Now southern China, the world’s most efficient virus factory and ground zero for most of the globe’s influenza epidemics, is revving up for another cold and flu season. This year, though, SARS has lost the element of surprise. Health authorities are so intent on spotting signs that they’re getting skittish. When a Taiwanese man returned last month from a trip to the mainland running a fever, hospital officials put him in isolation. It was a false alarm. But most health authorities agree that a return of SARS this year is all but inevitable. In fact, one official at the World Health Organization lost a $64 bet when the disease hadn’t resurfaced by Nov. 18.
Such pessimism might seem surprising. After all, most health workers around the world dealt swiftly and effectively with last year’s pandemic. They showed how vigilance, responsiveness and good communication pay off when dealing with a global disease. The wild card this year is China. Of the 774 people who have died of SARS, three quarters lived in mainland China; if SARS is lying dormant, awaiting cold weather and the runny noses that come with it to make a comeback, China is the most likely starting point. How well has this vast country absorbed the lessons of SARS?
Chinese authorities couldn’t do worse than repeat last year’s performance. Even as SARS patients were inundating emergency wards throughout the country last winter, Beijing withheld information from WHO officials and forbade doctors and other health-care workers to talk publicly about the disease. Since then, “cooperation has been remarkably good,” says the WHO’s Beijing representative, Dr. Henk Bekedam. China’s leaders seem committed to preventing a new outbreak. The new Health minister, Wu Yi, impressed international health officials with her willingness to reform China’s woeful health-care system. To prevent the chaos that marked Beijing’s handling of the SARS crisis last year–authorities actually worked against the provincial hospitals by insisting that the new illness posed no threat–Wu worked closely with WHO officials to set up a new surveillance network. Three regional labs collect virus samples and track SARS cases with new software.
No doubt China is better prepared to fight SARS than it was six months ago. It’s probably also better equipped to fight influenza, AIDS, tuberculosis and other diseases. Last year’s SARS outbreak forced China to address weaknesses in its health-care system–particularly in research, monitoring and treatment–that should help it deal with other deadly diseases. That comes as a huge relief to the country’s long-suffering neighbors. “China is key in global influenza surveillance,” says Dr. Klaus Stohr, head of the WHO’s influenza team.
Improvements in data collection are helping China stop the flu and other bugs from migrating across its borders. In April, for example, the mainland cooperated with Hong Kong and Macau to build a reciprocal reporting system to track diseases. In June, officials in Guangdong province used this system to alert Hong Kong to a Japanese encephalitis outbreak. At a regional conference last month Chinese officials pledged more funding to strengthen international reporting systems further. They are also working closely with health experts to track Nipah, an even deadlier virus than SARS.
Scientists working on diseases such as HIV/AIDS say they have SARS to thank for new access to funding and state-of-the-art facilities. Dr. Shao Yiming, director of the department of virology and immunology at the Chinese Center for Disease Control and Prevention, expects funding for AIDS to increase twentyfold, in part because of the attention SARS has brought to public-health issues. Beijing has promised to build 20 to 40 new labs that meet inter-national safety standards, which–should the SARS crisis subside–could be used for AIDS research. “That’s a good trade-off,” says Shao, who recently received a $250,000 grant from the U.S. National Institutes of Health to help develop a SARS vaccine. “We help [fight] SARS first, and then SARS will help us.”
First, of course, China’s health experts must focus on preventing another SARS outbreak. China’s health-care system is still vastly underfunded. It doesn’t help that Beijing seems reluctant to concentrate its scant resources on high-risk areas, such as the south. Instead, it is taking on the entire country at once, even those places–like the sparsely populated west–that are unlikely to support a SARS outbreak. Making sense of information from the provinces won’t be easy, either. “China is a big country,” says the WHO’s Hitoshi Oshitani. “It’s not easy to set up a good system.”
A big challenge will be keeping the information about new infections flowing. Wu’s Health Ministry has issued guidelines to provincial hospitals designed to speed the reporting of SARS cases. She’s also given provincial administrators a dressing down for not taking the threat of SARS seriously. In a national teleconference on SARS prevention, she accused some local governments of having “lowered their guard, slackened efforts and developed the idea of leaving things to chance” in preventing a return of SARS.
Another concern is infection from lab samples. If a researcher could catch SARS in squeaky-clean Singapore, which happened in September, the more than 100 labs and hospitals in China thought to hold SARS samples may be disasters in waiting. Many of them are located in the provinces, where conditions are often unsanitary. WHO experts say Chinese officials have tried to track down these virus samples and explain to health-care workers the need to destroy them, or at least meet international standards of cleanliness and safety. But China won’t say how many samples are out there, which makes WHO officials nervous. They also worry that some labs will give up their samples only for cash.
Making an accurate diagnosis would help the effort to track a new SARS outbreak. Researchers have been working on a cheap and accurate diagnostic test but haven’t had much luck. Now they think a vaccine may be the best way of stopping the disease. One Chinese company claims to have developed a vaccine that works in monkeys, and plans to start clinical trials this month. Researchers at the University of Hong Kong will also begin testing a vaccine before the end of the year. Even if they work, they won’t be ready until next winter at the earliest.
One thing China hasn’t learned is that its eating habits–particularly the taste for freshly killed meat–might have to change. This winter the battle will be shaping up between China’s traditions and the world’s health.
