SARS Spread Still Mystery in Beijing
Most cases have no clear transmission route, health officials say
By Laurie Garrett
Staff Correspondent
May 9, 2003, 1:38 PM EDT
Beijing -- Health officials publicly acknowledged Friday that they do not know how the majority of SARS infections in the Chinese capital are occurring, and one of the World Health Organization?s top officials said it ?is impossible to say? whether the Beijing epidemic has peaked.
For several days Beijing?s leaders have insisted that the epidemic appears to have peaked, and may be on the decline. Wednesday and Thursday, new case reports numbered 94 and 97, in line with the roughly 100 daily new cases of the past two weeks. Friday the numbers of newly confirmed cases fell to 48 confirmed cases and two deaths. Nationally China reported 118 new cases Friday and six deaths.
What is frustrating health officials here is that the majority of new cases are not associated with hospitals, which means people in this city are acquiring their infections somewhere else. But where?
In the earlier stages of the Beijing epidemic about a third of all infections involved health care workers, and the wards of the city?s hospitals are full of ailing doctors and nurses. But Beijing has worked hard to improve infection control standards inside hospitals, consolidate SARS patients in designated facilities, and provide doctors and nurses with top of the line protective gear. The efforts are paying off, Beijing Propaganda Chief Cai Fuchao said in a news conference, because on Wednesday and Thursday only four of each day?s new SARS cases were health care workers.
?One thing is for sure,? the city?s top epidemiologist Dr. Liang Wannian said in a news conference, ?apart from hospitals there are other sources of infection in society ... Forty percent of new cases are in our control, under medical observation or in quarantine. For the rest of the cases we do not know who they are, or how they got infected.?
It is possible Beijing is rife with situations akin to the now notorious Amoy Gardens outbreak, in which more than 300 residents of a single apartment complex came down with SARS. The 60 percent unsolved cases currently are considered ?sporadic?, as if they spontaneously, out of nowhere, caught SARS. But in Singapore, Hong Kong, Vietnam and China?s Guangdong province the epidemics were clearly characterized by clusters of connected cases, usually beginning with one highly infectious individual who passed the virus to dozens of others.
So far, Beijing has not identified any clusters outside of the hospitals, and labels the 60 percent unsolved as sporadic. To ensure the ?sporadics? do not cause ?clusters,? Wannian said 2,500 disinfection workers have been deployed citywide to scrub down the homes of confirmed SARS cases.
The government?s inability to say where the majority of Beijing?s SARS cases are coming from is frustrating WHO representatives here. Leading the WHO team is Dr. Henk Bekedam, who on Thursday told Beijing?s mayor that, ?we are not at all satisfied with the current analysis. You need to focus on these sporadic cases. You have to find out how they are getting the diseases. You might have an Amoy Gardens here and you can?t do anything unless you figure out what is going on with your sporadic cases,? Bekedam recalled in an interview Friday.
World Health Organization Director General nominee, Dr. Jong-Wook Lee, flew into Beijing on Friday, met with Minister of Health Wu Yi and the Minister of Foreign Affairs, and then flew on to Geneva last night. In two weeks Lee, a South Korean physician, faces a perfunctory confirmation vote from the World Health Assembly, and he will take over as Director General of WHO in July. After meeting with Wu for nearly 90 minutes Lee spoke briefly with a handful of waiting journalists.
Lee described the talks with China?s Ministry of Health as ?very frank?, but noted there were serious shortcomings in China?s understanding of its still-evolving epidemic.
?Right now the only way to deal with this problem is to find the source of the infections,? Lee said, adding ?reliable information is very important for that.?
?We don?t know yet,? if Beijing is past the worst of its SARS epidemic, Lee said. ?It is too early to tell if this epidemic has peaked or not peaked?Everybody is now trying to analyze the data and make sense of it.?
China desperately needs affirmation from WHO that it is on the right track. Without it, China?s economy will continue to reel from international fears of contact with the SARS-hit nation. As of yesterday 109 countries had imposed travel restrictions on China, and Beijing was an island, isolated from the rest of its country by roadblocks and travel barriers.
Copyright © 2003, Newsday, Inc.
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