15 Years in China – Working through SARS
China Briefing has just published “The Story Of A China Practice” to commemorate the first 15 years of Dezan Shira & Associates in China. It is the first book available as a case study for the development of a professional services company in China. In this excerpt, Chris Devonshire-Ellis discusses SARS and the situation when faced with clients and working in China at that time. The book is available, priced US$20 plus p&p from firstname.lastname@example.org.
Working Through SARS
(excerpt chapter five, circa 2002)
A couple of years before I had set up Dezan Shira, when I was still with Asia Law & Practice in Hong Kong, I went on a week’s vacation to Guilin. It was stunningly beautiful, the karst limestone mountains, the River Li as the poets say, “A ribbon of blue silk through mountains of pure jade” and a wonderful lazy trip on a flat bottomed boat up the river to Yangshuo. Dinner was served on board, a large fat fresh water bream, I think the only time I’ve ever eaten fish caught by a bird. The local fishermen there use cormorants to go catch fish in the river, attached by a long line, with a throat choker to prevent them devouring their underwater catch; they bring the fish back on board and are rewarded with a morsel. The unfortunate fish was cooked on board the boat in a wok at the back, and served, 30 minutes later, river fresh, with spring onions and thin slices of ginger. It was delicious.
That evening, I was having dinner with a group of Chinese friends, and one of the dishes I was served was unfamiliar to me. It was a light pink sliced meat, braised in a sauce with celery and lotus bulbs. It was very tasty, but for the life of me I couldn’t work out what the meat was. Upon asking my friends, they chatted amongst themselves for awhile debating the point. Then one turned to me and said “Chris, we don’t know the English name of this animal. But it is black, and white, lives in the jungle and eats bamboo.” I was stunned and didn’t know what to say. I looked down at my plate in guilt. “However,” continued my friend, “there is another one, in a cage, in the kitchen. Would you like to see it?” I would. Getting up from the dining table, I squeezed into the tiny back room kitchen to have a look at what lay within. And there, in a small cage about two feet long by a foot wide, was the most beautiful rat I have ever seen – pure white fur and a long black tail. It was a Bamboo Rat, and it indeed lived in the jungle, was black and white, and ate, as its name suggests, a diet of fresh bamboo.
The story is pertinent, for as well as being mildly amusing for it’s obvious Panda cuisine allusions, as it demonstrates just how well ingrained the Chinese practice of eating wild animals is. A trip to the notorious, yet still functioning ‘wild animal’ market in Guangzhou is a desperately sad experience, cages of wild owls, herons, hares, ferrets, civet cats, and exotic species from overseas, giant wild turtles, cats, dogs and other strange creatures, all caged and waiting for the pot. Foxes, Flying Fruit Bats, Hoopoes, an entire guide book worth of wild species of snakes and lizards, and on one occasion a rather beaten up, totally stressed out, but still very much alive Ostrich was for sale, cramped in a cage far too small for it. Then there were the water beetles, live scorpions, and gently vibrating silk worm cocoons. Occasionally, a demented black bear would be brought out for show when the vendors were satisfied the police weren’t looking. “Jiba very good!” they would hiss, “Good man sexy!” meaning that bear penis was an aphrodisiac I should try.
There is a saying about people from Guangdong. “They’ll eat everything with four legs except the table, and anything with wings except an airplane.” It’s not an exaggeration, and it is quite appalling. It could also prove fatal, with potential consequences that could affect the entire population of the planet.
That autumn, stories began to appear in the Hong Kong media about a killer, as yet unidentified flu type virus that had laid waste to two victims, who had come down with high temperatures, and had died within a week of being admitted to hospital. The doctors had no idea what it was they were dealing with, or how to treat it. They went on immediate alert, not knowing how the disease was spread, but worried it was infectious.
The WHO was informed. At this point, it wasn’t a huge concern – every autumn varietals of flu always turn up, never identified and then pass away just as quickly. But typically they affect the sick, the elderly or the very young. This was different. The two victims had been healthy and relatively fit. They had also died exceedingly quickly.
A massive campaign was on to find out where these two people had been, what common links they had. Then more cases started to arrive in hospital. There were more deaths, just as quickly, and it was obvious this was a very serious matter. Calls to authorities in Guangdong to check on the situation elsewhere were answered with a reassuring “Nothing to report here.” But there was. Hospitals across the province were also receiving patients, dying of an unknown, flu like disease. Then outbreaks of the same symptoms began appearing in other Chinese cities. More deaths occurred in Hong Kong, and the media were on top of it like a flash reporting to horrified citizens in Hong Kong that an unknown disease was killing people. That is the benefit of having a free press, right there.
Still the Chinese side admitted nothing. It was a Hong Kong problem, and it was for them to deal with. But then came a breakthrough, the movements of many of the earlier deceased all converged to one central point. They had all been in an elevator in a building in Hong Kong at the same time, and someone had sneezed. Hong Kong’s police and detective work had been superb. But the man who sneezed was now dead, lying in a Hong Kong mortuary, undergoing autopsy to find the disease and identify it. Everyone else in that same lift was also dead. Then, appallingly, a doctor died, then two nurses. Hong Kong went into meltdown. Finally, the dead mans previous travels came to light, courtesy of the Hong Kong immigration bureau. He’d come in to Hong Kong, the day before he sneezed in the lift, across the border from Guangzhou.
Yet again, the Guangdong and Central Chinese Ministry of Health denied any relevance. “There is not this disease in China. Only in Hong Kong,” they claimed. But by now, no-one believed them, and no-one knew what the hell was going on or where the source of the disease was.
The South China Morning Post published an article about the numbers of hospital cases in Hong Kong and the death rate. It mentioned a figure of 10 percent. From Shanghai, I called up my friend Simon, from the German pharmaceutical company to discuss this. “What about the mortality statistics?” I said. “Do they make any sense?” With Simons help, we looked deeper into the SCMP journalists’ analysis and what it really meant. But journalists aren’t statisticians, and whoever had calculated the mortality rate hadn’t factored out the separate cases that were later described as normal autumnal flu, and who had displayed differing symptoms. We looked closer into it. There was one common symptom denominator amongst all those who had died. They all got high fevers, and they all died within a week. We reviewed the newspapers data again. There was only one possible conclusion. The real cases of what would later be dubbed “SARS” were closer to a horrifying 50 percent mortality rate. Simon got on the phone to his contacts elsewhere in the medical profession to voice his concerns, and I had to decide what to do about China, and advising our clients. Because this to us looked as if it was going to be a far more serious problem on the mainland than anyone had yet realized.
We put together an email, and sent it out that evening to our clients and all subscribers to China Briefing as a special alert, warning them of the potential dangers that we felt were brewing. We mentioned the 50 percent mortality rate and how we’d arrived at those conclusions. We also advised against travel to Guangdong and to immediately report and hospitalize any symptoms amongst staff. As far as I know, we were the first organization in China to issue such an alert.
The next week, under intense pressure from Hong Kong and the WHO, the Chinese government sacked the Minister of Health and installed Madame Wu Yi as temporary head. Local governments then panicked, and started issuing quarantine orders to anyone who arrived in their city from Guangdong. Still the Chinese were not able to issue any details of casualties in China. Finally, teams of WHO inspectors were allowed into the country. We issued another report, based on comments from Simon and in the Hong Kong press about health care in dealing with the disease. Much of it was common sense – wash your hands, don’t spit, cover your mouth when sneezing, and so on. Monitoring high temperatures were mentioned, and a list of do’s and don’ts was issued, and for good measure, translated into Chinese so our readers could distribute it to their local staff.
Shortly after that, the first of the consular warnings were issued by foreign missions in China. Face masks – actually totally useless in preventing any spread of the disease – began to appear, and flights started getting cancelled.
Unconfirmed reports of army hospitals in Guangdong province, Shanghai and Beijing being full of Chinese SARS patients did the rounds, apparently as army land such statistics weren’t counted as civilian patients and the sheer volume of those affected was, on paper, reduced. Tales of SARS patients being shoved into ambulances and driven around for several hours when WHO inspectors called at Chinese hospitals also became strongly rumored; no-one knew what to believe. Hong Kong closed its border with Guangdong temporarily, until the Chinese could install temperature monitoring systems at all borders and ports. Other countries imposed bans on flights inbound from China and Hong Kong.
Flights out of China back home to Europe and the United States were packed, when they could fly. We issued more bulletins, with comments from all our regional offices on the local status of quarantine detentions, numbers of presumed cases, and what to do if factories had to be closed down. Secure your stock we said, and ensure the premises are patrolled to prevent theft if temporary closure becomes a reality.
Slowly however, Wu Yi’s toughness, and ultimate openness with the WHO, some six weeks after the first outbreak, proved just enough to allow China to pull the SARS demon by the very end of its tail and back into the bag of containment.
By the end of March 2003, we issued our final SARS bulletin. There had been a total of eleven of them, all at the time passing on information on status, what to do, and emergency procedures to put in place if the worst came to the worst. We felt that as we were supposed to be advising on professional services in China, if no-one else was going to warn about SARS, and the potential impact on business, then Dezan Shira had better make our clients and China Briefing readers aware as to what was going on, the precautions to take, and the need for operational contingency plans if things got worse.
Eventually, the culprit was nailed down, as a viral infection that had crossed species, and begun to infect man, who had no natural resistance to the disease. It was traced back to the eating of civet cats, from the wild animal market in Guangzhou.
China, and the world, got lucky. The SARS virus proved actually rather inefficient in its ability to re-infect, and could only be passed on by almost direct close contact via drops of saliva. It was not resilient and died quickly on contact with oxygen. Yet if you caught it – you had a 50 percent chance of dying. Hundreds did, and most notably doctors and nurses in Hong Kong who treated many of the original batches of patients.
China’s inherent denial syndrome, or refusal to accept responsibility, and admit to something wrong that would cause a loss of ‘face’, as a cultural trait, had caused the deaths of many, many people. Also shown up were the inadequacies in the Chinese health care monitoring and reporting system, now largely put right by Wu Yi with assistance from the WHO.
But just the next year, another, similar virus sprang out of China, again from Guangdong. But it wasn’t caused by civet cats. Bird flu appeared, and is still with us, albeit relatively under control, if still exceedingly dangerous to those who catch it.
The WHO say the battle isn’t over, and it’s only a matter of time. Bird flu also isn’t so contagious, but when a similar virus mutates that deals with that problem, and can pass from human to human effectively, there’ll be a world pandemic. It’s overdue, and it’s the one thing that scares the hell out of us in China.
Meanwhile, if you’re served something in a Chinese restaurant that is wild, or exotic – it may be wise to decline.
More excerpts tomorrow including intellectual property fraud in China, Beijing wins the Olympics and a look at North Korea.
The entire series can be found here.