February 4, 2003
Guangzhou Institute of Respiratory Diseases, Guangzhou, China
345 Infected, 33 Dead
BY EARLY FEBRUARY, THE HEAD OF THE GUANGDONG CDC, CHOU Yenfou, and the head of the Guangdong Provincial Health Department, Huang Qingdao, admitted to each other and to other health officials, including those higher up the bureaucracy in Beijing, that this was an unusual occurrence. Still, they quietly reminded their colleagues, it was more a curiosity than an epidemic. Respiratory diseases were common, pneumonia was endemic, and, at any rate, outbreaks burned through Chinese provinces. Remember, Guangdong had roughly the landmass of Germany. How alarming would a few hundred cases of pneumonia be if they were spread out through all of Middle Europe? However, these officials were nervous about one possibility: though there were at least 250 cases—that they knew of—they still could not confirm if this was some mutated, and therefore potentially catastrophic, new type of influenza with pandemic potential. Among the frontline clinicians such as Deng Zide, there was already emerging a dispirited consensus that they were dealing with a virus of some sort, perhaps a mutated influenza. Hospital virology labs had not had any luck in identifying the microbe—there had been very few samples taken, and there were no reagents available in Guangdong for certain influenzas. The director of the Guangzhou CDC, Du Lin, received vials of nasal-pharyngeal samples from several Guangzhou hospitals in early February. “We thought it might be the flu,” she said. “It was the right season for it.” Her labs centrifuged the material and introduced it to several cell lines but were unable to identify any cytopathic effect. Du’s chief virologist, Ma Peng, working with an electron microscopy specialist, took samples from several cell lines but failed to find any abnormal cell pathology. Even when they employed human fetal cell lines, a practice that is not allowed in the United States, they were unable to observe any destruction of the cells. Du Lin still suspected that this was a bacterial infection of some sort.
Zhong Nanshan, the mediagenic chief of the Guangzhou Institute of Respiratory Diseases, told the head of the Guangdong CDC and the Health Department that he doubted this was a bacterial infection because it did not react to any broad-spectrum antibiotics, though he could not rule out the possibility of some mutated, antibiotic-resistant strain. Identifying the agent was certainly a worthy goal, Zhong reminded his colleagues, but what was necessary now was that the treatment protocol be established and especially that health care workers be told to practice barrier infection control and administer light doses of steroids and heavy antivirals. This disease, whatever it was, was burning through hospitals and taking down doctors and nurses at a faster rate than anything he had ever seen. Already, more than fifty health care workers around Guangdong had been stricken. Even in the height of flu season, he had never heard of this many being infected this quickly. (During influenza season in Guangdong, health care workers take Tamiflu, an anti-influenza drug, prophylactically.)
Zhong Nanshan urged public health officials to act quickly. The public was already panicking; the run on antibiotic and antiviral medication that began in Heyuan and spread to Zhongshan had now swept the whole province. “We are dealing with something completely new,” he told the head of the Guangdong CDC. “We have never seen patients deteriorate this quickly.”
OUTSIDE ZHONG NANSHAN’S GUANGZHOU INSTITUTE OF RESPIRATORY Diseases, a six-story, gray-and-brown ferro-cement structure with a bank of overcrowded elevators that stop at every floor, is a huge bronze statue of a lunging, cartoonishly muscled worker swinging a sledgehammer. The statue is a striking example of socialist realist statuary, pushing the genre to almost Botero-like extremes of physique and sexuality. Sometimes, when I visited the institute, hoping to catch Zhong Nanshan in between appointments—he seemed to spend most of his time lecturing government officials about how to better deal with respiratory diseases—I would imagine that this was a statue of Zhong Nanshan, wielding that sledgehammer to smash infectious diseases.
During the winter of 2003, that plaza by the river with its gaudy statue would become crowded with peasants and workers seeking some sort of protection from this dreaded disease. Perhaps no rumor travels faster than word of an impending plague. It is a primal, human fear; almost as soon as the possibility is implanted in the mind, some survival instinct transforms the idea into a motivating terror. A few came because they had relatives or friends in the institute, others because they suspected there was some information available at the hospital run by the most renowned doctor in Guangdong. Newspapers in Hong Kong—the Sun and the Hong Kong Commercial Daily—had carried reports about the curious disease outbreak across the border, mentioning the run on vinegar and the selling-out of certain medications. These newspapers, while not available in Guangdong, were disseminated in samizdat versions through Internet chat rooms, and they confirmed what the locals had known for a while: hundreds were falling ill—and those were just the patients who had made it to hospitals. Who knew how many were languishing in urban slums or rural hovels, unable to afford or reach first-rate medical care? “There is a fatal flu in Guangdong,” read a text message passed along more than 125 million times, according to Guangzhou’s Southern Weekend newspaper. Where or what this thing was simply was not clear, and this fed the worst sort of rumors.
One that was circulating was of a People’s Army biological warfare experiment gone wrong. Another was of a chemical weapons trial by the United States, seeking to test its arsenal before invading Iraq. Text message rumors passed along these and other equally implausible explanations, and fed an atmosphere of anxiety and tension. If there was a deadly outbreak, citizens wondered, could they count on the government to tell them about it? This was a government, after all, that had never really admitted to the massacre at Tiananmen Square or to the disastrous collectivization schemes that resulted in the starvation of millions.
The impulse, then, was to channel your panic into an area you imagined to be productive: socking away vinegar, buying Banlangen, eating plenty of winter greens, keeping the windows tightly sealed. Or, for those who were returning home for Chinese New Year, simply staying away from the cities. “People were overcome with Delusions,” wrote Daniel Defoe in Journal of the Plague Year, “as they had a Notion of the Approach of a Visitation, all their Predictions run upon a most dreadful Plague, which should lay the whole City, and even the Kingdom waste: and should destroy almost all the Nation, both Man and Beast.”
Word was passed to the National Health Bureau in Beijing in late January. By early February, Ma Xiaowei, the national deputy minister for health, was planning to visit Guangdong personally to monitor the situation. “We knew that something extraordinary was going on,” says the deputy minister. “But we didn’t know what exactly it was. That’s why I felt I needed to visit.”
While the deputy minister may have felt he needed to visit Guangdong personally—a remarkable and rare occurrence in itself—what is even more surprising is that no one bothered to notify Hong Kong, literally next door to Guangdong, about what was really going on in the province. “We just didn’t think about Hong Kong,” says Xu Ruiheng of the Guangdong CDC. “That was our mistake.”