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.