Now southern China, the world’s most efficient virus factory and ground zero for most of the globe’s influenza epidemics, is revving up for another cold and flu season. This year, though, SARS has lost the element of surprise. Health authorities are so intent on spotting signs that they’re getting skittish. When a Taiwanese man returned last month from a trip to the mainland running a fever, hospital officials put him in isolation. It was a false alarm. Aside from one official at the World Health Organization, who lost a $64 bet that the disease would surface by Nov. 18, nobody takes much solace in the lack of cases so far. Most health authorities agree that a return of SARS this year is all but inevitable.
Such pessimism might seem surprising. After all, most health workers around the world dealt swiftly and effectively with last year’s pandemic. They showed how vigilance, responsiveness and good communication pay off when dealing with a global disease. The wild card this year is China. Of the 813 people who died of SARS last year, three quarters lived in mainland China; if SARS is lying dormant, awaiting cold weather and the runny noses that come with it to make a comeback, China is the most likely starting point. How well has this vast country absorbed the lessons of SARS?
Chinese authorities couldn’t do worse than repeat last year’s performance. Even as SARS patients were inundating emergency wards throughout the country last winter, Beijing withheld information from WHO officials and forbade doctors and other health-care workers from talking publicly about the disease. Since then, “cooperation has been remarkably good,” says WHO’s Beijing representative Henk Bekedam. China’s leaders seem committed to preventing a new outbreak. The new Health minister, Wu Yi, impressed international health officials with her willingness to reform China’s woeful health-care system. To prevent the chaos that marked Beijing’s handling of the SARS crisis last year–authorities actually worked against the provincial hospitals by insisting that the new ill-ness posed no threat–Wu worked closely with WHO officials to set up a new surveillance network. Three regional labs collect virus samples and track SARS cases with new software.
Despite this progress, Wu faces a daunting task. China’s health-care system is vastly underfunded. Rather than focusing scant resources on high-risk areas, such as the south, authorities are taking on the entire country at once. Making sense of information from the countryside won’t be easy, either. “China is a big country,” says WHO’s Hitoshi Oshitani. “It’s not easy to set up a good system.”
Even the fanciest data-gathering facilities will be useless if information isn’t allowed to flow freely. Wu’s Health Ministry has issued guidelines to provincial hospitals designed to speed the reporting of SARS cases. She’s also given provincial administrators a dressing down for not taking the threat of SARS seriously. In a national teleconference on SARS prevention, she accused some local governments of having “lowered their guard, slackened efforts and developed the idea of leaving things to chance” in preventing a return of SARS.
Another concern is infection from lab samples. If a researcher could catch SARS in a squeaky-clean Singapore lab, which happened in September, the more than 100 labs and hospitals in China thought to hold SARS samples are disasters in waiting. Many of them are located in the provinces, where conditions are often unsanitary. WHO experts and Chinese officials have tried to track down these virus samples and explain to health-care workers the need to destroy them, or at least meet international standards of cleanliness and safety. WHO officials worry that there may be more samples the authorities don’t know about, and that some labs will give them up only for cash.
Making an accurate diagnosis would help the effort to track a new SARS outbreak. Researchers have been working on a cheap and accurate diagnostic test, but haven’t had much luck. Now they think a vaccine may be the best way of stopping the disease. One Chinese company claims to have developed a vaccine that works in monkeys, and plans to start clinical trials this month. Researchers at the University of Hong Kong will also begin testing a vaccine before the end of the year. Even if these vaccines work, they wouldn’t be ready until next winter at the earliest.
One thing China hasn’t learned from its SARS experience is that eating habits–particularly the taste for freshly killed meat–might have to change. Scientists found that civets, a cat-size creature and a local delicacy, can harbor the SARS virus. Chinese authorities banned sale of the animal in April, but reversed themselves in August after farmers and restaurateurs in Guangdong objected. “From a safety standpoint,” says WHO’s Bekedam, “we think it was premature to put it back on the menu.” This winter, the battle will be shaping up between China’s tradition and the world’s safety.
