Measures include improved training, more hospital beds, and a better national reporting system
A sudden recent drop in the temperature has chilled Beijing and not only because the municipal authorities do not start supplying gas central heating until November: health officials and residents also fear that the earlier than usual onset of cold weather could bring a return of the severe acute respiratory syndrome (SARS) virus.
Even before the last two SARS patients checked out of hospital in August, China's authorities and WHO warned that the deadly disease could re-emerge—like influenza—in the autumn, but their countermeasures have been hampered by public complacency, a lack of funds for health care, and insufficient knowledge about the new strain of coronavirus.
In Beijing, the sense of panic that cleared the streets and shopping malls in May already seems a distant memory. With no new cases for more than 2 months, most residents believe the disease has been defeated. In a recent poll, 70% of people said they were sure the virus would not come back. Nobody wears face masks, taxis no longer smell of disinfectant, and restaurants and hotels no longer screen customers with temperature checks. Less welcome has been a return of unhygenic habits: out has gone the frequent precautionary hand-washing seen during the peak of the SARS crisis and back has come copious and noisy spitting in the street.
The health ministry, which had a rare turn in the spotlight during the crisis, is once again being ushered back into its more familiar role in the political shadows, as the government's priority switches back to economic growth.
Nowhere is this more apparent than in Guangdong province, where the disease is believed to have originated. At the peak of the outbreak, health officials pushed through a ban on the sale of 54 species of animals suspected of spreading SARS. But the agriculture ministry has rescinded the move, which was affecting the livelihoods of local farmers and market traders.
WHO officials said the lifting of the ban was premature, given that studies are still being done to ascertain whether the animals might act as a possible reservoir for the SARS virus. Research by a WHO team of 14 international experts who visited Guangdong in August found that several species, including mammals, snakes, and birds, carried a SARS-like virus. Among them was the civet cat, which is now back on the menu in Guangdong.
Another resurrected victim of SARS is Meng Xuenong, the former mayor of Beijing, who was fired along with the health minister for trying to cover up the outbreak. Although they were villified at the peak of the SARS crisis, both have now quietly been cleared of blame in official inquiries into the disease. Last month, Meng—an ally of president Hu Jintao—was rewarded with a new job as chief of the nation's giant water diversion project, the world's biggest hydro-engineering operation.
The health ministry has introduced a series of internal measures designed to strengthen its ability to deal with future outbreaks, focusing mainly on improved training for medical staff, new facilities for infectious diseases, and a better national reporting system.
In Guangzhou, the capital of Guangdong, health officials have designated 158 hospitals and a total of 532 beds for infectious diseases. To improve coordination of action and the sharing of information, they will be grouped under the administrative control of six lead hospitals. The local authorities say they have also held training sessions for 440 000 health workers on SARS diagnosis and the transportation and isolation of people suspected of having infectious diseases.
Similar arrangements have been made in Beijing. According to local media, the capital will also soon have a new hospital for infectious diseases with more than 600 beds. A daily reporting system has also been established that will see the Dongchang hospital collate SARS information from around the capital.
With hospitals planning to isolate any patient with a cough and a temperature over 38°C for 7 days, the risk is that even these expanded facilities could be overrun if China suffers a major influenza outbreak. To ease this risk, the government is urging people to have flu vaccinations. Beijing has reportedly ordered 1·5 million shots of flu vaccine this winter, three times more than last year. But most of these have been given to health workers and military personnel. There have been several reports of individuals being unable to get vaccines even though they are willing to pay the US$8 cost.
Compared with the way China was caught offguard earlier this year, it is definitely better prepared to fight SARS. Even so, there is still no early diagnostic test, no vaccine, and no cure. Given the added uncertainties about the animal reservoir for the virus, how it jumps to human beings, and the possibility that it may have mutated, the authorities will be hoping that their preparations do not have to be put to the test when the mercury falls further.