But if party officials didn’t want to tell the public about the disease before the Spring Festival, they were even less eager to do so after the holiday. On February 10, the Guangdong government announced that three hundred people had been diagnosed with “atypical pneumonia” and five patients had died, but officials assured the world the disease was under control. It was a lie, but all provincial newspapers were ordered to publish it. With the National People’s Congress only weeks away, no one wanted to be blamed for spoiling the picture-perfect ceremonies installing Hu Jintao with headlines about a fast-spreading illness of unknown origin. Even after the congress, the cover-up continued. Now officials were worried about the impact on tourism during the next national holiday, the May Day vacation. It seemed like a bad joke: When is the best time for the party to break bad news to the public? Never.
The Communist Party devotes tremendous resources to the collection and control of information, and the care with which it guards its secrets has been critical to its ability to stay in power. But its institutional obsession with secrecy can also leave it vulnerable. As party officials withheld information about the “atypical pneumonia,” the disease was spreading. And unlike AIDS, it moved at a frightening pace. Doctors and nurses, kept in the dark about the illness and how contagious it was, continued treating people without protecting themselves or other patients. People who developed symptoms didn’t realize how sick they were and didn’t know how easily they could infect loved ones, coworkers, or fellow travelers. During the Spring Festival, millions of migrant workers packed into trains and streamed out of Guangdong. By late February, the virus had struck at least five provinces and crossed into Hong Kong, a travel hub with more than six hundred international flights daily. By the end of the month, it had reached Vietnam and Singapore, and jumped across the Pacific Ocean to Canada.
IN CHINESE, THEY called them Poison Kings. In English, they were known as “super-spreaders.” It is one of the lingering mysteries of the 2003 epidemic of SARS that certain individuals were prone to accelerate the transmission of the disease, infecting many more people than others who carried the virus. Scientists never figured out exactly why. But by tracking these Poison Kings, you could trace the progress of the epidemic, following the path of the virus from its initial appearance in the cities of Guangdong Province to the rest of China and then the world. One of the first super-spreaders to be identified was a twenty-seven-year-old businesswoman whom I caught up with in May, a few months after the epidemic became a national crisis. She was a frail, slender woman with long black hair, and she asked that I identify her only by her surname, Yu. I met her at night, in a car parked in front of her apartment compound, with her husband, whose surname was Chen, seated at her side. Her eyes were slightly puffy, perhaps from tears, and she wore on the sleeve of her white blouse a black button with a Chinese character, a traditional symbol of mourning.
She lived in Taiyuan, the dreary capital of Shanxi Province, an industrial region in north-central China best known for its abundant coal deposits and mining operations. The city was an epicenter of the SARS epidemic, with more infections than any other in China besides Guangzhou and Beijing, and Yu was an important reason why. In mid-February, she had traveled to Guangdong on a buying trip for the small business she ran trading in jade and jewelry. Before going, she had heard that a strange illness was spreading through the province. Because of the news blackout and the absence of good information, rumors of a “weird sickness” were circulating there and had led to panicked buying of vinegar, herbal medicine, and other items believed effective in warding it off. But Yu’s mother, a Taiyuan journalist, had called a few colleagues in the region and was told there was nothing to worry about. The provincial government, after all, had assured the public that the atypical pneumonia was under control. A few days into Yu’s visit, though, on February 22, she began to feel feverish on a bus ride from Shenzhen to Guangzhou. She thought about going to a hospital, but her husband persuaded her to fly home the next day instead.
Back in Taiyuan, Yu visited one hospital after another, telling doctors that she might have been infected with the atypical pneumonia reported in Guangdong. The doctors had received no information about the disease, and were naturally skeptical. None of them protected themselves when they asked her to cough and listened to her lungs. “They thought it was a cold and gave her normal antibiotics,” Chen told me. “They didn’t have the information about SARS.” Meanwhile, Yu’s fever was getting worse. After a few days, it was up to 104 degrees, and she was too weak to eat. The city’s best doctors were stumped. On February 27, the director of the respiratory department at the Shanxi Provincial People’s Hospital finally moved her into a special ward and ordered staff to wear masks when treating her. By then, though, Yu had already infected at least a dozen people in Taiyuan, probably more, setting off a chain reaction that would hobble the city.
The next day, Chen decided to take his wife to Beijing. It was an easy decision, because the capital was only 250 miles to the northeast and the nation’s best hospitals were there. He and a friend rode with Yu in an ambulance, while her mother and the doctor followed in another vehicle. The trip took nine hours, including a delay caused by a flat tire. Neither Yu nor any of her companions wore masks or other protective gear. They arrived after midnight on March 1 and checked into the People’s Liberation Army No. 301 Hospital, a well-known military facility that had a special ward for senior government officials. Deng Xiaoping himself had received treatment there in his final years. If a new illness was spreading through China, Chen thought, surely the doctors at this hospital would know about it. But he was wrong. The staff at the No. 301 Hospital was as unprepared as those at the hospitals in Taiyuan. The hospital admitted Yu to a general ward with other patients, and the doctors and nurses took no special precautions while examining her. Three days later they transferred her to a private room in the respiratory ward. By then, both of Yu’s parents had come down with fevers. They had tried to hide it, hoping not to upset their daughter, but on March 4, Yu’s mother was admitted to the hospital. Her father flew in from Taiyuan and checked himself in, too.
The next day, Yu and her parents were moved to the People’s Liberation Army No. 302 Hospital, which specializes in infectious diseases. But Chen was upset because the ambulance driver and medical staff failed to take any infection-control measures during the transfer. When he returned to his hotel room, he phoned a newspaper in Guangzhou with a reputation for investigative reporting, hoping to raise an alarm. “This disease is very dangerous and infectious,” he told the reporter who took his call, pleading with her to warn the public. But she told him the newspaper already knew about the disease and that there was nothing it could do. She suggested he contact the local health department instead. What the reporter didn’t say was that the annual session of the National People’s Congress had just opened in Beijing and negative news reports had been forbidden. As the party’s senior leaders were congratulating themselves across town, Yu watched her father and mother, both in their early fifties, grow weaker at the No. 302 Hospital. It became so difficult for her father to breathe, he was forced to sleep sitting upright to avoid violent fits of coughing. On March 6, a team of doctors tried to save him by performing a tracheotomy. He died the next day. Later, the epidemiologists would identify him as the first SARS fatality in Beijing.
Chen came down with a fever next, and friends who had accompanied the couple to the capital also got sick. Then came terrifying news from Taiyuan: their one-year-old boy also had developed a fever, as had Yu’s brother and her brother’s wife. The three of them flew to Beijing and were admitted to the same hospital. Yu and Chen were placed in rooms on opposite sides of a hallway, and they communicated by shouting from their beds. On television, they watched government officials continue to downplay the epidemic.
After a week, Yu and her child began to show signs of recovery, and doctors said they wanted to transfer them back to Taiyuan. The family resisted, arguing th
at they should be moved only if they had fully recovered. But the hospital insisted, saying it needed the beds for other patients. Chen wondered if they were forcing his wife to leave because they were scared, or because they wanted to reduce the number of cases of the new disease in Beijing for propaganda purposes. By then the virus was already spreading among the hospital’s staff. Several of the doctors who had performed the tracheotomy on Yu’s father fell ill. On March 11, the chief of one of the respiratory wards collapsed.
Thus did SARS make its way from the southern province of Guangdong to the nation’s capital. By the end of May, the virus would infect more than 2,500 people in Beijing and kill 175 of them—more than in any other city in the world. It is unclear how many people Yu infected in Beijing, or how many cases in the city were indirectly linked to her. At least two other super-spreaders accelerated the transmission of the disease in Beijing in those early weeks, but Yu was the first of the Poison Kings to arrive in the capital, and serious outbreaks were reported in both hospitals where she was treated. By the end of March, thirty of the forty doctors and nurses in the respiratory wards of the No. 302 Hospital would be diagnosed with SARS. At the same time, one of Yu’s uncles checked into another hospital in Beijing and infected at least a dozen doctors and nurses there, including a visiting physician from the province of Inner Mongolia who then carried the virus home, causing another outbreak that sickened as many as one hundred people.
It was snowing on March 15 when the No. 302 Hospital decided to send Yu and her son to a hospital in Taiyuan. The roads between Beijing and Taiyuan were sure to be treacherous, but the hospital refused to extend their stay. Yu and her son left at about 4 P.M. Because of the weather, they didn’t make it to Taiyuan until six the next morning. While Yu’s ambulance was making its way along the mountain roads that night, her mother died in Beijing.
On the same day, the World Health Organization issued its first global alert about SARS. At the time, the WHO had received reports of about 150 cases of the disease, including four deaths. The alert provided numbers and details of cases in Vietnam, Singapore, Hong Kong, Thailand, Canada, and the Philippines. But there was no information from China. Only two sentences addressed the glaring omission: “An epidemic of atypical pneumonia had previously been reported by the Chinese government starting in November 2002 in Guangdong Province. This epidemic is reported to be under control.”
As the carefully choreographed rituals of the National People’s Congress session played out, the party stood by the Guangdong government’s February announcement that the outbreak had been contained. Even after the parliament finished installing Hu Jintao and adjourned on March 18, the party said nothing about the worsening epidemic. By then, the cover-up was no longer a local matter. As soon as people started getting sick and dying in Beijing, the party’s top leaders had to be briefed. But if the new members of the Politburo Standing Committee were alarmed by what was happening or had any inclination to come clean with the public, they didn’t act on it. Instead, nearly four weeks after Yu checked into the No. 301 Hospital, party leaders broke their silence by issuing a feel-good statement about a mysterious disease they knew to be highly contagious and frequently lethal.
“Beijing Effectively Controls Imported Atypical Pneumonia” read the headline carried by state news wires on March 26. The story said eight patients from Shanxi and Hong Kong had been transferred to hospitals in Beijing for treatment. Three of them had died, it said, but the others had “basically completely recovered.” Two medical workers had developed symptoms, but they were quickly isolated and the disease had not spread to the general public. A spokesman added that the city “has already established a perfect disease monitoring network, set up a special team and lab for investigating and handling the disease, and trained relevant medical and nursing personnel.” The government, he said, was “capable of responding to the epidemic and guaranteeing the health of the people of the capital.”
It was the first of what would be a series of stunning lies uttered by officials in Beijing as SARS began to tear through the city of fifteen million. Far from the reassuring picture of calm and competence the article presented, the hospitals of Beijing were woefully unprepared and quickly overwhelmed with patients in respiratory distress running fevers. Doctors and nurses who were never warned to protect themselves contracted the disease in large numbers, and many of them later unwittingly infected their families and patients. As medical workers became patients in their own hospitals, fear and exhaustion haunted those who remained on the job. Meanwhile, the government research labs assigned to figure out what was happening and find a cure were struggling to make progress, slowed by professional rivalries, bureaucratic feuding, and the party’s limits on information sharing. Researchers in the Center for Disease Control and Prevention, for example, couldn’t get access to good tissue samples from their counterparts in Guangdong until late March, in part because the central government’s Ministry of Health couldn’t give orders to the Guangdong government, whose leaders ranked higher in the party hierarchy. Senior officials wasted time holding a series of “coordination meetings” instead.
As the cover-up continued, many doctors were too busy treating patients, or too accustomed to bad news going unreported, to ask why the government was hiding the disaster unfolding around them. Decades of party control and corruption, under both socialism and capitalism, had corroded the medical profession and its values. In its mildest form, this meant physicians accepting bribes from patients or prescribing unnecessary drugs to boost profits. At its worst, it meant the trade in organs from executed prisoners, the forced abortion of pregnancies violating the one-child policy, the psychiatric commitment of dissidents, even the euthanasia of infants born with severe disabilities. Doctors in China were trained as technicians to serve the state, to do their work and leave questions of ethics and public policy to others. Yet many on the front lines of the SARS epidemic privately questioned the wisdom of keeping the outbreak secret. Some were afraid to speak out and risk losing their jobs, or concluded there was little they could do because the government controlled the news media. Others complained to their superiors or sent urgent messages through internal channels recommending that the authorities go public with everything they knew about the disease. Only then, they argued, would the public and the hospitals have a fighting chance against it. But their appeals were met with silence.
AMONG THE DOCTORS who were uneasy about the cover-up was a semiretired military surgeon at the No. 301 Hospital named Jiang Yanyong. He was seventy-one, tall and distinguished-looking, with a long, crinkled face and a head of hair that he dyed black in the manner popular among aging intellectuals and party officials. If it was a cynical time to be a doctor in China, Jiang had come to the profession in a more hopeful era. Born to a wealthy Shanghai banking family, he studied medicine at Peking University just as the Communists were taking power and he trained at Peking Union Medical College, the nation’s most prestigious medical school. He eagerly joined the party and enlisted in the People’s Liberation Army even before graduating. He decided to specialize in surgery because he was inspired by the example of Norman Bethune, the Canadian battlefield surgeon who joined the Red Army and was eulogized by Mao as a martyr after his death in the Sino-Japanese War.
Jiang’s idealism was shattered not long after he was assigned to the staff of the No. 301 Hospital in 1957. His brothers were persecuted in the Anti-Rightist Campaign, and he came under attack himself in the Cultural Revolution. Imprisoned in the hospital, he endured beatings and public condemnations because of his privileged family background. Once, when he managed to escape, his sister betrayed him and turned him in. Later, he spent five lonely years on a prison farm in the remote deserts of Qinghai Province in western China, separated from his wife and children. Mao’s rule shook his faith in the party, but Jiang was the kind of man who needed to believe in something, and when he finally returned to Beijing and the No. 301 Hospital, he committed himself to the values of his pr
ofession. If he could not change society, he decided, he could at least do right by his patients. By the time of the Tiananmen demonstrations in 1989, Jiang had developed a reputation as one of the nation’s finest surgeons. He served as the hospital’s chief of general surgery, held a rank equivalent to that of a major-general and counted senior party officials and their relatives as former patients. After the massacre, the party asked him to express support for the suppression of the student-led democracy movement. He was a senior military official and a veteran party member, but Jiang resisted. The hospital responded by denying him a promotion and easing him into retirement. Others more willing to toe the party line moved up instead.
After his retirement, the No. 301 Hospital retained Jiang as a member of its experts’ committee and continued to call on him to perform operations and consult on difficult cases. It was in that role that he heard about the woman from Taiyuan whose parents died after they were transferred to the No. 302 Hospital. The cases were unusual—his colleagues said the diagnosis was atypical pneumonia—but what really caught Jiang’s attention was the fact that so many doctors and nurses became severely ill after treating them. Later, he learned that the president of his hospital, and those of all the hospitals in Beijing, had been summoned to a meeting at the Ministry of Health. They were told that a serious infectious disease had arrived in the capital, and that information about the outbreak was to be kept strictly confidential to ensure the success of the National People’s Congress session. “I heard about the meeting soon after it happened,” Jiang told me. “I thought it was wrong to handle the situation this way. But at the time, I didn’t realize that this disease SARS was so serious and dangerous. So I didn’t do anything.”
Out of Mao's Shadow Page 25
