Wall Street Journal - April 2, 2003
Peter Wonacott, Susan V. Lawrence and David Murphy, Staff Reporters of The Wall Street Journal

Wednesday's developments suggest that China's leadership -- facing its first major challenge since taking office earlier this year -- is seeking to address sharp criticism of its handling of the outbreak as economic and political fallout grows.

The World Health Organization said severe acute respiratory syndrome, or SARS, has spread to five Chinese provinces and Beijing, infecting a total of 1,190 people and causing 46 deaths since November. Included in the tally were figures released Wednesday by the southern province of Guangdong, which put its latest death toll at 40. The WHO, which is sending a team of doctors to Guangdong, also issued a rare alert urging travelers to avoid the province and Hong Kong, two of the hardest-hit areas.

China has come under fire at home and abroad for its rigid control of information and slow response to the epidemic. Besides its halting disclosure of new SARS cases, Chinese authorities took five days to grant the WHO's request to visit Guangdong. In a rare rebuke from the state-controlled media Wednesday, the English-language China Daily newspaper blamed local authorities for failing to inform the public about the outbreak.

The country also faces a financial toll as businesses and governments take steps to limit contact with affected regions in China. In addition to the WHO travel advisory, the U.S. State Department authorized the voluntary departure of nonessential employees and all family members of personnel at the Guangdong and Hong Kong consulates. China International Travel Service, the government's flagship tour agency, has recorded more than 10,000 inbound tourist cancellations and postponements because of anxiety over SARS, an official said.

In seeking explanations for China's actions, some analysts note the paradox facing Beijing. China's open door to investment has launched more than two decades of growth and prosperity. But that growth has led authorities to fear releasing information that might rattle the public and scare off the foreign investment on which the economy increasingly depends. Though it has been unwilling to concede that its public-health failures may be responsible for the disease's global spread, Beijing is now realizing the cost of that policy, these analysts say.

Beijing's handling of the outbreak is reminiscent of the secretive manner in which the Communist Party has dealt with the AIDS crisis. China didn't acknowledge the full scale of that problem until after the United Nations released a report in June 2002 describing AIDS as "China's titanic peril."

At the end of 2001 the U.N. estimated that there were as many as 1.5 million cases of HIV infection in China, while the Ministry of Health said there were just over 30,000. The ministry then raised its estimate of HIV infections to one million, but a news blackout on coverage of individual HIV cases has yet to be lifted.

An account of the spread of SARS makes clear that if Chinese authorities had acted differently, the outbreak might have taken a different course and more might now be known about the disease. The virus, which spreads through close contact with an infected person and incubates for as long as 10 days, seems to have first appeared in Guangdong in November, about the same time that new local Communist Party Secretary Zhang Dejiang was taking over the leadership of the province. Authorities quickly clamped down on reporting by the domestic media after nervous residents in southern cities began to stockpile medical supplies.

Guangdong authorities remained silent about the illness until Feb. 11, when provincial officials revealed the scope of the outbreak, reporting 305 recorded cases and five deaths from atypical pneumonia; they also said that the outbreak was under control.

Provincial authorities belatedly admitted on March 26 that by the end of February -- 15 days after Guangdong's assertion that the outbreak was under control -- cases in their province more than doubled, to 792 from 305, with 31 deaths.

During those 15 days, as alarm mounted over the new disease, Secretary Zhang, a Politburo member who outranks the minister of health, tried to calm public fears. On Feb. 14, he ordered provincial officials to educate the public to "voluntarily uphold social stability, not believe in rumors, not spread rumors" and to focus on the party's goal of building China into a "comparatively well-off society." According to the media outlet of the Guangdong party committee, the Southern Daily, police summoned the operators of leading Web sites and ordered them to carry only positive reports about the fight against the illness.

This approach wasn't limited to Guangdong. When Beijing authorities admitted on March 26 that there were SARS cases in city hospitals, the news didn't get front-page treatment in local newspapers the next day.

Under orders from the city's propaganda authorities, the capital's stable of papers, normally fierce rivals, all ran the same brief three-paragraph story tucked away on their inside pages, and all under the same reassuring headline: "Imported atypical pneumonia in our city has been effectively controlled."

It was only on March 28 -- more than four months after the first known case -- that the government told the WHO it would make SARS a "Category B" disease, meaning that provincial health officials would be obliged to notify central health authorities of cases. But as of Wednesday, according to Wu Kejun of the Department of International Cooperation at the Ministry of Health, "the ministry has required local governments to report to the central government about SARS cases once in a while, but how to classify SARS is still under discussion."

One reason for China's failure to provide accurate reporting, according to WHO officials, lies in the nature of the Chinese bureaucracy. The Ministry of Health is a weak bureaucratic player, with little power to demand data from the provinces. It can ask for the numbers, but those health departments answer first to provincial party organizations, and only second to the national ministry. Provincial party organizations' interests lie in preserving the local investment climate, not in advertising health risks in their provinces.

Even Wednesday, there were signs Beijing could do more. Chinese Health Minister Zhang Wenkang broke the general silence on the issue in a state-television interview, but he said the outbreak was "under effective control." State TV also said recently anointed Premier Wen Jiabao Wednesday called for measures to "eliminate the epidemic situation in a few areas at its roots."

There was some good news. Health Ministry officials agreed to nominate Chinese doctors to WHO expert teams, and have promised to provide the WHO with daily updates on a province-by-province basis on the progress of the disease, though there was no indication of when these might begin.

-- Karen Richardson and David Lague in Hong Kong contributed to this article.

Write to Peter Wonacott at peter.wonacott@wsj.com and to Susan Lawrence at susan.lawrence@feer.com and to David Murphy at david.murphy@wsj.com.

WARNING SIGNS

People infected with the SARS virus may experience the following symptoms:

High fever (greater than 100 Fahrenheit)

Dry cough

Shortness of breath or breathing difficulties

Changes in chest X-rays indicative of pneumonia

Headache, muscular stiffness, loss of appetite, malaise, confusion, rash and diarrhea may also occur

Source: World Health Organization

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