How China Turned Itself Around on SARS

It is mid-November 2002 and a strange disease has emerged in the city of Foshan in the Chinese province of Guangdong. It then popped up in Heyuan and Zhongshan. By mid-December, local Chinese health officials in the area were starting to get a bit concerned. On January 2, they reported the situation to the local anti-epidemic station.

This strange new disease will come to be known as SARS and over the span of 2003, it would change the world. At first, the Chinese government ignored and denied its existence. Then it would repeatedly downplay its spread, until one day in April 2003 they would turn around 180 degrees and fight a titanic and ultimately successful "People's War" against the disease.

Here, we are going to dive into the story of how China let a coronavirus epidemic bloom and then in a single day started an all-out war against it, nearly 20 years ago.

The Report

The Jan 2 report from Guangdong health officials triggered the dispatch of an epidemic health team from the national Ministry of Health. On January 20th, the first team arrived at Guangdong and took measure of things.

The Ministry of Health epidemic team completed a report 7 days later on January 27th. This report was written for both the central government in Beijing and the Guangdong health officials. However, because the report was originally written for the Beijing national government it had been marked as "Top Secret" - and only the highest levels of the Guangdong government had the authority to read it. It took 3 days to find someone who would read this report.

Once they did though, what they read did not leave them overly concerned. Later on, it will come to be known that the report - likely because the SARS virus at the time was so new and unknown - did not mention that the disease could be transmitted from person to person.

Regardless, provincial health officials began circulating a bulletin around the area's hospitals about this strange disease, this 非典 or "feidian" as it would come to be known. Nobody would read it though, because it came at the same time as the monumental Chinese New Year, a 7-day period when all of China's workers return to their villages and homes.

The Political and Legal Situation

SARS the disease isn't particularly infectious. It is most contagious when the patient is severely ill and showing symptoms, and those symptoms are serious enough to debilitate them. This makes quarantine very effective. The R0, basic reproduction number, is 2-4 without control measures. With measures, it is 0.4. So mounting a response means that you can suffocate the outbreak.

Looking back on it now though, SARS benefitted from a whirlwind of political and legal factors that effectively meant that everyone in the government had taken their eyes off the wheel.

In China, the control structure is strictly hierarchal. You got a local government in charge of a city for example. Then you got a provincial government in charge of a province (the Chinese equivalent of a state). Then the provincial government gives way to the national government. In each case, the inferior government is expected to give full control to the higher one and move on with matters. In this case though, the national government seemed to have been otherwise occupied. More on that later.

Legally, as dictated by the 1996 update to the 1988 State Secrets Law, diseases and outbreaks are state secrets until they are announced by the Ministry of Health. If you try to announce as such before the MoH does, then you are officially breaking the law and the government can legally prosecute you - or any physician or nurse or journalist - for leaking state secrets. Additionally, while there is a legal and bureaucratic structure within the local and provincial governments for reporting on infectious diseases, atypical pneumonia wasn't classified as one such disease. And the procedure for adding such new diseases was never codified.

Politically, 2002-03 would be monumentally fortunate for the virus outbreak. During that period, the Chinese Communist Party would be distracted, preparing for a momentous event. A few months on March 2003, Party leader Hu Jintao will nominally take power from former paramount leader Jiang Zemin. This is a transition that occurs once a decade and as with any such situation, the Party and the state are on edge. Top officials within the national government are busy horse-trading between the different Party factions happens behind the scenes. During such a time, no one wants to bring bad news - so a news blackout falls over the whole country. You do not want to be the guy bringing such news to light.

This sensitive situation became especially such the case in the province of Guangdong, China's richest province. Officials in Guangdong looked at the situation with the information they had at hand and weighed the tradeoffs of sounding the alarm - potentially damaging economic growth and development - for this apparently non-contagious disease. As Guangdong Party Secretary Zhang Dejiang - the head of the entire province - would later say: "If we made a contrary decision, it would have been impossible to achieve a GDP growth rate of 12.2 per cent."

They chose wrong. Guangdong reported to the central government that everything was fine.

Text Messages

On February 8th, text messages starting circulating between Guangdong people about a certain deadly flu. Words like "bird flu" and anthrax began reaching the populace in nearby Hong Kong. Health authorities in the city-state were totally baffled. What was going on?

On February 10th, a circular in the local Guangdong media acknowledged that there was a bit of a flu going around. It recommended that people take measures like ventilating their rooms and washing their hands. The World Health Organization for the first time (WHO) requested a response on these reports.

The next day on February 11th, the aforementioned Zhang Dejiang held a press conference where he announced that the disease had been brought under control. 305 people were infected, but only 5 had died. Guangdong Health Department head Huang Qingdao ramped up the fake news by implying that the virus could be prevented and was plenty curable. At the same time behind the scenes, the Communist Party issued guidelines for reporting this new atypical pneumonia disease, directing that all should stress that the disease was under control.

But the reality was different. The numbers were lies. The reality? 792 cases. 31 deaths. And the virus was moving fast through the hospitals.

The Halo Spikes

Nobody was ready in the Guangdong province. Basic hygiene measures were not even being practiced by healthcare workers around patients. City and provincial authorities were deliberately withholding information from the central government, which was distracted anyway.

The only authority that had people on the ground and could act independently was - of all things - China's army: The People's Liberation Army. The PLA maintained a network of relatively independent hospitals and it was on February 12th - a day after the big Guangdong province press conference - that army doctors at Nanfang Military Hospital in the Guandong province first performed an autopsy on a SARS patient. The autopsy determined that death came as a result of a viral pneumonia.

Tissue samples were distributed to the Guangdong CDC, Guangzhou CDC (the capital city of the Guangdong province), and the No.8 Peoples' Hospital, which provided the patient corpse. A week later, two more samples were given to three researchers at the Beijing CDC. Hong Tao, chief virologist, looked at the disease and determined that the cause of death was chlamydia, a sexually transmitted bacterial disease that is not particularly deadly.

But one of the other researchers, Zhu Qingyu saw something that challenged Hong's chlamydia diagnosis: the distinct halo spikes of a coronavirus. Zhu announced his conclusion on February 26th but his announcement failed to gain traction. Zhu soldiered on, finding additional evidence of a coronavirus but nobody would believe him.

It is likely that Zhang Wenkang, the health minister, would bring the disease to the attention of Wang Zhongyu (Secretary General of the State Council) and Li Lanqing (the vice premier in charge of public health and education), some of China's top health officials. But it appeared that what happened was that everyone was occupied with the coming political transition. No more would happen on a national or policy level. People lost interest.

Meanwhile, the disease spread out of Guangdong. It would spread unchecked within China until April.

Pressure and Denial

Outside of China, alarm bells were ringing. The virus hit Hong Kong and from there it would spread to Hanoi, Toronto and other cities around the world. Throughout March, the WHO issued alert after alert on the epidemic. Again and again though, Chinese officials would vehemently deny that SARS was widespread and that cases were being covered up.

But the wall of lies was starting to crumble. The provinces were suppressing news on the outbreak for face-saving and economic reasons, but the overwhelming pressure from others was starting to spring leaks.

Finally, a whistle-blower. Jiang Yanyong, a 72 year old military doctor in Beijing, responded to an April 2003 press conference in which claims were made that there were only 12 SARS cases in Beijing at the time. He reached out to China Central TV and the Hong Kong-based Phoenix TV on April 4th. He told them that at the time there were 100 cases and 6 deaths in Beijing alone. The story blew up and the government began to recant its retractions.

On April 6th, a new twist in the story. A 52-year old Swiss national named Pekka Aro died of SARS. Foreigners panicked and immediately started for the exits. Global alerts began ringing. The cat had left the bag.

A War is Declared

On April 17th, the Communist Party Politburo Standing Committee, China's most powerful body, held an urgent meeting in which it was deciding that there will be no more covering up of SARS cases. 3 days later, on April 20th, the government, led by President Hu Jintao, declared a nationwide campaign to begin truthful reporting on SARS and to stamp out the outbreak.

Health minister Zhang Wenkang and Beijing mayor Meng Xuenong were fired that day from their office. Inspection teams were sent from the central government to root out unreported cases and make sure no one was falling short on counter-measures. Over 120 government officials would lose their jobs.

Party leaders had lost face with the suppression of the virus during its early days and thus pledged to regain credibility by going all out. A "Patriotic Hygiene Campaign" was declared, and quarantines imposed. Over 17,000 people were quarantined in Beijing alone. 80 million people were mobilized to clean up the streets. CCP propaganda called for the people to "build out a new Great Wall ... for the fight against SARS". They called it a "baptism of fire" for the whole nation and asked the people to unite around the Party to defeat the crisis.

Thus, throughout the span of two months into late June, the outbreak was finally snuffed out.

Conclusion

In the years after, people have studied the bureaucratic failings of the SARS outbreak and learned its lessons. The outbreaks remains fresh in the minds of nearby Hong Kong, Singapore and Taiwan. All of whom suffered from the mini-incidents stemming from that first 2003 outbreak.

By the time it was finally stamped out, the 2003 SARS outbreak infected 8,400 people and killed 812 people, a record that would stand for 17 years.