CHINESE BUREAUCRACY FAILED TO INFORM DOCTORS



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Last Updated

18 Mar 2003

Source: Wall Street Journal, March 18, 2003

HEALTH

Chinese Bureaucracy Blocked News, Failed to Inform Doctors

By PETER WONACOTT and LESLIE CHANG, Staff Reporters of THE WALL STREET JOURNAL

GUANGZHOU, China -- What did Chinese health officials know? And when did they know it?

As a new outbreak of a deadly respiratory illness claims lives and confounds doctors around the world, a reconstruction of the course of a previous outbreak in southern China during the past four months suggests that Chinese patients and hospital workers, travelers to China and international experts may have been left in the dark about the disease's dangers because of official reluctance to acknowledge a problem. Chinese authorities didn't disclose until mid-February that more than 300 cases of the mystery illness had occurred in China starting in mid-November.

World Health Organization officials said at a news conference in Beijing Monday that a team of experts is due to arrive in China by early next week to help investigate the new outbreak and the old one. Victims of both outbreaks show similar symptoms, but the cases can't be definitely linked because no causative pathogen has been determined. In the past few weeks, the latest outbreak has infected about 200 people in Asia, North America and Europe, killing at least nine people, and was declared a "world-wide health threat" Saturday by the World Health Organization.

WHO officials praised China for beginning to provide information about the disease over the weekend, but said that China so far has declined to share biological samples taken from patients, test results, or even details about patient treatment.

The flurry of activity contrasts with the silence and denials that have mostly constituted Chinese official reaction during the past four months, even as the illness has appeared in different cities, felled hundreds, and exhibited time and again its highly infectious nature.

In mid-November, the first two or three cases of patients coming down with the illness appeared in Foshan, a factory-filled city near Guangzhou, the Guangdong provincial capital. The cases were treated as a normal respiratory illness and weren't reported to higher levels, according to a recent account in the Sanlian Life Weekly magazine that was confirmed by Feng Liuxiang, deputy head of the Guangdong province Department of Health.

In early December in Heyuan, about 200 kilometers away, three patients were found to be suffering from a similar ailment, and seven or eight hospital staff were infected, according to Mr. Feng. The outbreak was investigated by a high-level delegation but again no information was shared with health departments across the province, even though it was clear the disease was highly infectious.

On Jan. 3, the Heyuan city newspaper even printed a statement from the local health bureau that "no epidemic disease is being spread in Heyuan. ... Symptoms like cough and fever appear due to relatively colder weather."

In the month that followed, the outbreak would affect many more. But there was no official statement about the illness and only occasional reports in local newspapers, which often aren't circulated outside their home cities. Chinese reporters in cities as far afield as Shenzhen and Shanghai say they were ordered not to report on the Guangdong cases. A reporter at one Shenzhen newspaper said that his paper received such orders even as his employer passed out Chinese herbal medicine to reporters fearful of contracting the disease

In mid-January, a patient in Zhongshan, south of Guangzhou, came down with the same atypical pneumonia, as it was being called here. About Jan. 30, in a district of Foshan called Shunde, more than 10 patients came down with it and were sent to Guangzhou for treatment. Not until Feb. 11 did the Guangdong provincial government give its first news conference about the illness, stating that five people in China had died and 305 people had been infected, a third of them health workers. Officials said the disease was under control.

At the Sun Yat-Sen Memorial No. 2 Hospital in Guangdong, descriptions of the battle against the illness last month suggest that most people had little knowledge of what had happened elsewhere in China. At least 45 people, patients and doctors, came down with atypical pneumonia, which they now believe was transmitted from one of the patients transferred from Shunde.

Women in the hospital's maternity ward were hit in mid-February, according to patients. One says that she contracted a high fever and dry cough around the time she gave birth to twin boys on Feb. 14. At about the same time, the ward's doctors and nurses started showing the same symptoms, according to the woman, who identifies herself only as Ms. Deng. Some were quarantined in a 17th-floor room of a building on the hospital grounds. Still, patients at other hospitals in the city weren't immediately quarantined and may have spread the illness, says one hospital official who spoke on condition of anonymity.

It is also clear that doctors were grasping for treatment methods with little guidance from the outside. "They tried vitamin C, herbal medicine, lots of things," says a doctor in blue-striped pajamas who was admitted to the ward a month ago after caring for a patient. "Nothing was that effective." Administrators at the hospital declined to comment on any cases, citing rules that the provincial government adopted for the media during the outbreak.

The inability of the Chinese bureaucracy to react quickly to fast-breaking crises isn't new. Overlapping and often competing departments within the government must consult and reach decisions collectively. A hierarchical tradition in which all but the highest-level officials are wary of speaking out of turn often causes an information vacuum.

And when bad news is involved, the government often waits until it can deliver the good news along with the bad news, the cure along with the illness. In this case, it meant months of official silence even as people sickened and died.

But new technology has ensured that information from other sources, often of questionable validity, now fills that vacuum. In the absence of detailed official information, rumors spread rapidly through the Internet and mobile-phone messages about a large number of deaths from an out-of-control epidemic.

During the Lunar New Year holiday in early February, short text messages that read "Fatal flu has broken out in Guangzhou" were transmitted through so-called short-messaging services via mobile phones across the country, spurring panic-buying of herbal medicines and home remedies in Guangdong and nearby provinces. Many people also got e-mails from unknown sources about the disease. So far, medical experts say, no evidence of influenza has been found in any of the cases.

Internationally, China's lack of openness on the outbreak has also fostered unease. The government didn't request help from the WHO in identifying the cause of the Guangdong cases until March 10, WHO officials said, four months after the first case was detected. Officials did host a delegation of WHO experts last month, both to assess the flu-surveillance network and to trace possible links between the pneumonia cases and avian flu, which they have deemed "unlikely." But the WHO team stayed in Beijing and received reports from Chinese officials about the situation in Guangdong rather than being permitted to travel there on their own.

A deputy director of the information office of the Ministry of Health in Beijing, who gave his name only as Mr. Deng, said the recent deaths from the outbreak of severe pneumonia "are not necessarily related to mainland China" and denied that the government was reluctant to bring in outside assistance.

In Guangzhou, the disease now appears on the wane. At the No. 2 hospital, patients in the quarantine ward suffering from atypical pneumonia now number 11, down from the peak of about 40 last month, according to patients.

-- Susan Lawrence in Beijing contributed to this article.