Knight Ridder/Tribune: China again criticized over lack of cooperation on SARS

Knight Ridder Washington Bureau

April 29, 2003, Tuesday

By: By Michael Dorgan

BEIJING More than a week after promising to end the SARS cover-up in China's capital, where the epidemic is raging, government officials have continued to withhold information crucial to combating the spread of the deadly virus, the World Health Organization's chief representative in Beijing charged Monday.

"It's high time that information became available," Dr. Henk Bekedam said at a news conference.

Since April 20, when the city's mayor and the nation's health minister were fired for mishandling the epidemic, the number of reported cases of severe acute respiratory syndrome in Beijing has shot from 37 to 1,210.

That number, plus more than 1,300 suspected SARS cases, many of which will become confirmed cases in coming days, puts Beijing on a trajectory to quickly become the SARS capital of the world. Already, 59 people in Beijing have died.

Over the past week, officials have taken drastic steps to contain the virus in the crowded capital of 13 million people. Nearly 8,000 people have been quarantined. Schools, nightclubs, cinemas, museums, libraries and many office buildings have been closed. People entering or exiting the city are checked for fever, a key symptom of SARS.

Yet nearly eight weeks after Beijing's first official SARS case was diagnosed, health officials have still not provided the WHO or their own residents with essential information about the epidemic, Bekedam said.

Health authorities have reported an average of nearly 150 new SARS cases a day during the past week in Beijing. But Bekedam complained that they still have not disclosed how many of the newly reported cases are new cases and how many are old cases tardily reported.

Without that information, it is impossible to determine whether the infection rate is growing, declining or leveling off.

Officials also have not provided key information on the pattern of cases, Bekedam said. That includes the crucial matter of whether a few large clusters at hospitals or universities or elsewhere account for the bulk of the cases, or whether they are scattered widely across the city. Also missing is data needed to profile the victims of SARS by age, sex, occupation or other factors that could help identify the groups most at risk.

Without such basic information, Bekedam said, it is difficult for health officials to design effective measures to contain the epidemic, and difficult for residents to know what precautions to take.

"You need to know more to be able to protect yourself," he said.

The continuing dearth of honest, detailed information also appears to have contributed to the alarm and gloom that have gripped the city. Beijing's rumor mills have worked overtime to fill the void, often with false reports that heighten fear and insecurity.

One widely circulated rumor last week _ that the government was going to seal off the city and impose martial law _ sparked a flurry of panic buying and food hoarding.

That was followed by rumors over the weekend that government planes would spray the city with toxic chemicals to try to kill the virus, a rumor that caused many to seal their windows.

Workers continue to spray disinfectant everywhere. They have doused streets, sprayed the wheels of cars and flicked disinfectant in parks.

Beyond Beijing, Chinese health officials have collected voluminous data on SARS in the southern Guangdong province, where the epidemic started last November. The data have not been shared, even though it could help other countries, Bekedam said.

"China has had the highest number of cases," he said. "It's time that wealth of information should be shared with the outside. We do believe that China is sitting on a wealth of information."

The WHO on Monday reported that SARS apparently has peaked in Hong Kong, Singapore and Toronto and has been contained in Vietnam.

Initially, China's government withheld information about the epidemic out of an apparent fear that the truth would frighten the public and scare off foreign tourists and investors.

Why it has continued to withhold information after promising to cooperate was not clear, according to Bekedam and other WHO experts.

One possible explanation is the government's unwieldy bureaucracy.

WHO official Alan Schnur said China's top health officials, including newly appointed Health Minister Wu Yi, have pledged cooperation but that delays have resulted from "internal management issues."

"The statisticians doing the data have not been sharing (the data) with epidemiologists," he said, suggesting that the crucial information requested by the WHO has been withheld from China's own health experts.

Another possible explanation for the lack of good data is that the government might still be trying to hide the full scale of the epidemic, despite its threats to punish any officials who underreport cases.

China now officially has had 3,106 SARS cases, according to figures released Monday. A total of 1,306 patients have been released from hospitals, and 139 have died.

Based on anecdotal evidence and conversations with Chinese health officials, Schnur estimated that about half of the newly reported cases over the past week have been new, while the others have not been previously reported.

That could mean Beijing has a vast number of cases it has decided to disclose only gradually, perhaps to diminish the magnitude of its initial cover-up.

"Maybe there's a lot of backdating, maybe they (the cases reported each day) are new," Bekedam responded when a reporter asked about the cases. "Unfortunately, I cannot answer your question."

Whatever the true number of SARS cases in Beijing, they appear to be overwhelming the health care system.

The number of hospitals designated to handle SARS patients has more than doubled recently to 13, and the official Xinhua news agency reported Monday that three additional hospitals had made preparations to care for SARS patients.

State-run media also have reported that a 1,000-bed field hospital is under construction on the outskirts of the city to care for SARS patients, and that the Central Military Commission has ordered 1,200 medical staff members from the army to help with SARS cases in Beijing.

The explosion of cases has made travelers from China unwanted guests in many countries.

Taiwan over the weekend announced that it would suspend issuing visas to people from China, Hong Kong and other SARS-infected areas for two weeks.

Foreign travelers who already have visas or Taiwanese returning from SARS-infected areas will be quarantined for 10 days upon arriving in Taiwan. Violators face up to two years in prison.