Asia Times: Deception, by the numbers

China - Jun 4, 2003

By Asia Times Online Staff

HONG KONG - China has been slowly winning its battle against severe acute respiratory syndrome (SARS). Or has it? Its statistics indicate a steady decrease, now down to a trickle, in new and suspected cases. However, a doctor from the interior of China who asked his name to be withheld recently told Asia Times Online, "Starting at the middle of May, the SARS statistics issued by China should not be believed."

Since the shock of April 20's official firings and confession of cover-up, China's health ministry has released daily statistical updates of new diagnosed cases of SARS and suspected cases. But what the world doesn't know is that within the government there is another set of statistics known as "observed cases".

"It can be understood this way: Since May 11, domestic observed cases are actually what the outside world has been told are 'suspected' cases, whereas domestic suspected cases are actually presented to the outside world as diagnosed cases. Hence, when referring to domestic confirmed cases, the definition a while back was for those who had transmitted SARS to others. Now, it's a new policy of 'avoid it if you can'." What this means is that a gray area has been created which allows for SARS cases, confirmed or suspected, to fall through the statistical cracks.

One patient's story

The experience of Tang Mei, a young man with a high fever from Xiangxiang city in rural Hunan as he went through the SARS examination process, offers a revealing look at the real situation.

After Tang returned to his village in Hunan from neighboring Guangdong province at the end of April, he experienced a fever of 39.4C (102.9F). On May 5 he was received by the hospital in Jinshi town for treatment. Workers at Xiangxiang's emergency center did not dare avoid dealing with the young man's case, so they proceeded promptly to Jinshi hospital. They discovered that he was exhibiting accompanying symptoms of headache, teary eyes and lack of strength. He had a light cough and diarrhea. They did not want to diagnose him in Jinshi, so they immediately implemented quarantine measures and took him back to Xiangxiang.

The next day at noon, the Xiangxiang People's Hospital conducted a second chest examination on the man. They discovered that his left lung was exhibiting localized problematic symptoms and his white-blood-cell count had dropped noticeably. A group of hospital specialists immediately reported the situation to the Xiangxiang municipal government, whereupon the Xiangxiang municipal government reported to the municipal disease control center of nearby Xiangtan.

On May 7 around 10am, a team of Xiangtan epidemiologists were dispatched to Xiangxiang, where they examined the man three times. They discovered that his right lung had developed new localized symptoms and, after checking his blood, discovered that his white blood cell count had dropped even further. Tang Mei was a possible SARS case.

From when a seriously ill Tang entered the hospital on May 5 to when he, healthy once more, checked out of the hospital, Hunan officials did not announce a single suspected case from May 3 on, despite the constant insistence by Tang's hospital that he was indeed a suspected case. Tang's case had been thoroughly examined, but in the end hospital officials determined that Tang had viral pneumonia or some sort of bronchial pneumonia, or maybe he had SARS.

From the beginning to the end, the hospital never made it clear whether Tang was carrying the SARS virus, and he was never considered a confirmed or suspected SARS case. Hunan was not the pioneer of this SARS examination style - Shanghai had long had its own version. When World Health Organization (WHO) experts touched down in Shanghai at the end of April to inspect the city, they expressed interest in Shanghai's definitions of diagnosed and suspected cases, but did not elaborate further.

A South China Weekly reporter learned through internal channels that at the end of April in Shanghai, there were 38 confirmed cases in isolation, which exceeded official statistics. When the magazine was published, it deleted the true picture of SARS in Shanghai, which the reporter had worked so arduously to obtain. After a while, the State Council, China's cabinet, expressed concern that SARS had penetrated the country's vast countryside. However, suspect regions in the countryside were issuing few reports. The words of the chief of Jingyuan county in Ningxia Hui Autonomous Region are worth pondering.

Desperation

The county chief, who had served in the army for more than 20 years, stated: "We are a very poor county with only 100,000 people and 3 million [yuan, about US$362,400] in the county finance bureau. Add on that we don't even have 10 doctors in the entire county. We have a law for anyone coming here from outside that they be quarantined and observed. If one day they develop SARS, we enclose the person in quarantine and let the situation run its course, afterward we torch the quarantine building."

He added: "Think about it, based on our current circumstances, this is the most responsible way of dealing with things."

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