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Monday, January 05, 2004

SARS: A Thorough Cleaning

Actually looking at the title I've given this piece does make me think about comparisons between the current vigour of the Chinese authorities and the European anti-cholera campaigns in the 19th century: lets try scrubbing it away.

This notwithstanding Sars 2004 is likely to be a very different animal from Sars 2003: in many senses. What follows is a slight rehash of something I have just put up on Living in China. The Mr Sars expression comes from young Chinese blogger Hailey Xie, and she coined the term in this post, which is well worth reading for anyone with an interest in how young Chinese bloggers think. (And BTW there is a world of difference between the Chinese and the Indian blogging community, a difference which I cannot help observing as the posts come in, and a difference whose importance I a sure to want to reflect on here in the coming days).

So what actually gives on the Sars front? Well for starters State media in China are saying that a campaign of culling civet cats is underway in Guandong. In fact the decision seems to have come from the Guangdong Health Bureau. Official Feng Liuxiang is quoted as saying that they "will start a patriotic health campaign to kill rats and cockroaches in order to give every place a thorough cleaning for the Lunar New Year." Meantime the WHO seems to be frantically calling for caution in the proposed slaughter. Roy Wadia, the WHO's Beijing spokesman, has been drawing attention to the fact that "the WHO hopes that the slaughter of animals and closure of wild animal markets will not be done in a way that will drive the trade underground" since "driving the trade underground could be counter-productive to containing the disease."

This point should obviously not go unheaded. Be that as it may, it is already possible to discern a number of important differences between Mr Sars 2004 style, and the 2003 version. In particular in connection with the media handling of the problem.

The Chinese authorities are certainly trying to be far more proactive. The deficiencies of the earlier secrecy approach were all too apparent, and clearly this year there is a much greater attempt to lead from the front. This is in part made possible by the first rate scientific capacity which seems to be available in China at the diagnosis end, and which can be seen in action in the reports from the Centres for Disease Control in Shenzhen and Guandong cited in my post yesterday. However some of the old weaknesses are still apparent, this time in the dangers of overreaction in the de-infestation campaign which, as some media rightly note, is somehow reminiscent of 'oldstyle' Mao Zedong's pest eradication campaigns. However, there are clear signs of a learning curve being at work.

At the other end of the spectrum is the apparent caution and timidity of the current WHO campaign. Fiercely criticised last year for over-dramatising, the WHO now seem to be adopting a much more 'low key' approach. There is still a dedicated page on the WHO site, but at the time of writing this has not been updated since the 31st December. Whilst the Chinese Ministry of Health has stated that "the only suspected SARS case in south China's Guangdong Province has been confirmed as a diagnosed case", the WHO has yet to pronounce. Xinua have also reported that "42 people with close contact with the patient have been isolated for further medical observation and 25 of them with normal physical symptoms have been freed from observation". Although it is not clear, it seems that the 42 and the 25 in question are different groups.

Another of the key features of the way the subject is presented this year is sure to be an increased emphasis on corona virus mutation. As this is a post in itself, I will not go further here. But clearly it is important to note that we are dealing with a different strain, and the consequences of this are as yet unknown. Hence, in part, the WHO's caution. Also of note is the fact that we are dealing with a more informed global public, so naturally the degree of scientific depth in the reprting will be correspondingly greater.

Finally, it should be noted that the confirmed case (plus quaranteened contacts) may not be the only one. There have been reports in the Hong Kong Standard that a waitress has become the second suspected SARS case in Guangdong but provincial officials and hospitals have denied the report. The paper claimed that the waitress, in her early 20s, developed a fever a week ago and has been kept in isolation at the Guangzhou No. 1 People's Hospital. Citing unidentified reports from Guangzhou, it said the woman had symptoms of the flu-like illness but an announcement would not be made unless test results confirmed the disease.

However Wang Ming deputy director of Guangzhou City diseases prevention and control center, subsequently told a news conference that "We do have a fever patient due to pneumonia, but this has no direct connection with any suspected SARS case," while the No. 1 People's Hospital informed Reuters: "We don't have a suspected SARS patient because we are not a first-line SARS hospital."

The reasoning behind this last quote is curious, to say the least. Meantime I would say the jury is still out here.

On another front a Filipino maid, recently returned from working in Hong Kong, and her family, are being tested as possible cases. The maid , who has a fever, is currently isolated at a hospital along with her doctor, according to health department spokesman Dennis Magat. At the same same authorities are busily trying to trace people she may have had contact with.

Are we about to see a major return of Mr Sars? It is hard to say. What we can say, is that this situation needs some extremely careful attention.

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