The never-ending adventures of a travel writer in Vietnam, Cambodia, New Zealand and throughout the Asia-Pacific region.

Saturday, March 1, 2008

SARS & Vinegar

The Untold Story of Mainland China

In early 2003 the world watched anxiously as the SARS (Severe Acute Respiratory Syndrome) epidemic erupted in Hong Kong and Guangdong province on the Chinese mainland. Cases soon popped up in Beijing, Toronto, Hanoi, Taiwan and elsewhere. The cause and even the means of transition was a mystery. My mother and I were nervous as we followed the latest news. We were planning to visit my brother in April, while he was teaching English in Sichuan province.

Despite Dr. Jiang Yanyong’s highly publicized open letter detailing Beijing’s under-reporting of the official number of SARS cases and subsequent deaths, we were fairly optimistic. We would only be in Beijing for a couple of days and then fly to Chengdu, the capitol of Sichuan, which was far from the effected areas. My mother was a nurse, and I had worked in NIH funded primate labs, so we understood how good hygiene and basic precautions can prevent the transmission of most illnesses. We knew we would be alright if we were careful, and besides, we were armed with several boxes of trusty surgical masks, gloves and handy wipes.

We arrived in Beijing on April 16, the same day WHO confirmed a previously unknown form of coronavirus was the cause of SARS. We didn’t meet any other foreigners in the city. By this time, tourists had fled the country and groups like the Peace Corps were evacuated. The only news coming out of China was from Hong Kong or Beijing. Most foreign news agencies were covering the story from outside the country. Typical tourist spots like Tiananmen Square, the Forbidden City, Wang Fu Jing Street, and the Pearl market were deserted. Many Beijing residents wore dirty, disposable surgical masks, not realizing it was necessary to actually change them from time to time, to avoid contamination.

My brother met us in Chengdu a couple of days later, and we traveled a few hours away to visit his school in the countryside. On April 20, while we were in Sichuan province, there was a major shake-up in Beijing. China’s health ministry raised its official number of confirmed cases by 300 individuals. China's health minister and the mayor of Beijing were fired from their jobs and removed from their Communist Party posts due to their handling of the epidemic. The central government also canceled the week-long May 1 International Workers’ Day holiday for the entire country. It was done in an effort to discourage travel, and thus prevent the spreading of the disease to inner provinces. Such sweeping measures and candid response to the SARS threat suggested the direness of the epidemic. It was unsettling, but still seemed far away from us in Sichuan.

On April 25, we drove up to the Wolong Panda Reserve in the mountains, about 3 hours from Chengdu. I was looking forward to getting my picture taken while holding one of the Pandas (yes it’s shameless, but this is the only place on the planet where you can do it) but we were told that human contact was prohibited now due to SARS, and the red pandas were taken off display entirely. That day the official SARS count jumped by 125 cases, and an entire hospital in Beijing was quarantined.

Afterwards, we set off for Lijiang city in Yunnan province. Although the May holiday was canceled and classes continued, my brother was still given the week off from teaching, allowing us to travel without experiencing the typical holiday crowds. We were happy to visit a remote area and escape the SARS hysteria that was brewing. The overnight train ride from Chengdu to Lijiang offered great scenery, although it always seemed to be through the opposite side of the train. The bus ride on April 27 to Lijiang, was a hellish mix of over-amplified karaoke; flying luggage; and driving way too fast through hairpin, cliff-hugging mountain roads.

It was on this last bus ride that we discovered the SARS epidemic had suddenly gotten much more serious. Several of the other passengers coughed constantly. One woman seemed seriously ill and appeared to have a fever. Even worse, everyone had a habit of spitting right in the aisles (in China, spitting is such a problem that some cities have begun enacting laws against it). We kept our face masks on nice and tight and prayed we’d get to Lijiang soon.

The bus stopped every thirty minutes at makeshift checkpoints. We were ushered off to wait while health workers in contamination suits sprayed down everything inside the bus—including the seats and our luggage—with diluted vinegar. We asked someone what was going on and they merely replied, “because of SARS.” Apparently it was hoped that vinegar would work as an effective disinfectant and kill the virus. It was a small comfort that the government thought sitting in a cold puddle of vinegar might be all that stood between me and some SARS carrier spitting loogies in the aisle.

We arrived in Lijiang that afternoon and learned that the government had just closed all but two hotels in the city to tourists (which were themselves government-owned), as a way of managing the SARS outbreak. There were also rumors that the local hospitals were full of SARS patients.

When we arrived at the hotel, we were told that our temperature must be taken before we could check in. Then when we got to our room, we found the carpet was soaked with vinegar, and there were puddles of it in the bathroom. It was more “SARS decontamination,” we were told by the hotel staff.

My first priority now was to find internet access. I scoured the old quarter for an hour, looking for an internet café. Normally the area is bustling like Disney’s Epcot Center, with mobs of tourists wandering through the souvenir shops and restaurants. Today it was a ghost town. No sooner did I find a café and sit down at a terminal, and I was told that the police shut down all internet cafés nationwide, until May 8, for reasons of “national security.” News reports on national television that night later confirmed the shut-down. It was an effective way to limit unofficial communication about the epidemic.

I met a Canadian man sitting in the café. He told me he was an English teacher in Lijiang, but his school ordered him to leave over fears of SARS. He was determined to wait it out instead, and was secretly staying with friends, hoping the epidemic would soon blow over and he could go back to work.

The next afternoon my brother and I caught a bus to Qiaotou, the starting point to hike the Tiger Leaping Gorge. We were stopped several times for more vinegar showers, but at Qiaotou there was a mandatory temperature and passport check. I glanced at the temperature lists on the officer’s desk, curious because so many people on the bus were coughing, and noted numerous entries for 38 °C (100.4 °F) or more—the most consistent symptom of SARS. Oddly, no one was detained for further diagnosis. Was it just an empty exercise? Were officials so overwhelmed by potential cases way out here in the countryside that they didn’t bother to follow up?

The officer said we couldn’t go into Qiaotou, not because of our temperatures, but because we’d been in the immediate area for less than 2 days and should remain under quarantine for a few more days, to be sure we showed no symptoms. Noting that we were in one of the most remote areas in China now, we were concerned that “quarantine” could mean being left on the side of the road. Fortunately a young, bilingual Chinese man helped us provide all the “right answers” to get us through the checkpoint and on our way to Qiaotou again.

A few days later, after our wilderness adventure, we flew on to Kunming and then Chengdu. At each airport and hotel we submitted to more thermometers. When we finally returned to my brother’s school, we had the worst surprise of all. We were told that the town officials enacted a new regulation while we were away to manage the outbreak. Now anyone entering the town had to submit to a mandatory health exam at the military hospital. We went very reluctantly—especially concerned about the possibility of coming in contact with SARS patients at the hospital.

The hospital was filthy. Dirt was caked on the floors and walls. There were rusty doorknobs, leaky pipes, exposed wires and puddles of mystery liquids. I saw a child drop his pants and defecate right on the floor. There was medical waste—bloody Q-tips, cotton balls, razor blades and used needles--laying on the floors and counter tops.

First a lab tech told me to put a thermometer under my arm. I was relieved. That was easy. When it came to the blood test, I was terrified. The tech assigned to this task was an older, hefty, battle-axe of a Chinese woman. She wore no gloves and her fingernails were yellow and dirty. I watched her dip Q-tips directly into the bottle, and retrieve syringe and needles from open containers sprawled on the counter. We protested until the tech reluctantly washed her hands, puts some gloves on, and got new needles and syringes out of unopened boxes. She was visibly irritated by the inconvenience.

The chest x-ray came next. There were no instructions to take off our money belts and large metal objects, no protective shields for our groins, and no suggestions to hold our breath or even remain still. It was hard to believe any serious diagnosis could be made from this. We were just glad to receive a clean bill of health.

When I took my mother to the Chengdu airport on May 8, measures against the outbreak had been stepped up. There was now a perimeter around the city. As we pulled up to the new checkpoint, the driver rolled down the windows, and health officers reached in and pointed hand-held scanners at our eyes. The driver said the scanner recorded our body temperature. I was amazed because I’d never seen a device like that, but at the same time I was annoyed that no one had used one on us previously. Up to that point I’d had thermometers shoved in just about every part of my body that could accommodate one.

On May 12, the official count of SARS cases in China passed 5000. Four days later a warning was issued by China’s Supreme Court, via the official Xinhua News Agency, stating that people who violated quarantines and spread the SARS virus may be imprisoned for up to seven years. Further, anyone causing death or serious injury by "deliberately spreading" the virus could be sentenced to prison for 10 years to life, or could even face execution. It was a scary thing to let sink in. We were worried about getting the disease itself, but we were equally concerned about being sent to one of the quarantine hospitals. If we did become ill, whether we actually had SARS or not, any hesitation to seek diagnosis and treatment at the hospital could have serious consequences.

On May 23, my brother took me later to the bushmeat market to see all the exotic animals in cages. Normally it’s like death row at the zoo, but today it was empty. A friend told us that in nearby Chengdu, dogs (not just the dinner variety, but actual pets as well) and exotic animals were being slaughtered for fear they carried SARS. That same day a link between SARS and eating the meat of civet cats had been suggested by scientists. In response, the police apparently shut down bushmeat markets across the country and citizens overreacted by killing their own pets. The news didn’t impress everyone in the region however, as I saw civet served in restaurants in Hanoi, later that summer.

By this time things were getting sentimental and a little corny in the media. There were endless pageants and concerts on TV to show support for SARS victims. Around 80 singers got together in Taiwan to produce a “We Are the World” style music video, entitles “Hand In Hand (Against SARS),” which was then played over and over again on the airwaves.

When I finally got ill in early June, I was understandably worried, but I was worried as much about being misdiagnosed with SARS as actually having the disease. I wanted to avoid another trip to the hospital at all costs. I hid in our flat until my symptoms were gone. I didn’t want anyone to catch me coughing. In the end I apparently just had Bronchitis, but with all the typical symptoms of SARS—fever of 100.4 °F, fatigue, coughing, sore throat, aches, difficulty breathing, respiratory infection, etc. It was a scary time.

I finally left China on June 22, as the outbreak subsided. We survived the first great viral epidemic of the century! Many criticized China for the way it managed the SARS epidemic. While obviously China’s response was secretive in regard to the outside world, they certainly weren’t ignoring the problem. To many people it was a mystery why SARS burn itself out after a single outbreak in just one year. After witnessing China’s reaction to the epidemic, I have no doubt that China’s intensive management was the reason why SARS was contained. I wondered if my own country would be willing to take the same kinds of measures by restricting travel, canceling holidays, quarantining communities and instituting mandatory health exams to save lives. Imagining the outcries against loss of individual freedom and liberty, I knew we might not face the same positive outcome.

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