Although SARS claims more lives everyday worldwide, all eyes are on China as it tries to contain the largest outbreak
China responded to growing international criticism over its handling of the Severe Acute Respiratory Syndrome (SARS) outbreak by sacking its health minister and the mayor of Beijing—one of the country's worst affected cities—last week.
China followed this announcement by also revealing that the outbreak in Beijing was ten times worse than it had previously admitted. Although WHO queried the case definition used by China, some people from Beijing—a city of 14 million people—have started to leave after state media reported the true scale of the outbreak.
On April 23, China said it would close all schools for 2 weeks in Beijing, which will affect 1·7 million children, as it now increases efforts to control the growing SARS outbreak. Examinations have been postponed and children will continue their studies at home.
WHO has been frustrated by China's poor response to the outbreak and was furious when it began reporting SARS cases in February this year—with 305 SARS cases and five deaths—when China now admits it was aware of atypical pneumonia cases in the southern Guangdong province from November last year.
China, excluding Hong Kong, has now reported 1807 cases, including 79 deaths. But WHO is aware that two-thirds of Chinese provinces have not reported a single case. On April 22, WHO said there were 3947 probable cases with 228 deaths reported from 25 countries. WHO also revised the SARS mortality rate from 4% to 5% this week adding that this rate was true “both globally and for China”.
In a telephone briefing, Henk Bekedam, WHO's chief representative in Beijing, told journalists that China's health system has collapsed over the past 10–20 years because the government has not invested in health. “If China is not able to deal with SARS, then it will be very problematic to deal with globally”.
Recent reports indicate that SARS has now spread to some of China's poorest provinces. Chinese authorities have announced plans to send SARS prevention teams to Shanxi, Inner Mongolia, Henan, and Ningxia, where cases have also been recently reported, as well as to Guangdong. However there are vast areas with no disease surveillance and where no one has reported a SARS case.
A WHO team is currently in Shanghai investigating the extent of the SARS outbreak in the country's largest city. Officials from Beijing, Hong Kong, Taiwan, and Macau met in Beijing on April 23 to coordinate SARS response policies. WHO said the SARS outbreak “is increasingly being viewed as a problem beyond the control of any single government acting alone”.
China's President Hu Jintao's sacking of the health minister, Zhang Wenkang who had said the crisis was “under control”, and the Beijing mayor, Meng Xuenong from their government posts, indicates a tough new line against SARS.
The deputy health minister Gao Qiang said from now on “under-reporting, late reporting, or failure to report” SARS cases would not be allowed. He added that the health ministry was “not being well prepared for public-health emergencies” and admitted that “the epidemic control system is comparatively weak”.
Gao admitted that if SARS did spread to the countryside the “the consequences would be grim” and has now promised more aid for rural areas. Bekedam said he understood that China will take longer to respond to SARS since Singapore and Canada, who have model health systems, were struggling to contain SARS.
Despite the grim outlook China will be able to manage SARS if it follows more aggressive screening and treatment procedures, said WHO. Also, there were now clear signs that China was responding to WHO's advice.
“All hospitals including the military hospitals are reporting”, he said. “The same is true for the public health surveillance system. They have sent 2500 people to strengthen the system, including contact tracing”.
“It is still an enormous job to train people properly. But they are moving in the right direction.”
Meanwhile WHO said it will investigate claims by Hong Kong, which has had 105 deaths from SARS—that the disease is spread by sewage leaks, personal contact, or even cockroaches and rats.
WHO will hold an international scientific meeting in Geneva to review the epidemiological, clinical management and laboratory findings on SARS and to discuss global control strategies on June 17–18.