>>Barricading Against SARS - Life in China's Hardest-Hit Areas Transformed by Fear of Virus
By Philip P. Pan
Washington Post Foreign Service
Sunday, June 8, 2003; Page A01
ON ROUTE 110 OUTSIDE XINBAIMIAO, China -- The corn farmers were dressed in camouflage and sitting in the dark on the side of the road, their unshaven faces barely visible in the dim light cast from the doorway of a small shack. When a jeep tried to turn off the highway, they jumped up and ran into the road to block it.
"You can't go this way," shouted Qiao Pingjia, 52, a burly fellow waving a stick with a piece of red cloth tied to one end. This was the way to Xinbaimiao village, he said, and visitors were no longer welcome. Spurred to action by village officials, residents had set up 24-hour checkpoints to keep out people who might be carrying the SARS virus.
"We won't even let our relatives in," said Lei Quebiao, 53, another farmer watching the road from the village to Route 110, a potholed highway that stretches across the Chinese province of Inner Mongolia. "We're afraid," he said. "We're afraid of dying."
Throughout northern China, where severe acute respiratory syndrome has infected and killed more people than anywhere else in the country, people have answered the ruling Communist Party's call to wage an all-out war against the epidemic. A four-day, more than 600-mile drive from Beijing through the hardest-hit provinces revealed a region on alert, where ordinary life has been transformed as much by the government's campaign against SARS as by fear of the disease itself.
From the parched fields of Hebei and the coal towns of Shanxi to the grasslands of Inner Mongolia and the port city of Tianjin, the journey also highlighted one of the Chinese Communist Party's enduring strengths. Though it enjoys fewer controls over society than ever before and has transferred power from Beijing to the provinces, the party can still organize a mass political campaign that reaches deep into the hinterlands and snaps people into action, in this case to crush a virus.
The highways are dotted with roadblocks, where police officers wearing hospital gowns stop every motorist, record their names and numbers, then spray their vehicles, inside and out, with pungent disinfectants. Medical workers check every traveler's temperature, usually with a gadget that takes a reading by beaming a laser at a person's forehead. Those found to be running a fever are confined to isolation booths at the side of the road until an ambulance arrives.
In many cities and towns, authorities have suspended classes, closed restaurants, shut down shops and strung red banners urging the masses to "join the battle" against SARS and treat it as a "great political task." The party has directed its vast apparatus of informers, loyalists and bureaucrats to do whatever it takes to identify and isolate people with symptoms of the disease.
Driven by political zeal as much as fear or vigilance, local officials have sealed off villages, apartment complexes and university campuses, quarantined tens of thousands of people and set up "fever checkpoints" at train terminals, bus stations and hotels.
Officials in Tianjin and Hohhot, the capital of Inner Mongolia, followed Beijing's lead and raced to open new SARS hospitals, completing the single-story structures in less than three weeks. In Hebei's Xuanhua city, officials even diverted public buses away from neighborhoods with hospitals with suspected cases.
The approach may seem excessive, but it appears to be working. Doctors and nurses at more than a dozen hospitals, speaking without local officials present, described a steady decline in infections in the region, and said they had seen little evidence of an extensive coverup like the one attempted in Beijing. Interviews with journalists, local officials and residents along the route also supported the conclusion that the nightmare of a widespread outbreak overwhelming the fragile health care system in China's poor, interior provinces has not been realized.
"The peak is over," said Li Peiwen, a senior physician at the No. 2 Hospital in Fengzhen, located in Inner Mongolia near the border with Shanxi. "The disease is coming under control."
China reported one new case of SARS on Friday, and two deaths. There have been 5,329 SARS cases in the country and 338 deaths, more than anywhere else in the world. While 2,500 of the cases occurred in Beijing, a city with a population of about 13 million, the provinces around the capital, with a combined population of more than 130 million, have reported only about 1,100 cases.
Doctors said the virus may have spread less quickly through the provinces because they are not as densely populated, and people travel less. It also has been easier to isolate patients and ensure good ventilation in older, simpler hospitals in the provinces than in more modern hospitals with air conditioning systems, said Dan Sermand, who heads a Doctors Without Borders team helping train medical workers in Hebei's Zhangjiakou city to contain the illness.
But Sermand and others warn that it is too early for China to let down its guard. While the Communist leaders have demonstrated an ability to spur people to action in even the most remote villages, it may be difficult for them to sustain such a state of high alert for an extended period of time.
Outside Xinbaimiao village, as the farmers spoke with the occupants of the jeep, a truck and a motorcycle slipped past them and disappeared into the darkness.
Villages Off Limits
The sign above the dirt road said, "The Villagers of Dongganzhuang Welcome You." But three men blocked the way with a wooden pole and refused to let anyone through.
Located about 80 miles northwest of Beijing, Dongganzhuang was the first village in Hebei province to report a SARS case. A resident who had sought medical care for the illness in Beijing returned in late March. By mid-April, he was dead, and his wife, son, daughter, son-in-law and another in-law were running fevers, a relative said.
Then, soon after Beijing acknowledged the epidemic and launched the campaign against it, local authorities declared a quarantine of the entire village, population 1,174. Residents interviewed at the entrance to the village said they had been confined to their own fields and homes, and forbidden from getting together even to play mahjong. Party officials arranged for food and water deliveries.
Three weeks later, the quarantine was lifted, but village officials decided to keep Dongganzhuang off-limits to outsiders. "We're afraid of people bringing in the virus," said one farmer, who asked to be identified only by his surname, Yu.
Similar measures have been adopted throughout northern China. Residents said they were acting both to protect themselves and to carry out orders from party-controlled village and neighborhood committees.
"If I let you in, I'd be letting the people down, and the village committee down," said Kang Zhaizhong, 46, a farmer who had blocked the entrance to nearby Santaizi village with a pile of sticks and stones.
About 20 miles farther northwest, in the city of Zhangjiakou, party officials were paying retirees about $1.25 per day to watch the entrances of their apartment complexes and keep out strangers. Local officials also quarantined 4,000 students, teachers and staff at a college after a student returned from a job fair in Beijing with the illness and infected nine classmates. And construction on a massive housing complex was suspended for 20 days after six new hires were found to have fevers.
"Our rule now is that workers can't leave," said Wang Jinping, a manager designated to head anti-SARS efforts. "They work, they go to the dormitories, and that's it. They can't leave the site."
On television, newscasters spent five minutes every night reading the names of city residents who had donated money to fight the virus. Television stations also aired bulletins from police officers searching for two cabdrivers who had picked up a migrant worker later diagnosed with SARS.
In the Xinhuayuan apartment complex, the city's largest, party activists in all 26 buildings were asking residents to check their temperatures daily and snitch on neighbors who had traveled out of town or developed coughs, so they could be isolated.
"If a neighbor returned from a trip, I would definitely report him," said barber Wang Yaping, 36. "It's the responsible thing to do."
Tianjin's Success
At the Health Department in Tianjin, a city of 10 million located just east of Beijing, everyone's temperature is taken at the door. In a second-floor conference room, the city's deputy mayor, Zhang Junfang, described how the city avoided a major outbreak.
Newly appointed and responsible for health issues, Zhang had gone to Beijing for a courtesy call on her superiors at the Health Ministry.
But the visit took place on Feb. 11, the same day a team of investigators returned to the capital with a report on a mysterious outbreak of atypical pneumonia in southern Guangdong province.
Zhang declined to say in an interview exactly what she was told about the disease. But when she returned to Tianjin, she said, she was alarmed enough to order health officials to prepare a plan for dealing with the outbreak of a new infectious disease.
Most local officials in China waited until late April to take action against SARS, but Tianjin began mobilizing in February, well before even Beijing.
"We were more sensitive to the issue," said Zhang Yu, director of the city health department, explaining the impact of the meeting in Beijing. By the time the first case appeared in Tianjin in mid-April, he said, officials had already designated two hospitals for the disease, briefed doctors across the city, established emergency procedures for quarantines and trained 300 medical investigators on how to trace the path of a virus and isolate it quickly.
That first patient, who contracted the virus in Beijing, still managed to pass it directly or indirectly to 163 people in Tianjin, many of them medical workers who underestimated the infectiousness of the disease. But by moving quickly to identify and isolate people who had been in contact with him, the city managed to prevent a widespread outbreak.
Tianjin has reported only 175 confirmed cases, compared with the 2,500 in neighboring Beijing. In addition, investigators have figured out how 97 percent of Tianjin's SARS patients contracted the virus, while Beijing has been unable to identify the source of infection for about half of its patients.
As in other localities, Tianjin directed a vast network of party activists to set up "fever checkpoints" and monitor residents for symptoms. But officials and doctors said the city succeed in limiting the spread of SARS largely because it began preparing early.
Residents in the gritty mining town of Qingxu, about 270 miles southwest of Beijing in Shanxi province, were not so fortunate.
Hou Gaihua, chief of epidemic prevention in the county, said she and her colleagues were unprepared when a local Communist Party official returned from Beijing with the virus in March.
"In the beginning, we knew nothing about SARS," she said. "We didn't know how dangerous or infectious it was. We didn't even wear masks or protective clothing."
And when she tried to quarantine friends and relatives of the party official, "they just wouldn't listen to us," Hou said. Now, at least 17 of the party official's friends and relatives have been infected, and his driver and his driver's wife died.
After the party declared war on SARS, though, the situation improved. Hou's staff has doubled, and residents are more cooperative, calling her office with tips about people with symptoms and readily obeying quarantine orders.
"Everyone is alert now," Hou said. "But I'm still worried. It seems to be under control, but what if it comes back?"<<
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