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Outbreak: What happened when the previously unknown SARS virus flew around the world

Author: Laurie Garrett, Senior Fellow for Global Health
April 9, 2006
The Washington Post

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China Syndrome
The True Story of the 21st Century’s First Great Epidemic
HarperCollins. 442 pp. $25.95
By Karl Taro Greenfeld


Shortly before Easter of 2003, I took a nearly empty jumbo jet flight to Tokyo, landing in the usually cacophonous Narita Airport. The massive concrete terminal was almost deserted. My footsteps issued eerie echoes that bounced back so loudly that initially I thought someone was following me. While waiting for my connecting flight I noticed that people averted their eyes from one another. A nervous electricity filled the air.

When the PA system announced my connection to Hong Kong, a bizarre thing happened: Everybody in sight—not just the people boarding—reached into their bags, withdrawing masks and placing them carefully over their noses and mouths. Even 1,700 miles away, the words “Hong Kong” inspired presumably rational human beings to don everything from huge gas masks to tie-on cotton affairs; those lacking official gear wrapped kerchiefs or scarves around their faces. As I boarded my nearly empty aircraft, alarmed flight attendants, barely audible through their N-95 facemasks, asked why I was not also wearing protection. I thought they were nuts.

And so I had a divine flight, with an entire section of Business Class and an abandoned food/liquor cart all to myself. Nobody anywhere in Asia wanted to be around a mask-less passenger during the SARS epidemic.

As the world braces for a possible influenza pandemic, it is wise to recall what happened when a previously unknown virus surfaced in China in November 2002, sparking an outbreak of Severe Acute Respiratory Syndrome (SARS). Though most American soon forgot SARS, for many Asians and Canadians the period from November 2002 to June 2003 remains as starkly memorable as the date 9/11 for residents of Washington and New York. And it has had a profound impact on the world’s conception of disease: SARS, which infected just over 8,000 people within a few months of being identified in China, was the first previously unknown microbe to jump rapidly from continent to continent on the pathways of globalization.

When the virus first broke out in China’s southern Guangdong province—covered up by orders of the Chinese Communist Party—Karl Taro Greenfeld was living a couple of hours’ train ride away in Hong Kong. As the young editor of Time Asia, Greenfeld had worked all over the region for years and authored two popular books, including the bestselling frolic across Japan, Speed Tribes, and had been put in charge of a team of veteran Asia hands.

The Time staff’s efforts to cover the SARS epidemic is one of three reasonably well-integrated tales that make up China Syndrome. The others are the story of a new virus and its scientific pursuit, and the Chinese government’s attempts to prevent the world from knowing what was happening. Greenfeld—who currently works for Sports Illustrated—is a compelling writer, and China Syndrome echoes the sort of gritty, breathless thriller pace that Richard Preston employed 10 years ago in The Hot Zone. Here is Greenfeld’s description of potential contamination in the restaurant district of Shenzen:

“One night, when several of the chefs and chop boys were sitting around on the back steps, passing back and forth a jar of grain liquor, Chou Pei looked at Fang Lin.

“‘You’ve got blood on your face,’ he said.

“Fang Lin reached up with his hand and rubbed his cheek.

“‘Other side,’ Chou Pei pointed out.

“Fang Lin tried the other cheek…The entire side of his face, in fact, was covered with some animal’s spilled guts.

“He shrugged and wiped the blood and guts off with his T-shirt…This wasn’t the first time the chop boys had gotten animal blood in their eyes or noses or down their throats. But what did it matter? Who had ever been harmed by the blood of a few wild animals?”

The easiest of the three tales for Greenfeld to tell is that of Time’s coverage. The magazine’s Beijing reporters, Susie Jakes and Huang Yong, put themselves squarely in the middle of a Chinese political hotbed in a way that could well have gotten them deported or jailed. Beijing authorities were telling the World Health Organization that there was no SARS in the nation’s capital while secretly shuttling patients around in the dark to hide them from WHO investigators. Meanwhile, the Time team met with Jiang Yanyong—a lifelong Communist Party member and military physician who is probably the ultimate hero of the SARS epidemic. Knowing that he was risking his life, Jiang leaked details of the hidden patients’ whereabouts to the reporters, and Jakes passed information on to WHO. It was dangerous work all around, and though Jiang was briefly hailed in China, his status was highly controversial inside the Communist Party. Jiang’s subsequent release of details regarding the 1989 Tiananmen Square massacre landed him under house arrest for more than a year, and to this day his every movement, phone call and letter are monitored by the state.

China Syndrome does not, sadly, delve into Jiang’s story in detail (though, in fairness to Greenfeld, it has been impossible to talk to him since his house arrest). Readers will also be hungry to know more than Greenfeld provides about the personal insights, fears and motivations of Jakes and the beer-swigging, chain-smoking Huang Yong. (If Johnny Depp were Chinese, he could play Huang in the movie.)

In recounting the tale of SARS and the scientists who chased it, Greenfeld produces helpful, accurate background on everything from how viruses are isolated from tissue samples to methods for proving who passed his virus on to someone else. But in his attempts to give a novelistic verve to the hunt, Greenfeld makes some sorry choices regarding his characters. Some individuals are portrayed in overly glowing lights; some genuine heroes get a nasty drubbing. In particular, I take issue with his portrayal of three University of Hong Kong scientists: Malik Peiris, K.Y. Yuen and Guan Yi. The three produced what, to this day, represents the finest SARS science in the world. But Greenfeld drives a wedge into the trio, making Yi seem an indefatigable, eccentric genius whose efforts were nearly thwarted by the jealous, malicious machinations of Yuen and Peiris. It is an inaccurate and unfair portrayal.

The third tale, that of Chinese government and Communist Party intrigue, is the most complex. It is extraordinarily difficult for foreigners to penetrate the corridors of power in the People’s Republic. But China-watchers will find plenty of juicy political morsels in China Syndrome. Greenfeld got his hands on some amazing Chinese documents, and he elegantly explores the feuds and deceits both inside the Communist Party and within the government.

Today, as the deadly H5N1 flu virus spreads, the whole world prays that China’s leaders have learned from their SARS mistakes. Hopeful signs have included a remarkable new openness regarding HIV/AIDS in China and vigorous efforts to control any further spread of that virus while offering treatment and battling the stigma against those who are infected. In September, Chinese President Hu Jintao and President Bush jointly issued a declaration of pandemic principles, calling for complete transparency and global cooperation in the face of deadly microbial threats. But since then it has been revealed that the Chinese were withholding samples of influenza virus taken from infected birds and probably covering up some human H5N1 cases, even deaths. That originally cooperative spirit may be breaking down—and that is a dangerous sign.

The 1979 Jane Fonda movie that inspired the title of Greenfeld’s book portrayed the potential meltdown of a single nuclear power plant. Given the vastly larger number of deaths that could be expected from a virulent global pandemic, the original China Syndrome threat seems almost trivial.

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