Military

DATE=05/19/2003

TYPE=ON THE LINE

NUMBER=1-01330

TITLE=IMPACT OF SARS ON CHINA

INTERNET=Yes

EDITOR=OFFICE OF POLICY 619-0038

CONTENT=

THEME: UP, HOLD UNDER AND FADE

Host: Can China recover from SARS? Next, On the Line. [music]

Host: Thousands in China have been infected with Severe Acute Respiratory Syndrome, or SARS. Hundreds have died. This new infectious, flu-like disease first emerged in the Guangdong province of Southern China last November. For months, provincial and national officials denied the existence of the epidemic. They banned local media from reporting on the growing death toll. But as the disease spread, China could no longer keep the outbreak a secret. On April 17, Chinese president Hu Jintao told his government to end its cover up. But the long period of lying allowed SARS to spread far and wide in China. How is SARS affecting Chinese society, its economy and the grip of the ruling communist party? What has been its impact on the rest of Asia? I'll ask my guests: Gordon Chang, author of the book, "The Coming Collapse of China"; Nicholas Eberstadt, scholar at the American Enterprise Institute; and Michael Fumento, a senior fellow at the Hudson Institute. And also, in a little bit, joining us by phone from the University of Michigan will be Dr. Sandro Cinti, clinical assistant professor of Internal Medicine in the division of infections diseases. Welcome and thanks for joining us today. Does China have SARS under control, Gordon Chang?

Chang: Most certainly not. What it has done is it's been able to contain SARS in the major cities of the coast. And in Beijing, it appears -- though we're not quite sure -- but it appears that they have at least stopped the spread. The problem though is that there is infection throughout rural China, not only in the area around Beijing and Guangdong, but throughout the country. And that really is the story, because there, the public health system is not able to deal with it. Decades of neglect have meant that China is not able to provide health care for hundreds of millions of people. And this is where the real problem for China is going to be.

Host: How do we know about the extent of infection through rural China? Has there been any clear reporting on that?

Chang: There's been some reporting, but the big story is that we don't really know as much as we should. And so, therefore, we have glimpses of what's going on, but certainly we don't have as much, as good a picture as we would like. And neither does the World Health Organization and perhaps the communist party is also in the dark.

Host: Well Nick Eberstadt, how dangerous is SARS?

Eberstadt: It's a Corona virus. It's new. It's what's called a zoonoses. It is a disease which has spread from another species to humans, just the way that H-I-V spread from primates to humans, [and] the way that Ebola spread, I think, from bats to humans. We don't know yet a lot about the disease, although it is being genetically tracked or coded by C-D-C [Center for Disease Control] and that's happened in Singapore as well. The initial information we have on SARS suggests that it's pretty deadly compared to standard-issue pneumonia or even standard-issue influenza. The initial numbers suggest mortality rates of maybe three or four percent, which is a lot higher than influenza. Of course, as Gordon indicated, we may have a small denominator. There may be many more people who have actually been infected than we have so far learned about. But there may also be deaths that we don't have in the numerator as well. Initial suggestions are that this is quite a serious disease, quite a serious infection.

Host: Michael Fumento, is this a serious disease, serious infection?

Fumento: I would have to differ with that somewhat for a few reasons. One is -- and I think this helps explain why the Chinese government was caught off guard -- that, at least according to the figures being reported by the World Health Organization, China, and this includes Hong Kong, has reported about seven-thousand SARS cases and about five hundred deaths. Now in the United States alone, influenza kills annually, about thirty-six thousand people. That means, almost certainly in China, influenza kills over a hundred thousand people. So they're looking at something now that's killed perhaps 500. Perhaps they're lying and its somewhat more, but you can see how they would look at the numbers themselves and say, "This isn't such a big deal." What they failed to reckon with is that often, reality gets trumped by perception. And, I think the world has overreacted to SARS and if China pays the price for that, then I think they still deserve it, even if the epidemic has been overstated.

Host: Gordon Chang?

Chang: But aren't we really reacting not so much to the disease, but to the way that the party has handled the problem? Because in the absence of information, people are always much more concerned and you just don't know. That's the reason why I think foreigners are not traveling to China, and why the Chinese people themselves have gotten concerned, panicked, upset about this whole situation. So it's really, it's not just a disease question. It's a political system question.

Fumento: Exactly right. We trust our Centers for Disease Control. If they tell us there are thirty-six-thousand flu deaths, we believe it. It's thirty-six-thousand. The Chinese -- and nobody else for that matter, the non-Chinese -- they don't trust the public health system in China and so it could be irrelevant that perhaps right now, at this point, they could be telling the truth one-hundred percent. They've set themselves up with such a bad reputation that they have lost that trust and it's going to take a long time for them to regain it.

Host: Nicholas Eberstadt, the Chinese government not only was not reporting actively this information, but they were taking steps to stop newspapers from reporting it. How extensive was that cover-up?

Eberstadt: It looks as though it was very extensive and even the government bragged about it, the cover-up. The vice-minister, vice-governor of Guangdong province said, "See, you've got a panic in Hong Kong and we've got everything under control here. Why do you want to have open information about this epidemic?" It's not unique. It is entirely of a piece with the Chinese-Communist Party's approach to inconvenient diseases. The Chinese Communist Party has tried to censor people talking about H-I-V-AIDS in China. They've arrested people talking about politically sensitive aspects of the H-I-V-AIDS problem. The difficulty from the leadership standpoint is that you can censor people but you can't censor an epidemic. And, in attempting to censor an epidemic, you create exactly the opposite of the conditions you hope to. You encourage its spread. Once the cat is out of the bag, as Michael and Gordon were saying, the level of public trust declines so that people have to, if you will, relearn everything that they need to, to prevent contagion.

Host: Gordon Chang, has that lack of public trust affected the potential spread of the disease in the sense of people leaving Beijing to the provinces, perhaps spreading the disease as they fled from the cities?

Chang: Well, exactly. Just a few days or a week after the announcement of the leaders in the middle of April, approximately one million people, almost eight or nine percent of the population of Beijing just left. Government leaders were debating what to do and in the meantime, Beijingers just left the city. And so you had a million people going throughout China, some of them carrying the disease and others carrying panic. So essentially what they had was a situation which, in a sense is not so serious, but on the other hand it created a situation far more critical for the Chinese state.

Host: I'd like to bring into the conversation, Dr. Sandro Cinti from the University of Michigan. Dr. Cinti, are you there by phone?

Cinti: Yes, I am listening.

Host: I'd like to know what you think about the seriousness of the disease and whether it is more serious or as serious as pneumonia, say?

Cinti: Well, I think at this point I'd like to put in a plug for the World Health Organization and their ability to be able to identify this illness. And I think to their credit, to the credit of the C-D-C and the investigators that they're sending out, we have been able to contain this disease even though it had run rampant in China. Is it a serious disease? The articles that I'm reading that have come out on The Lancet, in the electronic journal really do show that it is very devastating with the mortality rate climbing. Again, I think those mortality rates will change, but it's a significant mortality rate. And a recent article from Hong Kong, in the Amoy Gardens episode, showed that some of those people, even the people that recovered, were in the hospital for up to twenty-two days. So, we are dealing with a very serious epidemic. In the United States, we've been spared. The good news is that we're finding that about eighty percent of people don't spread this disease, but that super-spreaders are capable of restarting an epidemic in any city in the world.

Host: Explain a little bit about that. What is the theory behind why some people might be particularly contagious with this disease?

Cinti: It's not clear at all. I don't know that I could even speculate. At this point there is a lot of speculation going on, part of it may be the make-up of somebody, whether they have some immune compromise that allows the virus to overtake them more quickly and thereby be more evident in bodily fluids. We know that it's in diarrhea fluid. We know that its in urine now. We know that its in nasal fluid too. But we don't have enough evidence to figure out, for instance, I can't and the people that have seen most of these patients can't look at a patient and say, "This is a super-spreader." Even some of the patients that have died have not been super-spreaders and those that have survived and maybe not done so poorly have been super-spreaders.

Host: Has there been any notion of why the disease spread so much more effectively within hospitals and healthcare settings than within the population at large?

Cinti: Yes I think, and the C-D-C just redid their contact precautions and they state pretty clearly that this is not spread casually. So, passing somebody on the street, going up to a countertop at a store should not pass this disease, probably even in the case of super-spreaders, although there have been people that have spread possibly with casual contact. However, in the community, it doesn't spread efficiently. In the hospitals, where you have close contact, within three feet, where you have to deal with patients. Bodily fluids, where you have to intubate patients, where you have patients on oxygen, many patients initially had gotten what are called nebulae inhalers and things that can aerosolize the virus to cause more spread. Those are the kinds of things that cause increased spread within the healthcare setting.

Host: Now, several countries that have had outbreaks of SARS including Vietnam and Canada, have managed to keep the disease from spreading into the population at large in any large way. Are there lessons for why the disease has spread so widely in China and not elsewhere?

Cinti: Well, Canada, even though there's been some criticism, I think they did an excellent job. Singapore did an excellent job. Taiwan's having a problem at the moment, but what they did, Canada quickly realized that this epidemic was going on. They dealt with it in their hospitals by having separate SARS wards. They quickly put out public information. They made sure that people with SARS were only taking care of by certain staff. People in the hospital were all wearing masks, gowns and as studies come out, we realize that wearing masks, washing hands and putting people in negative pressure rooms -- these are rooms that blow air to the outside and not to the rest of the hospital -- are really the ways to prevent this. And what they did and the three things that are key are making the diagnosis, isolating the person that is sick and then contact tracing. Canada and Singapore realized this very early on and they were able to do it and control their epidemics. In China, there was very little ability to do any of that if it was even tried in the beginning. Hong Kong has and has started to get their epidemic under control. So I think those are coming out. Just these basic, epidemiological and infection control procedures really do work.

Host: Well, Dr. Cinti, thank you so much for joining us. And coming back to the panel here at the table, Gordon Chang, those kinds of basic public health procedures that have been effective in other countries, why weren't they taken in China?

Chang: Well, I think essentially you've had twenty-five years of fast economic growth, but to get that they have nearly neglected education, healthcare and other essential social services. So you don't have the public health infrastructure in all of these cities and villages across China. And they really had to learn it in the consect of a crisis. So essentially the World Health Organization and other countries sent people in to sort of teach the Chinese about what to do. But they have to do it in the middle of an epidemic. And I think that essentially, it's a neglect of the public health system.

Host: Michael Fumento, do you think that once there is the kind of public health system that exists in Western Democratic societies that SARS will be effectively contained in China?

Fumento: The difference between healthcare systems just makes a tremendous impact. For example, the fifteen-percent figure does have a problem in that, that Lancet study was disproportionately comprised of the elderly. And the elderly always disproportionately die of any type of pneumonia.

Host: You mean the notion that there's a fifteen-percent mortality rate.

Fumento: Right, mortality rate, right. It's not that high. They were looking at people generally over fifty-five, over sixty. So it's not that high. That said, the mortality rate in all of Europe and the United States, which is over a hundred cases stands at zero. What are we doing that they're not? Now, there's no cure for SARS. There is no cure for any viral disease in existence. We just don't have those yet. But what we can do is simple things like just keeping a patient hydrated, for example; treating the secondary infections, not the virus itself per se, but the bacterial infections that come up because the virus has weakened the immune system. Those are the things that are keeping people in the United States and Europe alive that are simply not really available, at least to a great extent, in China and in many other countries.

Host: Well, Nick Eberstadt, if you think of public health regimes and what it takes to have an effective public health regime, they are both elements that you would think a state with a robust security system would be good at, which would be tracking down people, knowing who had come into contact with whom. But to what extent is it also reliant on the kind of openness that allows information to spread among hospitals. Where's the balance there?

Eberstadt: Very much so. There are a lot of aspects that are consistent with the needs of an open society and the needs of public health control. First of all, an educated and informed public, educated about health risks, also about the media and urgent health risks. An information system, a national information system that alerts the public so that it can take appropriate protective measures. And also, a responsive public health mechanism that deals without particular political preference with the public health threats that faces. Part of the Chinese public health system is really quite good. Part of the military health system and part of the privileged parties' health system are really quite good. But those are not capable of addressing or mitigating the larger part of this sort of infection. It will protect a limited part of the elite perhaps, or at least address a limited part of the elite's afflictions once identified. But that leaves the whole base of the pyramid essentially still exposed.

Host: Gordon Chang, Nicholas Eberstadt talks about political issues coming into these decisions. To what extent was the initial cover-up part of the political hand-over of power going on in China from the old guard to the new guard?

Chang: Well, clearly you've got two distinct groups in Beijing today. You have the third generation leaders, Jiang Zemin, former general party secretary and president, and then you have the new guys, Hu Jintao, Wen Jiabao. And clearly there's been a difference in approach that both groups have taken towards SARS, where Jiang Zemin and the older cadres really doing the traditional things: basically trying to keep information [from the people]. And then you have the newer guys who need to really create their own leadership pace, essentially trying to take a new approach. Maybe not because they're more modern, but because they see that this is a means of basically building their own power. So it's been a very difficult time for the leadership because there has been this push and this pull between the two groups. And essentially what you have is an authoritarian state which has not been able to control people, has not been able to do the things that democracies are able to do in terms of fighting diseases. Because the Chinese people have set up barricades in their own villages, they have kept out the outsiders. They've found out all sorts of things that the government has not told them to do, largely because the political system, if not in paralysis clearly is in crisis.

Host: Michael Fumento, the government, after it said that it had been lying about the disease, then has made a point of being very vocal about mounting a huge fight against the disease. Has the Chinese government instilled unnecessary panic in overreacting to its initial cover-up?

Fumento: It's entirely possible that they have contributed to that. We know that there has been panic in China. Some terrible things, in fact, have gone on with people attacking other people and what have you, just because they're suspected of having SARS. It can be so bad now that if you cough, they basically bodily will throw you out of the building. How much of that you can blame now on the Chinese government trying to get its act together as opposed to understating it earlier on, I don't know. Once the panic gets out there, it's very hard to pull it back. What it's going to finally take is for the disease to get down to such a low level -- I don't think it will ever go away, I think it's here forever -- but it will go down to a very low level until perhaps next year, all over again, once its gone down to a low level and its been there a while, then the panic will abate. And until then, there's nothing anybody can do about it.

Host: Well, Nick Eberstadt, I'm afraid we only have about thirty seconds left, but what's the impact going to be on the government and the society of China from the economic impact of SARS?

Eberstadt: Well, economic impact is obviously negative. We don't know yet exactly how bad its going to be but some of the initial figures suggest big impact on travel, commerce and the like. Canton trade faired down eighty-percent in terms of its contracts. We don't know yet if this is going to be China's Chernobyl or not.

Host: I'm afraid that's all the time we have for today. I'd like to thank my guests: Gordon Chang, author of the book, "The Coming Collapse of China;" Nicholas Eberstadt of the American Enterprise Institute and Michael Fumento of the Hudson Institute here in the studio. And by phone, we were joined by Dr. Sandro Cinti of the University of Michigan. Before we go, I'd like to invite you to send us your questions or comments. You can e-mail them to Ontheline@ibb.gov. For On the Line, I'm Eric Felten.