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Last Updated

28 Mar 2003

Source: Wall Street Journal, March 28, 2003


A Mystery Illness Spreads In Asia, and So Does Fear

Hong Kong Travel Plans Are Canceled; Authorities Tell Residents 'Avoid Talking'


HONG KONG -- An ambulance pulled onto the sidewalk in front of Block E of Amoy Gardens, a concrete high-rise housing complex in a crowded neighborhood. As the siren stopped, four men wearing masks and transparent plastic uniforms jumped out and raced through the front door. Several minutes later they emerged escorting a Chinese family: an elderly woman, a boy and two young women, one of them in a wheelchair clearly frightened and in distress.

"They've got the symptoms," said a medical technician as he steered them past a few anxious residents wearing surgical masks. "We're taking them to the hospital."

Hong Kong is a city suddenly gripped with fear. An outbreak of a mysterious pneumonia, which has jumped from person to person and spread around the world on airplanes, has turned a self-confident metropolis into the epicenter of a potential global health crisis.

Many people walking Hong Kong's crowded streets wear surgical masks. Television talk-show hosts and their guests wear them on the air. The Rolling Stones, who were scheduled to play at a concert tonight, have canceled.

And the proverbial uncomfortable silence of elevator rides is now official city policy. Authorities have told residents to "avoid talking" and to wear masks on elevators.

Since November, there have been more than 1,400 reported cases of Severe Acute Respiratory Syndrome, or SARS, in 14 countries. More than 50 people have died, including 34 in China, 11 in Hong Kong and a handful each in Singapore, Vietnam and Canada. So far, 51 cases have been reported in the U.S. but no deaths. All but seven of the U.S. patients are believed to have caught the disease while traveling to Asia.

"As outbreaks go, this is not rampaging," says Chris Powell, a spokesman for the World Health Organization. Compared with influenza, the number of deaths caused by SARS is insignificant. In the U.S. alone an average of 36,000 people succumb to the flu each year.

But SARS shows how, in a time of routine global travel and instantaneous information, the outbreak of a serious disease can quickly set off world-wide alarms. SARS may have economic implications as well. Analysts have begun issuing gloomy reports about the effect SARS already is having on Hong Kong's tourism and retail industries.

The first known outbreak was in China's southern Guangdong province, which abuts Hong Kong. Early cases weren't noticed by world-health authorities and went unreported by China's tightly controlled state-run media. But by early February, word of the pneumonia began appearing on Chinese Internet sites. Soon after, the provincial government announced that the outbreak was under control.

It wasn't. Liu Jianlun, a Guangdong doctor, traveled to Hong Kong for a wedding in late February just as he was coming down with the symptoms, which include high fever, muscle aches and shaking chills, followed by coughing and labored breathing. While staying at the Metropole Hotel, Dr. Liu spread the virus to seven other people who carried it with them to Vietnam, Canada and Singapore. Most of the cases outside mainland China have been traced to Dr. Liu, who died earlier this month.

Microbiologists at the University of Hong Kong announced Thursday that SARS is caused by a previously unknown member of the family of viruses known as coronavirus, which also causes the common cold. They suggested changing the name of the new disease to Coronavirus Pneumonia, or CVP. But Thursday, the U.S. Centers for Disease Control and Prevention announced that it was holding off making a definitive decision about the pneumonia's cause, even though "the preponderance of evidence is consistent with coronavirus playing an important role," said James Hughes, director of the CDC's National Center for Infectious Diseases.

What is understood so far about the disease is that it can be caught by people of all ages, probably through inhaling respiratory droplets from those who already exhibit symptoms. Doctors have been treating patients with the antiviral drug ribavirin and steroids in an attempt to beat back the disease. After about seven days, 80% to 90% of patients begin to improve. Another approximately 10% get worse and require a respirator to help them breathe. The death rate appears to be hovering at about 4%, according to virologist Klaus Stohr, director of the influenza program of the WHO in Geneva.

It may be too soon to determine whether people who don't die suffer lasting problems, but it appears that at least some may have permanent lung damage. In Hong Kong, about 20 patients have been released from hospitals and doctors expect them to make a full recovery.

China's sudden announcement this week that it has twice as many cases -- and more than twice as many deaths -- as previously reported has sent a jolt of panic and anger through the region. Many now believe that China's efforts to conceal the extent of the outbreak was driven by a desire to preserve the massive flows of foreign investment and tourism that buoy its economy.

Quarantine Orders

In Hong Kong and other parts of Asia, officials are calling for calm. But at the same time they are issuing quarantine orders. Business people are canceling travel plans, and there's been a run on surgical masks. The upshot: an atmosphere reminiscent of the polio scare in the U.S. in the 1950s, and also of the anthrax scare 18 months ago, during which a relatively small number of incidents left the entire country on edge.

In Hong Kong, many bus drivers and office workers now wear protective face coverings, usually paper masks. Many people who haven't been able to find masks in drugstores or surgical supply houses resort to holding tissues in front of their mouths as they make their way through Hong Kong's crowded, noisy thoroughfares. Managers are encouraging employees to work from home. They are asking workers to report any contacts they have with people who have the disease and to stay home if they feel ill. Companies in the U.S. and elsewhere are discouraging travel to China and other areas affected by the malady.

Cathay Pacific, Hong Kong's major airline, is checking all passengers at the airport and refusing to allow anyone who looks sick aboard its planes. The WHO on Thursday called on airlines to screen all travelers from areas significantly affected by the virus. The organization urged airlines to ask passengers whether they had symptoms including high fever or a dry cough.

Daily Checkups

On Thursday night, Hong Kong Chief Executive Tung Chee Hwa ordered schools closed for a week and invoked a colonial-era quarantine law originally imposed to fight an outbreak of plague in the 1890s. As a result, starting Monday, more than 1,600 people who have had contact with SARS patients will have to submit to 10 days of mandatory daily medical checkups. They will be required to spend the rest of that time at home. If they refuse, they can be fined or sentenced to six months in jail.

In Singapore, where two people have died of the disease, the government has ordered 861 people who might be infected into quarantine -- with stiff penalties if they don't comply. Schools ranging from daycare centers to junior colleges have been closed in an effort to prevent panic. That's left parents of some 600,000 schoolchildren scrambling to make care arrangements. Parents are being told not to allow their children to congregate in shopping malls. In Hanoi, some children of people suspected of being exposed to the disease have been shunned at school.

Business travel to Hong Kong has plummeted. One local textile and furniture company owner says 80% of the foreign executives who had been scheduled to travel to Hong Kong this week to see his company's staff have canceled their trips.

Morgan Stanley this week said that Hong Kong could lose more than $250 million in tourism revenue over the next two months. The scare comes at a bad time, with the war in Iraq already frightening some travelers and the city's economic outlook clouded by fiscal tightening. Singapore government officials said Thursday that about 9% fewer visitors arrived in the city-state in March, compared with a year ago. Singapore's tourism industry accounts for about 10% of its gross domestic product.

The E Block Outbreak

On March 18, cameramen and news reporters crowded into a conference room for a briefing from Hong Kong health authorities. The officials assured reporters that while cases among hospital staff were increasing, there were no signs of an outbreak in the wider community. Five days later one of the officials, Dr. William Ho, chief executive of the city's Hospital Authority, came down with the disease himself. He had been visiting staff and patients at hospitals hit by the disease in an effort to boost morale.

What is unfolding at Amoy Gardens may represent a grave turn in the spread of the disease. Most cases that have popped up over the past few weeks have been among health-care workers infected by a small number of patients. Now "it's out there in the community," says Tom Buckley, a physician treating cases at Hong Kong's Prince of Wales Hospital. The outbreak in Block E is believed to have started with a man who visited a sick relative at that hospital. This week, he and others from the 36-story apartment building began showing up at hospitals with pneumonia.

On Wednesday, teams of doctors and nurses wearing protective gear descended on the building, going door to door. They asked residents about their health and left behind leaflets urging them to call as soon as they developed a fever or experienced other SARS symptoms.

By the end of the day Wednesday, officials announced that five families who lived on four floors of the building were believed to have contracted the disease. The family taken away by ambulance Thursday lived on yet another floor of the building.

Mask Culture

In Hong Kong a mask culture has cropped up in the course of a little more than a week. On Wednesday the entire stock of thousands of masks at one drugstore was cleaned out. Some customers bought hundreds at a time. On a busy walkway in the city's Wanchai district, a hawker was doing brisk business selling pink and blue masks with Bambi and teddy bear logos on the front. He said he'd sold 70, at $1.30 a piece, in half an hour.

"My kids don't want to wear them," said Petronila Mejia, forking out money for two. "With cartoons on them, they might change their minds."

The situation raises odd questions of etiquette. Businesspeople are having a hard time deciding whether wearing masks puts customers more at ease or frightens them off. Many restaurant staffers are wearing them, although most restaurants have seen a sharp drop in business. Some cab drivers are not donning masks for fear they will frighten away fares. Instead they leave their car windows rolled down.

Hong Kong residents are fast becoming mask experts. Cheap paper and gauze masks are giving way to "N95s," special masks better at blocking viruses than routine surgical masks and form-fitting varieties featuring valves. A clinical care physician trying to buy the top-of-the-line N100s was dismayed to learn that 10,000 were shipped to Iraq.

Many tourists arriving in Hong Kong this week were shocked at the extent of the panic. Raul Teixeira, a liquor-store owner from South Africa, says he talked to his doctor before he left for Hong Kong Thursday. His physician had told him not to worry about the virus. But when he and three business associates got off their nearly-empty Cathay Pacific flight in Hong Kong, "we got very scared," Mr. Teixeira says. "All the passport control officers were wearing masks."

-- Margot Cohen in Hanoi, Richard Borsuk in Singapore, Betsy McKay in Atlanta and Marilyn Chase in San Francisco contributed to this article.