SARS How serious is it really?

[owenkrout]

It is official now that the SARS outbreak is serious. WHO and the CDC are now advising people against travel to Hong Kong or Mainland China. I would like to take this time to discuss just why in reality there is so much concern about the spread of SARS in and from China right now. This involves topics that many of the Chinese members tend to be sensitive about, but I am not making judgements, I am just reporting what the actual situation is.

 

First of all, right now, there are not an overwhelming number of people who are ill with SARS in any of China. There are many people infected, but as a percentage of the population, the total numbers are still very small.

 

The problem lies in that it is beginning to spread much more rapidly and in the potential for rapid widespread infection in China. Currently, Hong Kong does not have the disease under control. The number of new cases each day is spirally upward. The reasons for such a potential very serious problem are manifold. Some of those reasons are:

 

Basic sanitation. To put it bluntly, only very basic levels of basic sanitation exist in most places in China. In the environment outside of the major cities where most people still live, it is almost non-existent. In most places, anything outside of people’s actual home is absolutely filthy and there is no attitude of there being any reason to make an effort to keep things clean in public areas.

 

Sewers that have collapsed and are partially exposed are a common site. The sewers themselves often dump out untreated sewage into the waterways. Right now in Shenyang the drought has completely dried up the smaller streams except for where they in flow of sewage is enough to turn them into huge open sewers. The same holds true even outside the cities. In villages sewage is commonly dumped into the streams. As I was writing this, I looked out the window to see the neighbor helping their about three year old boy take a squat in the yard just outside the entrance to their apartment block. This is common in China.

 

Tap water is not potable water. One of the most common sources of travelers sickness is the tap water.

 

We are so used to the health standards enforced on restaurants in the US that we tend to assume such is true everywhere. Its not. I have taken a peek behind stage at several Chinese restaurants and have found that their idea of clean eating wear would get them shut down without even the benefit of a warning in the US. In the US cooking wear, and serving wear must be washed with soap in water that is at least 160 degrees F. In China they are rinsed, not seriously washed in the cold non-potable water, usually with no soap. Same for those reusable chopsticks.

 

People hock and spit everywhere. There is actually much less of this in Guangahou, Shanghai and Beijing than in most of China. In most places it is hard to walk without stepping in somebody’s spittle. People will spit on the floor of the bus, the store, even in the classroom. Obviously, this is an open invitation to the rapid spread of something like SARS. It is one of the big reasons that TB is still a problem in China.

 

Making that problem even worse is that the typical method of “cleaning” the floor is to throw out a bucket of cold water and then drag a filthy mop around the floor. No attempt is made to use hot water or any cleaning or disinfecting agent. No attempt is made to actually transfer the dirt from the floor to a bucket of water which is then discarded.

 

Of course one of the most basic reason for concern about China is that they still insist that close contact is needed to contract the disease. You cannot avoid close contact with large numbers of people on a daily basis if you are in the Eastern third of China. People are crowded together so tightly that it is a perfect breeding ground for disease. Don’t fool yourself. You cannot avoid it.

 

Chinese hospitals and doctor’s clinics are unbelievably filthy. There are some exceptions, but 99% of the medical care facilities in China don’t even come close to the cleanliness standards of your local veterinarian’s office. The #1 hospital here in Shenyang, (the numbering system is supposed to indicate levels of proficiency) is absolutely frightening to see. The dirtyness and the horrid crowding are perfect breeding grounds for disease. I have personally seen in more than one hospital doctors using metal tongue depressors on multiple patients. One of the exceptions that I have seen, by the way, is the “hospital” (more accurately a clinic) on Shamain Island that you can use for the immigration physical another is the military hospital near us here in Shenyang.

 

Add to all that the seeming lack of understanding about just how disease spreads and you have a perfect culture for a serious disease like this one getting out of hand. As my good friend, Mick, has said to me, “this thing could reach critical mass quickly and begin spreading like wildfire in a dry cornfield.” That is why WHO and CDC are so worried about China. Once an infectious disease like this reaches a certain critical number of people infected, it reaches a “critical mass” where it can no longer be contained as the numbers of new cases overwhelms any containment effort. With a billion people closely packed together, if that happens even the current relatively low 5% death rate would be catastrophic.

 

Final conclusion. Think long and carefully before coming to China right now. The odds are in your favor at this point, but that could change very rapidly. I would say that there is a real chance that you could be stuck here with your only option being a health care system that you would rather avoid contact with. I think that if the numbers in Hong Kong and Guangdong continue climbing like they are now, the US or even WHO may institute a ban on travel from China temporarily. If you are already here, you may be stuck here. If you already have a health issue such as any heart problems, then I would definitely say that now is not the time to visit China.

[tonado]

Owen,

 

I agree with you especially most people in China don't realize that SARS is so serious. Here is a post that came from AAC and CUC.

 

-------------------------------------------------------------------------------------

BEIJING, Apr 1 (IPS) - Severe acute respiratory syndrome (SARS)

may have originated in China, but in the Chinese capital one can

obtain more information about the invasion of Iraq than about the

internal effort to contain the killer virus.

 

Beijing, a city in denial about the possibility of new global

pandemic that may have originated in China, is coming to grips

with a startling reality: Here one gets to learn more about the

invasion of Iraq than about China's internal front of fighting to

contain the killer virus that causes atypical pneumonia.

 

Preoccupied with maintaining social stability and fearing any

bad news that may tarnish China's international image, Beijing

authorities have shunned away from reporting about the outbreak

that is causing fear and panic across East Asia and other parts

of the world.

 

According to World Health Organisation (WHO) statistics, 806 of

1,622 cases of the severe acute respiratory syndrome (SARS)

worldwide as of Mar. 31 have been reported in China, where at

least 34 people have died.

 

Yet a series of interviews by IPS in the city found that the

majority of Beijing's residents are either ignorant of it or

have scant information about the illness raging inside China --

even if Beijing is a hotspot for the illness and is one of six

countries were local chains of transmission have been identified,

along with Hong Kong.

 

At the Yansha flower market, where on the weekend hundreds of

people were busy buying flowers for the annual festival of

sweeping the graves, salesgirls and customers were surprised to

hear about the disease.

 

"Dangerous pneumonia in Beijing? I haven't heard of it

and the papers haven't reported it," a salesgirl who gave

her name as Liu said confidently.

 

"I think this pneumonia is spread only in Hong Kong but

I'm not surprised because they often have dangerous epidemics.

Remember the chicken flu?" asked another businesswoman

surnamed Zhang.

 

Over the years, Beijing residents have become used to a string

of nasty flu epidemics, with ever-new mutations that have

rendered new vaccines useless and have learnt to meet them

stoically by using piles of Chinese herbs and remedies.

 

While people wearing gauze masks have appeared in some of the

narrow and densely populated city lanes as well as on public

buses, many have been quick to dismiss the seriousness of the

disease.

 

"It is probably just another bad 'liugan' (Chinese term

for a flu)," said one traditional Chinese medicine doctor.

"The panic is because they haven't treated it timely and

properly with Chinese herbal remedies."

 

"Because of the weather change, many upper-respiratory

infections appear in spring," asserted Dr Li Liming, head

of the national Centre for Disease Control and Prevention.

"We don't foresee any nationwide epidemics in near future

but few localised and small epidemics are quite possible."

 

Beijing people's tempered stoicism in fending off annual flu

epidemics, coupled with the government's deliberate news

blackout, have transformed the capital into a surreal city where

problems do not exist as long as they are not mentioned.

 

Hong Kong -- a Chinese territory that Beijing was so proud to

embrace back from its British colonial rulers in 1997 -- has

suddenly become a blank spot on the map of Chinese media.

 

Few here are aware that in the last couple of days Hong Kong,

which has seen 530 cases of SARS and 13 deaths, had imposed

stringent public health measures.

 

All schools on the territory of Hong Kong have been closed,

those who have had intimate contact with victims have been

quarantined and new cases are to be sent to a designated

hospital.

 

But nothing of these desperate attempts to combat the spread of

the disease has been reported in Beijing.

 

Chinese officials and the tightly controlled state media fell

virtually silent after saying in early February that atypical

pneumonia had killed five people and infected 305 in the southern

province of Guangdong.

 

But last week, China drastically raised its death toll from the

new disease, saying that 31 people had died in Guangdong and

that there were three deaths in Beijing.

 

Despite the government-imposed news blackout, fears and rumours

about the spread of the deadly strain of pneumonia have slowly

begun to filter. Two international sports events based in Beijing

have been cancelled because of SARS fears.

 

The World Economic Forum has delayed its annual China Business

Summit set for Beijing this month until September or October.

 

Rock music lovers in the city have been also asking why the

first-ever concert in China of the British veteran rockers

Rolling Stones has been suddenly called off.

 

Last week, the popular tabloid 'Beijing Star Daily' quoted

experts as saying they had no scientific proof that Chinese

traditional medicine such as Banlangen could prevent pneumonia.

The article also dismissed the use of boiling vinegar inside the

house as a reliable fumigation method.

 

”Gauze masks out of stock in the capital city”,

read the headline in the 'Beijing Youth Daily' on Monday

morning. Without giving any figures for the number of people

infected and the background of the disease, the paper described a

panicky situation in the city where people prompted by rumours

have rushed to buy surgical masks and stock up Chinese herbal

medicines.

 

Investigators from the WHO, meanwhile, were still awaiting

daily updates from across China that Chinese health authorities

promised them on Friday.

 

Members of the WHO investigative team in Beijing were also

awaiting approval for a request to visit the southern province

of Guangdong, where the outbreak is believed to have originated.

[tonado]

The Chinese still doesn't believe that SARS is out of the control.

 

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Wednesday April 2, 9:03 PM

China health minister says SARS under control

 

BEIJING, April 2 (Reuters) - Chinese Health Minister Zhang Wenkang said an outbreak of a deadly flu-like virus in China was "under effective control" on Wednesday in a rare interview on state television.

State television also reported that China's policy-making State Council, or cabinet, had called on Wednesday for measures to "eliminate the epidemic situation in a few areas at its roots". The meeting was chaired by Premier Wen Jiabao.

 

"Starting in March, the illness has gradually been brought under effective control," Zhang told China Central Television (CCTV) in a 20-minute interview on a popular news talk show.

 

The nationally broadcast pronouncements marked the first time senior leaders had publicly addressed the outbreak of Severe Acute Respiratory Syndrome (SARS), which has killed nearly 80 people -- 46 in China -- and infected more than 2,300 people worldwide.

 

China has been criticised for dragging its feet in reporting new cases and hiding information about the disease from the public.

 

Zhang said the outbreak may not have originated in the southern province of Guangdong, although experts widely suspect that it did. He compared SARS to AIDS, which was first discovered in the United States but did not originate there.

 

"Guangdong province was the first to discover and the first to report the disease, but we cannot say where in fact the source of the disease was," Zhang said.

 

"Right now we do not have reason to say Guangdong was the source," he said.

 

"The number of medical workers infected is becoming smaller and smaller," he added.

 

Zhang listed symptoms of the disease and preventive measures people could take. He also said the "path through which the disease is transmitted" had been found, but did not elaborate.

 

The State Council had ordered that new SARS cases be reported to the World Health Organization (WHO) as they occur and called for the establishment of a nationwide system for efficiently dealing with public medical emergencies, CCTV said.

[Nicole]

I just saw my gg off at the airport yesterday. he was stay here a week. I worry about him so much about SARS when he took the flight. But we were both ok. I think it just keep a distance to everyone then it would be better. I still think Beijing is a little bit safe than GZ now.

[Mick]

Owen, thanks so much for posting this insightful message to board members. I think the perspective of someone living in China is useful at this point and what you have written gives a balanced and realistic view of what is actually going on. Having lived in China for five years, I can attest to the reality of what you reported in terms of sanitation, spitting, and cleanliness (or lack thereof) of most public facilities. What concerns me most is two things. First, the reality of the crowded conditions make for easier spread of the disease. This is especially true in the larger cities and the necessity of the use of public transportation creates greater potential for hazard. Secondly, the lack of accurate information made available to the public fosters a false sense of safety or outright denial of the problem. This point was vividly brought home in the ariticles so kindly posted by Tony.

 

I guess I just want to say that I have grave concerns about this thing. The concept you mentioned of "critical mass" is so important. Once it reaches a certain number of people in an overcrowded area, containment becomes a moot point. The epidemic takes on a life of its own and spreads rapidly. I don't want to sound alarmist here, but I think all of us who are considering travel to China, especially the south, should rethink the situation. If one decides to go, then I strongly encourage folks to take every precaution possible. I was in GZ less than a week ago and can say that it is as crowded as ever and starting to heat up. Humidity levels beginning to rise as well. This is perfect weather for spreading of viruses. They thrive on heat and moisture. Li and I are symptom free and are grateful to be home in America at this point. This virus was one of the major factors in our leaving early. I took this thing quite seriously from the start as I have heart problems and such a disease could have serious ramifications for me.

 

Another cause for alarm is the fact that the Consulate in GZ, as reported in another thread, is reducing staff and providing free transport home for all non-essential personnel. This is an indication of how serious the government is taking this issue. Hopefully, this will have little impact on the visa process but that is hard to predict at this point. What is easier to predict is that this thing will continue to spread until its source is found and some sort of treatment developed. Until these things occur, the best advice is to pursue prevention. I urge anyone traveling to GZ or other parts of China to take every precaution.

[Don&MuSi]

Hi,

I am leaving for Guangzhou this Sunday. I have weighed all of my options and have decided that my love for MuSi is most important to me. Of course, I intend to follow all precautions and wear the masks, I am bringing alcohol wipes (I read that alcohol kills the virus) to wipe down the hotel room and of course surgical gloves. I will also quarantine myself for 7-10 days in my home when I return, so as not to infect others incase I come down sick. I feel that is all I can do to prevent the spread of this virus. I feel that had the Guangzhou Embassy efficiency had been better I would not have been caught up in this timeline and need to run this risk.

Don

[tonado]

Hi,

I am leaving for Guangzhou this Sunday. I have weighed all of my options and have decided that my love for MuSi is most important to me. Of course, I intend to follow all precautions and wear the masks, I am bringing alcohol wipes (I read that alcohol kills the virus) to wipe down the hotel room and of course surgical gloves. I will also quarantine myself for 7-10 days in my home when I return, so as not to infect others incase I come down sick. I feel that is all I can do to prevent the spread of this virus. I feel that had the Guangzhou Embassy efficiency had been better I would not have been caught up in this timeline and need to run this risk.

Don

Have a safe trip.

[manhattanmoon]

Chinese hospitals and doctor’s clinics are unbelievably filthy.  There are some exceptions, but 99% of the medical care facilities in China don’t even come close to the cleanliness standards of your local veterinarian’s office.

Owen, I am sorry to say THIS IS NOT true! ....... and not very nice!

[vince]

"It is official now that the SARS outbreak is serious.  ...."

oh my goodness. There is so much false information in your post that it's even worse than most of the government propaganda. And some of them are just flat out lies. If you hate it so much, why not leave once and for all? Take it easy.

[tonado]

Even Swiss is getting scared. I wish my gal would just leave China now. In a month from now, I hope our government would not ban people from Asia from coming because of virus scare.

-------------------------------------------------------------------------------

 

Thursday April 3, 3:24 AM

HK dismayed by Swiss trade fair ban on virus fears

 

(Adds Swiss reaction to Hong Kong complaints, updates number of suspected cases in Switzerland)

HONG KONG, April 2 (Reuters) - Hong Kong said on Wednesday it was dismayed by Switzerland's decision to bar its exhibitors from a jewellery and watch trade fair in Basel and Zurich because of fears over a spreading deadly flu-like virus.

 

Jewellery and watch making are major industries in the Asian financial hub, which has been hit hard by Severe Acute Respiratory Syndrome (SARS).

 

The virus, spread around the globe by air travellers, has killed at least 75 people worldwide, 16 of them in Hong Kong.

 

"We are disappointed and we are concerned about this decree because there has been no previous notification nor has there been previous consultation," Henry Tang, Hong Kong Secretary for Commerce, Industry and Technology, told reporters.

 

Thomas Zeltner of the Swiss Health Ministry said the situation in Hong Kong had worsened dramatically, forcing the authorities to act. "It is a matter of public health," he said.

 

Reacting to reports Hong Kong exhibitors would withdraw from the fair, he said the ban would not be reversed.

 

Some 350 exhibitors from Hong Kong had been expected to attend the World Jewellery & Watch Fair 2003 and a vast majority of them had already arrived in Switzerland or were on their way.

 

Banning Hong Kong traders from the fair, which opens on Thursday, could hurt the city's economy, which is already on the edge of recession. A slumping property sector, a sharp fall in tourist numbers because of the war in Iraq and the SARS outbreak have taken a heavy toll.

 

The World Health Organisation advised travellers on Wednesday to postpone visits to Hong Kong and southern China's Guangdong province where the majority of cases have been found.

 

Officials believe the outbreak began in Guangdong in November.

 

SWISS BAN

 

Wary of the threat of SARS to visitors, the Swiss Health Ministry told exhibitors at the fair on Tuesday not to employ people arriving from China, Hong Kong, Singapore or Vietnam on their stands.

 

The fair, which ends on April 10, attracts up to 80,000 visitors and more than 2,000 exhibitors from more than 40 countries each year, organisers said, making it the largest event of its kind in the world.

 

There would be no immigration ban on those travelling from countries affected by the illness, the ministry said. However, they would not be allowed to work on stalls.

 

"It is simply a matter of trying to reduce direct contact with visitors to the show," Zeltner said.

 

People from China, Hong Kong, Singapore or Vietnam who were already in the country would not be forced to undergo medical checks.

 

The ministry said that since March, nine suspected cases of SARS infection had been reported in Switzerland. In five cases, it had been definitively established that patients suffered from a common form of influenza.

 

Zurich's university hospital said on Wednesday it was treating a man with SARS symptoms in isolation. It declined to give details, but Swiss television said the 41-year-old man was a pilot for Singapore Airlines.

[Robert S.]

Don,

 

Thank you for this balanced and well thought out reasoning. That was just what I needed.

 

- Robert

[owenkrout]

What is in everybodies favor here is that it is starting to get near the end of the traditional flu season and this does appear to be a virus like the flu. Hopefully, the change of seasons will cut this short before it gets terribly widespread. At the moment, it is a serious threat, but has not yet reached that critical level of infection.

[beishan4]

Aloha from Beijing,

Thanks Owen for your comments about health care in China. They are

correct. Hospitals for the public are unsanitary, military hopsitals are

better and private clinics are the best. I have seen all of them. My

father in law is a retired air force general. My sister in law works for

company that has it's own clinic. The problem gets worse in the poor

provinces.

Myles aka Annakuen'GG

[Mick]

I would agree that being cautious is the best bet right now. Like I mentioned earlier in the thread, I think those who are planning travel to China need to take every precaution to prevent infection. Also, I still maintain the point that folks need to take this thing seriously. The points that Owen made regarding the lack of sanitation in health care facilities is a good one, even though they may not be what folks want to hear. I lived in China for quite a while and traveled throughout the country with the exception of Tibet and the Northwest. I can say without reservation that the cleanliness, or lack thereof, that Owen mentions is a reality. Further, I don't think he meant any criticism of China but instead was making an attempt to give a realistic picture of what the situation is.

 

Like I said, being cautious is the key here. We don't need to be unduly worried or alarmed, but an ounce of prevention is worth a pound of cure.

[panda]

the reason is money !! tourism and profit ....they are a dveloping country ! as many other in the past .