for 1-2 weeks only...., there's no vaccine yet, and the curve of number of cases reported is going straight up!
As Dr Manoon said: it's fair if the spreading is 1 on 1, but if we are not going to be aware/responsible about SARS 1 person may affect 300 others or more (as has already been the case in HKG, and possibly China), and the multiplier effect might unnecessarily kill thousands of people who would otherwise have had a fair chance.
Face masks:
the much heralded 3M type called N-95 is excellent but totally unobtainable for the moment; moreover it is extremely difficult to wear anyway as even experienced surgeons can only breath through it for up to 10 minutes
find 3-layered surgical masks from a certified manufacturer (for your info: 2 weeks ago I bought a few boxes; today I scraped 10 boxes together but the price has doubled; they are now at least 2-3 Baht a piece).

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