SARS: Unmasking A Crisis

This is the hospital ward China’s Ministry of Health doesn’t want you to see. Here in the infectious-diseases section of Beijing’s You’an Hospital, dozens and dozens of patients with SARS (severe acute respiratory syndrome) are crammed into tiny rooms. “Every single one of us in this building is a SARS patient,” says a nurse named Zhang, who worked at the People’s Liberation Army Hospital No. 301 until 11 days ago when she was diagnosed with the disease and admitted to You’an. “There are at least 100 SARS patients here, if not several hundred. The conditions here are really bad. We’re not allowed out of this room. We pee in this room, crap in this room and eat in the room. As far as I know, at least half of the patients here are doctors and nurses from other hospitals.”

As a TIME reporter continued through the ward, another nurse who wouldn’t give her name stopped him and explained, “Look, I’m not pushing you away. I do this for your own good. It’s too dangerous here. Even we who work here don’t know when we’ll get it. Don’t believe the government. They never tell you the truth. They say it’s a deadly disease with 4% mortality? Are you kidding me? The death rate is at least 25%. In this hospital alone, there are more than 10 patients dead already.”

China, flush from having won the rights to host both the Beijing 2008 Olympics and the 2010 Shanghai World Expo, is presenting a rosy, reformist face to the rest of the world. But the nation’s handling of the deadly SARS epidemic, which is believed to have originated in southern Guangdong province last November, shows that behind closed doors, Beijing can be as secretive as ever. Extensive reports from local doctors suggest that the country’s health-care system remains hostage to a government that values power and public order above human lives. “You foreigners value each person’s life more than we do because you have fewer people in your countries,” says a Shanghai respiratory specialist, who sits on an advisory committee dealing with epidemic diseases. “Our primary concern is social stability, and if a few people’s deaths are kept secret, it’s worth it to keep things stable.”

But Beijing’s emergency plan may be backfiring spectacularly with SARS, which has burst out of China’s national boundary to kill 119 people and infect 2,960 people worldwide by the end of last week. And even as the deadly pneumonia proliferates across the world–Africa is the latest continent afflicted with the bug–China continues to massively underreport its SARS epidemic. As late as last Saturday, China’s health authorities continued to stick to an accounting of 60 SARS deaths and about 1,300 cases–even though China’s Premier Wen Jiabao visited You’an Hospital, where medical staff say the full caseload there has not been incorporated into the figures.

As the government continues its denials, a number of whistle-blowers have begun contesting Beijing’s figures. A retired military hospital surgeon alleged last week that in one Beijing hospital alone, there were more than 60 SARS patients and seven deaths. A local official from Shenzhen told TIME that during an internal meeting last week a city health official spoke of at least six deaths there so far while still publicly denying any cases. And in Shanghai, local doctors spoke of 14 cases at one hospital, while Dr. Li Aiwu of the Shanghai Pulmonary Hospital confirmed seven foreigners were being treated for the disease–contradicting the city’s previous claim that no foreigners were suspected of having SARS.

“I guess that means I don’t exist,” jokes a middle-aged English man who has been confined to the 14th-floor isolation ward for a week. He connects with the outside world by cell phone. “The care here is good, but I must admit I’m feeling a little cut off from the real world,” he says between dry coughs. China’s persistent obfuscation contributed to the U.S. issuing a travel advisory warning against nonessential trips to China. And in Hong Kong, the government ordered family members of confirmed patients to stay in home quarantine. Travelers wishing to fly from Hong Kong’s Chek Lap Kok airport also had to have their temperatures taken before they were allowed to board their flights. Back in China, luxury-hotel occupancy in Shanghai has slipped to 30% from the usual overbooked 120% this time of year. A planned visit by President Bush and a World Economic Forum event have been scrubbed. “The drop-off in visitors is worse than 1989,” grumbles a Shanghai foreign-affairs official, referring to the foreign exodus after the Tiananmen crackdown.

China has a long history of not facing up to its medical problems, but a few doctors are overcoming the fear of losing their jobs to talk about cover-ups. Jiang Yanyong, a retired military doctor who spoke out about inaccurate reporting in one hospital, says he was outraged that China’s Ministry of Health reported only 12 Beijing SARS cases and three deaths in early April. According to Jiang, Beijing military hospitals suffered their first SARS death in early March, just as the city was hosting the politically sensitive National People’s Congress. Health authorities quickly called an emergency meeting but instead of instructing doctors on how to contain the disease through public-education campaigns, Jiang says medical officials told physicians they were “forbidden to publicize” the SARS death “in order to ensure stability.” Physicians in Shanghai were instructed by the municipal health bureau not to wear masks in the hospital, except in isolation wards and a few select diagnostic rooms, to prevent panic.

The information blackout has resulted in unnecessary deaths as local doctors have resorted to trial-and-error treatments rather than using therapies that have proved relatively effective in other hospitals. The blackout has also put doctors in some peril. At Beijing’s You’an Hospital, for instance, nurse Zhang estimates that about half of those in the isolation ward are medical staff from other area hospitals. To complicate matters further, the only people who are officially allowed to diagnose SARS in China are researchers for each city’s Center for Disease Control (CDC), not the physicians who are treating the patients. “I had a patient whose symptoms clearly seemed to be those of a SARS-positive patient,” says a doctor who consults at a hospital in a leafy district of Shanghai. “But after I contacted the CDC, the patient was suddenly transferred without my knowledge, and I never found out whether he had the disease or not. We doctors are all left with a lot of questions. I think it’s shameful not to let us know what’s going on.”

Doctors worry that ignorance about the disease could allow the virus to spread even further. Misinformation abounds: a Shenzhen health official, Zhang Shunxiang, warned last week that people shouldn’t wear masks because they impede proper breathing–contrary to advice given practically everywhere else in the world. State newspapers suggested that a protein-rich potion containing cicada shells and silkworms could be a SARS panacea. Even more worrisome is the possibility that the disease is making its way into China’s estimated 100 million-strong migrant-worker community, which has little access to health care. Already, doctors suspect that the first case of SARS in Beijing came from a migrant who worked in Guangdong province. If the virus is indeed infecting members of China’s vast floating population, experts fear it could spread quickly into the country’s undeveloped interior. With much of China still in the dark about the killer bug, the worst may be yet to come. –With reporting by Bu Hua/Shanghai and Huang Yong and Susan Jakes/Beijing