SARS

Item

Title
SARS
extracted text
Health for Life

RF_DIS_21_SUDHA

Health 2003:
The Top Ten
Dramatic advances and frustrating setbacks. In medical
research, the biggest challenges are not always the
technical ones. A look at the key health stories of the year.
Also Inside:
SARS, ROUND TWO

Has China absorbed the
lessons of the SARS crisis?

STOPPING STROKES

An experimental device can
vacuum out blood clots
FROM TOP CHiEN-CH) CHANG-MAGN'JM.
ILLUSTRATION 6Y LOST IN SPACE FCR NEWSWEEK

| TWAS A YEAR THAT SAW

I major advances in medicine
B and health—fields that are ever
M more complicated and confus| ing. Cutting-edge technology
■ and new (often contradictory)
studies seemed to appear every
day, making it hard for readers con­
cerned about their own and their
families’ health to sort out what was
accurate and important. In this
special Health for Life section, we
report on the year’s 10 most impor­
tant health stories (they’re not
ranked in any particular order).
Science has come up widi some
amazing answers to an array of
daunting problems. Researchers are
moving closer to effective treatments
for cancer and Alzheimer’s and dis­
eases caused by assaults from our
own immune systems. Innovators
are exploring bold new approaches
to stroke—a problem drat lulls more
than 5 million people eveiy year.

In medical research, progress is
tentative and sometimes illusory.
There are exciting new ways to
think about depression, but early
attempts to turn these ideas into
drugs have yet to succeed. Women
this year fled from hormone treat­
ment as new studies confirmed
that the widely used therapy has
serious risks. Experts still dis­
agreed about how best to deploy
cholesterol-reducing drugs—and
whether offering free antiretroviral
drugs is enough to solve Africa’s
AIDS epidemic.
What the year in medicine re­
vealed was this: the biggest health
challenges are often not the techni­
cal ones. Controlling AIDS now
depends more on wall than ways.
Obesity, one of the biggest health
crises facing the world, may be a
disease, but curing it will require
not just a new generation of pills,
but changes in our own lives.
El
35

How to Prevent
Another Outbreak
BY FRED GUTERL AND
SARAH SCHAFER

TTH1ST1MEOF

A

the year, tire animal
markets in southern
China’s Guangdong
province are usually
crowded with civets, raccoon
dogs, snakes and even kittens,
destined for local restaurants.
Entrees in this part of the
world are traditionally kept
alive until moments before
they’ land on die dinner table.
The practice would be nothing
more than a cultural curiosity if
it weren't so bad for the world’s
health: animals and humans
living in such close quarters
tend to pass around viruses un­
til. once in a while, one turns
into an epidemic. Last year one
virus happened to cause severe
acute respiratory’ syndrome, or
S.ARS. By the time the world
took notice—in March—this
new bug had slipped into the
countryside, through tile air­
ports of Beijing and Hong
Kong and beyond.
Now southern China, the
w’orld’s most efficient virus fac­
tory’ and ground zero for most
of the globe’s influenza epidem­
ics, is revving up for another
cold and flu season. This year,
though, SARS has lost the
element of surprise. Health
authorities are so intent on
spotting signs that they’re get­
ting skittish. When a Taiwanese
man returned last month from
a trip to the mainland running
a fever, hospital officials put
him in isolation. It was a false
alarm. But most health authori­
ties agree that a return of SARS
this year is all but inevitable. In
fact, one official at the World
Health Organization lost a $64
bet w'hen the disease hadn’t
resurfaced by Nov. 18.
Such pessimism
might seem surprising.
After all, most health
workers around the
world dealt swiftly and

36

effectively with last year’s pan­
demic. They showed how vigi­
lance, responsiveness and good
communication pay offwhen
dealing with a global disease.
The wild card this year is Chi­
na. Of the 774 people w'ho have
died of SA.RS, three quarters
lived in mainland China; if
SARS is lying dormant, await­
ing cold weather and the runny'
noses that come with it to make
a comeback, China is tire most
likely starting point. How’ w'ell
has this vast country absorbed
the lessons of SARS?
Chinese authorities couldn’t
do worse titan repeat last year’s
performance. Even as SARS
patients w'ere inundating emer­
gency wards throughout the
country last winter, Beijing
withheld information from
WHO officials and forbade
doctors and other health-care
workers to talk publicly about
the disease. Since then, “coop­
eration has been remarkably'
good,” says the WHO’s Bei­
jing representative, Dr. Henk
Bekedam. China’s leaders seem
committed to preventing a new'
outbreak. The new Health min­
ister, Wu Yi, impressed inter­
national health officials with
her willingness to reform Chi­
na’s woeful health-care system.
To prevent the chaos that
marked Beijing’s handling
of the SARS crisis last year—
authorities actually worked
against the provincial hospitals
by insisting that the new' illness
posed no threat—Wu w'orked
closely with WHO officials to
set up a new surveillance net­
work. Three regional labs col­
lect virus samples and track
SARS cases with new’ software.
No doubt China is better
prepared to fight SARS than it
was six months ago. It’s proba-

SARS
Severe acute respiratory
syndrome infected 8,098
people in 2003; 774 died.

bly also better equipped to fight
influenza, AIDS, tuberculosis
and other diseases. Last year’s
SARS outbreak forced China
to address weaknesses in its
health-care system—particular­
ly in research, monitoring and
treatment— that should help it
deal with other deadly diseases.
That comes as a huge relief to
the country’s long-suffering
neighbors. “China is key in
global influenza surveillance,”
says Dr. Klaus Stbhr, head of
the WHO’s influenza team.
Improvements in data col­
lection are helping China stop

department of virology and
immunology at the Chinese
Center for Disease Control and
Prevention, expects funding
for .AIDS to increase twenty­
fold, in part because of the at­
tention SARS has brought to
public-health issues. Beijing
has promised to build 20 to
40 new labs that meet inter­
national safety standards,
which—should the SARS crisis
subside—could be used for
AIDS research. “That’s a good
trade-off" says Shao, who re­
cently received a $250,000
grant from the U.S. National
Institutes of Health to help
develop a SARS vaccine. “We
help [fight] SARS first, and
then SARS will help us.”
First, of course, China’s

the flu and other bugs from
migrating across its borders.
In April, for example, the
mainland cooperated with
Hong Kong and Macau to
build a reciprocal reporting
system to track diseases. In
June, officials in Guangdong
province used this system to
alert Hong Kong to ajapanese
encephalitis outbreak. Ata re­
gional conference last month
Chinese officials pledged more
funding to strengthen interna­
tional reporting systems fur­
ther. They are also working
closely with health experts to
track Nipah, an even deadlier
virus than SARS.
Scientists working on dis­
eases such as HIV/AIDS say
they have SARS to thank for
new access to funding and
state-of-the-art facilities. Dr.
Shao Yiming, director of the

health experts must focus on
preventing another SARS out­
break. China’s health-care sys­
tem is still vastly underfunded.
It doesn’t help that Beijing
seems reluctant to concentrate
its scant resources on high-risk
areas, such as the south. In­
stead, it is taking on the entire
country at once, even those
places—like the sparsely popu­
lated west—that are unlikely to
support a SARS outbreak.
Making sense of information
from the provinces won’t be
easy, either. “China is a big
country,” says the WHO's Hi­
toshi Oshitani. “It’s not easy to
set up a good system.”
A big challenge will be
keeping the information about
new infections flowing. Wu’s
Health Ministry has issued
guidelines to provincial hospi­
tals designed to speed the re-

STAYING SAFE IN TAIWAN:
Most health authorities agree
that a return of SARS this
winter is almost inevitable

37

porting of SARS cases. She’s
also given provincial adminis­
trators a dressing down for not
taking the threat of SARS seri­
ously. In a national teleconfer­
ence on SARS prevention, she
accused some local govern­
ments of having “lowered their
guard, slackened efforts and
developed die idea of leaving
things to chance’’ in prevent­
ing a return of SARS.
Another concern is infec­
tion from lab samples. If a
researcher could catch SARS
in squeaky-clean Singapore,
which happened in September,
the more than 100 labs and
hospitals in China thought to
hold SARS samples may be
disasters in waiting. Many of
them are located in the prov­
inces, where conditions are of­
ten unsanitary. WHO experts
say Chinese officials have tried
to track down these virus sam­
ples and explain to health-care
workers the need to destroy
them, or at least meet interna­
tional standards of cleanliness
and safety. But China won’t
say how many samples are out
there, which makes WHO offi­
cials nervous. They also worry'
that some labs will give up
their samples only for cash.
Making an accurate diag­
nosis would help the effort to
track a new SARS outbreak.
Researchers have been work­
ing on a cheap and accurate
diagnostic test but haven’t had
much luck. Now they think a
vaccine may be the best way of
stopping the disease. One Chi­
nese company claims to have
developed a vaccine that works
in monkeys, and plans to start
clinical trials this month. Re­
searchers at the University' of
Hong Kong will also begin
testing a vaccine before the end
of the year. Even if they work,
they’ won’t be ready until next
winter at the earliest.
One thing China hasn’t
learned is that its eating
habits—particularly the taste
for freshly killed meat—might
have to change. This winter
the battle will be shaping up
between China’s traditions and
the world's health.
With ALEXANDRA A. SEND in Hong Kong

38

Next: The Polypill Prescription

BY JERRY ADLER

pi ICK WALD’S GREAT

■'\

brainstorm, which

1 \ ■ came to him a few
La
years ago during his
father-in-law’s struggle with
cardiovascular disease late in
life, has the virtue of utter
simplicity’, and perhaps also its
drawbacks. Watching as tire
old man downed the usual
cocktail of heart medications,
Wald, a professor of preven­
tive medicine at the Wolfson
Institute in London, realized
that his father’s trouble could
have been averted, or at least
minimized, if he’d begun his
regimen years earlier. Of
course, he didn’t have symp­
toms then, but that’s the
point: half the population in
Britain eventually develop se­
rious heart disease. Rather
than try to identify which half,
why not just give the medica­
tion to everyone older than 55?
Out of that hunch came

issue in which it appeared
might be “the most important
forgo years.”
It certainly has proved to be
one of the most controversial.
Critics argued that even aspirin
has the potential to cause seri­
ous or even fatal side effects,
such as gastric bleeding. And
some British doctors seemed
uneasy with the idea of a pill
you give to everyone. “Let’s
take this to its logical conclu­
sion,” wrote one medic, "and
put every drug known to medi­
cal science in the water supply.”
A more measured response comes from Dr. Robert O.
"
Bonow, president of the Ameri­
can Heart Association. “It’s not
totally a bad idea,” he says. “Car­
diovascular disease is the lead­
ing cause of death worldwide,
and we’re not going to be able to
do enough angioplasties to treat
entire populations.” But he wor­
ries that packaging six drugs in
a single pill carries the twin
dangers of unnecessary side ef­
fects for people at low risk, and,
conversely, undertreating those
who need more aggressive care.
the Poly’pilI. It would consist
The availability’ of such a pill
of six relatively’ inexpensive,
might also deter people from
generic components: a statin
making healthy’ lifestyle
(to lower cholesterol), three
changes (such as losing weight
different drugs to lower blood
and stopping smoking). “My’
pressure, aspirin (to interfere
idea of a polypill,” says Bonow,
with blood-clot formation)
“is exercise and a good diet.” A
Undaunted, Wald hopes ™
and folic acid (to reduce levels
of circulating homocysteine, a
begin clinical testing of the
suspected risk factor for heart
Polypill soon. He doesn’t
disease). These are all drugs
imagine its being sold over the
commonly’ prescribed for pa­
counter, at least initially. Peo­
tients at risk for heart disease,
ple with certain conditions
and folic acid is found in mul­
(such as asthma or bleeding
tivitamins, but the idea of giv­
ulcers) shouldn’t take one or
more of the proposed ingredi­
ing them routinely to every’ents, and you wouldn't want to
one over a certain age is, as
give tlte pill to someone who
Wald and collaborator M. R.
was already taking some of the
Law admit, “radical.” In pub­
components in another form.
lishing their paper last sum­
“There’s much to gain and lit­
mer, the editor of the British
tle to lose by’ the widespread
Medical Journal suggested the
use of these drugs,” Wald
writes. “No other preven­
The Polypill
tive method would have
Each year 17 million people
so great an impact on
die of cardiovascular
public health in the
1 disease around the world.
Western world.”
ILLUSmATIOK BY LOST IN SPACE FOR NEWSWEEK

of rheumatoid arthritis. Today
anti-TNF therapy is proving
useful for a range of inflamma­
tory' conditions. But it does not
hold the master key to all auto­
immune diseases, so doctors
are targeting other immunesystem components in a search
for new treatments. Genentech’s drug Rituxan, a bioengi­
neered antibody against B cells,
is now in early' trials for lupus,
tire most challenging autoim­
mune disease because it affects
organs throughout the body.
Muzzling the immune sys­
tem’s pit bulls is only one ap­
proach. Another—in theory’ at
least—is to boost the compo­
nents of the immune system
that naturally rein in attacks.
Last month immunologist
Nathan Karin at theTechnionIsrael Institute of Technology
in Haifa published a paper
showing that tire immune sys­
tem can make its own anti-TNF
antibodies when it needs to. “If
we could harness these anti­
bodies,” he says, “we might be
able to teach the body to ampli­
fy its own beneficial response."
In the long run, however,
the goal of doctors (if not drug
companies) is to retrain the im­
mune system so that drugs are
no longer needed. Sound im­
possible? “I’ve staked my whole
career on it,” say's Bluestone.
Several years ago he developed
a bioengineered antibody to
various kinds of T cells that can
treat type 1 diabetes; he has
tested it in 23 newly diagnosed
enhance antibody production,
kill virus-infected cells, initiate
patients. Two y'ears later, those
inflammation anti finally shut
who received just two weeks of
down an immune attack. B cells
treatment at the outset are
and T cells also make more
making twice as much insulin
than 100 types of helpers called
as patients who didn’t receive
cytokines that assist in orches­
the antibodies. “What’s really’
trating every' aspect of the im­
exciting is that the T cells seem
mune assault.
to remain in the pancreas and
Maini and Feldmann in the
retrain other T cells,” he says.
1980s zeroed in on one such
Unfortunately, even if the
cytokine called tumor necrosis
treatment works perfectly, it’s
factor (TNF). It derives its
not a cure. By’ tire time type I
name from its ability to kill
diabetes is diagnosed, the pan­
cancer cells, but in excess it
creas has lost 80 to 90 percent
also initiates the inflammation
of its insulin-making ability’.
That’s why the ideal time
to treat autoimmune dis­
Autoimmunity
eases is earfy on, before
. 90% of individuals
symptoms even emerge.
'. J ’■
diagnosed with lupus
Doctors have their work
globally are women
cut out for them.
0

When the Body Attacksitself
BY ANNE UNDERWOOD

HE IMMUNE SYSTEM

is a tiring of beautysubtle enough to dis­
tinguish dangerous in­
vaders like viruses from benign
interlopers such as food; clever
enough to recognize when the
body’s supposedly friendly' cells
turn cancerous and should be
eliminated. But the immune
system can also go awry. When
it begins mauling healthy’ tis­
sues, the result can be any one
of 80 autoimmune diseases
such as lupus or rheumatoid
arthritis. “It’s the price we pay
for having such a dynamic,
finely' balanced system,” says
immunobiologist Jeffrey
Bluestone of the University of
California, San Francisco.
Must we limit ourselves to
ILLUSTRATION BY LOST IN SPACE FOR NEWSWEEK

treating the symptoms of these
disorders, or could we modu­
late the immune system itself?
Immunologist Marc Feldmann
and rheumatologist Ravinder
Maini of Imperial College in
London posed that very ques­
tion in tire mid-1980s. Doctors
scoffed. But three drags for
rheumatoid arthritis emerged
from their research. And this
year Maini and Feldmann won
tire Lasker Award for clinical
medical research.
Drug companies are eager
to expand dris approach into
therapies for other autoimmune
diseases, which have been on
the increase since tire 1950s, but
it won’t be easy. The immune
system is a vast network with a
bewildering array ofwarriors—
from antibody-making B cells to

SOURCE: LUPUS FOUNDATION OF AMERICA

39

Health for Life
women subjects was 24, indi­
cating a healthy weight; in the
WHI study it was 28, indicating
an unhealdiy weight. The wornen in the first studies were also
younger—and therefore less at
risk for heart attacks-whcn
tiicy started taking hormones
(about 51, the average age for
the start of menopause).
Some critics blame the phar­
maceutical industry. Doctors
“let themselves be very manipu­
lated by the drug companies,”
says Barbara Seaman, author of
“The Greatest Experiment Ever
Performed on Women,” a histo­
ry' of hormone therapy. Seaman
contends that doctors who ac­
cept pharmaceutical grant
money or perks might have
been more likely to overlook fl
complications. Most doctors, of
course, say that they were act­
ing on die best available scien­
tific evidence.
Over the next two years the
NIH will continue to study the
long-term effects of taking es­
trogen without progesterone;
doctors speculate that estrogen
alone might be safer. Mean­
while, one result of the furor is
already clear: women and their
doctors will no longer reach au­
tomatically for hormones at the
first hot flash. “Pharmacothera­
py is not your first choice," says
Wulf Utian, executive director
of the North American Meno­
Massachusetts General Hospi­
pause Society'. “If she’s smoking
tal in Boston. Because women
and she’s overweight, her hot
on hormone dierapy appeared
flashes may even decrease if^*
to have fewer cardiovascular
stops smoking or watches he^P
problems, doctors concluded
diet and exercises.”
diat hormones prevented heart
As for heart attacks—which
disease. “It was a runaway
prompted so many women to
train.” Schiff says. “We lost the
start hormone therapy—WHI
focus about -what estrogens are
investigator JoAnn Manson of
really helpful for. And it’s for
Harvard say’s that 80 percent
symptom relief?'
of die risk can be eliminated
What tiicy didn’t realize is
through a healthy lifestyle. Oth­
diat die patients who took hor­
ers have tried natural remedies
mones were healthier than the
like black cohosh. Still, despite
general population—and signifall the negative publicity’, doc­
icantiy healthier than die wom­
tors continue to prescribe limit­
en in die WHI study. In die first
ed HRT (no more than diree
major observational study, die
years) for patients who've tried
average body-mass index of die
other remedies and still
suffer from debilitating
Hormones
hot flashes or odier
About 9 million women
menopausal symptoms.
use hormones, down from
For diese patients, relief
15 million last year.
is worth the risk.
C

Relief That May Be Too Risky
BY KAREN SPRINGEN AND

BARBARA KANTROWITZ

OR 15 YEARS SIDNEY

F

Consden took hormone
therapy for symptoms of
menopause. “I kept ask­
ing the doctor, ‘How long do I
have to take this?’ He kept say­
ing, 'How long do you want to
live?' ” Bolstered by the wide­
spread belief that hormone
therapy prevented heart disease
in postmenopausal women,
Constien stayed on it. Then, in
die spring of2002, she was di­
agnosed widi breast cancer. A
few months later the U.S. Na­
tional Institutes of Health halt­
ed its study ofestrogen-plusprogesterone dierapy because of
evidence that it increased die
risk of strokes, blood clots, heart
attacks and—most shocking to
Constien—breast cancer. Al­
though she's cancer-free after
lumpectomy and radiation,
Constien, now 66, has a new
mission. “I want to get die word
out because I have friends who
are still on it,” she says. “They
think it’s keeping them young.”
No problem getting die
word out this year. It seemed
as if every mondi researchers
released more bad news. New
data showed that hormone
therapy increased the risk ofde­
mentia, and diat women who
took hormones were more like­
ly to have more advanced breast
cancers. Research also showed
that the heart-disease risk in­
creased 80 percent during the
first year of use.
The scary headlines are be­
wildering to a generation of
women who grew up thinking
hormone dierapy was virtually a
fountain ofyouth. Many simply
threw out their pills. In the four
months after the July 2002 pub­
lication of the NIH’s Women’s
Healdi Initiative study, about a
third ofwomen on estrogenplus-progesterone products
stopped taking diem, according
to research by a company called
Express Scripts, which studies
prescription data. A year later
40

only 15 percent of die quitters
had started taking hormones
again. The decline continued
this year. In March, Express
Scripts found diat an additional
26 percent of women who had
originally decided to stick widi
hormone dierapy' had later
dropped it. And everybody'
wondered: how could die doctore get it so wrong?
The simple answer is that
doctors originally decided hor­
mone dierapy was safe because
tiicy’d seen positive results in
their patients who began treat­
ment at the start of menopause.
Based on observational studies
ofdiese first patients, doctors
began to tiiink in the late 1980s
that besides easing hot flashes,
hormone therapy prevented
all kinds ofchronic diseases,
says Isaac Schiff, chief of
obstetrics and gynecology at

NEWSWEEK DECEMBER 15, 2003

Into the Darkness
Of the Mind_______

BY ANNE UNDERWOOD

HEN WAYNE

W

Huizengaof
Blockbuster fame
bought the Miami
Dolphins football team in
M4, he asked a trusted col"gue to write the $127 million
check: Gillian Bristol of Flori­
da. Bristol handled financial
matters for Huizenga for 26
years, until in early 2000 the
math started giving her trou­
ble—not arcane accounting
problems, mind you, but sim­
ple addition and subtraction.
Within months, she was diag­
nosed with .Alzheimer’s disease
and spiraled rapidly down­
ward. Then in August 2001,
her husband, Richard, enrolled
her in aclinical trial testing a
combination of a U.S.approved drug called Aricept
and a European one known as
memantine. Gillian finally be­
gan stabilizing and has not de­
clined further in the past year.
PETER CRAHSER-lAll

Is that the result of the drug
combo or the unpredictable
course of the disease? Doctors
don’t know. But with the trial
longover, Richard continues to
buy her both drugs.
In a year of steady progress
against Alzheimer’s, one of the
most concrete developments
was the release of data showing
how effective this ding combi­
nation is. “Now finally we as
doctors can tell family mem­
bers that there is something we
can do to slow the disease,”
says Dr. Barry Reisberg of New
York University School of
Medicine. And it comes none
too soon. Already 12 million
people have Alzheimer’s world­
wide. By 2050, die total could
reach 45 million. Will we learn
to treat or prevent the ailment
in time to reduce that toll? Sci­
entists arc optimistic, citing
potential new treatments and
preventive measures.
The drug combination is a

al developed brain inflamma­
tion. But this fall the U.S. gov­
ernment cleared drugmakers
Wyeth and Elan Corp, to test a
treatment
safer, “passive” vaccine diat de­
facility
livers ready-made antibodies,
without prodding die immune
system to make its own. That
should avoid the side effects of
die earlier trial.
Anyone who’s truly con­
cerned about developing Alz­
heimer’s can take a simple pre­
caution: lose excess weight. A
major Swedish study this sum­
mer found a striking associa­
tion between obesity in women
at age 70 and die risk of devel­
oping Alzheimer’s 10 to 18
years later. For each one-point
increase in body-mass index,
die risk of dementia increased
by 36 percent. “You don’t have
to be Twiggy,” says epidemiolo­
gist Deborah Gustafson of the
Medical College of Wisconsin,
who worked on die study. “The
women at greatest risk were
clearly overweight.” No one has
a definitive explanation. But
obesity is the leading risk factor
for diabetes, and diabetes dou­
bled die risk for Alzheimer’s in
two studies.
Now neurologist Dennis
Selkoe and colleagues at Har­
good start. While Aricept
vard Medical School may have
boosts low levels of a key brain
figured out why. The link is an
chemical involved in memory',
enzyme diat breaks down both
memantine protects neurons
insulin and A-bcta. This year
from excessive stimulation by a
the scientists showed that mice
second brain chemical that can
who were deficient i n die en­
damage or even kill brain cells.
zyme failed to clear A-beta
But the drugs will not halt the
from tiieir brains and also de­
disease. Nor will they address
veloped insulin resistance.
what many scientists see as die
Does the same tiling happen in
actual cause of Alzheimer’s—
people? Pre-diabetic patients,
excessive levels of a substance
trying to overcome insulin re­
called A-beta, die major con­
sistance, produce abnormally
stituent of die amyloid plaques
high levels of insulin. Perhaps
diat clog patients’ brains.
the enzymic is drawn preferen­
That’s why many scientists
tially to the insulin, allowing Aare excited about die revival of
beta to build up.
vaccine trials against A-bcta.
Either way, the key to con­
Most people had assumed that
trolling Alzheimer’s is early in­
the quest for a vaccine was
tervention. “Waiting until a pa­
dead two years ago, after 18 of
tient has Alzheimer’s is like
375 patients in a phase-two triwaiting for a heart attack to
start treating cardiovascular
disease," says Peter Lansbury'
Alzheimer’s
of Harvard Medical School.
Two thirds of people
With die looming caseload,
with dementia live in
new treatments can’t come
the developing world.
soon enough.
H
COMFORT:
Friends at
a Stuttgart

5

41

The Next Wave of

Antidepressants
BY MICHAEL C. MILLER, M.D.

■ N HIS 1968 NOVEL “DO

■ Androids Dream of Elec­
fl trie Sheep?" (which in­
fl spired the movie “Blade
Runner”), Philip K. Dick in­
troduced his hero fighting
with his wife over what mood
to be in. The couple, living in
the dreary California of2021,
is fortunate enough to own a
Penfield Mood Organ, a device
that allows the user to dial up
any desired state of mind.
They spar over the wife’s deci­
sion to schedule, twice a
month, three hours of hope­
lessness and despair.
Would you want to manip­
ulate your moods with such
precision? If your hopeless­
ness and despair were out of
control, you probably would.
As helpful as today’s anti­
depressants are, about one
third of depression sufferers
get little or no relief from
them. And because the causes
of depression are still so poor­
ly understood, it's hard to tell
if an intervention is getting to
the heart of the problem.
But the science is changing
fast. Researchers are amassing
new insights into the biology
of depression. According to
the new model, depression
stems not from a “chemical
imbalance" (too little sero­
tonin, too little norepineph­
rine) but from unhealthy
nerve-cell connections in the
regions of the brain that create
our emotions. If that’s true—
and the evidence is com­
pelling-then the real goal of
treatment is not to alter the
brain’s chemistry but to repair
its blighted circuitry.
The new paradigm reflects
a growing awareness of how
chronic distress affects the
brain. Our stress-hormone sys­
tem, which kicks us into action
in an emergency, may remain
switched on in susceptible peo­
ple, especially those who were
very' stressed during child­

42

hood. Overexposure to stress
hormones slows the growth
of nerve fibers in a region of
the brain called the hippocam­
pus. This brain center allows
us to soak up sensory' input,
link experience to emotion and
store all of it as coherent mem­
ories. The hippocampus is typ­
ically small in depressed peo­
ple, with some brain cells lost
and some shrunken.
The idea that depression is
linked to stalled nerve-cell
growth or faulty connections
may explain an old mystery. If
antidepressant medications
boost neurotransmitter con­
centrations immediately
(which they do), why does it of­
ten take six weeks or longer to
feel better? Recent experiments
in mice tell us that antidepres­
sants stimulate the growth of
new hippocampal nerve cells,
which form connections with
older nerve cells. This process
takes several w’eeks. If drugs
like Prozac ease depression by
inadvertently' boosting neuro­
genesis, tire thinking goes,
drugs designed specifically for
that purpose might bring surer
reliefwith fewer side effects.
That’s a tall order, but re­
searchers are already pursuing
several strategies. One quest is
to find a drug to block tire ac­
tion of Substance P, one of the
chemical messengers involved
in the stress response. Aprepitant, die first Substance P
blocker to enter clinical trials,
has recently proved worthless
as an antidepressant. But other
compounds are under study,
and one of diem may’ w’ork.
A second possible target for
therapy is CRH (corticotropin­
releasing hormone), a chemi­
cal produced by' the hypothala­
mus, a tiny part of die brain

6

diat integrates hormones with
behavior. CRH starts a cascade
that ends with the release into
the bloodstream of die stress
hormone cortisol. An experi­
mental CRH blocker called
R12I919 can dampen die
stress response, both in lab
animals and in depressed
patients, but it also
damages the liver. Drug­
Depression
makers are now' develop­
Over 121 million people
ing odicr CRH block­
are affected by depression;
ers—and learningto
less than 25% are treated.
manipulate still other

parts of the stress response.
Drags that suppress vaso­
pressin—another hormone re­
leased under conditions of
stress—leave rodents less anx­
ious and more spirited. Drugs
that mimic a stress-busting
hormone called Neuropeptide
Y have similar effects. They
may also have the ability to re­
duce a mouse’s desire for alco­
hol—pointing the way to a pos­
sible new' biological model for
alcoholism. Some experts be­
lieve diese compounds are the
ILLUSTRATION BY LOST IN SPACE fOH KL. • • 11 <

Welfare for
Capitalists
BY ROBERT J. SAMUELSON

he scandal ofceo pay is not that it ascended to

stratospheric levels or that—despite some restraint—it’s still
unreasonably high. No, the genuine scandal is that few CEOs
have publicly raised their voices in criticism and rebuke.
Wiey’Il condemn many corporate practices (accounting standards,
auditing procedures) that now seem suspect. But on tlieir own pay,

T

there’s a widespread and self-serving silence.
Ifthey can’t defend what they’re doing, then
maybe what they’re doing is indefensible.
As everyone knows, CEOs—and a few
other top executives—have been on a finan­
cial joy ride. From 1992 to 2001, the top five
executives of die largest 1,500 U.S. compa­
nies made $67 billion in stock-option prof­
its, report Joseph Blasi, Douglas Kruse and
Aaron Bernstein, authors of“The Company
of Owners: The Truth About Stock Op­
tions." Even if these gains were skewed to­
ward a small group, typical compensation
exploded. From 1993 to 2002, die median
cash portion (annual salary, plus bonus) of
CEO pay packages at 350 companies rose 53
percent to $1.8 million, says Mercer Human
Resource Consulting. Including the value of
ig-term “incentives” (mainly stock opTTOns and stock awards), median CEO pay
tripled, from $2 million in 1993 to $6 mil­
lion in 2002. Over the same period, com­
pensation for all workers rose only a third
(all figures unadjusted for inflation).
Sprinkling so much money over so few
people has created a sense of entitiement.
The upper echelons of Corporate America
have come to believe that they shouldn’t sim­
ply do well. They deserve to become rich, per­
haps fabulously so. Now, a flourishing capi­
talist system ought to bestow great fortunes
on people who create huge enterprises or re­
vive flagging old ones. But great fortunes
should not routinely go to people who merely
preside successfully over existing firms. The
CEO conceit is that everyone near the top of
the corporate staircase should become a mul­
timillionaire several times over.
What this produces is a self-justifying
set of rules and practices, reinforced by a
growing insensitivity to appearances. Last
NEWSWEEK MAY 5, 2003

week American Airlines was die latest com­
pany to suffer from this mind-set. The air­
line flirted with bankruptcy after disclosures
that its top executives had received special
pension protections, even while pilots, me­
chanics and flight attendants were agreeing
to take pay and benefit cuts averaging about
23 percent. The contrast was too much for
many workers. Flight attendants suspended
their concessions and CEO Donald Carty
was forced to resign.

American Airlines is just
the latest example of
CEOs’ insensitivity to
the appearance of
entitlement in their
excessive pay packages
Ofcourse, let's be fair to CEOs. Though
popular, CEO bashing is sometimes scape­
goating-blaming all CEOs forthe mistakes or
sins ofa few. Even Catty' proposed cutting his
base salary 33 percent to $543,453- But CEOs
and corporate elites have partly brought this
on diemsclves by not confronting the excesses
ofexecutive compensation. Ordinary people
may not grasp the technicalities ofaccounting
irregularities. But everyone understands pay.
Some will say that CEO pay is now being
curbed. Thue, annual surveys by die business
press (The Wall Street Journal, BusinessWeek
and Fortune) show modest changes. A few
CEOs are working for $1 or no salary; this
surely reflects dieir existing wealth. The Mer­
cer survey, done for die Journal, found tiiat50
CEOs out of350 received no cash bonus for

2002. Given sagging profits and stock
prices—and all die bad publicity—it would
have been astonishing if nothing had
changed. But die changes are mostly cosmetic
and don’t question or threaten the underlying
nature of die CEO entitiement system.
CEOs justify their compensation by say­
ing tiiey get what “tiie market" dictates, just
like everyone else. Rubbish. Their market is
highly artificial. CEOs match their pay with
that of other CEOs, as revealed by surveys.
But this comparison isn’t especially relevant
because other CEO jobs aren’t open. A CEO
dismissed today can’t easily get a compara­
ble job tomorrow. Compensation levels are
what economists call “administered prices,”
set by corporate directors who are usually
top executives or retired executives. The re­
sult is an artificial welfare system designed
to ensure that even mediocre top executives
do well—and everyone else receives repeated
chances to make a fortune.
Corporate executives ought to be well paid.
But wrong “incentives” are destructive. Ifun­
derinvested in company stock, executives may
have little interest in improving efficiency and
profitability’. But ifoverinvested. tiiey may be
tempted to stretch accounting rules to puffup
profits and stock prices. Today’s oversize com­
pensation packages often hinder—as Ameri­
can Airlines reminds—everyday management
by demoralizing workers.
What’s the right compensation? This is
not an easy question. But it’s one that top
executives should openly address. Defend­
ing what you’re doing, in public and on pa­
per, is a powerful moral and intellectual dis­
cipline. Until that happens, we’ll find that
pay follows two poor guides: executive
greed and, once public anger produces new
laws, popular prejudice.

11

salth

As this strange new vims continues its spree, killing
hundreds and infecting thousands more, scientists are
working overtime, trying to keep people from harm

GLOBE-TROTTER: Fear of SARS prompts a Lufthansa crew to wear masks in the Hong Kong airport (above); the virus

BY CLAUDIA KALB

oronto was a city on edge last week, people

walked the streets as they always do, families went out to
tion
had
declared
the
Canadian
city
—known
for
its pristine
dinner
and
die Bluejays
game
on
Friday
drew
thou
parks
friendly
residents
—aThe
hazard
to night
public
health,
ad­­ ­
sands.and
But
nobody
was happy.
World
Healdi
Organiza
vising tourists not to visit after several SABS cases in other countries,

T

including die Philippines, were linked to Toronto. In a furious attempt
to reclaim the city’s reputation, Mayor Mel Lastman praised Canadian
health efforts and lashed out at the WHO.
“Let me be clear,” he told reporters. “It’s safe
to come to Toronto.” But the alert had set off
global alarms. A Toronto girls’ soccer team,
on its way to Pennsylvania for a muchanticipated exhibition match, was told it
was no longer welcome. Player Katie Nizio,
16, had hoped to show off her skills and win
a scholarship to college. “It was my one big
chance,” she says. “I was 1 iterally crushed.”
From dashing the dreams of teenage ath­
letes to forcing a stunning political fallout in
China, severe acute respiratory'syndrome, or
SARS, is proving itself a formidable enemy
14

at every level—medical, political, economic
and even psychological. Ln Beijing, the gov­
ernment’s Health minister and mayor were
sacked, tlrree hospitals shutdown and 4,000
citizens suspected of exposure to the poten­
tially fatal disease told to stay at home or in
hospitals. A false alarm at San Francisco In­
ternational Airport panicked travelers after a
50-year-old man suspected of hating SARS
was removed from a Northwest Airlines
flight. In Hong Kong, only about 100 people
turned up to ogle Qianlong porcelain at a
Sotheby’s cocktail party—the first major so­
cial event in weeks. The party normally

draws hundreds in Manolos; last week’s
guests accessorized with paper masks.
In Britain, students returning to board­
ing school after spring break in Asia were
quarantined in separate buildings or askfl
to spend an extra 10 days at home. Severer
dozen University of California students
were called home from a study-abroad pro­
gram in Beijing. A new Gallup poll report­
ed that 43 percent of Americans are now
worried about the disease—up one third
from the week before. And in Los Angeles,
politicians dined in Chinatown to counter
rumors that you could get SARS from eat­
ing Asian food. Dr. Jonathan Fielding, the
city’s public-healdr director, made a point
ofeatingwontons and chow mein at a press
conference. “It’s scarily reminiscent of the
early days of AJ DS,” he says.
By late last week, drere were more than
4,800 cases of SARS in 27 countries and
293 deaths—small numbers in tire scheme
of global threats. Many people couldn’t
help but wonder if healdi officials and the
media were manufacturing hysteria over a
microscopic bug, now that Iraq was no
longer fodder for 24-hour cable news. But
an to son- mtn parxs-atf. htotochafh syuahwtu paacy too hewswttk

may have been born on a farm like this (above) in Guangzhou, China, where animals and people live close together
the insidious nature of the virus, its capaci­
ty' to spread and kill, remained. And its lin­
gering mysteries—how it’s transmitted,
why it’s more virulent in some people dian
f liers, how it’s best treated—have public'riealth experts discernibly worried and un­
apologetic for erring on die side of caution.
In the United States, where die tally of
“suspect” and “probable” cases is fewer dian
300, with no deadis, there was still concern:
Could the epidemic spread further? Why
hasn’t it? How worried should we be? The
medical batde is being fought on multiple
fronts: doctors are trying to diagnose, treat
and contain die virus. Scientists are launch­
ing seck-and-destroy missions in petri dish­
es. And public-health officials are mapping
strategies for drug and vaccine development.
As with any’ new enemy, victory' will not
come easily—or quickly. “This is still a work
in progress,” said Centers for Disease Control
and Prevention directorJulieGerbcrdinglast
week. “We have a lot to leant.”
Eoraminteraative.guide.to.the____

symptoms, and treatmentof.SARS,
NBC goto Newsweek.MSNBC.com____

NEWSWEEK MAY 5, 2003

The quest to understand SARS starts in why I was determined to conquer SARS."
So, too, are the scientists. Thanks to tech­
the lungs of victims like Dr. Henry Liknology’and a spirit ofglobal cooperation, the
yuen Chan, 34, who contracted the illness
first genome of the virus that causes SARS
in the Hong Kong hospital where he works.
was mapped by Canadian researchers in less
Chan’s first few days as a patient are a blur.
He had high fevers and was racked with than a week; soon after, it was identified as a
coughs. Taking a shower felt like running coronavirus. Since then, more than a dozen
sequences of the virus, decoded by labs from
a marathon. A colleague who called Chan
Singapore to Liver­
to see how he was do­
pool, have been post­
ing cried when slu^<
.A. POLITICIANS
ed on the WHO's Web
heard his wheezjXg
gasps for breath. n
DINED IN CHINATOWN site. All show slight
differences in tire
day’ 10, when rest
TO COUNTER RUMORS string ofabout 30,000
X-rays showed fluid
bases that make up its
han
in his lungs,
THAT YOU COULD GET blueprint, but re­
drought he was g\ing
searchers say that is
to die. Now, six we
SARS FROM EATING
not surprising. Coro­
later, Chan is
SIAM FOOD
'
naviruses are com­
pounds lighter, but
posed
of
single
is
recovered.
He
lucky: early in the course of his illness, strands of genetic material called RNA,
hospital officials insisted he check in for which has no built-in proofreading system to
observation. That vigilance, a cocktail of catch mistakes in replication. Every time the
virus copies itself, it changes very slightiy.
drugs—including steroids, antibiotics and
“Coronaviruses mutate for a living," says vi­
the antiviral Ribavirin -and a fighting spirrologist Mark Denison, of Vanderbilt Uni­
it helped him through. “I am quite
an aggressive person," Chan says. “That is versity Medical Center.

15

LHealthL

SIGNS & SYMPTOMS

The New Bug

Fever, greater than
100.4 degrees.
Fatigue, headaches,
chills.

SARS is the first new deadly disease in years that can
easily pass from person to person. Here’s what you
need to know about its science and how it spreads.

Dry cough
Chest Xrays sug­
gestive of
pneumonia

THE VIRUS BEHIND THE EPIDEMIC

E Stage 1(2-7
days after incubation)

Inflamed lungs, difficulty in

SARS is caused by a corona­
virus, which is related to the
virus behind the common cold.

breathing. Patients may
have trouble getting enough

oxygen to their blood.

■ The source: The virus may

Muscle
aches

have lived in livestock before
jumping over to human
victims. Here’s how it could
have switched hosts:
ANIMAL CELL

then progresses
in 2 stages.

Stage 2 (3- days)

■ The bug: Scientists think

Surface
protein,

The SARS virus
incubates in the
body for 2 to 7
days before symp­
toms emerge. It

Loss of appetite,
diarrhea

Canada: Tourists brought

HUMAN CELL

the virus from Hong Kong
to Toronto. The WHO has

since advised against

Surface <
receptors

MOVING FROM
ANIMALS TO
HUMANS
;

visitingthe hard-hit city.

Original virus: The

Mutated virus: Genes in

coronavirus is coated
with proteins designed to
latch onto tissues of its
traditional animal victim.

the virus mutate, chang­
ing the proteins' shape
so they can now latch
/
onto human tissue.
/

sickest

f BlsSARS

patients may

here to stay?

least three coun­

China: SARS may
China
2,753/122

Globalism: A crowded,

tries in February.

markets here.

cases

Hong Kong
1,527/121

100

Days to
circle globe

World population, in billions

Taiwan 29/0

Thailand 7/2°
Vietnam 63/5 Cr

I

it may have been hit

simply be those

Last week the

by a weaker strain

with already weak

CDC said the dis­

of the virus.

immune systems.

ease might prove
ineradicable, per­

was genetically

The pathogen’s

■ How can we
cure it? For the

sequenced three

moment, we can’t.
Doctors are testing

at low levels in the

NEW INFECTIONS

weeks ago. A few

genome varies,
and some versions

population. But

Leveling off: New cases are down

think other viruses

may be especially

the WHO thinks we

since their peak in March

may be involved.

virulent. Or, the

antivirals and
other compounds.

might just beat it.

Jan. 1

The critical issue, then, is whether those
mutations affect the severity ofdisease. So far,
most people have recovered from SARS, but
about 6 percent have died; researchers are
desperate to know why. Scientists have
learned from viruses such as the 1997 bird flu
in China, which hopped to humans, that even
a single change in the genetic code can mean
die difference between a virus that sickens

Europe 30/0

afflicted as Canada,!

:
1

navirus, which

16

virus back to at

disperse new infections.

■ Why is SARS
fatal for some
and just a bad
cold for others?

points to the coro­

KEY: CASES/DEATHS |

mobile population helps

U.S.: Not as

THE UNKNOWNS

hotel carried the

almost 5,000 people on six continents. Here’s how.

Canada 142/19

U.S. 39/0

at a contaminated

Emerging in rural China last November, SARS has gone on to infect

in crowded poultry

protein

Hong Kong: Guests

TRACKING THE GLOBAL SPREAD

have been spawned

Protein

■ What causes
SARS? The WHO

SAY AAAH: Chinese health officials testing for SARS in hopes of containing the deadly virus

1850

Year

Singapore
198/21

2000

Vietnam: Visitors
carrying SARS

manently lurking

birds and one that can kill people. Experts
suspect that the coronavirus mutations may
explain why some people suffer more than
others. But additional factors, such as the
amount of virus in the body or a weakened
immune system, could be to blame. And drere
may be different strains of SARS altogetherviral siblings in the same genetic family, bom
at different times as die bug spreads. “I’d bet a

bottle ofchampagne diat diere are,” says vi rologist Robert Webster of St Jude Children’s
Research Hospital in Memphis, Tenn.
The chameleonlike quality of a corona­
virus makes coming up with accurate diag­
nostic tools all the more challenging. Right
now doctors must rely on a checklist of
symptoms—fever, dry cough—a history of
travel to SARS hot spots or close contact with

PHOTOS. LEFT TO RIGHT BRANDX PICTURES (DUCK). JIM 0ATHAHV-C0C-C0R0IS (VIRIK1

from China made it

the second coun­

try hit by the virus.

April 21

patients and chest X-rays to spot the disease.
Public-healtii officials use two main tests to
confirm the diagnosis: a blood screening,
which looks for evidence of antibodies to die
virus, and a poiymci-a.se chain reaction
(PCR) test, which searches for its genetic
footprint in saliva or cough residues. Experts
caution that existing tests may have eitlier
false positive or negative results, and

they are working hard to refine them.
An accurate diagnosis might have spared
Mark Van Camp. 49, ofWichita, Kans., a dif­
ficult welcome home from China. In March.
after he and his wife returned from adopting a
baby girl in Guangzhou, Van Camp became
sick and was diagnosed as Kansass first
suspect case of SAILS. Even after he recovered
and doctors concluded he probably had a bad

SOIJRCES COC. WHO DATA FOR INFECTIONS REPRESENT PROBABLE CASES. FIGURES AS OF APRIL 20.
TEXT ANO REPORTING BY JOSH UUCK. GRAPHIC BY KARL CODE AHO TOHIA COWAN - NEWSWEEK

case of pneumonia, his day-care provider
said she wouldn't be able to mind his kids.
And when Van Camp ran into his former
physician and his wife at a local restaurant,
the couple moved to another table. “That’s
the fear factor of SARS,” he says.
The fear is that we don’t know exacdy
how the vims spreads. While it’s clear that it
jumps from person to person through air­
borne droplets—a sneeze or a cough—ex­
perts suspect it may lie transmitted fecally as
well. In Hong Kong, residents who contract­
ed SAILS in a housing complex, Amoy Gar­
dens, suffered severe diarrhea, and experts
found coronavirus in feces and on an infect­
ed resident’s toilet. Health officials conclud­
ed that the pathogen spread at least in part
through breaks in the building’s sewer lines.
Worldwide, experts are also working hard to
determine how long the SARS virus survives
in the environment—on countertops or door
handles—and whether that might contribute
to its spread.
Treatment is another puzzle. The illness
is caused by a vims, rather than a bacterium,
so antibiotics are ineffective. Hong Kong
doctors are using the antiviral dmg Rib­
avirin, often in combination with steroids,
but U.S researchers say the dmg has no ef­
fect on the SARS vims in a lab. At the United
States Army Research Institute for Infec­
tious Diseases in Frederick, Md., scientists
are conducting a treasure hunt for treat­
ment. Every few days, a shipment of dmgs
collected from the National Institutes of
Health and dmg manufacturers around the
world is delivered to a team ofvirologists led
byJohn Huggins and Peter Jahrling.
Clad in gloves and respirator masks, the
team bombards the SARS vims in plastic
trays witii whatever it can get its hands on:
antiviral medications on the market for dis­
eases like HIV, herpes, flu and hepatitis;
anti-canccr agents, anti-inflammatories and
anti-asthmatics, and more than 1,000 other
compounds, including experimental dmgs
like cysteine protease inhibitors, which block
some viruses from replicating. So far some
interferon drugs look promising in early test­
ing, but the medication can cause severe side
effects, like depression and muscle pain.
Scientists may have to develop a newantiviral dmg altogether, and biotech com­
panies are eager to try out their latest inven­
tions. “Every day. I get 20 to 30 e-mails from
biotech start-ups telling me why their dmg
would work," says WHO virologist Klaus
Stohr. The U.S. Department of Health and
Human Services, meanwhile, is trying to lure
vaccine manufacturers into the fight. Health
Secretary Tommy Thompson held a recent
meeting witii Merck, Wyeth, Aventis Pasteur
and other companies. About 70 people at­
tended, including officials from the Depart-

17

Health
of patients. The data are troubling, but
other scientists say a number of factors
could account for the finding, includ­
ing weak or incomplete diagnostic
tests. Halfway around the world in Hong
Kong, doctors were reporting patients
who tested positive for SARS—but had
none of the classic symptoms. And then
there’s Sam Sun, a third-year law student
in Beijing, who was cooped up in his

ment of Defense. “The message clearly was,
'This isn’t business as usual',” says Dr. Bruce
Gellin, director of tire HHS's national-vaccine-program office.
With every' step forward, new myster­
ies arise. Last week a Canadian virologist,
Dr. Frank Plummer, questioned the link
between tlie coronavirus and SARS alto­
gether, announcing that he’d found evi­
dence of the virus in only 40 percent

dorm room after classes were canceled
last week. “I’m worried,” he said. “I don’t
know when this will end." The fact is,
SARS may never be vanquished, but its
lessons are preparing scientists for what­
ever conies next.
With ANNE UNDERWOOD, ANNA KUCHMENT and
DEBRA ROSENBERG, ALEXANDRA A. SEND in Hong Kong
SARAH SCHAFER in Beijing, STEFAN THEIL in Genova’
BARRY BROWN in Toronto, DALIA MARTINEZ In London’

FINANCE

As scientists track mortality rates, analysts assess a
Bualty: international business and tourism
diffej

conomies

n Empty

NADINE JOSEPH and JULIE SCELFO

Air Transport Association reported
that transpacific travel was down
40 percent compared with this

time last year. Chinatowns in San

Francisco and other cities became
ghost towns. All this without a
single American death.
Despite these developments, .
SARS isn’t likely to be lethal to
’
the U.S. economy. In fact, it might
even have an upside. If fewer firms
invest in China, says Diane Swonk,
chief economist of Bank One Corp.,

BY MTtHYLCAQMICHAEL
y now, everyone Knows
the early signs of SARS
are high fever and a dry
cough. But there’s a sec­
ond set of symptoms: canceled
business trips, the collapse of
tourism and falling stock prices.
SARS (and fear of the mysterious
disease) has already infected

B

economies in Asia and Canada.
Now U.S. markets are starting to
look a little sickly, too. Last week
analysts here blamed SARS for
both a domestic stock slump and
the airline industry’s most recent
woes. That’s got economists pon­
dering the kinds of questions doctors usually worry about: how far will this contagion spread, and what will
be its final toll?
In Asia, where tourism can account for as much as 9 percent of a
country’s gross domestic product, companies and families alike are
canceling travel plans and locals are staying home. Hotels and restau rants in Hong Kong and Singapore now regularly go more than half empty,
if they're open at all; analysts estimate that more than 40 percent of Chi­
na's annual $67 billion in tourism -related income may be lost this year.

that’s not necessarily a bad thing.
“Everyone says China is the new
Asian tiger, but it’s lacking in in frastructure,” she notes. “Maybe
this will puncture the hype—and
bring that investment back to the
U.S.” Cutting back on travel could
also benefit some companies, es­
pecially in tough times.
But SARS’s unpredictability
makes assessing its potential eco­

nomic impact difficult. So far, most
projections have assumed that the
United States will stay relatively
SARS-free and the rest of the world will get things under control by late
May. But if those predictions turn out to be wrong and a major outbreak
hits, say, Orlando, it could send the U.S. economy plunging faster than |
the Space Mountain roller coaster. For SARS to have any real impact on
GDP, though, it would have to cause a collapse in tourism to almost all
parts of the United States, and that's never happened before. The upshot:
nooneinthe world knows what to base predictions on. Last week a Lon don consultancy claimed SARS would have an even greater impact than
Asia's 1998 currency-devaluation meltdown, particularly because face-

Food prices across Asia have tumbled as restaurants cut down on pur­
to-face contact is a cornerstone of Asian business. But, says Swonk, “the
chase orders, leaving the region's farmers and fishing fleets high and dry.
Asian financial crisis was the result of years of overinvestment, of build­
The only luxury goods flying off shelves are fake Louis Vuitton surgical
ing skyscrapers with nobody in them. This is much more isolated."
masks. "It's pretty clear the Chinese economy will shrink this quarter,"
If SARS’s major economic effects do remain limited to Asia, it’ll
says chief economist Mark Zandi of Economy.com. “That's taking out
largely be due to smart thinking by national govern­
a growth engine for the entire global economy." Morgan
ments. Most of Asia moved quickly to curb the virus’s
LEADING INDICATORS
Stanley chief economist Stephen Roach has pared his
spread, and China is taking big steps now to make
forecast for global economic growth down to 2.4 per­
A 4 4 Amount SARS has
up for lost time (more than 4,000 are quarantined
cent; 2.5 is the Rubicon for worldwide recession.
V AAcost Asia, in billions
in Beijing alone). Ailing Asian economies are also
On Friday, the Federal Reserve acknowledged that
A rt % Drop in transpacific
getting heavy doses of medicine, including a $1.5
economic troubles abroad were starting to cause ripple
■ Vtravel on U.S. airlines
billion relief package for local businesses announced
effects at home. The U.S. stock market, already weak­
Singapore and Hong
ened by war and winter weather, slid even further last
by the Hong Kong government last week. Throwing
Kong hotel-vacancy rate
week as the chairman of American International Group,
big bucks around will help, but the only sure cure
the world's largest insurer, said that SARS fears were
will be to control the disease.
New projection of
behind weakening sales in Hong Kong and China. The
With DANIEL MCGINN and STEFAN THEIL
fc«T'world economic growth

9 /|%

yj’.-t j f: In Taipei, a young girl takes care to escape infection as she walks to her elementary school

. ' ./I:

How progress
Makes Us Sick
Advances that make life more comfortable can also make it more dlingcrous
BY GEOFFREY COWLEY

ARS MAY HAVE DOMINATED

S

the headlines last week, but it
wasn’t the only weird disease on
the World Health Organization’s
radar screen. In central Africa, an
outbreak of the dreaded E,bola fever had
stretched into its fifth month. In Belgium
and the Netherlands, a virulent new strain
of avian flu was wiping out entire chicken
farms. Dutch farmers recently slaughtered
18 million birds in hopes of stopping the

outbreak. Yet the bird flu has spread to sev­
eral provinces and jumped from poultry to
pigs and even people, causing 83 human
cases. Most ofthe infected people have suf­
fered only eye inflammation, but some have
developed respiratory illness. One of them.
a 57-year-old veterinary surgeon, recently
died of pneumonia. “Bird flu virus was ...
found in the lungs," according to an April
19 statement from the Dutch Agriculture
Ministry, “anil no other cause of death
could be detected.” Sound familiar?

SARS. Ebola. Avian flu. The parade of
frightening new maladies continues, each
one confirming that our species, for all its
cleverness, still lives at the mercy of the mi­
crobe. It didn’t seem that way 30 years
ago—not with smallpox largely defeated,
AIDS still undreamed of and medical sci­
ence evolving at an unprecedented clip. But
even as optimists proclaimed victory over
the germ, our megacities, factory farms, jet
planes and blood banks were opening
broad new avenues for infection. The dark

19
18

NEWSWEEK MAY 5, 2003

PHOTOGRAPH BYCHIEN-CHICHAHG-MAGNUM PHOIOS FOR NEWSWEEK

Iraq

Ehud Barak

THESH’IT" S

More an Actor
Than a Leader

Already, a subtle shift in
power is underway in the
Muslim Middle East. And
just about everyone has a
reason to be nervous.
BY BABAK DEHGHANP1SHEH
AND CHRISTOPHER DICKEY

haled abdullah wait-

cd 23 years for this mo­
ment. The 43-year-old Iraqi
climbed a Hight of stairs last
week and gazed ecstatically
on die golden dome of
Shiite Islam’s holiest shrine,
die tomb of Imam Hussein in Karbala. He
closed his eyes, turned his palms toward
die sky and gave a prayer of thanks.
In the streets below, dirongs of Shiites
were celebrating the festival of Arbaeen
with ancient rituals of penance and de­
votion. Chanting men and a few blackshrouded women pounded dieir chests,
while drummers filled the air with deafen­
ing rhythm. Other men circled die shrine,
flogging themselves widi heavy chains.
Youths, dusty and bleeding, crept on hands
and knees toward the shrine’s golden arch­
way. Inside, odier young men with shaved
heads slashed their own scalps widi cere­
monial daggers. Attendants bandaged the
wounds of some; others were half-carried
onto donkey carts outside to be paraded
around the courtyard in dieir bloodstained
white shirts.
Abdullah was glad to be home. He had
been living in Persian Iran since 1980,
when he fled die Iraqi dictatorship. He has
made a comfortable income selling clodi in
Tehran’s main bazaar, but he hasn’t been
happy. “The Iranians are racist,” he says.
“They don’t respect Arabs.” At die bazaar
his Persian neighbors sometimes snubbed
him when he said good morning. Some
clodi suppliers wouldn’t deal with him.
Once a cabdriver refused to let him ride
after hearing Abdullah’s Iraqi accent. The

K

RAPTURES OF PENANCE; Shiite pilgrims in
Karbala celebrate the festival of Arbaeen

HEN I MET YASIR ARAFAT FOR THE FIRST TIME, IN

W

1996,1 was struck by the contrast between his revolutionary
appearance—with his uniform and his gun-and his softspoken manner. That hasn’t changed. He has a fragile,
seemingly helpless physical appearance, but according to Israeli intelli­
gence files he’s a corrupt terrorist. I watched him through the gun sights
for 20 years, and then spent time with him
*mund negotiating tables at Camp David
Vd elsewhere. I gradually found him to
be a sophisticated manipulator, more an
actor than a leader, holding a mirror and a
weather vane to find his way, rather dian
a compass.
Arafat is a man of die past. Yes, the
Palestinian crowds sti11 cheer for him, and
die struggle diat preceded the formation of
Abu Mazen's government shows that he
still retains power. He remains a living sym­
bol of die Palestinian national movement.
But since the attacks of September 11,2001,
and die war in Iraq, a new chapter in Mid­
dle East history has been opened, and it has
no natural place for him. Hence, witilin a
year or two, I believe, Chairman Arafat will
begin his march into history'. He has failed
to rise to the challenge of historic leader­
ship, and has thus become a source of
tragedy for his own people.
Last week’s release of die Roadmap is a
. knanding, and potentially’ damaging,
'Imallenge to Arafat. It was launched only
after Arafat was coerced into accepting
the executive triumvirate of Abu Mazen
(whose formal name is Mahmoud Abbas),
Muhammad Dahlan and Salam Fayad.
Abu Mazen, the Palestinian prime minis­
ter, will deprive Arafat of some executive
power. Dahlan, the minister of internal
security, is supposed to crack down on
Hamas and Islamic Jihad as well as on
Arafat’s own Aqsa Martyrs Brigades. /And
Fayad, the Finance minister, will try to find
die Palestinian money that’s trickled into
die private accounts of Palestinian leaders,
and to establish new, transparent and ac­
countable institutions.
They will not have an easy time, mosdv
because it’s not in Arafat’s interest for them
to succeed. If they implement reforms and
move toward reconciliation with Israel,
honest Palestinians might wonder who
was responsible for die thousands of Pales-

PHOTOGRAPH BY ROH HAVIV FOR NEWSWEEK

NEWSWEEK MAY 12, 2003

There have been opportunities before—
as the late Israeli foreign minister Abba
Eban used to say, “The Palestinian leader­
ship has never missed an opportunity to
miss an opportunity." The Israeli-Palestin­
ian conflict, I once told Arafat, is one of the
most complicated conflicts on earth, and it
won’t be solved unless human beings are
ready to make decisions and put an end to
it. We happen to be the human beings in
chaige, 1 added, and the price ofour failure
will be the loss of thousands of innocent
lives on both sides before our successors
return to the negotiating table to solve
exacdy the same issues. Yet in July 2001,
Arafat rejected die Camp David proposal as
a basis for negotiation and deliberately
turned to terror.
Last week President Bush, addressing
the American people from an aircraft carri­
er, said that whoever commits terrorist
acts, or supports or harbors those who do,
is the enemy of the United States. No one
better fits those descriptions than Arafat.

Chairman Arafat has failed to rise to the
challenge of historic leadership, and has thus
become a source of tragedy for his own people
tinian lives that have been lost in a vain
attempt to dictate a political solution to
Israel through homicidal bombings. As
long as Arafat holds power, there will be
no Israeli-Palestinian peace. Orwellian
double-speak and treachery will prevail.
The Israeli-Palestinian peace process is
a painful divorce drat should be executed
for die benefit ofboth sides. Israel should
give die Roadmap a fair chance to succeed.
Illegal settlement outposts should be dis­
mantled. The rule of law should be fol­
lowed by all. Ways should be found to ease
daily life for Palestinians. Ifand when tire
Palestinians launch a coherent and deter­
mined crackdown on all terror groups,
then Israel will have to use common sense
and not let a single attack stop die peace
process. But we’re not yet there. And Israel
can not he expected to step forward before
statements turn into action on the Palestin­
ian side. The opportunity is here, but the

He has engendered hatred in a generation
of Palestinians, poisoned the souls of mil­
lions of young Arabs and Muslims around
die world. But beyond that, he represents
a failure ofcharacter and leadership. If
die Palestinians had a leader like Egypt's
Anwar Sadat or Jordan's King Hussein, we
would have had peace by now.
At decisive moments leadership is about
moving against die stream, asking yourself
not what the people want right now, but
rather what the people need in the long
term anti what should be done about it
now. It’s not easy’; leadership has its risks.
You might lose your office, like Mikhail
Gorbachev. You can even lose your lite, as
happened to Sadat, Yitzhak Rabin and
Abraham Lincoln. But when leaders aren't
ready to lead, many odier people have to
pay the price. Thar is die failure ofArafat

challenge is immense.

to 2001.

BARAK was Israel’s prime minister from 1999

.17

With no cure in sight, Chinas SARS epidemic has set off a tussle for
power in the upper reaches of the Communist Party leadership. The
country’s political virus could linger long after the health hazards.

>r A iewata n i

BY RODERICK MACFARQUHAR

tury Leninist paranoia that still infects the
has
its'sleadership
been
so ex­
posed
to sars
the humiliating
hina
epidemic
behavior of China’s leaders, and die Third
ing inscrutiny
Tiananmen
Square
glare ofinternational
and criticism.
has its Communist
Party World nation that lingers behind the glitter­
The cancellation
of
prestigious
conferences
leaders
their
heels.upris
Not­ ing skyscrapers of Beijing and Shanghai.
since
theon
1989
student
in the capital and the potentially precipitous
The public-health crisis is also begin­
drop in foreign trade and investment as for­
ning to pull back the curtain that hides the
eigners obey the World Health Organiza­
divisions within the party itself. Clearly', the
tion’s advisory' to shun Beijing are embar­
honeymoon is over for the new leaders,
rassing enough. Worse is the image of President Hu Jintao and Premier Wen
China’s leaders behaving in feckless fash­
Jiabao. Whether praise for the energetic
ion, putting politics before people.
measures they have taken to contain
I
The leadership’s perennial obsession
epidemic ultimately outweighs blame for
1 with secrecy led it to prevaricate about the
concealing it will doubtiessly depend on the
B extent ofthe disease in the capital for five
human toll SARS exacts. The public­
B months. The rationale seems to have
relations battle will be fought out partly
H been a desire to avoid public panic durtitrough the ubiquitous urban Residents’
I i ng die passing ofdie torch to newleadCommittees, the asphalt-level apparatus
■ ers at the Party’ Congress last Novemthrough which the party confronts its sub­
0 ber and the National People’s Congress
jects. But for China’s leaders tite popular
in March. But in truth, the party' has al­
mood will be of less consequence than the
ways carried the “hear no evil, see no evil.
factional struggle within the party.
When Hu took over in March, he did
not inherit the full panoply of China’s lead­
ership posts. His predecessor, Jiang Zemin,
retained the key chairmanship of the par­
tv’s Central Military' Commission. Jiang
also seeded a significant number of his
speak no evil” policy-preferred by bureau- ’ ‘Shanghai faction” in the ranks of the new
‘
__ _____ j:------------- *—
Politburo, orchestrated by his mam trusty,
crats everywhere—to extraordinary lengths.
The assignment of the 2008 Olympic Vice President Zeng (Jinghong, a brilliant
Games to Beijing augured for many China’s
political operator. At the time Jiang gave
arrival in the modem world. But the SARS
every appearance of leaving office reluc­
epidemic has revealed the early-20th-cen- tantly, and having bowed to necessity he

C

•fWEDEHic J. BROWN-AFP

seems determined that his fac­
tion should preserve his legacy
in die people’s ey’es as the third
member in an apostolic succes­
sion—Mao, Deng and Jiang.
Today, when eveiy Chinese
leader is of a reformist bent, the
endemic factionalism in the
leadership appears to be driven
more by personality' than policy'.
i^St Western observers as­
sumed that pow’erplays between
Hu and Jiang would begin in
earnest in several years when Hu
began to lay die groundwork for a second
term. The SARS epidemic could be the cata­
lyst for the struggle to begin now. As the sen­
ior civilian overseeing the military, Jiang has
ultimate responsibility’over the capital's mil­
itary' hospitals. The military’s initial refusal
to reveal the number of their SARS cases led
to China’s international humiliation when
tlie full extent of the epidemic in Beijing was
finally' revealed. Was Jiang kept ignorant or
was he trying to protect his power base from
external interference?
Most party' officials would
probably like the military made
subservient to the civilian bu­
reaucracy and deprived of its
special relationship to Jiang.
The military’s insubordination
in the early stages of the crisis

may be an opportunity for Hu to whittle
away Jiang’s power base. But he is proceed­
ing cautiously. One of the two principal
scapegoats so far, the minister of Health.
was certainly a Jiang protege, but the other.
the mayor of Beijing, was one of Hu’s
men—almost certainly a sacrifice to pr event
a backlash from Jiang loyalists. And signifi­
cantly, the more powerful Beijing official,
the party's first secretary—also of Jiang's
clique-escaped with only a public selfcriticism. Hu cannot go too far too fast.
But he is not entirely
alone either. Hu has found a
potent ally in Wen Jiabao, a
protege ofjiang’s former po­
litical opponent.Zhu Rongji.
Indeed, Huappcarsto be ex­
ploiting tire moment to em­

ploy a number of officials from
Zhus circle. Known as the “Iron
Lady,” Vice Premier Wu Yi—the
highest-ranking woman in the
government—was
appointed
last week as chief of the leader­
ship team overseeing tire battle
against tire deadly virus. And
Wang Qishan, also a longtime
Zhu protege, is now serving as
the acting mayor of Beijing.
For their part. Jiang and his
frontman, Zeng Qinghong.
know it would be fatal to seem
to be endangering tire anti-SARS campaign
in the interests of scoring political points.
So, much will depend on tire success of the
campaign. If SARS is quickly contained,
the position of Hu and Wen w ill be greatlystrengthened. 11 is hoped they might be em­
boldened to experiment with greater trans­
parency in other spheres of public life. But
if the epidemic spreads through large parts
of the country and primitive rural medical
care proves unable to cope, then Jiang
could point out that the epidemic bur­
geoned only after Hu took over the party.
Either way. the political virus unleashed by­
China’s SARS crisis may persist longer than
the health hazards.
MACFARQUHAR is lire Leroy B. Williams Professor of

History and Political Science at Harvard University.

!th_

.he slippery SARS vims
is giving rich countries
plenty of trouble. But
doctors fear the real
devastation could come
in die developing worldt
Toronto,
where home,
she worked
at a nursing
and
probably
caughtwhen
the rams
in­
BY TOM MASLAND
brought
it to the
Philippines
she re
he her
killer
sars She
vnws
turned to care for
ailing father.
vis­
modem
cities.
Adelafatally
Catalon
traveled
to Barangay
Vacante
ited three provinces
before
falling
ill.
from onewhose
oftheimmune
world’s most
Her father, Mauricio,
sys­
tem had already been weakened by a bout
with abdominal cancer, also died from
SARS. Police ordered 210 Barangay
Vacante residents to stay home, and local
health officials went door-to-door twice a
day to check up on them. That didn’t stop
some residents from slipping away on foot
to shop in the nearby market town of Al­
cala. To persuade them to stay put, the gov­
ernment rushed in dried fish, rice and
canned goods.
Such are die simple tools deployed
against severe acute respiratory syndrome
in the so-called developing world. Even
rich countries haven’t exacdy produced a
lightning victory against the disease. Last
week, just as the World Health Organiza­
tion lifted its travel advisory for Toronto,
Canadian health officials announced two
new cases. And scientists in Hong Kong
raised the frightening possibility that pa­
tients who have already recovered from the
disease may still infect otiiers. What if
SARS holds another punch for the world’s
poorest countries?
The
prospect
has health experts
in South Asia and
Africa, in particular,
on edge. So far In­
dia has kept its 19
mild cases from

T

wow■I A'-’

Health clinics in
the Kibera slums
of Nairobi aren't
ready for SARS

turning into an epidemic, and only one case
has cropped up in Africa. With the disease
on the wane in Vietnam and leveling off in
Bangkok, it’s possible that SARS won’t be­
come a pandemic. But it’s far from a sure
thing. The epidemic is still raging in China,
only a plane ride away from vast popula­
tions of vulnerable people. Thirty million

20

HIV-infected Africans, who have compro­
mised immune systems, are sitting ducks
for the disease, warned Luc Montagnier,
one of the discoverers of the AIDS virus.
Millions more people sick with malaria,
hepatitis and bilharzia are similarly at risk.
A recent report from the World Health Or­
ganization sounds an ominous note:

“Nearly two thirds of all die patients who
die in all age groups already suffered
from chronic diseases.” Dr. Alfred Jumba,
who works in the eight-bed Vipawa Medi­
cal Center, one of the main health-care fa­
cilities in the teeming Nairobi slum of Kib­
era, says, "This is potentially devastating."
The Philippines is better off than many
PHOTOGRAPH BYSVtN TORflRN TORNEWSWffIC

developing countries, but it is hard-pressed
to defend itself against SARS. Unlike 1 long
Kong, which has erected virtual holiday
camps for its SARS victims, or Singapore,
which has installed video cameras to police
urban areas, it makes do with the 2 percent
of its annual budget that goes to health care.
Officials say they can’t afford to buy gloves
NEWSWEEK MAY 12, 2003

and masks for nurses. The Philippines’
trade minister said last week that the coun­
try has run out of \95 face masks. ”We arc
hoping that the WHO will help us out,”savs
Dr 'Box’ Gente, a government spokesman.
People arc turning io home preventions like
papayas and ginger-and-garlic infusions.
Indian health officials have even more

cause to be jittery. None of the country's 19
SARS victims so far has died. But with a bil­
lion people crammed together, a fifth of
them in megacities like Mumbai and New
Delhi, the Subcontinent is ripe for a SARS
epidemic. Only a quarter of all Indians have
toilets; SARS. scientists suspect, can be
spread by feces. A major outbreak of SARS

LHealth.

ThePcrilsof
The true cost of the SARS crisis may be a lot less
than many economic forecasters are predicting
BY GEORGE WEHRFRITZ

AND ALEXANDRA A. SEND

ARS

would overwhelm India’s health-care sys­ nursing. But even in Kenya, one
WARY-Taking
but if SARS comes into a
tem. The country has fewer than five physi­ ofAfrica’s best developed coun­
temperatures in
niunity, it may be as bad as
cians per 1,000 people and one small com­ tries, only 10 respirators arc
Manila (above,
1918 influenza outbreak.”
munity health center for every 80,000 available for isolation rooms.
left), lecturing
The South African govern­
people. The government's drive to promote Ghana, another well-off African
on SARS in India
ment, Africa’s best-heeled ad­
family planning has starved other health
country, is equally at risk. “In
ministration, has deployed its
services of funds. “The danger is extremely
tlie whole of Ghana there are only a few defenses quietly in order to avoid sowing
great,” says Ghanshyan Shah of Delhi's
isolation units with respirators,” says
panic. With no fanfare, it opened a 24-hour
Jawaharlal Nehru University. “Over time
Dr. Peter Ottengraf, who works in the clinic at Cape Town airport for checking
the health system has become weaker capital, Accra.
international visitors for SARS symptoms.
and weaker.”
The presence of HIV makes the situation .All airports are now required to check
Because most Indians aren’t covered bv potential]}- catastrophic. Most AIDS pa­ each airplane from an outbreak country. A
health insurance, many may wait too long- tients in South Africa, which has the world's public-heath officer boards the plane, ad­
before reporting to the rudimentary health
highest incidence of the disease, go untreat­ dresses the passengers and hands out cards
clinics serving rural areas. India’s plan to
ed. State hospitals are overwhelmed with
listing SARS symptoms and phone num­
use airports as a first line of defense doesn’t tuberculosis patients, many weakened by bers to call for help. Health officials will
inspire confidence either. Although all ar­ AIDS. “We are already living a nightmare track those who seem ailing. The govern­
riving passengers are required to fill in
here,” says Dr. Steve Andrews, a Cape Town
ment has also created outbreak-response
questionnaires, many say they haven’t been AIDS specialist. “Six hundred people are
teams and designated hospitals for sus­
asked any questions once they've landed.
dying each day from AIDS in South Africa,
pected SARS patients. “People now know
African health officials cast
about SARS, they are worried
a worried eye toward India.
about the symptoms and
SARS:
Will
It
Jump
to
India
and
Africa?
Here’s their nightmare sce­
those who fly here with Am
India
suffers
from
the
same
crowding
nario: .An expatriate Indian
disease will let medical peo­
and
poor
health
care
that
helped
from Nairobi returns to Mum­
CHINA"
ple know immediately once
134 $205
spread SARS in China. HIV raises
bai, where some SARS pa­
they feel sick,” says one South
Africa's SARS risk, too.
tients live, for a visit. He
African specialist. “But what
comes home and infects his
about their gardener or maid,
housemaid. She in turn
UGANDA
who lives in the township,
spreads the virus to Kibera,
and goes home that night
90
Kenya’s largest slum. There,
with a cough?”
working in shacks with sign­
It hasn’t happened so far.
boards out front, local staffare
And for now, the south’s best
trained to diagnose familiar
KENYA
chance is that the rich north
diseases like fiu or malaria—
stamps out SARS before it
$115
57
but not SARS.
rolls into a slum like Soweto.
Whatever the route might
“Let us hope that tire WHO
be, Africa lacks die ability to
manages to keep it under con­
People persq. km.
fight S.ARS. Suspected carri­
trol,” says Dr. Jumba in Nairo­
Per
capita
health
ers should be quarantined,
bi's Kibera slum. Millions of
spending
SOUTH
AFRICA
and victims need an intensivelives hang in the balance.
Cases (as of May 2)
care unit and an isolation
$663
With ERIN PHELYPCHANin Manila.
ward, equipped with respira­
Percentage of
IAN MACKINNON in New Dahl'
tors and staffed by specialists
adults infected
TEIJE BRANOSMA In Nairobi
trained in so-called barrier
•WCLUDES HONG KONG AND IMCA'J SOURCES CU UKAICX, WHO
and JEFFREY BARBEE In Capo Town

I]

22

FROM LETT ERIK DE CASTRO-REUTERS. AMAN SHARUA-AP

HAS TURNED

S

MICHAEL

O’Keefe’s business upside down,
but not for the reasons you might
think. As a risk consultant at
Kroll International, he normally
flftiys the voice of caution. Not now. In
Japan, which has yet to confirm a single
case of SARS, he’s telling clients that draco­
nian emergency measures—from bans on
corporate travel to quarantines for employ­
ees who have visited Asia even briefly—are
“overkill.” His advice: be prudent, but rec­
ognize that SARS is not an Asia-wide pan­
demic, even if it looks like one in headlines.
“Just because there’s a sick man in Asia,” he
says, “doesn’t mean all of Asia is sick.”
Amid warnings from
prominent
economists that SARS threatens to produce
a financial crisis as bad as tire 1997-98
Asian currency contagion, it’s time for a re­
ality check. SARS has crippled travel, trans­
port and retail industries, but the damage is
largely confined to a few “hot zones” like
I-Iong Kong, Singapore and, most recently,
China. No, SARS isn’t all in our heads, but
predictions of an economic disaster assume
egionwide epidemic, which now looks
s and less likely. “In my 28 years in Asia, I
have never seen such blind pan­
ic,” says Steve Vickers, CEO of
International Risk, a security'
consultancy. “I’ve heard about
people in Europe concerned
about packages coming from
Asia. DHL takes 36 hours;
viruses don’t last that long.”
In a report released late last mondt, the
World Bank lowered its growth forecast for
Asia from 6 percent to 5 percent, which puts
the cost of tlie SARS epidemic at roughly
$30 billion, a tiny fraction ofAsia’s losses in
1998. The study attributed most of the loss­
es to panic, not illness, noting that “in the
short run, tlie economic consequences arise
almost entirely from public perceptions and
fears about tlie disease—and from precau­
tions tlie public is taking against it—radier
dian from die disease itself”
That observation should quiet melodra­

matic comparisons of the SARS scare to the
Asian contagion. Back then, all of Asia fell
into a serious recession, with regionwide
growth plummeting from 8.3 percent in
1996 to 4-4 percent in 1998; in Thailand,
Malaysia, and Indonesia, tens of millions
fell into poverty. Even China (which cooked

most companies here,” says Frank Martin of
Hong Kong’s American Chamber of Com­
merce. Traffic at Kwai Chung—the world’s
busiest deepwater port, which deals mainly
in China cargo—has not slowed a bit.
The voices of reason are not getting
much airplay these days, however. Pradumna Rana, director of the Asian Develop­
ment Bank’s Asia Recovery Information
Center, says Asian countries are healthy
enough to defend their economies against
short-term capita] pressures should they
arise, and the region has foreign-currency
reserves 400 percent larger dian in 1996.
Mark Mobius, emerging-markets guru at
Franklin Templeton Investments asset
management, remains unruffled by SARS
after recent business trips to Singapore,
Hong Kong and China. “In a few months
we will see a return to a normal dynamic

Q

NEWSWEEK MAY 12, 2003

its books to hide the impact)
saw GNP growth fall to as little
as zero percent by some esti­
mates. In comparison, SARS is
a paper contagion.
Consider the epicenter oftlie
SARS crisis, Hong Kong. “The lobby of the
Mandarin Hotel is empty', sure, but this is
pent-up demand, not destroyed demand,
says Enzio von Pfeil, CEO ofadvisory group
Commercial Economics Asia, adding that
media accounts of the city s dismal
prospects are “90 percent based on fear, 10
percent based or. reality.” By tire numbers,
tourism accounts for about a tenth ol 1 long
Kong’s GDP, so drops in air travel, hotel occupanev and genet al tourist spendi ng could
push the economy into recession this year.
But trade, thecitv’s lifeblood, remains large­
ly undisturbed. ' It’s business as usual for

economic environment and growtn win
pick up again,” says Mobius.
Even in China, where SARS remains out
of control, the outbreak looks like a bump in
tlie financial road. “I don’t see SARS destabi­
lizing China’s economy,” says Cesar Bacani,
author of “The China Investor.” "The mo­
mentum from trade, investment, restructur­
ing and growing household affluence is sim­
ply too strong.” Last week the World Health
Organization lifted bans on travel to Singa­
pore and Vietnam. If those states can contain
SARS, why not China? "Once China’s leaders
focus on problems, they usually manage to
resolve them -sometimes with brutal effi­
ciency,” a Coldman Sachs report concluded.
"You may call that a virtue of authoritarian
government.” Its also another reason not tn
tear contagion..
Wah S

’ Lt

••• Seoul

23

note book
milestones

SENTENCED. GOHAR KHEIRAN-

DISH, Iranian actress; to 74

lashes for illegal physical contact
with a man to whom she is not
married; in Tehran. Kheirandish
kissed filmmaker Ali Zamani on
tire forehead during an awards
ceremony last September. Her
sentence was suspended after
she apologized for the offense.
RESIGNED. DONALD CARTY, 58,
as chairman and ceo of Ameri­
can Airlines,
the world’s
largest air car­
rier; after
unions found
out that he
had awarded
large bonuses
to himself and other top execu­
tives last March, while workers
were being urged to accept wage
concessions; in Fort Worth,
Texas. The unions still agreed to
$1.6 billion in wage cuts, helping
American stave off bankruptcy.

I'.’-'v

To his American friends, Ahmad Chalabi is a ..
democrat and a paragon of Iraqi patriotism.
To his enemies, he’s a crook. Does lie have die stuff
to reshape Iraq? A NEWSWEEK investigation:

' /

Banker, Sc
j

-

- ■

A DIED. FELICE BRYANT, 77, CO-

daughter, to actors Catherine
Zeta-Jones and Michael Doug­
las; in Ridgewood, New Jersey.
The couple already have a twoyear-old son named Dylan.

autlior, with her late husband,
Boudleaux Bryant, of such hits
of the 1950s for the Everly
Brothers as Wake Up Little
Susie and Bye
Bye Love; of
cancer; in
Gatlinburg,
Tennessee.
The pair’s
more than 800

:' ter and classically trained piaIW who was known, somewhat
inaccurately, as the “high priest­
ess of soul”; after a long illness;
in Carry-le-Rouet, France.
Bom Eunice Waymon,
the onetime aspiring
concert pianist took a
new name so that her
mother wouldn’t
catch on to her pop
career. The self­
described diva had
only one hit singleI Loves You Porgy in
1959—but won fans
with her alternately
smooth and grav­
elly tones, majestic
stage presence

N THE BATTERED PRECINCTS OF BAGHDAD’S HUNTING

I CLUB, Ahmad Chalabi holds forth on the bright future of his
I country and the sordid history of his enemies. The Iraqi fiI nancier and freedom fighter, just returned to his homeland
I after 45 years in exile, says he’s taken possession of 25 tons of
documents from Saddam Hussein’s secret police, and he’s
thinking how best to use them. He and his brotiters have been die
victims, as he tells it, of many conspiracies by Saddam and byjor- ■
dan’s late King Hussein. According to Chalabi, even Swiss bankers
and Saddam’s brother Barzan collaborated on schemes to destroy
the family’s banking empire abroad. But novi’ Ahmad Chalabi
could turn the tables on his many old enemies.
“It’s a huge diing,” Chalabi told NEWSWEEK. “Some of.die
files are ven' damning.” And some of the most incri minat- ‘a
ing, Chalabi implies, could tell a lot about the royal family

BORN. CARYS ZETA DOUGLAS, a

► DIED. NINA SIMONE, 70, fiery

BY CHRISTOPHER DICKEY AND MARK HOSENBALL

■

■

i

and maverick opinions. Simone
called her music “black classi­
cal,” embracing such genres as
African folk, jazz and gospel. An
influential voice in the civilrights movement—she wrote
Mississippi Coddam, a response
to the murder of Medgar Evers
and a church bombing, and the
anthem Young, Gifted and
Black—she left the U.S. in the
1970s to protest racism,
eventually settling in France.

songs were also recorded by
Elvis Presley, Bob Dylan and
Buddy Holly.
DIED. CHOLLY ATKINS, 89,
pristinely polished, graceful tap
stylist turned Mo^jlwnZhoreographort in Las YegtoCAs part of,
Motown’s ajjiyre oxyfliopm^Xt,
ht/engirtVeivd thYimagejf
oosnjmes vno dance mdves of ,
puchXcts a\Marvm<Cay^ , '
“Smoker Robinspn ancithn^A
Miracles andxfie ifcrrpIei^isX
DIED. MARTHA GRIFFITHS, 91,
kegxfy intellectual former U.S.
Congresswoman from Michigan,
whose persistence led to the
House and Senate passage of
the never-ratified Equal Rights
Amendment; in Armada,
Michigan. During her 20-year
tenure in Washington (she chose
not to run again in 1974), she
was responsible for adding “sex”
to the 1964 Civil Rights Act, thus
banning discrimination based on
gender, and became the first
woman to serve on the powerful
Ways and Means Committee.

A DIED. KAREN MORLEY, 93,
brainy blonde bombshell of
1930s Hollywood, who played
Paul Muni’s moll in Scarface,
Greta Garbo’s fellow spy in
Mata Hari, and a farm cooper­
ative pioneer in King Vidor’s
Our Daily Bread; in Woodland
Hills, California. In 1947,
Morley was blacklisted for
refusing to answer questions
from the U.S. Congress about
her ties to the Communist Party.

SO NOW
WE KNOW
►jo matter ho
their
I ■ paTOcaps i

ulant
fbbles,
emerge

fromclosfCudocZsummits
^appearing
grown-umNow
a DanisftKrpadca^fngCOTpoteirajdocui notary, Fogh

Tiehind The
Facade, shown
last week in
Denmark, re­
veals some em­
TOUGH ACT:
barrassing mo­
PM Fogh
ments as E.U.
Rasmussen
leaders negoti­
ated the formal acceptance of
10 new countries to the Union.
French President Jacques
Chirac is caught in a tete-atete with Danish PM Anders
Fogh Rasmussen, during which
Chirac throws his hands up in
dismay when Fogh Rasmussen
suggests a deal on agriculture
might not go through. "No, no.
it’s too much," Chirac moans.
“I can't do that. The French
farmers... get furious. I can­
not give something one day
and take it back the next." An­
other revealing episode came
when Danish Foreign Minister
Per Stig Moller expressed his
vexation with his German coun­
terpart Joschka Fischer’s posi­
tion on Turkey joining the E.U.
"Did I tell you that Joschka Fis­
cher had three different points
of view in less than 12 hours on
the question of Turkey's appli­
cation?" Moller asks Rasmus­
sen. The statement angered
the Turks, and the German For­
eign Ministry issued a state­
ment saying the film’s account
of Fischer's supposed equivo­
cation is ’’not true." Moller was
so mortified he felt obliged to
explain himself to Fischer dur;nga recent meeting in Brus­
sels. If nothing else, the film
affirr -that there are good
reasons to keep the doors on
c’.'J. meetings closed. —
Ulri f .'nn.Copenhppen

H

E A L T H

HOW BAD IS

Beijing has come clean, but the litmus test of China’s new openness is Shanghai
By HANNAH BEECHySHANGHAI

,,

or a metropolis teeming wrA

F

13 million people,’it xyas the most
spectacular of disappearing acts.
Overnight, Beijing, a city whose
wide avenues
usuallybuses,
jampacked
with are
crowded
squadrons of bicycles and even the occa­
sional donkey cart, had transformed into a
ghost town. Panicked about Beijing’s bur­
geoning severe acute respiratory syndrome
(sars) crisis, residents were flee­
ing or staying indoors to evade
the deadly disease that had by
week’s end claimed 48 lives and
afflicted 988 others in the capital.
Restaurants, theaters and shop­
ping malls resembled abandoned
movie sets. Elementary and mid­
dle schools were closed for two
weeks, while some universities
confined students to their
campuses. Three major hospitals
were quarantined, including
the Peking University People’s
Hospital with its 2,000 or so em­
ployees. Only the city’s dilapidat­
ed railway stations bustled with activity as
frantic, face-mask-clad citizens pushed
and shoved for a ticket out of town. “I’m
very worried about getting on a train with
so many people,” says a student surnamed
Wang, who was waiting for the poorly
ventilated train back to his native
Changzhou in Jiangsu province. “But I’ll
do anything to get out of Beijing. It’s simply
become too dangerous.”
It is a crisis the international communi­
ty has known about for more than a month,
but only now is it hitting home in China. On
April 20 the government ended a weekslong policy of massively underreporting
sars cases in the capital, sacking the city’s
Mayor Meng Xuenong and tire nation’s
Health Minister Zhang Wenkang. In just
one day, the city’s sars caseload was revised
from 37 to 339. By week’s end even that

12

figure had almost tripled. But increased
• transparency has hardly meant an end to
/’Beijing’s looming biological nightmare,
and the scramble to make up for lost time
has only succeeded in spooking residents
who had genuinely believed the city's orig­
inal lowball sars statistics. As nervous citi­
zens cooked up exit strategies, the social
stability that China’s leaders were trying to
maintain when they underplayed Beijing’s
sars numbers has been shaken. The World
Health Organization (who) slapped a trav­

el advisory on the capital city', portending a
slowdown of foreign investment in Beijing
and sluggish economic growth.
Panics can happen anywhere, but they
take on epidemic proportions in countries
lacking a free flow of information. Unable
to rely on government reports, Beijing’s
citizens were forced to depend on the ru­
mor mill, which was turning at 1,000
r.p.m. last week. Grannies in Mao suits
whispered that the entire capital was
going to be quarantined, while Internet
chat rooms buzzed with claims that the
disease was a conspiracy courtesy’ of the
Americans and the Taiwanese. Yu Jun, a
worker at a private metal company, had
heard that shops would soon be closed and
was raiding a grocery store for basic food
supplies. “I know this is probably a rumor,”
says the 32-year-old, whose neighbor has
TIME, MAY 5, 2003

come down with sars. “But right now
I’d rather believe rumors than what the
government tells me is true.” Meanwhile,
in villages on the outskirts of Beijing,
terrified citizens have set up blockade^)
bar all outsiders from entering, creating an
atmosphere of desperate vigilantism.
Even more worrying, hospitals on the
epidemic’s front lines are also spooked.
Medical facilities in both Beijing and the
country’s impoverished interior are reeling,
as the very doctors supposed to be fighting
the disease are themselves falling
ill; at the quarantined Peking
University People’s Hospital, 70
medical staff caught the disease
after one virulent victim arrived at
the emergency room. When that
first patient checked into the hos­
pital on April 7, doctors had not
been adequately schooled in in­
fectious-disease protocol, since
Beijing was still denying the capi­
tal had a sars problem. Medical
staff quickly fashioned a makeshift
isolation ward, but their quarto
tine techniques proved fawy
when 20 patients and dozens of
doctors were infected. “We just didn’t have
the right resources to handle the problem
properly,” says a department head at the
hospital. It was hard to do the right tiling
before the government started reporting
accurate numbers.” In an effort to prevent
the disease from spreading to other vulner­
able hospitals, Beijing has touted a soon-tobe-finished facility dedicated to treating
sars victims. The complex is a converted
clinic formerly used to treat sexually trans­
mitted diseases. Wards are being construct­
ed out of sheet metal and resemble the
temporary dormitories usually used to
house migrant workers.
For the Chinese government, the sars
crisis presents the gravest threat since the
student protests at Tiananmen Square 14
years ago. Confidence that the Party always
knows best is badly shaken. China’s leaders

HEALTH

Did Guangdong Beat the
By MATTHEW FORNEY
GUANGZHOU
n the struggle to contain
SARS, Ma Lin is the man with
his finger in the dike. Ma is
the vice director of the center
for disease control and
prevention (CDC) in Guangzhou,
and it’s his job to track every
suspected SARS victim in the
capital of China's Guangdong
province. That makes him one of
the busiest men in China. Last
Thursday, a Guangzhou man
reported by his employer as
running a fever was refusing to
submit to a SARS examination.
The response was instant. “Tell
him he can deal with us now, or
deal with the police later,” Ma
says, dictating an order to one
of hundreds of health officials
working around the clock. He
turns to a reporter from TIME.
“The police haven’t actually
become involved, but people
always respond to the threat."
The health department is
not normally an agent in
mainland China’s feared
security apparatus, but decisive
measures like this seem to have
enabled Guangdong, birthplace
of SARS, to stabilize the spread
of the disease. While Beijing
panics, Shanghai quibbles and
Hong Kong continues to flounder,
Guangdong has apparently seen
a reduction in new cases from a
peak of almost 50 a day in
February to an average of nine
for the past month, although it
has hit the teens in recent days.
“If SARS can be contained in
Guangdong," notes World Health
Organization (WHO) Beijing
representative Hank Bekedam,
“it becomes clear that strong
action can help other provinces."
So what's Guangdong’s
secret? First, according to WHO
sources, provincial officials on
Feb. 3 set up an effective system
of reporting new cases and
disseminating information among
its health-care workers. Unlike in
Beijing or Hong Kong, where

I

14

SARS patients have been
scattered throughout the
network of hospitals, Guangdong
has consolidated them in a
handful of its best hospitals. On
Feb. 11, when the province
publicly admitted to 305 cases,
it was already running a central
command to coordinate the fight
against SARS. “We're tracking
down every suspected case,
quarantining patients and letting
them go only after we're sure
they’re not infected,” says Huang
Fei, director of the command
office. In the absence of a
vaccine or effective treatment,

on the dead man. “We were
terrified he had died of SARS,"
says Li. Nine hours later, the
officials had their result: the
dead man's name turned up on a
hospital computer as having been
treated days before for a stroke.
Doctors concluded the case was
not SARS. but still recorded
contact details of everyone on
the bus and forwarded the list
to the CDC in Guangzhou, where
Li’s contact information remains
on file. “The whole process
was remarkably efficient," Li
told TIME by telephone from his
home in Hunan.

circulating air, which doctors in
the province and the WHO alike
believe plays an important role in
preventing hospital infections.
Politically, though,
Guangdong has acted as
shamefully as Beijing—and those
mistakes have cost the rest of
the world. The province dithered
in January when it first identified
the virulent new atypical
pneumonia that would later
be labeled as SARS, losing a
chance to stop the disease in its
tracks. Even after Guangdong
had set up its efficient response
system, officials there failed
to share their expertise wiUj,x
Beijing and Hong Kong, arW/

developed antibodies against
a specific disease, slowing its
spread. But Malaysian
microbiologist Dr. Lam Kai Sit
notes that "with SARS, the
incidence is so low there cannot
be much immunity in the gener­
al population.” Herd immunity
could be aided by large
instances of asymptomatic
infection (infections with no sign
of disease), but scientists have
no way of knowing if such cases
exist without using wide-scale
diagnostic tests.
A more likely, and
frightening, possibility is that the
unsafe SARS coronavirus has
mufflBI since it left Guangdong,

misrepresented the extent of the
deadly new disease. Although
the WHO is “pretty satisfied” with
the way the outbreak has been
handled medically,
t "that’s distinct from
“ how it was handled
o politically," says Peter
f Cordingley, WHO’s

perhaps into a more virulent and
contagious form. Scientists at
the Beijing Genomics Institute
announced last week that there
were significant genetic
differences between
i
coronavirus samples
sequenced from patients in f
Guangdong and in Beijing.
I
In Hong Kong, doctors
L
believe the virus may have
W’
mutated when it infected
'

Asia spokesman.
But infection­
control methods
alone seem unlikely
to account for the
SARS tally gap
between Guangdong and neighboring
Hong Kong, the latter
having recorded over
130 more cases in
only a month-and-ahalf, with a fatality
rate that's
Akj
significantly hi^ef

that kind of dogged, shoe-leather
epidemiology is vital to bringing
an outbreak under control.
A look at how suspected
cases are handled reveals a level
of sophistication probably
unseen in other parts of China.
On April 20, Li Junhua, a worker
on a construction site, boarded a
bus for the five-hour ride to his
home province of Hunan. Near
the border with Guangdong, the
man sitting behind the bus driver
suddenly died. The driver
contacted the police, who 10
minutes later arrived with health
officials. They distributed masks
and ordered that nobody was to
leave the bus as the officials
performed a background check

Perhaps even more crucial,
Guangdong quickly recognized
the importance of protecting its
medical staff, which early on
accounted for nearly 40% of
all SARS cases. After an initial
delay, in late February front-line
workers received full-body
protective suits for use in
dangerous cases of the
disease—something doctors
and nurses in Hong Kong are
only now being given. In the
past month, the number of new
SARS cases among health-care
workers has fallen steadily to
"basically none," according
to Huang. SARS wards In
Guangdong are well ventilated,
with open windows and fans

TIME. MAY 5,2003

than Guangdong's
reported figure of 3.5%. Dumb
luck plays a part. Guangdong
officials say the province hasn't
suffered a single explosive
outbreak along the lines of Amoy
Gardens in Hong Kong, where
321 people were infected, possi­
bly via contaminated sewage, in
a matter of days. That sudden
mass of seriously ill patients
spread SARS through the local
community and overwhelmed
hospitals, directly leading
to more infections among
health-care workers.
It's also possible that
Guangdong natives have built .
up herd immunity to SARS,
which occurs when a significant
percentage of a population has '

Amoy Gardens residents, who
suffer unusual symptoms
(including severe diarrhea) and
have a higher fatality rate. Says
Dr. Michael Lai, a coronavirus
expert at the University of
Southern California: “As the virus
responds to different
environments, different strains
will emerge."
possibility weighs on
s of Guangdong’s health
officials, who know the province
is just one superspreader away
from a new outbreak. If SARS re­
turns, it could spread rapidly
among the province's 31 million
migrant workers, who live in
cramped dorms and enjoy few
health services. “Even just one
case a day is a problem," says
Chen Rongchang, vice director of
the Guangzhou Institute of
Respiratory Disease. “One
person could easily pass SARS
on to 10 people, and then to a
hundred. The virus is not dying
out." Fortunately, neither is
Guangdong's will to stem the
tide on this deadly disease.
—With reporting by Neil Gough
and Bryan Walsh/Hong Kong and
Jodi Xu/Guangzhou

U

have parlayed their success at transform­
ing the mainland economically into a de­
politicization of the masses that enables
continued one-party rule. But if the
Communist Party cannot handle a public­
There is some debate about theAjgue^Sa
health crisis-a basic service in most de­
mortality rate/some say it is as high as
veloped countries-then will it really be
Here is a lodk at how the vims attacks- I kills
effective as China hurtles toward even
greater transformations ahead?
How the crisis ultimately rattles China
Left
depends, in part, on what happens in the
country’s financial capital, Shanghai. The
lung
city is home to Jiang Zemin’s power base,
and if any heads roll there, the former
Infected area
President and his acolytes lose out. So far
this city of 16 million has appeared largely
untouched by the mystery virus. Last
Saturday, local health officials had only
confirmed two cases and 15 suspected
patients, one of whom was an
W
American. So worried were
Bronchus
central-government officials
that this last bastion of
Fluid and
■k good health might be indebris
fected that they sent a
Oxygen
k directive to Shanghai
k authorities early last
k week
demanding
I that local bureau9 crats maintain the
arbon
loxide
■ city’s reputation as
“SARS■ essentially
J free,” according to
v a vice-mayoral aide.
Whether that meant
Capillaries
Shanghai really was immune to the disease or
Alveoli
whether they were just supposed to give outsiders the im­
pression that China’s biggest city
didn’t have a sars outbreak wasn’t clear.
“All I have been told is that we must main­
tain tire image of Shanghai as a place with­
The SARS virus enters the body through tiny
droplets expelled by SARS carriers
out a sars problem,” says a Shanghai
health official, before adding: “Sometimes
By the fifthor sixth day, X rays will show a
the reality can be different from the image,
whitening of lung tissue—a sign of inflammation and
but if you want to attract foreign invest­
immune system response
ment, image is the most important thing."
Over the next few days the inflammation
But as the week progressed, Shanghai’s
spreads and lung tissue swells., Millions of tiny air sacs in
the lungs, called alveoli-respohsible for removing carbon
much-vaunted image was starting to fray.
dioxide from thd
Local doctors, who have been instructed
>therdebrl
with fluid, white blood cell
not to talk to foreign media lest they lose
their jobs, haven’t accused Shanghai of a
Swollen tissue
jg tliejcarbon
collapses the fluid-fillgd s
cover-up as extensive as the one in Beijing.
dioxide-oxygen exchange
y.
%
But they have voiced doubts about the ve­
racity of the government's statistics. In a
fieWoodTtream.
By the 12th da;
hypoxic-not enough qxyge
press briefing last Friday, the who. which
ffieffssatjated
The patient dies from lung
concluded a five-day bip to Shanghai that
breakdown of other organ
day, said it generally accepted the govern­
ment’s confirmed caseload, despite having
Sources: Prihce?pf
posted a notice on its own website the day
before saying that it suspected Shanghai
MAY' 2003

15

VIEWPOINT

Perry Link

Will SARS Transform China's Chiefs?
Only i£ the Communist Party believes it needs to come clean to survive
HY DID THE CHINESE GOVERNMENT WANT TO COVER

W

up sars? Who lied and why? Does the sacking of
two high-level officials, Minister of Health Zhang
Wenkang and Beijing’s Mayor Meng Xuenong, mean
that China is on the verge of liberalization?
The answers to these questions can be found in the way the
Chinese leadership handles information. The Communist Party
runs two different communication systems with very different
missions. One system collects information and sends it up the
bureaucratic hierarchy. This information is supposed to be—and
often is—solid and “objective.” But it is kept secret. The higher
a person’s position, the higher the quantity and quality of the
information he receives. The other system channels information
from the top down. This is the open, public information Party
leaders fiave decided that people below them may—and in some
cases should—know about. It might or might not be solid, but it
should never harm the interests of the leaders.
The two systems work in tandem, often with the same
officials performing both functions. During the nationwide
student demonstrations in 1989, New China News Agency
reporters in all the provinces wrote detailed daily reports on
local student activities and sent them to Beijing for the eyes of
top leaders. The information was remarkably accurate; but
hardly any of it went into the agency’s bulletins that were sent
back down the bureaucracy, which merely told the citizenry
that “a small clique of hooligans was causing turmoil.”
A bureaucrat in both systems might drag his feet in report­
ing bad news, because in Chinese culture local trouble, what­

was underreporting the numbers. (An in­
formal press conference set up by a who of­
ficial on Thursday evening was halted by
security personnel.) Though the who re­
ported it had been given full access to med­
ical facilities, a doctor at the People’s No. 6
Hospital said the international experts were
shown “a sanitized version of Shanghai’s
sars problem." A doctor at the Shanghai
Contagious Diseases Hospital told Time
there were more than 30 suspected cases at
his hospital alone, double the official sus­
pected caseload for the whole city. He and
other physicians also complained that
Shanghai’s requirements for diagnosing
sars had been much more stringent than
elsewhere in the world and that if the stan­
dards used in, say, Hong Kong were applied
in Shanghai, many patients in the suspected
caseload would be shifted to confirmed cas­
es. The same questionable accounting had
been used in Beijing, before the capital be­
came more forthright about its viral crisis.
On Friday, the who reported that Shanghai
16

ever its cause, is assumed to reflect poorly
on local leaders. But his clear duty is
always to report truthfully to those above
and speak officially to those below. The
by-product of the difference between the
two systems is prevarication.
With sars, as with earlier crises man­
made (Tiananmen in 1989) or natural (the
Tangshan earthquake of 1976) in China, the
spread of information to the public under­
went distinct stages. The first stage is cover­
up. If that fails, the next is to say “the
problem is small.” If that becomes untenable, the last message is
“everything is under control.” Meanwhile, the flow of accurate
information upward is never supposed to stop. We do not know
when word of sars first reached Beijing, but in late February the
government’s propaganda department ordered a halt to public
reporting on the disease in order to “ensure the smoothness” of
the National People’s Congress meetings in March. Since then
the Politburo has met three times about sars. Party boss and
President Hu Jintao has issued nine directives on the topic and
Premier Wen Jiabao has released 29. Still, at a meeting of the
Politburo’s Standing Committee on April 17, Zhang Wenkang
and Meng Xuenong were accused of failing to keep their superiors adequately informed. For that, they were made scapegoats.
But if the need for scapegoats is routine, the question of who
should be purged is almost never so. Factionalism sometimes so
dominates the decision making that dispatching a political op-

would be adopting a less strict standard for
calculating suspected cases and that the city
therefore would soon be substantially in­
creasing its suspected caseload.
At the Huashan Hospital in a leafy dis­
trict of Shanghai, doctors and nurses con­
firmed there were seven suspected cases at
their hospital, although the hospital’s official

press liaison said it had none. The patients
were being treated in a makeshift isolates
ward housed in a dilapidated prefab bi®*
ing formerly used for hepatitis patients.
Doctors and nurses were not wearing for­
mal isolation suits, and many were wearing
four or five simple surgical masks over each
other. But last Wednesday, security guards

GLAD-HANDING
Hu on an inspection
tour of Guangdong
province in April-

■

ponent can become the main reason for the firing. Strategies and
motivations for such maneuvers are usually kept private. It is
hard to say, for example, whether the current shake-up will af­
fect the balance of power between Hu and his predecessor, Jiang
Zemin. Of the two positions at stake, mayor of Beijing is far more
important politically than Minister of Health. Beijing mayors
have been chosen with great care ever since Chairman Mao’s
day. If push comes to shove, administrative control of China’s
seat of power outweighs many other things, including public
health. So who wins and who loses when Meng Xuenong is
replaced by Wang Qishan? Meng is from the Communist Youth
League organization, a base for Hu Jintao. Wang Qishan has re­
cently been close to former Premier and economic reformer Zhu
Rongji, but was also once favored by Chen Yun, a champion of
central planning, and is the son-in-law of the late Yao Yilin, a
conservative Party elder. It is not clear where Wang will stand on

waiting for possible visit from who officials
■ - ye instead ushering interested foreigners
kjfe fancy high-rise nearby. On the 15th

floor of this building, medical staff in full
barrier suits greeted the guests, while other
staff conspicuously sprayed disinfectant
around the ward. The road leading to the
building had been recently repainted and
an elevator lady stood in the lobby, helpful­
ly directing the visitors to the official isola­
tion clinic. No such sprucing-up measures,
however, had been taken at tire makeshift
ward where the patients were actually be­
ing treated. In the end, the who did not vis­
it the hospital, although it toured many
others. Says one security guard there: “Now
we can go back to being normal.”
Similar games were played out at other
hospitals. At the People’s No. 6 Hospital, di­
rector He Mengqiao formally denied there
were any suspected cases there, instead
maintaining that the hospital was merely a
“monitoring station.” Yet just 10 minutes
earlier, another doctor who mistakenly

issues. Zhang Wenkang, the sacked Health Minister, was once
Jiang Zemin’s personal doctor and has been politically close to
Jiang for a long time. But Jiang has so many other allies in the
Politburo and military that this loss hardly seems to matter.
The process of the personnel shifts might be more signifi­
cant than the shifts themselves. Apparently Flu Jintao and Wen
Jiabao made the decisions and then ushered them through the
Politburo without consulting Jiang. Hu and Wen, who since last
November have made some tentative moves toward press
freedom, seem also to be using the admission of sars patients
into military hospitals to leverage more access to the military
bureaucracies controlled by Jiang’s group.
At the fringes, such efforts to skirt Jiang might do some
good for liberalization in the mainland. Some China watchers
have even speculated that sars might be the country’s
Chernobyl—a traumatic event that forces a closed political
system into more permanent openness. Such optimism is
probably misplaced. Chernobyl inspired glasnost because
Mikhail Gorbachev chose to see it as serving the Soviet Union’s
best interests. But for a decade now, Chinese leaders have been
looking at the Gorbachev precedent and inferring exactly the
opposite lesson: they believe Gorbachev made a fatal mistake
by loosening up. True, some Chinese leaders secretly may be
waiting for a chance to dismantle China’s repressive system and
thereby earn a glorious place in Chinese history. But there is
currently no evidence of that.
On the contrary, the current generation of top leaders, ed­
ucated Soviet-style in the 1950s and 1960s, and having traveled
abroad less than even previous generations, are inured to the
system in which they rose. It is the only system they truly
understand, and control of information is its lifeblood. They
are still unlikely to relinquish that control willingly.
■
Perry Link is professor of East Asian studies at Princeton
University. His latest book is The Uses of Literature: Life in
the Socialist Chinese Literary System

wise in its Friday press conference. Largeassumed a Time reporter was affiliated
scale events in the city were to be canceled,
with the who showed X rays of a 14-yearand Shanghai’s much-vaunted auto exhibi­
old patient suspected of having the disease.
tion was ordered closed two days early af­
He said that other students at the same
ter rumors that SARS-positive patients had
school were also running fevers and were
visited the show. The media were instruct­
being monitored. Education officials
ed to ramp up a sars public-education
denied knowing of any such cases.
campaign so that city residents would know
Political analysts say Shanghai’s Party
how to prevent the spread of the virus.
discipline has never been so tight as it has
But then the meeting took an alarming
been in recent weeks. Early last week, top
turn. Party’ officials cautioned that
Shanghai Communist Party officials met
“Shanghai's sars caseload was still a state
with local state-run media to discuss the
secret,” according to a journalist in atten­
city’s sars situation. The meeting was clas­
dance. The state media were not to report
sified as neibu (internal), meaning that the
any sars statistics higher than the govern­
information discussed would not be dis­
ment-sanctioned figures, nor were
seminated to the public. Officials told the
Shanghai-based journalists allowed to in­
gathered media that medical experts had
terview any sars patients or their families.
told them Shanghai would not escape the
“Readers are going to be very confused,”
sars epidemic, despite previous public as­
complained the journalist. “On the one
surances to the contrary. The cadres also
hand, we tell them there are almost no cassaid the who had told them that the U.N.
agency did not believe the government ■ es in Shanghai. On the other, we tell them
that they must be very vigilant in avoiding
number of only two confirmed cases-before the w:to basically proclaimed otlier- . the disease. But if Shanghai has barely any
TIMt, MAY

2003

17

"sOLH

H

3T wlj fU
"!■

HEALTH

global

agenda

Michael Elliott
HONG

G

Mother Nature: Political Reformer

System Failure
hen Betty Tung, wife of Hong
Kong’s beleaguered Chief
Executive Tung Chee-hwa,
toured the city's SARSslammed Lower Ngau Tau Kok housing
estate to pass out hygiene kits, she
dressed up for the occasion. Clad in a
face mask, a protective cap, goggles, a
plastic disposable gown, gloves and
shoe guards, Mrs. Tung alarmed local
residents. The protective suit was more
elaborate than an ICU doctor would
wear—if ICU doctors had ready access
to that sort of gear—and local media
had a field day criticizing her.
Mrs. Tung's misguided mission
exemplifies the Hong Kong
government's half-measured response
to SARS. Medical staff are facing short­
ages of vital protective equipment even
as more health-care workers are afflict­
ed. Medical resources are stretched to
the limit, but the government has been
slow to consolidate the SARS patients
scattered among more than 10
hospitals. "There is mismanagement
within the Hospital Authority," says
Dr. Lo Wing-lok, chairman of the Hong
Kong Medical Association. It's not just
a lack of hardware but also of will and
common sense. Hong Kong authorities
are screening airport passengers but
have been slow to institute health
checks along the busy border with
Guangdong province. "This government
is unwilling to take up matters with
(Beijing],” says Allen Lee, a Hong Kong
delegate to China's National People's
Congress. “It's pathetic."
Hong Kongers are usually resigned
to such incompetence. But last Friday,
encouraged by the sacking of
China's Health Minister and
.Beijing's mayor, legislator
H Albert Chan made a for” mat call for Tung's

Chernobyl and an earthquake in Mexico City led to great change. Will SARS?

W

resignation. Whether or
not Tung goes, his
ministration's credibilhas already become a
ictim of SARS.
—By Bryan Walsh.
Reported by Ilya
Garger and
L Carmen Lee/
\ Hong Kong
V BETTY BOO:
Mrs. Tung
proved to be
analarming
sight

HAT SCARES YOU MORE, SARS OR TERRORISM? FOR ME,
the economic prosperity they bring, without a free flow of truth­
it’s the disease, though I’ll concede to a bias: I spent ful information. “They don’t understand what it means to handle
part of last week in Toronto, where commuters are now things openly. They don’t understand it’s the start of a crisis. They
worried about whom they’re sitting next to and where are not psychologically, materially or politically ready for this,”
a favorite bar of mine—packed when I was there in February- says Huang Jing, a political scientist at Utah State University.
is now as empty as the Yukon.
There’s another model China’s leaders would do well to study.
The problem isn’t just the virus, which has traumatized at In 1985 a massive earthquake shook Mexico City. At the time,
least two other cities: Beijing and Hong Kong. What’s espe­ Mexico was, in effect, a one-party state, governed by a deeply cor­
cially nerve-racking is the cover-up at the source, in the cor­ rupt and softly totalitarian regime whose leaders were beggaring
ridors of power in China. Hu Jintao, who became leader of the country. But within the bureaucracy was embedded a gener­
■China’s Communist Party half a year ago, now has to manage ation of brilliant technocrats who were trying to open the nation
^the country’s biggest internal polit­
and its closed economy to the world.
The crisis of legitimacy posed by the
ical crisis since the 1989 massacre
at Tiananmen Square. After Beijing”s
earthquake was a catalyst; it con­
initial efforts to hide the severity of
vinced the Mexican public and many
crisis, Hu will have to step nimbly to
of the technocrats that Mexico had to
change in a fundamental way—that its
protect the party’s authority—and his
society and politics, not just its
career.
economy, had to welcome new ideas.
Once upon a time, outbreaks of
After a decade and a half of many
disease and environmental catastro­
bumps and some tragedies, the
phe could be swept under the rug.
process reached a pinnacle when
Man-made famines in Russia in the
the 2000 presidential election saw
1930s and China two decades later
the overthrow of the old order. The
were scarcely known outside their
candidate of the Institutional Revo­
borders. But more recently die world
lutionary Party, which had ruled
has become too interconnected for de­
Mexico without a break since the
ception of that magnitude. In 1986,
1920s, lost to Vicente Fox.
when a nuclear reactor exploded at
The story holds another lesson:
Chernobyl, in Ukraine, the Soviet gov­
Mexico could not have changed on
ernment initially tried to keep it qui­
its own. The transformation from a
et. But when Geiger counters in
closed, state-dominated economy to
Scandinavia went haywire, Moscow
an open one was wrenching. Mexico
had to come clean. This year the truth
needed help, which it got from the
about sars emerged after citizens in­
U.S. The North American Free Trade
fected in China traveled outside the
Agreement, negotiated by the first
country—and after the ground­
Bush Administration and signed by
breaking reporting of Time and other
MEXICO, 1985: An earthquake shook up the system
that of Bill Clinton, guaranteed that
international publications.
the U.S. would buy what Mexico produced; later, when the
China still has a long way to go. Beijing even now has been
less forthcoming than tire Soviets were during their crisis 16 years peso collapsed, Clinton put together a rescue package.
Successive American administrations helped Mexico not
ago. Mikhail Gorbachev finally admitted that Chernobyl was a
disaster (with some caveats, to be sure) 18 days after the explosion; because they had drunk of the milk of human kindness but
Beijing is still being less than honest about sars, unless you real­ because it was in their interests to do so. Economic turmoil
ly believe that, as of last week, there were just two cases of tire dis­ in Mexico would have spilled north of the border, just as pol­
ease in Shanghai (pop. 17 million). Chernobyl eventually helped luted water and diseases do. For Clinton, especially, it was
promote positive change in the Soviet Union as citizens grasped axiomatic that the U.S. could not be immune to economic,
just how awful the system had become. Gorbachev realized that environmental or health crises elsewhere in the world—that
“even if you wanted to be Stalin, you couldn’t anymore)* says such “soft” issues posed as real a danger to American inter­
Michael Mandelbaum of the Johns Hopkins School of Advanced ests as “hard” ones like terrorism. ‘People looked askance,”
International Studies. Within months, the Soviet leader acceler­ Clinton told me last week, “when we said that aids and othated his perestroika and glasnost reforms, which speeded the col - i er diseases were a security threat, that environmental degra­
lapse of Soviet communism. In China, Hu sacked the health dation was a security threat, sars is just the latest example.”
minister and Beijing’s mayor. But it is still unclear if the Chinese You don’t have to visit Toronto to know that he’s right. —With

W

cases, why does the public need to be wor­
ried about sars?" The answer to that ques­
tion is self-evident. The Part}-, however,
appears to still be putting its own survival
above the well-being of ordinary Chinese.
AS FRIGHTENING AS CHINA’S MEDICAL Epi­

demic is, the country’s leaders could find
the economic and political fallout even
more terrifying. For years, the Communist
Party has based its legitimacy on a record of
rapid economic development. Soaring cdp
rates and rapidly improving material well­
being have distracted the masses from a
still spotty human-rights record and scle­
rotic political system. Fear of an economic
downturn, such as the one hitting Hong
Kong, was among the reasons the govern­
ment covered up the epidemic for so long.
Now, the disease looks like it could indeed
have a devastating effect on the country’s
finances—precisely at a time when other
Asian nations were counting on China to
serve as an engine for regional economic
growth. Already, Citigroup has lowered its
forecast of China’s growth for this year to
6.5%, far below the 8% Beijing considers
the minimum requisite level to provide
work for the millions who are being let go
by money-losing state enterprises each
year. A poll by the American Chamber of
Commerce in Beijing shows that 20% of its
member companies have already sent fam­
ily members out of China for fear of sars.
“Anything that requires face-to-face meet­
ings is on hold,” says Jack Langlois, director
of Morgan Stanley Properties for China.
But expatriates are the least of China’s
problems. The brunt of the economic bur­
den will be largely borne by the laboring
masses, namely the country’s estimated 120
million migrant workers, who have already
been flocking to Beijing’s train stations in
the tens of thousands after being let go
from menial jobs at restaurants, markets
and factories. “(The impact) will fall dis­

proportionately on those least able to cope,” |
says Tang Min, chief economist at the Asian |
Development Bank in Beijing.
These economic and social implica-°
Hons of the disease may be pushing China’s ’
leadership to a make-or-break point. 5
Containing the outbreak is the first big test
for the country’s new President, Hu Jintao,
a man who appears to have reached the top
by keeping his head down and not formu­
lating a single memorable policy. But in an
unprecedented display of forthrightness,
both Hu and Premier Wen Jiabao have
called for increased transparency in deal­
ing with sars—a radical policy departure,
and major political gamble, for a leadership
that traditionally feels more comfortable
with obfuscation than candor. If Hu’s move toward open governance pays off by con­
taining the disease and winning public
confidence, analysts say it could help him
consolidate his power base by shunting
aside forces loyal to his predecessor, Jiang
Zemin. “This is his chance to grab the
port of the people and stand up onw!

1
j

□

own, says Bao Tong, a former senior Party
official who was purged after the 1989
Tiananmen uprising and lives in Beijing.
But should China’s gdp rates tumble or the
public remain skittish, Jiang, with his con­
tinuing control of the military, could re­
assert his authority. That could signal a
return to the bad old days when the
Communist Party regarded the massacre
around Tiananmen Square and the deaths
of some 200,000 people in the 1976
Tangshan earthquake as state secrets.
Keeping information about sars a secret,
however, could ultimately undo much of
the progress China has made over the past
10 years in securing foreign investment and
ensuring growth. It’s hard to do business
with a government that won’t talk openly
about a disease that could kill you. —With
reporting by Bu Hua/Shanghai and Matthew
Forney, Huang Yong and Susan Jakes/Beijing

leadership knows that it is not possible to have free mark'd:. and

TIME, MAY 5. 2003

reporting by Matthew Forney/Guangzhou and Susan Jakes/Beijing

19

L

►►COVER STORY

Is the crisis spawned by this

new viral infection a failure of

global health governance?
ast November, a trader in
Foshan, a small industrial
town in Guangdong province
,in China, fell seriously ill with
an incurable high fever and
cough. He was suspected to be suffering
from pneumonia, a non-infectious
disease common in the area. But then
►bur health workers who had been treat­
ing him in the local hospital also fell
critically ill. This confounded Chinese
clinicians. Initially, they believed this
was just another variant of the flu and
countered it with traditional concoc­
tions and high doses of antibiotics.
To be sure, the affliction resembled
any pneumonia or viral infection: moderate-to-high fever accompanied by
shivering, headache and body ache; after
three to seven days, the formation of
dry, non-productive cough. Strangely,
the Chinese authorities kept the out­
break under wraps.
The panic button was pressed only
after conventional treatment methods
failed and more cases of the strange

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JOINING THE (

North Korea claims it has the Bomb, pushing the nuclear deadlock over i
TIME, MAY5,2003

"

fever surfaced. By February, the per­
plexing infection got out of hand.
Finally, the authorities admitted that
they were grappling with an unknown
pneumonia — Severe Acute Respiratory
Syndrome (sars). Yet they reluctantly
permitted experts from the World
Health Organization (who) to access
hospitals in affected areas. By April, the
virus causing the disease had created
enough of a scare to cause mass hysteria.
From China, the virus entered the
porous borders of Hong Kong. To date,
the other affected areas are Singapore,
Toronto and Hanoi. Hong Kong has the
highest number of sars cases after
China — 2,158 infected, of which
105 have died. Singapore has 186 cases
with 16 deaths; Vietnam has reported
63 cases with five deaths, while Canada
had 304 cases of whom 14 have died.

In usa 220 cases of sars have been
recorded. Since November 16, 2002,
when the first case was reported, more
than 4,059 cases and 211 deaths have
been caused by the virus globally, of
which 1,807 affected and 79 officially
dead are in China alone. The outbreak is
threatening to trigger a financial disaster
like the Asian economic meltdown.
Persistent rumours about the dis­
ease did the rounds in different comers
of India. Every fever death was grist to
the mill. The first case was that of an
American backpacker in Mumbai. Then
reports came in of suspected cases from
Goa, Chennai and Kolkata. On April 17,
the first case of SARS was “confirmed” in
Goa. A marine engineer who had been
to Hong Kong was a passive carrier and
had recovered after a visit to the Goa
Medical College. On April 19, three

COVER STORY

COVER STORY

confirmed cases were reported from
Pune. A bride and her family contracted
SARS after her brother returned from a
visit to Indonesia. The passenger seated
next to him on the flight was reportedly
ill. Another case was reported from
Jaipur on April 21,2003.
China continued to hush up the
controversy by removing patients from
isolation wards in hospitals ahead of
visits by WHO officials. After startling
discoveries made by them and western
journalists in military hospitals in
China, the Chinese health minister was
asked to resign on April 19.

The pathogen’s path
everal strains of influenza or flu have
been named after Guangdong
province, where the first SARS cases sur­
faced. This dubious distinction stems
from the agricultural practices prevalent
in the region. Rice fields support ducks
and chickens, which feed on pig waste.
The waste of one becomes the food of
the other, resulting in a perfectly selfsufficient nutrient cycle. Helped by their
ability to exist in faecal matter, condi­
tions become ideal for viruses to evolve
very quickly in different animals.
Luis Villarreal, director, Center for
Virus
Research,
University
of
California, Irvine, USA, believes that
China’s otherwise ecologically sound
agricultural systems facilitate recombi­
nation between silent viruses in farmed
species and other organisms. This, he
says, increases the likelihood of the
emergence of new human infectious
agents. “The domestication of the duck
has brought a ‘harmless’ virus from its
natural, aquatic avian habitat into the
farmyard, with economic consequences
for the poultry industry and serious
health implications for humans,” says
Kennedy Shortridge, professor of
microbiology at the Hong Kong
University.
If this is the case, then highly potent

Tracking SARS

S

16 November 2002:
First possible case of
SARS in a Foshan-based
businessperson

zoonotic infections like Ebola kill
many, but appear sporadically. SARS is a
zoonotic — animal to human­
disease that belongs to the Coronavirus
family. Often zoonotic viruses become
less virulent over time and become part
of the normal disease cycle of humans.
SARS could be one such example.
The virus spreads today much faster
because of the integration of the world
air travel, large-scale migration and
crowding in cities. Hong Kong, the air­
line hub of Southeast Asia, was success­
fully exploited by the coronavirus to
spread to other countries.
Different types of flu viruses mutate
in the body of a duck, pig or human. A
new strain is considered created when
an imperfect version of the original
survives and re-infects its hosts success­
fully. Chances are that the previous
strains would confer cross-immunity,
but very often some viruses mutate once
in each host or each generation thereby
acquiring additional virulence. This
genetic lottery' makes viruses deadly.
The first coronavirus was isolated in
1937 which caused infectious bronchitis
in birds, especially in chicken flocks.
Since then researchers have found its
cousins to infect cattle, pigs, horses,
turkeys, cats, dogs, rats, and mice. Most
coronaviruses cause either a respiratory
or an enteric disease, and some do both.
Coronaviruses are relative giants in the
virus world. Their genome has more
than 30,000 nucleotides and have a
complex two-step replication mecha­
nism. Like many rna viruses, it uses the
host’s nuclear material to produce all
viral proteins. But coronaviruses have
up to 10 separate genes and use a com­
plex enzyme called rephease, to produce
a series of enzymes. These use the rest of
the genome as a template to produce a
set of smaller, overlapping messenger
RNA molecules, which are then translat­
ed into the so-called structural proteins
— the building blocks of new viral par­
ticles (see: sars at work).

10 January 2003: WHO reports
in the Weekly Epidemiology
Record for the first time of a
mysterious pneumonia in China

15 December 2002: Two
more cases detected in
Guangdong hospital

There is another complication rela­
ted to influenza, quite similar to the cur­
rent SARS problem. Varying population
density and age structures may allow for
coexistence of two strains. Changes in
population density or transmission
potential can alter pathogen virulence.
Similarly, different people of different
ages have different genetic make-up
which make some susceptible and oth­
ers not. The phenomenon of ‘superinfection’ by multiple strains, where one
strain can infect a host already infected
by a related strain, has been confound­
ing scientists. Co-existence means the
viruses can jointly manipulate the
immune system and form a mechanism
to evolve into new forms. Super-infection is a prerequisite for recombinant
viruses and, therefore, for new strains of
influenza-like viruses. Several strains of
SARS, if it follows an infectious pattern as
the flu viruses, can be assembled in a
single generation.
In September 1999, in a seminar
organised by the US Centers for Disease
Control and Prevention (cdc), based in
Atlanta, Georgia, Guangdong was
described as an influenza “hotspot”. It
was said to be the place of origin of the
chicken flu virus that caused deaths and
widespread panic in Hong Kong
between March and early December
1997. The virus was identified as h5n!
(see: Down To Earth, Vol 6, No 16,
January 15, 1998). In November 2001,
the European Commission’s (ec)
Health & Consumer Protection
Division found food contaminated withMfa
avian influenza strains. In this report
CDC had pointed towards a need for an
effective surveillance system. It is
unclear if China lacks a national surveil­
lance system, or if sars is the result of
government policy of information con­
trol and clamp down.
According to CDC, China has been a
source and reservoir for many other
recent epidemics and outbreaks.
Hantaan virus, the cause of Korean

10 February 2003: WHO office
in Beijing reinforces its staff to
learn more about SARS

7 February 2003: Claims that in
Guangdong Province, 305 cases and
5 deaths have occurred between 16
November 2002 — February 7, 2003

28 February 2003: Carlo
Urbani, WHO epidemiologist
in Hanoi, identifies the first
case of SARS

18 February 2003: Bird flu
strikes Hong Kong.
A man and his nine-year-old
daughter hospitalised

as behaviour, was the cause.
What is perplexing is that who con­
firmed on April 19 that fatality rates
have risen to 5.1 per cent of the infected
population from 4 per cent at the
beginning. Does this mean that the
virus is becoming more virulent? Or
does it simply mean that treatment is
inadequate?
Antivirals like ribavirin supple­
mented with steroids have been suggest­
ed as treatment for full- blown SARS.

Testing time
he who and CDC have a clinical diag­
nostic protocol for those affected by
sars. They have laid down clear-cut
guidelines in order to prevent suspected
patients from coming into contact with
infected people.
A team of scientists in the depart­
ment of microbiology, University of
Hong Kong, was the first to succeed in
culturing the viral agent that causes
sars. Using a special cell line, the
Hong Kong scientists isolated the virus
from the lung tissue of a patient who
developed
pneumonia
following
contact with a professor from
Guangdong. Both persons have ince
died. The scientists have devised a basic
test that relies on neutralising antibo­
dies. This “hand-made” technique will
now be developed into a more sophisti­
cated diagnostic test.
India’s Mumbai-based SRL Ranbaxy
Limited is checking for the presence of
coronavirus with its influenza test
panels. These can be used to identify
Influenza a virus, Influenza B virus,
parainfluenza virus, respiratory synctial
virus (rsv) and enterovirus. According
to the company, if the virus does not
turn out to be any of these, the disease
can be assumed to be sars. “This is a
diagnosis by exclusion,” says Shishir
Malwankar of Ranbaxy.
On April 16, the Institute of Medical
Research in Malaysia and Germany’s

T
haemorrhagic fever, causes over 100,000
cases a year in China. In 2002, the
Crimean Congo haemorrhagic fever
and new varieties of pertussis (whop­
ping cough) have re-emerged here.

BBS mrawliM
etween March 25 and 27, 2003, two
different groups of researchers in the
cdc and Hong Kong University
announced that a previously unrecog­
nised coronavirus could have caused the
sars epidemic. This family of viruses is
the second leading cause of colds in chil­
dren and premature infants but has
never been perceived to be a serious
health threat. Other labs in Hong Kong,
Germany and Singapore proposed that
another virus from the family of
polymyxovirus could be a helper or a
cause of co-infection in sars. But on
April 15, the who confirmed that monkeys experimentally infected with a new
coronavirus developed an illness similar

B

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to SARS.

Close contact with infected persons
raises the risk of contracting sars.
Transmission usually takes place
through direct contact with respiratory

11 March 2003: The Polymerase
Chain Reaction (PCR) test for
detection of SARS virus made

10 March 2003: 22 hospital
workers in Hanoi French
Hospital with SARS

secretions and body fluids of patients.
But another recent discovery that it
can survive in human faeces implies
that unhygienic conditions even in
homes — like moist toilets and sinks
— could enable the virus to survive
for long periods of time. The people
who checked into the Metropole
hotel in Hong Kong show that the
virus can endure in the area for several
days and drift through airspaces into
other rooms. In E-block of Amoy
Gardens apartments in Hongkong,
where 213 people got infected, it is
believed to have spread through leaking
sewage pipes and drains. “If the SARS
virus can infect from faeces and is
capable of spreading via airborne
sources, then we have a persistent
killer on our hands,” says Kiwana
Thapurkakorn, influenza virologist at
the Royal University of Bangkok.
Cockroaches too have been alleged
to carry the virus. Another strange
mode of spread of SARS is that
some individuals spread the virus
more prolifically than others. Doctors
are still not sure if such patients carry
an especially infectious form of the
virus or whether some other factor, such

14 March 2003: WHO receives a report
from Canada about tour cases of atypical
pneumonia within a single family in
Toronto that resulted in 2 deaths

12 March 2003: First global alert
on severe atypical pneumonia
with unknown etiology placing
health workers at high risk

24 March 2003: CDC
announces Coronavirus as
the causative agent of SARS

i- March 2003: Singapore
government notifies WHO, of a
similar illness in a 32-year-oid
physician

27 March 2003:

International travel
advisories issued

COVER STORY

Hamburg-based
company
Artus
announced that they had developed the
first and only commercially available
diagnostic kit. Since April 12, Singapore
has used a high-tech thermal-imaging
thermometer at Changi airport. The
device automatically checks the temper­
ature of air travellers as they step off
the plane. These sensors alert health
authorities to quarantine and isolate an
infected person.
But sars is slippery. Singapore’s
ring-fence approach — cordoning off
the infected-seems to have suffered a
setback when another hospital in the
city was declared to have a patient of
SARS. Hong Kong on the other hand has
had a significant rise because it believed
in voluntary measures (self-reporting)
rather than the military-style quaranti­
ning in Singapore. Germany, too, was
able to isolate the single victim that
reached Frankfurt airport and is report­
edly keeping a keen watch.
In India, the first confirmed case in
Goa was found to be a passive carrier
who had crossed the “window” period.
“As per WHO norms, the patient was
released but asked to take rest and
remain indoors,” said Suresh Amonkar,
Goa’s health minister. Till Down To
Earth went to press, the Pune case was
the only active and confirmed sars case.
A neighbourhood in Mumbai has been
reportedly cordoned off by the hapless
state government.

Caught off guard
ars is a stark reminder that there is

no universal safeguard against infec­
tious diseases. The syndrome has actua­
lly exposed the lack of preparedness
with regard to infectious diseases —
from hospitals, public hygiene and sani­
tation, to access to drugs.
David Heymann, executive director
of the communicable disease pro­
gramme at who, believes that emerg­
ing infections can be controlled by

S

29 March 2003: 213 cases of SARS
confirmed in Amoy Gardens, a high-rise
residential area in Hong Kong. Carlo
Urbani, who detected the first case
of SARS, dies of SARS

COVER STORY

economy US $71.3 billion to US $166.5
billion annually.
Meanwhile in China, international
crisis management efforts are under­
way. The cdc has activated its emer­
gency operations center. A similar ini­
tiative has been taken up by who in
Hongkong, Beijing, Shanghai and
Geneva. With who’s assistance, China
has developed a national SARS reporting
system and elevated sars to the status of
cholera and yellow fever.

h® &
containing known risks, responding
to unknown risks and improving
preparedness.
When the case made headlines on
March 12, in Hong Kong, it was found
that the syndrome has devastated the
Chinese healthcare system. With the
virus reaching distant provinces and
even Mongolia, Chinese authorities
have been forced to clamp down on
migration between villages.
While China dithered, Singapore
responded by quarantining even its
healthy citizens and shut all schools
after the first sars death. Taiwan has
successfully prevented a potential pub­
lic health crisis from mainland China
and Hong Kong through its stringent
seven-level surveillance systems oper­
ating since 1999. These include moni­
toring of poultry markets, wild birds
and pig stocks. An active repository of
flu virus strains is maintained that
keeps track of the presence of any new
strains.
In India, the two nodal agencies
responsible for detecting and diagnos­
ing suspected SARS cases are the New
Delhi-based National Institute of
Communicable Diseases (NICD) and
National Institute of Virology (niv),
Pune. NIV would receive all samples
from tests and would present results
within four days. “As a precautionary

12 April 2003:
One case of SARS
observed in South
Africa

measure, the Union government is only
screening all incoming passengers at the
international airports and ports,”
reveals a nodal project officer of NICD.
Further, all hospitals dealing with infec­
tious diseases in the country are
required to report suspect cases to the
NICD. Cases detected in any state should
also be reported to the Directorate
General of Health Services (dghs). The
DGHS would then intimate the NICD and
send samples to the niv.
Global preparedness against infec­
tious diseases in recent times has been
from the perspective of bioterrorism.
But this cannot address the possibility of
prevention from an ecological perspec­
tive. Through better sanitation and dis­
ciplined monitoring, and understand­
ing what ecological changes can trigger
release of microbes, governments can
ensure that they keep ahead of out­
breaks by microbes.
What is the actual cost of prepared­
ness? A study by Dutch researchers
found that an additional investment of
us $120 million would be needed to
avoid influenza-related mortality. But
then, even a “prepared” country like the
US has looked uncertain in its approach
towards sars. A study by Martin Melzer
and his associates at cdc estimate that
for flu control, if the current strategy is
employed unchanged, would cost the

14 April 2003:
Scientists map
suspected SARS
virus genome

18 April 2003: First case in
Goa, India, reported: a
marine engineer who had
travelled all over South Asia

o some extent, the crisis spawned by
SARS is a failure of global health gov­
ernance. The International Health
Regulations (ihr) — a set of rules pro­
posed by the who — are a legally bind­
ing framework for preventing the
spread of disease across the world.
These laws, however, focus on plague,
cholera and yellow fever. They have not
been modified significantly enough
since its inception in 1969 or recent
amendment in 2002.
The World Health Assembly in
Geneva is specifically authorised to
administer “sanitary and quarantine
requirements and other procedures
designed to prevent the international
spread of disease”. But current regula­
tions are also restricted to the three dis­
eases and based on outdated quarantine
practices.
Even if ihr’s scope was expanded to
cover all infectious diseases, implemen­
tation of health-based trade barriers by
member nations would throw a spanner
in the works. Driven by political and
economic pressures, neighbours and
trading partners of countries affected by
epidemics often overreact. The restric­
tions they impose are far in excess of
those permitted by the ihr.
SARS has curtailed liberty, where
individual rights are pitted against pub­
lic health imperatives. Legal action can
now be enforced to isolate, hospitalise,

T

18 April 2003: About 150 boarding
school pupils arriving back in
Britain from Asia taken to
quarantine camps

and quarantine individuals. Singapore’s
authoritarian government had no such
reservations in imposing strict quaran­
tines for doctors and suspected patients.
A more people-friendly and cosmopoli­
tan Flong Kong, on the other hand, did
not quarantine at first, and recom­
mended isolation, which led to rapid
spread of sars. In the long run such
leniency will prove expensive. Enforcing
strict quarantine will cause temporary
loss of liberty but it is a decision that can
prevent health damages of an unforseen
nature, sars created a wave of xenopho­
bia — both in a tolerant Asia and in the
intolerant west.
The only strict action that the World
Health Assembly is authorised to take
under “exceptional circumstances” is to
withdraw membership privileges of a
country. But such sanctions would also
hinder the who’s objectives of tracking,
controlling and preventing incidence
and transmission of disease.
who has been criticised for relying
solely on information provided officially
by member states regarding outbreaks
within borders. Fearing self-incrimina­
tion, countries do not report diseases —
as in the case of the SARS episode.

international law could well decrease
the likelihood of such events, laws alone
will not control disease emergence. This
phenomenon is possibly inherent in all
living systems so I don’t expect it to be
eliminated."

Ths faOout
ong Kong, Singapore and Malaysia
have received bad economic hits.
Tourism has fallen by more than 20 per
cent. Hong Kong’s pre-SARS gross
domestic product (gdp) projection of
3 per cent for 2003 is now down to 1.5
per cent, according to Dutch
Investment firm ING Financial Markets.
Tim Condon, Ing’s chief Asia econo­
mist, observes: “sars appears to be a
more serious threat to regional growth
than the war in Iraq.” Regional forecasts
done for these countries by Merrill
Lynch also show lower growth.
Ironically the GDP of China is expected
to go down by a mere 0.1 per cent. This
is because China’s agricultural and
manufacturing base can offset losses to
tourism and the services sector. Airlines,
cargo and courier services and the
telecommunication industry have been

H

SAF3S appears so be a more serious threat to
regional! growth than the war in Iraq
Unfortunately, the current WHO regime
gives individual nations the liberty to
determine whether a disease constitutes a
public health emergency of international
concern. To some extent, the who s
Weekly Epidemiological Record (wer)
under the IHR and Global Outbreak Alert
and Response Network have helped plug
the loopholes. For example in the sars
case, the wer reported the sars incidence
only by January, almost two months after
the first case occurred in Guangdong.
Villarreal is sceptical about legal
measures: “Although a new body on

affected worldwide. “If the sars episode
is linked to domestic animal origin, then
we can see a significant decrease in the
near future of agriculture exports large­
ly because countries will put non-trade
barrier to goods from the region”,
opines John Cheung, director of inter­
national trade services, government of
Taiwan.
The battle may have just begun. □
Story co-ordinated by Pranay G Lal, with
inputs from D B Manisha, Sarita and
Vibha Varshney

20 April 2003' China’s official number of SARS cases account for
about half the world's total China sacks its health minister and
Beijing's mayor on Sunday after reporting a huge increase in SARS

22 April 2003.
Suspected case
of SARS found
in Jaipur

Cases: 2,722; Dead: 106

10 April 2003: Three US
health workers detected
with SARS

13 April 2003:
Death toll in Hong
Kong rises to 40

15 April 2003: Situation
still grave in China.
number of deaths: 56,
and 42 new patients

19 April 2003: 12 people die in
Hong Kong, the highest number
of fatalities in a single day

20 April 2003: One man die::
d 1’■ “°re reported to be affected,
raising the number of cases to 304 ,’n Canada

21 April 2003: Three
confirmed cases of
SARS in Rune, India

NEWS

Deal shelved
Chhattisgarh decides to scrap a privatised water supply
project. What happens next?

Who will own this anicut now?
THE Chhattisgarh government has
decided to cancel the agreement under
which a project to supply water from
Sheonath river to factories was leased
out to a private company. At a highlevel meeting on April 2, chief minister
Ajit Jogi instructed the advocate gene­
ral, Chhattisgarh State Industrial
Development Corporation (csioc) and
the departments of water resources,
public health engineering and legal
affairs to scrap the deal immediately.
The departments are yet to submit their
reports. The deal had become the rally­
ing point for groups opposed to privati­
sation of water supply, who termed it as
the ‘selling of a river’.
In the eye of the storm is a ‘buildown-operate-transfer’ (boot) agree­
ment signed in 1998 between the
| 20 | Down To Earth • May 15, 2003

Madhya Pradesh government
and private firm Radius Water
Limited to supply water to the
Borai Industrial Growth
Centre in Chhattisgarh’s
Rajnandgaon district. A
stretch of 23 kilometres of the
river was ceded to Radius
Water Limited, which is
developed and owned by
Kailash Engineering Com­
pany Limited.
Adverse reports in the
media made the state govern­
ment distance itself from the
agreement. It asserted that the
pact was signed before
Chhattisgarh’s creation in
November 2000 (see: Down
To Earth, Vol 11, No 18,
February 15, 2003). With elec­
tions to the state legislature
due later this year, the deci­
sion to cancel the project is in
line with the popular senti­
ment. The two main criticisms
of the project were:
• Residents of villages sur­
rounding the project area
were not consulted. They feel
cheated by the fact that their
traditional rights and access to
the river have been restricted.
• The agreement ensured payment for
a minimum of four million litres of
water per day by the state government,
regardless of the amount of water used.
CSIDC lost Rs
1.29 crore between
December 2000 and June 2002. This is
because water-intensive
factories
haven’t come up as had been expected.
Now, the issue is: what happens to
the project? Who will own the anicut
built by Radius? Who will decide about
the usage of water? What will be the
nature of the settlement with Radius?
csidc does not have the money to pay
back the company, which had taken a
loan to build the anicut.
Shakrajit Nayak, state minister for
water resources, says his department
would pay the compensation and would

settle the loan for the ar h.
would also decide the amou :
back. The anicut is seen as
series of similar structur
department has planned f<
of Sheonath and the Mahar
This region is category .1
shadow area, and a propos;
cuts in the two basins has
the Union government f
support. Nayak says work 1
six anicuts, which are exj
ready before the monsoon:.
the water supplied to t
would be priced at Rs 0.'
litres, according to Nayak v ...
gation would be provided I
The agreement also m ...I
possibility of an effluent tre ■
for the water-intensive i
:
Borai. But the future of th<
uncertain, as it is not clea .
not the state government 1: ■ ■
ahead with the plan. ■

Unprecede
Madhya Pradesh set

precedent
two recent developments;

the forest dwellers of Mai
(mp). Firstly, under the job
agement plan (jfm), fore
committees in the villa;
receive all revenue collecte i
timber and bamboo. And
MP government has decid
late the trade of minor fc
(mfp). The significance of
be gauged from the fact thj:
of the people inhabitin!'.
forests depend on mfp
their livelihood.
The state governmej
intense opposition from f]
to implement the new rev? ■
plan under jfm. Until no\.
bodies used to get 10 per ce...
ber revenue and 20 per cer
ceeds from bamboo sales|
decision would, therefor!
earnings of the forest proi
mittees considerably. MP is
state to take such a step unq
During the past two ye)

tury Leninist paranoia that still infects the
behavior of China’s leaders, and the Third
has its Communist Party' World nation that lingers behind the glitter­
leaders on their heels. Not ing skyscrapers of Beijing and Shanghai.
since the 1989 student upris­
The public-health crisis is also begin­
ing in Tiananmen Square ning to pull back the curtain that hides the
has its leadership been so ex­ divisions within die party itself Clearly, the
posed to the humiliating
honeymoon is over for the new leaders,
glare of international scrutiny and criticism.
President Hu Jintao and Premier Wen
The cancellation of prestigious conferences Jiabao. Whether praise for die energetic
in die capital and the potentially precipitous
measures they have taken to contain the
drop in foreign trade and investment as for­ epidemic ultimately outweighs blame for
eigners obey tire World Health Organiza­ concealing it will doubdessly depend on die
tion’s advisory to shun Beijing are embar­
human toll SARS exacts. The public­
rassing enough. Worse is the image of relations battle will be fought out partly
China’s leaders behaving in feckless fash­ through die ubiquitous urban Residents’
Committees, the asphalt-level apparatus
ion, putting politics before people.
The leadership’s perennial obsession
through which the party confronts its sub­
with secrecy led it to prevaricate about the jects. But for China’s leaders die popular
extent oftire disease in the capital for five
mood will be of less consequence than die
months. The rationale seems to have . factional struggle within the party.
Wien Hu took over in March, he did
been a desire to avoid public panic dur­
ing tire passing ofthe torch to new lead­ not inherit the full panoply' of China’s lead­
ers at the Party Congress last Novem­ ership posts. His predecessor, Jiang Zemin,
ber and the National People’s Congress
retained the key chairmanship of the par­
in March. But in truth, tire party has al­ ty's Central Military Commission. Jiang
also seeded a significant number of his
ways carried the “hear no evil, see no evil,
speak no evil” policy—preferred by bureau­ “Shanghai faction” in die ranks of the new
crats everywhere—to extraordinary lengths.
Politburo, orchestrated by his main trusty'.
The assignment of tire 2008 Olympic Vice President Zeng (Jinghong, a brilliant
Gaines to Beijing augured for many China’s political operator. At the time Jiang gave
every appearance of leaving office reluc­
arrival in the modern world. But the SARS
epidemic has revealed the early-20tii-centantly, and having bowed to necessity' he
BY RODERICK MACFARQUHAR

HINA’S

SARS

EPIDEMIC

FREDERIC J: BHOWN-AFP

More an Actor
Than a Leader
HEN I MET YASIR ARAFAT FOR THE FIRST TIME, IN

W

1996,1 was struck by the contrast between his revolutionary
appearance—with his uniform and his gun—and his softspoken manner. That hasn’t changed. He has a fragile,
seemingly helpless physical appearance, but according to Israeli intelli­
gence files he’s a corrupt terrorist. I watched him titrough the gun sights
for 20 years, and then spent time with him
around negotiating tables at Camp David
and elsewhere. I gradually found him to
be a sophisticated manipulator, more an
actor than a leader, holding a mirror and a
weathervane to find his way, rather than
a compass.
Arafat is a man ofthe past. Yes, the
Palestinian crowds still cheer for him, and
the struggle that preceded the formation of
Abu Mazen’s government shows that he
still retains power. He remains a living sym­
bol of the Palestinian national movement.
But since the attacks of September 11,2001,
and the war in Iraq, a new chapter in Mid­
dle East history has been opened, and it has
no natural place for him. Hence, within a
year or two, I believe, Chairman Arafat will
begin his march into history. He has failed
to rise to the challenge of historic leader­
ship, and has thus become a source of
tragedy for his own people.
Last week’s release of the Roadmap is a
demanding, and potentially damaging,
challenge to Arafat. It was launched only
after Arafat was coerced into accepting
the executive triumvirate ofAbu Mazen
(whose formal name is Mahmoud Abbas),
Muhammad Dahlan and Salam Fayad.
Abu Mazen, the Palestinian prime minis­
ter, will deprive Arafat of some executive
power. Dahlan, the minister of internal
security, is supposed to crack down on
Hamas and Islamicjihad as well as on
Arafat’s own Aqsa Martyrs Brigades. And
Fay’ad, the Finance minister, will try to find
the Palestinian money that’s trickled into
the private accounts of Palestinian leaders,
and to establish new, transparent and ac­
countable institutions.
Thev will not have an easy time, mostly
because it’s not in Arafat’s interest for them
to succeed. If they implement reforms and
move toward reconciliation with Israel,
honest Palestinians might wonder who
was responsible for the thousands ofPalesNEWSWEEK MAY 12, 2003

NOT LEADING: Barak, Clinton and Arafat

There have been opportunities before—
as tire late Israeli foreign minister Abba
Eban used to say, “The Palestinian leader­
ship has never missed an opportunity to
miss an opportunity.” The Israeli-Palestin­
ian conflict, I once told Arafat, is one of the
most complicated conflicts on earth, and it
won’t be solved unless human beings are
ready to make decisions and put an end to^
it. We happen to be tire human beings iri^H
charge, I added, and the price of our failure
will be tire loss of thousands of innocent
lives on both sides before our successors
return to the negotiating table to solve
exactly tire same issues. Yet in July 2001,
Arafat rejected the Camp David proposal as
a basis for negotiation and deliberately
turned to terror.
Last week President Bush, addressing
tire American people from an aircraft carri­
er, said that whoever commits terrorist
acts, or supports or harbors those who do,
is the enemy of the United States. No one
better fits those descriptions than Arafat.

Chairman Arafat has failed to rise to the
challenge of historic leadership, and has thus
become a source of tragedy for his own people
tinian lives that have been lost in a vain
attempt to dictate a political solution to
Israel through homicidal bombings. As
long as Arafat holds power, there will be
no Israeli-Palestinian peace. Orwellian
double-speak and treachery will prevail.
The Israeli-Palestinian peace process is
a painfill divorce that should be executed
for the benefit of both sides. Israel should
give tlie Roadmap a fair chance to succeed.
Illegal settlement outposts should be dis­
mantled. The rule of law should be fol­
lowed by all. Ways should be found to ease
daily life for Palestinians. If and when the
Palestinians launch a coherent and deter­
mined crackdown on all terror groups,
then Israel will have to use common sense
and not let a single attack stop the peace
process. But we’re not yet there. And Israel
cannot be expected to step forward before
statements turn into action on the Palestin­
ian side. The opportunity is here, but the
challenge is immense.

He has engendered hatred in a generation
of Palestinians, poisoned tire souls of mil­
lions of y'oung Arabs and Muslims around
tire world. But beyond that, he represents
a failure of character and leadership. If
the Palestinians had a leader like Egypt’s
Anwar Sadat or Jordan’s King Hussein, we
would have had peace by now.
At decisive moments leadership is about
moving against the stream, askingyourself
not what the people want right now, but
ratherwhat the people need in the long
term and what should be done about it
now. It’s not easy; leadership has its risks.
You might lose your office, like Mikhail
Gorbachev. You can even lose your life, as
happened to Sadat, Yitzhak Rabin and
Abraham Lincoln. But when leaders aren’t
ready to lead, many' other people have to
pay the price. That is the failure ofArafat.
BARAK was Israel’s prime minister from 1999
to 2001.

17

With no cure in sight, Chinas SARS epidemic has set off a tussle for
power in the upper reaches of the Communist Party leadership. The
country s political vims could linger long after die health hazards.

seems determined tliat his fac­
tion should preserve his legacy
in the people's eyes as the third
member in an apostolic succes­
sion—Mao, Deng and Jiang.
Today, when every Chinese
leader is of a reformist bent, the
endemic factionalism in the
leadership appears to be driven
ore by personality than policy.
ost Western observers as­
sumed that power plays between
Hu and Jiang would begin in
earnest in several years when Hu
may be an opportunity for Hu to whittle
began to lay tine groundwork for a second
term. The SARS epidemic could be the cata­ away Jiang’s power base. But he is proceed­
ing cautiously. One of die two principal
lyst for the struggle to begin now. As the sen­
ior civilian overseeing the military, Jiang has scapegoats so far, the minister of 1-lcaldi,
ultimate responsibility over the capital’s mil­ was certainly a Jiang protege, but die odier,
the mayor of Beijing, was one of Hu’s
itary hospitals. The military’s initial refusal
men—almost certainly a sacrifice to prevent
to reveal the number of their SARS cases led
a backlash from Jiang loyalists. And signifi­
to China’s international humiliation when
cantly, die mor e powerful Beijing official,
die full extent of die epidemic in Beijing was
finally revealed. Was Jiang kept ignorant or die party’s first secretary—also of Jiang’s
was he trying to protect his power base from clique—escaped with only a public selfexternal interference?
criticism. Hu cannot go too far too fast.
But he is not entirely
Most party officials would
alone eidier. Hu has found a
probably like die military made
MAY DAY: Tiananmen
potent ally in Wen Jiabao, a
subservient to the civilian bu­
Square was eerily
protege ofJiang’s former po­
reaucracy and deprived of its
empty during the
litical opponent, Zhu Rongji.
special relationship to Jiang.
workers’ holiday, save
Indeed, Hu appears to be ex­
The military's insubordination
for a few police (inset)
ploiting die moment to em­
in the early stages of die crisis

ploy a number of officials from
Zhu’s circle. Known as die “Iron
Lady,” Vice Premier Wu Yi—die
highest-ranking woman in die
government—was
appointed
last week as chief of die leader­
ship team overseeing the batde
against die deadly virus. And
Wang Qishan, also a longtime
Zhu protege, is now serving as
the acting mayor of Beijing.
For tiieir part, Jiang and his
frontman, Zeng Qinghong,
know it would be fatal to seem
to be endangering die anti-SARS campaign
in the interests of scoring political points.
So, much will depend on the success of the
campaign. If SARS is quickly contained,
die position of Hu and Wen will he greatly
strengthened. It is hoped they might be em­
boldened to experiment with greater trans­
parency in other spheres of public life. But
if die epidemic spreads through large parts
of the country and primitive rural medical
care proves unable to cope, then Jiang
could point out that the epidemic bur­
geoned only after Hu took over die party.
Either way, the political virus unleashed by
China’s SARS crisis may persist longer than
the health hazards.
MACFARQUHAR is the Leroy B. Williams Professor of

History and Political Science at Harvard University.

Health

The slippery SARS vims
is ogiving
o rich countries
plenty of trouble. But
doctors fear the real
devastation could come
in die developing world.
Toronto,
where home,
she worked
at a nursing
and
probably
caughtwhen
the virus
in­
BY TOM MASLAND
brought
it to the
Philippines
she re
killer
sars She
virus
turned to care he
for her
ailing father.
vis­
modem
cities.
Adelafatally
Catalon
traveled
to Barangay
’ Vacante
ited three provinces
before
falling
ill.
from onewhose
of the immune
world's most
Her father, Mauricio,
sys­
tem had already been weakened by a bout
with abdominal cancer, also died from
SARS. Police ordered 210 Barangay
Vacante residents to stay home, and local
health officials went door-to-door twice a
day to check up on them. That didn’t stop
some residents from slipping away on foot
to shop in the nearby market town of Al­
cala. To persuade them to stay put, the gov­
ernment rushed in dried fish, rice and
canned goods.
Such are the simple tools deployed
against severe acute respiratory syndrome
in the so-called developing world. Even
rich countries haven’t exactly produced a
lightning victory' against tine disease. Last
week, just as the World Health Organiza­
tion lifted its travel advisory’ for Toronto,
Canadian health officials announced two
new cases. And scientists in Hong Kong
raised the frightening possibility that pa­
tients who have already recovered from the
disease may still infect others. What if
SARS holds another punch for the world’s
poorest countries?
The
prospect
has health experts
in South Asia and
Africa, in particular,
on edge. So far In­
dia has kept its 19
mild cases from

T

VULNERABLE:
Health clinics in
the Kibera slums
of Nairobi aren’t
ready for SARS

turning into an epidemic, and only one case
has cropped up in Africa. With the disease
on the wane in Vietnam and leveling off in
Bangkok, it’s possible that SARS won’t be­
come a pandemic. But it’s far from a sure
tiling. The epidemic is still raging in China,
only a plane ride away from vast popula­
tions of vulnerable people. Thirty million

20

HIV-infected Africans, who have compro­
mised immune systems, are sitting ducks
for the disease, warned Luc Montagnier,
one of the discoverers of the AIDS virus.
Millions more people sick with malaria,
hepatitis and bilharzia are similarly at risk.
A recent report from the World Health Or­
ganization sounds an ominous note:

“Nearly two thirds of all the patients who
die in all age groups already suffered
from chronic diseases.” Dr. Alfred Jumba,
who works in the eight-bed Vipawa Medi­
cal Center, one of the main health-care fa­
cilities in the teeming Nairobi slum of Kib­
era, says, “This is potentially devastating."
The Philippines is better off than many
PHOTOGRAPH BY SVEN TORFIKH f OR NEWSWEEK

developing countries, but it is hard-pressed
to defend itself against SARS. Unlike Hong
Kong, which has erected virtual holiday
camps for its SARS victims, or Singapore,
which has installed video cameras to police
urban areas, it makes do with the 2 percent
of its annual budget that goes to health care.
Officials say they can't afford to buy gloves
NEWSWEEK MAY 12, 2003

and masks for nurses. The Philippines’
trade minister said last week that the coun­
try has run out of N95 face masks. “We are
hoping that the WHO will help us out,” says
Dr. Troy Gepte, a government spokesman.
People are turning to home preventions like
papayas and gingcr-and-garlic infusions.
Indian health officials have even more

cause to be jittery. None of die country s 19
SARS victims so far has died. But with a bil­
lion people crammed together, a fifth of
them in mcgacities like Mumbai and New
Delhi, the Subcontinent is ripe for a SARS
epidemic. Only a quarter of all Indians have
toilets; SARS, scientists suspect, can be­
spread by feces. A major outbreak of SARS

21

□Health.

would overwhelm India's health-care sys­ nursing. But even in Kenya, one
WARY: Taking
but if SARS comes into a coivB
munity, it may be as bad as th?
tem. The country has fewer than five physi­ of Africa’s best developed coun­
temperatures in
Manila (above,
cians per 1,000 people and one small com­ tries, only 10 respirators are
1918 influenza outbreak.”
left), lecturing
munity health center for even- 80,000
available for isolation rooms.
The South African govern­
people. The government's drive to promote
Ghana, another well-off African
on SARS in India
ment, Africa’s best-heeled ad­
family planning has starved other health
country, is equally at risk. “In
ministration, has deployed its
senices of funds. “The danger is extremely the whole of Ghana there arc only a few defenses quietly in order to avoid sowing
great,” says Ghanshyan Shall of Delhi’s
isolation units with respirators,” says
panic. With no fanfare, it opened a 24-hour
Jawaharlal Nehru University. “Over time
Dr. Peter Ottengraf, who works in the
clinic at Cape Town airport for checking
the health system has become weaker capital, Accra.
international visitors for SARS symptoms.
and weaker."
The presence of HIV makes tire situation All airports are now required to check
Because most Indians aren’t covered by potentially catastrophic. Most AIDS pa­ each airplane from an outbreak country. A
health insurance, many may wait too long tients in South Africa, which has the world’s
public-heath officer boards the plane, ad­
before reporting to die rudimentary healdi highest incidence oftire disease, go untreat­ dresses the passengers and hands out cards
clinics serving rural areas. India’s plan to
ed. State hospitals are overwhelmed with
listing SARS symptoms and phone num­
use airports as a first line of defense doesn’t
tuberculosis patients, many weakened by bers to call for help. Health officials will
inspire confidence either. Although all ar­ AIDS. “We are already living a nightmare
track those who seem ailing. The govern­
riving passengers are required to fill in
here,” says Dr. Steve Andrews, a Cape Town
ment has also created outbreak-response
questionnaires, many say they haven’t been AIDS specialist. “Six hundred people are teams and designated hospitals for sus­
asked any questions once they’ve landed.
dying each day from AIDS in South /Africa,
pected SARS patients. “People now know'
African health officials cast
about SARS, they are worried
a worried eye toward India.
about the symptoms and|
SARS: Will It Jump to India and Africa? those who fly here with tfl
Here’s their nightmare sce­
India suffers from the same crowding
nario: An expatriate Indian
disease will let medical peo­
and poor health care that helped
CHINA* Q 134 $205
from Nairobi returns to Mum­
ple know immediately once
spread SARS in China. HIV raises
bai, where some SARS pa­
they fee! sick,” says one South
tients live, for a visit. He Africa’s SARS risk, too.
African specialist. “But what
comes home and infects his
about thei r gardener or maid,
housemaid. She in turn
who lives in the township,
spreads die virus to Kibera,
and goes home that night
Kenya’s largest slum. There,
with a cough ?”
working in shacks with sign­
It hasn’t happened so far.
tan
S7ij
boards out front, local staffare
And for now, the south’s best
trained to diagnose familiar
chance is that the rich nortli
diseases like flu or malaria—
stamps out SARS before it
^7^057
«H5
but not SARS.
rolls into a slum like Soweto.
Whatever die route might
“Let us hope that die WHO
be, Africa lacks the ability’ to
manages to keep it under con­
People per sq.km.
fight SARS. Suspected carri­
trol,” says Dr. Jumba in Nairo­
<.
Per
capita
health
ers should be quarantined,
bi’s Kibera slum. Millions of
SOUTH AFRICA
spending
and victims need an intensivelives hang in the balance.
ITO Cases (as of May 2)
care unit and an isolation
With ERIN PRELYPCHAN in Manila.
ward, equipped with respira­
kjvrsyM Percentage of
IAN MACKINNON in New Delhi,
adults infected
tors and staffed by specialists
TEIJE BRANOSMA In Nairobi
•INCLUDES MONO KONG AND MACAU. SOURCES. CIA, UNAIDS. WHO
trained in so-called barrier
and JEFFREY BARBEE in Capo Town

fesa m

B90

$36

tan tom

22

FROM Lin: ERIK DE CAS1R0-REUTERS. AMAN SHARMA-AP

The tine cost of the SARS crisis may be a lot less
than many economic forecasters are predicting
BY GEORGE WEHRFRITZ

AND ALEXANDRA A. SEND

HAS TURNED MICHAEL
^£"■1 O'Keefe’s business upside down,

ma tic comparisons of the SARS scare to the
Asian contagion. Back then, all of Asia fell
into a serious recession, with regionwide
growth plummeting from 8.3 percent in
1996 to 4.4 percent in 1998; in Thailand,
Malaysia, and Indonesia, tens of millions
fell into poverty. Even China (which cooked

but not for the reasons you might
think. As a risk consultant at
Kroll International, he normally
plays die voice of caution. Not now. In
japan, which has yet to confirm a single
case of SARS. he’s telling clients diat draco­
nian emergency measures—from bans on
corporate travel to quarantines for employ­
ees who have visited Asia even briefly—arc
“overkill." Elis advice: be prudent, but rec­
ognize diat SARS is not an Asia-wide pan­
demic, even if it looks like one in headlines.
“Just because there’s a sick man in Asia,” he
says, “doesn't mean all of Asia is sick.”
.Amid warnings from prominent
economists that SARS threatens to produce
a financial crisis as bad as die 1997-98
.Asian currency contagion, it's time for a re­
ality check. SARS has crippled travel, trans­
port and retail industries, but the damage is
largely confined to a few “hot zones” like
Hong Kong, Singapore and, most recently,
China. No, SARS isn’t all in our heads, but
^predictions of an economic disaster assume
a regionwide epidemic, which now looks
less and less likely. “In my 28 years in Asia, I
few
have neverseen such blind pan_______
ic,” says Steve Vickers, CEO of I
its books to hide the impact)
International Risk, a security I RARE RESPITE:
j saw GNP growth fall to as little
Hospital
workers
as zero percent by some esti­
consultancy. “I’ve heard about j
people in Europe concerned I outside a SARS
mates. In comparison, SARS is
about packages coming from I clinic in Beijing
a paper contagion.
Asia. DHL takes 36 hours; Lnrasro
Consider the epicenter of the
viruses don’t last diat long.”
SARS crisis, Hong Kong. “The lobby of die
Mandarin Hotel is empty, sure, but this is
In a report released late last month, die
World Bank lowered its growth forecast for pent-up demand, not destroyed demand,”
Asia from 6 percent to 5 percent, which puts says Enzio von Pfcil, CEO ofadvisory group
the cost of die SARS epidemic at roughly Commercial Economics Asia, adding that
media accounts of the city’s dismal
$30 billion, a tiny fraction of Asia’s losses in
1998. The study attributed most ofthe loss­ prospects are “90 percent based on fear, 10
es to panic, not illness, noting that “in the percent based on reality.” By the numbers,
tourism accounts for about a tenth of Hong
short nin, the economic consequences arise
Kong’s GDP, so drops in air travel, hotel oc­
almost entirely from public perceptions and
fears about the disease—and from precau­ cupancy and general tourist spending could
tions die public is taking against it—radicr push the economy into recession this year.
than from die disease itself”
But trade, the city’s lifeblood, remains large­
That observation should quiet melodra­ ly undisturbed. “It’s business as usual for
NEWSWEEK MAY 12, 2003

most companies here,” says Erank Martin of
Hong Kong’s American Chamber of Com­
merce. Traffic at Kwai Chung—the world’s
busiest deepwater port, which deals mainly
in China cargo—has not slowed a bit.
The voices of reason are not getting
much airplay these days, however. Pradumna Rana, director of the Asian Develop­
ment Bank’s Asia Recovery Information
Center, says Asian countries arc healdiy
enough to defend their economies against
short-term capital pressures should they
arise, and the region has foreign-currency
reserves 400 percent larger than in 1996.
Mark Mobius, emerging-markets guru at
Franklin Templeton Investments asset
management, remains unruffled by SARS
after recent business trips to Singapore,
Hong Kong and China. “In a few months
we will see a return to a normal dynamic

economic environment and growth will
pick up again,” says Mobius.
Even in China, where SARS remains out
of control, Ute outbreak looks like a bump in
the financial road. “1 don't sec SARS destabi­
lizing China's economy,” says Cesar Bacani,
author of “The China Investor.” “The mo­
mentum from trade, investment, restructur­
ing and growing household affluence is sim­
ply too strong.” Last week the World Health
Organization lifted bans on travel to Singa­
pore and Vietnapt. Ifthose states can contain
SARS, why not China? “Once China’s leaders
focus on problems, they usually manage to
resolve them—sometimes widi brutal effi­
ciency,” a Goldman Sachs report concluded.
“You may call that a virtue of authoritarian
government.” It’s also another reason not to
fear contagion.
With B. J. LEE in Seoul

23

To Iris American friends, Ahmad Chalabi is
democrat and a paragon of Iraqi patriotism.
.Tollis enemies^ he’s a crook. Does he have die stuff
to reshape Iraq? A NEWSWEEK investigation:
'’•«-As-’

iL

BY CHRISTOPHER DICKEY AND MARK HOSENB.

N THE BATTERED PRECJ^CE^&^^W>^

CLUB, Ahmad Chalabi holds forth on the bright future of 1
country and the sordid history of his enemies
T
nancier
and freedom
fighter,
just
returned
to
after
45
years
in
exile,
says
he
’
s
.taken
possession
o^5j
documents from Saddam Hussein’s secretpof
”‘1
. thinking how best to use them. He and his brothers1
victims, as he tells it, of many conspiracies by Saddam and by.
dan’s late King Hussein. According to Chalabi, even Skv
and Saddams brother Barzan collaborated on schen
the family’s banking empire abroad. But now Ahmai
could turn the tables on his .many old enemies.
“It’s a huge tiling,” Chalabi told NEWSWEEK. “Some of.the '
.files are veiy damning.” And some of the most incriminat­
ing, Chalabi implies, could tell a lot about the royal family

I

B PUBLIC HEALTH

The SARS epidemic
Even as the SARS virus arrives in India, with the first case being
reported from Goa, laboratories under the WHO continue to
explore ways to counter the rapidly spreading disease.
R. RAMACHANDRAN
ITH the spread of Severe Acute
Respiratory Syndrome or SARS, a
hitherto unknown atypical form of
pneumonia, to more and more countries
as a result of international travel, India
could not have escaped for long. Since
uary 26, when the first case was ded in Hanoi, SARS has spread to 27
countries, including India. The first case
of SARS in India was identified on April
16, in Prasheel Varde, a 32-year-old ma­
rine engineer from Goa. He had travelled
to Hong Kong and Singapore - both
categorised as SARS ‘affected areas’ or
hot zones - before returning to India on
April 1.
A diagnostic test based on the Po­
lymerase Chain Reaction (PCR) done by
the Pune-based National Institute of Vi­
rology’ (NIV) confirmed the presence of
the SARS virus in samples of the pa­
tient’s blood, sputum and urine, which
were sent by the Goa Medical College
Hospital (GMCH) where he was being
treated. In a press briefing on April 17,
officials from the Health Ministry' said
that all the samples were found to be
' .ive for the SARS virus. However, it
rious that even though the samples
rated the presence of the virus in the
blood stream, the patient showed no
clinical symptoms characteristic of the
disease - high fever, cough, breathing
difficulty and, most importantly, signs of
pneumonia or respiratory distress syn­
drome in a chest X-ray.
Thus, the Indian SARS case, with an
apparent mismatch between clinical
symptoms and the diagnostic test, is a
unique one. Since the cause or the aetiol­
ogy °F l^e disease was unknown till
about four weeks ago, the case definition
has been done solely on the basis of clin­
ical svmptoms specified by the World
Health Organisation (WHO). Of the
3,461 suspected and probable SARS
cases reported worldwide so far, the
WHO has recorded the Indian case as
one that has recovered.
Diagnostic tests are being developed

W

&

122

after the causative agent was identified
recently as a hitherto unknown form of
coronavirus, a family to which the com­
mon cold virus belongs. But all the three
different tests - Enzyme-Linked Immu­
nosorbent Assay (ELISA), Immunofluo­
rescence Assay (IFA) and PCR - seem to
have their limitations. A PCR test that
was developed in early April by the Cen­
tres for Disease Control and Prevention
(CDC) of the United States is stated to
be effective only in the early stages of the
disease.
However, with the isolation and ge­
netic sequencing of the SARS virus,
primers - pieces of genetic material that
are specific to a given virus and are the
key pieces for a PCR test - have been
made available to laboratories around the
world by die Hamburg-based BernhardNocht Institute for Tropical Medicine
(BNI), one of the laboratories in the
WHO consortium for research on SARS
aetiology. Arcus Biotech, a Hamburg­
based firm, has developed a real-time,
ready-to-use PCR diagnostic kit that us­
es primers. The company has offered to
supply these kits, which became available
since April 14, free of cost to laboratories
participating in the WHO network of 13
laboratories from 10 countries. No Indi­
an institution is part of this network.
Therefore, in all likelihood, the NIV test
is based on the primer sequences that
were made available by the WHO on its
website.
According to Kumar Rai, head of the
communicable diseases wing at the
WHO’s Regional Centre in New Delhi,
as diagnostic tests are still being devel­
oped, there is also a high probability of
the test indicating a “false positive” re­
sult. Christian Drosten, the BNI scien­
tist who was responsible for identifying
the primers and developing the PCR
test, said: “The case definition of SARS
does not include findings in PCR. Re­
sults of PCR can be used to complement
clinical diagnostic evaluation. However,
tests have not been validated for confir­
mation of cases or exclusion of rhe dis­
ease.” Therefore, it is unclear why the

WHO decided to confirm the Indian
case, which is based entirely on the PCR
test, as an instance of SARS.

RASHEEL Varde, his wife and his
father had sailed from Hong Kong,
where they stopped for four hours on
March 26, to Singapore, where they
spent a couple of days. On April 1, the
three arrived in Mumbai, where they
spent a couple of days, before reaching
Goa on April 4. On reaching Goa,
Prasheel developed fever and cough and
on April 8 he went to a private medical
practitioner, who referred him to the
medical college hospital. There, he was
kept under observation from April 10 to
12 in an isolation ward and was treated
with antibiotics. The treatment was ef­
fective, and since his X-ray did nor reveal
any pneumonia patch, he was dis­
charged. Although the hospital had sent
his samples to NIV for testing, by the
time the test results became available on
April 14, he had been discharged.
And in a strange and inexplicable
move, on April 14 it was decided that he

P

FRONTLINE. MAY 9. 2003

Feature on ICF
The following is a communication received from M. Vf Rarnani, General Manager,
Integral Coach Factory, Chennai:
I Frontline (April 25) has carried a feature on ICF, which also includes an
interview with me. While the feature has been well brought out, I would like to
point out some inaccuracies in my replies to the interviewer, which will not in any
way change the correct meaning and significance of my responses.
I am indicating below these details so that a correction can be published in your
magazine:

Page no.

As it appears

Corrected version

110 (col.2)

In fact, casualties are higher
due to the cumulative weight
caused because of the
collision per se.

In fact, casualties are higher due
to the added weight of the
coaches which have climbed on
top which results in crushing of
the coach and these damages are
not attributable to collision perse.

110 (col.2)

Technically it is all right.

Technically it is cleared.

110 (col.3)

.... consequential effects of
an accident will come down
by up to 20 per cent of
what they are now.

.... consequential effects of an
accident will come down by
20 per cent ofwhat they are now.

110 (col.3)

Now we paint a coach
every year, but ....

Now maintenance workshops
paint a coach every year, but....

112 (col.l)

There is a set system,
nationally and internationally.

There is a set system as
per national standards.

112 (col.l)

We were re-certified last
month (February 2003)
under ISO 9000.

We were re-certified last month
(February 2003) under
ISO 9000 - 2000 version.

112 (col.2)

This also makes the
self-certification process
serious......

This also makes the
self-certification process
effective....

112 (col.3)

We made Metro coaches
(16 rakes of six cars each)

We have to make Metro
coaches (16 rakes of six cars each)

114 (col.2)

We will focus on our core
strength - rhe running car, rhe
steel shell and rhe structurals.

We will focus on our core
strength - under carriage, the
steel shell and the structurals.

114 (col.3)

.... As and when high-speed
.... As and when high-pelnets
bullets are fired on to the coach. are fired on to the coach.

114 (col.3)

We are trying to modernise
the basic fabrication
and the assembly of the
bottom of a coach.

I.G. Khan
I read with shock and deep sorrow the
news of the brutal murder of Dr. I.G.
Khan (April 11). He was a front-ranking
historian of medieval India. He represent­
ed in his work and in his personality the
best traditions of Aligarh historians. I was
privileged to come into contact with him
in Britain and experience his charm and
graciousness. His social commitment and
his ability to combine a scholarly vocation
with trade union work among the rick­
shaw-pullers were admirable.
I am, however, saddened by die fact
FRONTLINE, MAY 9. 2003

We are trying to modernise
the basic fabrication and
under carriage of rhe coach.

that the killing of such an intellectual has
not been taken up as a campaign issue by
the national media. I hope the CBI in­
quiry will lead to die early apprehension
and conviction of the culprits.
Gyanesh Kudaisya
Singapore

Sena’s overtures
This has reference to “Opportunistic
overtures” (April 11). Keeping in view die
2004 Assembly elections in Maharashtra,
the Shiv Sena has proposed an alliance
with the Republican Party of India. Bur

the RP1 is a divided party with four fac­
tions, headed by Ramdas Athavale, Pra­
kash Ambedkar, R.S. Gavai and Jogendre
Kawade respectively. Dalit leaders have
been unable to come together, let alone
work together for the welfare of Dalits.
Factionalism has been a major hindrance
to Dalit consolidation. The leaders must
come together to form a united RPI.
An RPI leader, Namdeo Dhasal, had
formed an alliance with the Shiv Sena but
the experiment failed to achieve its ob­
jective. Now the Sena is trying to influen­
ce other RPI leaders for the sake of power.
Moreover, die Shiv Sena has been
constantly opposed to the RPI and its
leaders. The Sena had opposed the renam­
ing of the Marathwada University after
Dr. Ambedkar. It banned Dr. Ambedkar’s book Riddles in Hinduism, which
led to clashes between Sena and RPI a^^
ists in Mumbai. Considering all thest^P
tors, it would be foolish on the part of the
RPI to form an alliance with the Shiv
Sena.
D.R. Jaware
Maharashtra

JPC report
This is with respect to the article “A
guide to the JPC report” (February 24) by
Mani Shankar Aiyar. The author has done
well to throw light on the findings of the
JPC investigating the stock market scam
and the UTI imbroglio. It is indeed
shameful that despite monitoring institu­
tions like SEB1, die RBI and the Ministry
of Finance, rhe common man finds him­
self robbed of his hard-earned money.
These institutions failed not once but nu­
merous rimes during the course of these
scams, as is evident from the J PC’s obser­
vations. What is more shameful (beej^k
of the nature of the post he held) isWF
role Finance Minister Yashwanr Sinha
played whilst all diis was going on.
Sinha must realise that he cannot pass
die buck. His statement in rhe Rajya Sabha that P.S. Subramanium, the then
Chairman of the UTI, had repeatedly as­
sured him through the Ministry that ev­
erything was hunky-dory at die UTI and
with US64 reflects his irresponsible atti­
tude of Sinha. Whatever may be the case,
the truth remains that all this has cost the
country dear, both in terms of money val­
ue and in terms of the faith of millions of
investors who feel betrayed. Our judicial
system should be geared to cake care of all
the loopholes that exist in the system.
Those who misuse public trust and mon­
ey must be punished.
Himanshu Panwar
Shimla
121

£
At present, Hong Kong,
z SARS.” He added: “Now we
2 with 1,327 cases and 69 deaths
can move away from methods
as of April 18, is the hardest-hit
like isolation and quarantines
area. Healthcare workers conand move aggressively towards
g tinue to become get infected
modern intervention strategies,
and hospitals are overwhelmed
including specific treatments
by the growing number of pa­
and eventually vaccination.’
tients. A large cluster of 268
He noted that if the vaccine or
SARS cases has been reported
drug was to be developed by
from a single high-rise apart­
the private sector, it would
ment block called Amoy Gar­
want to be certain that the dis­
dens Estate. It is the first
ease was a permanent resident
known instance of a possible
in human beings, in order to
environmental spread of the
recaver its investment. There­
SARS virus. The vast majority
fore, it had to be funded wholly
of the cases have been traced to
by the public sector or in part­
vertically linked apartments in
nership with the private sector.
a single building. This pattern
he said. “The history of treat­
of transmission, according to
ing viral infections showed that
anti-viral drugs were very diffithe WHO, indicates that the
disease has moved out of the
^^ilt to develop, and even then,
^Jey had an effect only very
healthcare setting and is now
occurring within the commu­
early when the virus level was
nity. Epidemiologists investi­
low,” he observed.
gating the peculiar outbreak
Going by the rapidity with
which the disease is spreading,
released a report on April 17,
SARS appears to be the first
identifying the enviromental
route as the source of the large
severe and easily transmissible
disease of the 21st century,
cluster of cases.
Heymann said. Although the
As of April 15, 321 Amoy
residents had been affected. In­
causative agent of SARS has
been identified in a remarkably
vestigation has identified a sew­
age contaminated with the
short span of time, the poten­
tial of the disease was not clear,
SARS virus as the probable
particularly whether it would A tourist visiting the Great Wall of China on the outskirts of
source of exposure. According
become a permanent infectious Beijing on April 21. All evidence points to the disease having to the report, a 33-year-old
disease, he said. All evidence first appeared in the Guangdong province of China.
man, who developed symp­
points to the disease having spread from instance of what it has termed “super­ toms of SARS on March 14, visited a
the Guangdong province of China. The spreaders”, in which one person from the relative in the apartment building on rhe
outbreak seems to date back to Novem­ province is thought to have infected as same day. His symptoms included diar­
ber 16, 2002, when an initial case was many as 100 other persons. The phe­ rhoea and it is believed that the virus
reported in Foshan city.
nomenon of a “super spreader”, which is from his faeces was transmitted through
not a medical condition, dates back to the sewage route. The rapid spread to
HEN a global alert against SARS the early days of the outbreak when other residents has been attributed to de­
was issued on March 12, it was SARS was not identified as a disease re­ fective U-traps in bathrooms, the ampli­
hoped that SARS would not spread quiring special precautions of isolation fying effect of bathroom exhaust fans, a
throughout Asia and the rest of the and infection control. In the absence of cracked sewer vent pipe, and an aero­
world. According to him, until the sit­ such measures, a large number of health dynamic effect in a lightwell to which
uation in mainland China, which had workers, family members, relatives and bathroom windows opened. Laboratory
1,482 cases, became clear and a number visitors to rhe hospital were exposed to investigations confirmed the presence of
the SARS virus in a swab from the toilet
of key questions were answered, the fu­ the virus by a single unprotected case.
ture of the disease would not be known.
A “super spreader” has been traced in bowl in the bathroom of a SARS patient,
Since April 3, four WHO teams have Singapore too. The report expressed par­ but not in numerous other environmen­
been working in Guangdong, Beijing ticular concern on the situation in Beij­ tal samples. The study found no epide­
and other major cities of the country to ing, where there could be underreported miological or laboratory evidence that
assess the situation.
cases. According to the WHO, the sit­ the SARS virus was transmitted by air,
An interim report on the Chinese uation in Beijing’s military hospitals has water, or infected dust aerosols. “It is
been the source of many reports about reassuring that speculations about a pos­
situation was prepared by the WHO on
April 9. The report concluded that while the real magnitude of SARS in rhe Chi­ sible airborne transmission have not
the health system in Guangdong respon­ nese capital. On April 13, President Hu been borne out by the evidence available
ded well to rhe outbreak, all other prov­ Jintao appeared on state television and to date,” the WHO said.
inces were less equipped to cope with the expressed concern about the situation.
According to Heymann, although
severity of the challenge.
He has appealed for “accurate, timely the last decades of the previous century
In Guangdong, the team found an and honest reporting” of cases.
witnessed the emergence of several new
124

FRONTLINE, MAY 9. 2003

SARS patients across several countries'^
has been isolated consistently by several
network laboratories. The virus has been
demonstrated to cause disease in African
green monkey kidney cells (Vero cells)
and Rhesus monkey kidney cells
(FRhK-4 cells), which was found to be
inhibited with serum from SARS conva­
lescents. Significantly, signs of reactivity
with the new coronavirus, namely the
presence of antibodies, could not be de­
tected in the serum samples of several
non-affected individuals in the U.S.,
Canada and Hong Kong.

ORONAVIRUSES belong to a vi­
ral family called Coronaviridae,
which infect vertebrates, especially
warm-blooded vertebrates, including
mammalian species such as human be­
ings, cattle, cats, pigs, and rats, and a foA
avian species such as turkeys and chicW
ens. The SARS virus has never been seen
in humans before. In fact, its genetic
make-up shows that it is only “distantly
related” to known coronaviruses. It is not
known whether it existed in other species
earlier and jumped species recently, or
whether it is an entirely new virus. “The
WHO and the network of laboratories
dedicate the detection and characterisa­
tion of the SARS virus to Carlo Rubani,
the WHO scientist who first alerted the
world to the existence of SARS in Hanoi
and who died from the disease in Bang­
kok on March 29,” a WHO release said.
This definitive determination was
particularly important because earlier
evidences from different laboratories
suggested that the pathogen could be an
unknown paramyxovirus. Indeed, Cana­
dian researchers {.Frontline, April 11,
2003) isolated a relatively new paramy^
ovirus, known as human metapneumovi^
rus (hMPV). The finding was supported
by some other laboratories in the net­
work. In medical science, it is difficult to
understand the aetiology of a disease in
terms of two pathogens. According to
the WHO, hMPV and antibodies
against hMPV have been found in the
serum samples of some SARS patients.
Evidence of dual infection with hMPV
and the new coronavirus has also been
found. But the significance of hMPV in
SARS remains unclear. Perhaps hMPV is
in the nature of causing opportune in­
fections, making the affliction worse.
David Heymann, Executive Director
of the Communicable Diseases Cluster
of the WHO said: “Because of an ex­
traordinary collaboration among labora­
tories from countries around rhe world,
we now know with certainty what causes

C

Nuns and worshippers wear masks to protect themselves against SARS, while
attending Good Friday mass at Hong Kong’s Catholic Cathedral of the Immaculate
Conception.

would be quarantined for 10 days, after
he was allowed to mingle with the gener­
al public for two days. He was readmit­
ted to the GMCH on the night of April
16. However, on April 18, Goa Chief
Minister Manohar Parikkar announced
that Prasheel would be discharged as he
had been “cured” of SARS. So far, Prasheel’s wife and father, who had been with
him all along, have not developed any
symptoms. However, post-diagnosis,
they were advised not to be in his prox­
imity.
There are several unanswered ques­
tions. Why did he see a doctor four days
after he developed fever? Who were the
people he came in contact with before
being kept in the isolation ward on April
10? Did he develop fever in Mumbai or
on the way to Goa? What was his mode
of travel from Mumbai? These questions
assume importance if the chain of pos­
sible transmission from him to others is
to be traced. According to the WHO,
FRONTLINE, MAY 9, 2003

there is no evidence to suggest that the
human-to-human transmission occurs
by means other than air-borne droplets
of cough, sneeze and so on.
The first indication of the SARScausing virus being a coronavirus came
from research work done in Hong Kong
on March 21. This was confirmed by
researchers at the CDC. However, defin­
itive proof can be obtained only after
verifying Koch's Postulates, which stip­
ulate four conditions for a pathogen to
be the causal agent. The micro-organism
must be found in all cases of the disease,
it must be isolated from the host and
grown in pure culture, it must reproduce
specific symptoms when introduced into
a susceptible host, and it must be re­
isolated in the experimental host. The
work at the Erasmus Medical Centre,
Rotterdam, particularly relating to ani­
mal models, led to the definitive proof
that the coronavirus causes SARS.
According to WHO, the virus from

123

The SARS virus arrives in India
but the case remains shrouded
in confusion and contradictions

THE
DREAD ALERT
■ by Supriya BEZBARUAH

with Nidhi TAPARIA

he dreaded sars virus has
finally arrived in India. Or has
it? In typical Indian style, the
case of India's first SARS victim
has been shrouded in confusion
and contradictions from day one.
Till z\pril 16. Prashil Varde, 32. was
merely a marine engineer suffering
from a mild fever while in Goa. Varde
had sailed to Hong Kong in March and
from there went to Singapore with his
wife before flying back to Mumbai and
proceeding to Goa. It was in Goa that
Varde developed a mild fever of 100 de­
gree F. Had he not visited a SARS-affccted
country recently, it was hardly a reason
to be alarmed about. So Varde went to a
private practitioner, who saw his itiner­
ary and immediately referred him to the
Goa Medical College on April 10. The
who definition of a probable sars case

T

includes high fever, coughing or breath­
ing difficulty and pneumonia. Anyone
visiting a SARS-affected country or
having prolonged close contact with a
SARS victim is vulnerable. But Varde's
fever had subsided and his chest X-ray
appeared normal. It seemed he was in
the clear. He wasn't.
On April 1 7. at two hurriedly con­
vened press conferences—one addressed
by Director-General of Health Services
S.K. Aggarwal in Delhi and the other by
Goa Chief Minister ManoharParrikar in
Panaji—it was announced that the sars
virus had been found in Varde's blood.
sputum and urine samples tested at
Pune's National Institute of Virology
(Ntv). sars had arrived in India.
Later in the evening, Union Health
Minister Sushnta Swaraj confirmed the
alarming development. "We are happy
that the reagents we arc using to test for
the sars virus are effective and that our
surveillance system for sars is working

effectively." she said. She added that a
team from Delhi's National Institute of
Communicable Diseases (Nicn) had been
sent to Goa. Varde. who had been
discharged from hospital on April 12.
was placed in an isolation ward to ensure
that the infective stages of the disease.
normally 2-10 days, were truly over.
sars—or Severe Acute Respiratory
Disease—first came to light in February
this year in China. Vietnam and Hong
Kong. Caused by a new, deadly form of
the virus family that causes common
cold, sars has spread rapidly in this jet
age. triggering possibly the shrillest
global health alert in recent limes. Till
date, some 3,400 people have been in­
fected by the virus worldwide. About 16 5
have died. Eleven disease control centres
in nine countries have worked overtime
to study the causes of .sars. It has now
been confirmed by WHO that a corona
virus, previously unknown to man. is t he
cause. The presence of another new

66 Our surveillance system for SARS is working effectively. 55
SUSHMA SWARAJ, Union Health Minister
50

INDIA rODAY ♦ APRIL

THE BILL...
■ Bans all advertising
and regulates sales of
all tobacco products.
■ All tobacco products to
carry text and pictorial
health warnings.
■ All tobacco products to
indicate nicotine and tar
content on packaging.

■ Smoking and sale of
tobacco banned in all
public places.
■ Bans sale of tobacco
products to persons under
18 and within 100 yards of
educational institutions.

CIGARETTES: The Rs 10,000-

will not apply to tobacco products not
sold in packets. Praful Patel, a National­
ist Congress Parly member of the Rajya
Sabha and one of the biggest bidi manu­
facturers in the country, admits that the
bill's impact, in the first instance, will be
greater on the cigarette industry simply
because it is more organised and spends
a larger amount on advertising. "Bidi
industry is anyway being hit because
urban markets are shifting to cigarettes
while chewing tobacco is becoming more
popular in rural areas." he points out.
The Health Ministry, which drafted
and steered the bill, finds the law nondiscriminatory. In fact, the original bill
tabled in the Rajya Sabha in 2001 was
applicable only to the cigarette industry.
The revised bill includes all tobacco products. "We are banning neither the pro­
duction northesaleof tobacco products.
The bill only prohibits advertising and
aims to create better awareness," says
BhawaniThyagarajan. joint secretary in
the Health Ministry. And since
the consumption is aimed to
be curbed through a ban on
ads, the impact on employ­
ment and tobacco fanning
will be gradual.
The support of states
will be key in the implemen­
tation of the bill, especially
Graphs Dy YOGESH CHAUDHARY'^^S^

crore industry fears it will
suffer at the expense of bidi
and chewing tobacco makers
on whom the law will be lax.
BIDIS: Biggest segment of
tobacco industry claims it is
being hit by the shift to ciga­
rettes and chewing tobacco.
CHEWING TOBACCO: Few big
players welcome bill but
regulation of the segment
will be difficult.
ADVERTISING: Tobacco
accounts for 9% of Rs 4,050cr annual print ad revenue.
MEDIA: Print media—espe­
cially magazines—will take
immediate hit.

SMOKESCREEN
In India, tobacco is mainly used
as bidi and chewing tobacco
Cigarette ■ Bidi

l'.I Chewing/Gutka

16%

on products other than cigarettes. And
here the political clout of big bidi
manufacturers, especially in the states
of Madhya Pradesh and Maharashtra,
could be a deterrent.
A segment of the tobacco industry
that will be hit the least is chewing to­
bacco. The organised players in the
chewing tobacco industry though prom­
ise to follow the new bill. "We will start
printing nicotine and tar content on all
our tobacco products as soon as the law
demands it." claims Ashok Agarwal.
president of DS Foods which owns brands
like Baba andTulsi.
The bill also prohibits sale of tobacco
products within 1OO yards of all educa­
tional institutions. It is a lofty provision
since the sale of tobacco products to mi­
nors is already prohibited. Besides, the
definition of an educational institution
isn't clear—if it includes coaching cen­
tres and cybercafes, then the bill could!
cover the whole of India.
The main weapon of the bill though
is the ban on advertising. And the key
question is: do advertising bans reduce
tobacco consumption? According to
who, the answer is yes. A study con­
ducted by who shows that the ban on to­
bacco advertising in Norway, Finland,
New Zealand and Canada brought down
consumption by 4-9 per cent between
1977 and 1992. On the other hand, the
cigarette industry claims that in most
countries cigarette consumption has
risen following advertising bans.
Whatever the argument and effec­
tiveness, everybody has accepted the re­
ality of the ban. What is unclear though
is the fate of surrogate advertising. The
bill proposes to "ban all direct and indi­
rect” ads of tobacco. Agarwal is in favour
of an all-encompassing ban. but experts
aren't sure if surrogate advertising can
be legally proven and prohibited. The
Government also needs to ensure that
foreign tobacco companies don't sneak
in ads through the print and electronic
media of countries where the ban is not
as rigorous as in India.
The tobacco industry's adspend is
about Rs 3 50 crore a year—9 percent of
the Rs4,000-crorc annual advertising in
print media. Says Preet K.S. Bcdi. presi­
dent-designate of ad agency Rediffusion:
"The size of advertising is a non-issue in
deciding on ad bans on tobacco. Not
because the advertis­
ing size today isn't
very big but becattse
J such bans are determined by
bigger and loftier factors."
In the end. the bill’s worth
will be tested on how uniformally it curbs all forms of to­
bacco consumption.

-38-%Figures are volume of consumption

Al’Hlt _’.X. _'<nu ♦ INDIA TODAY

49

case which showed up only in fever. But
he definitely has been infected by sars."
Indeed, there are reports of sars
patients with mild symptoms. Neither is
the polymerase chain reaction tech­
nique used by Ntv for t he tests completely
fool-proof. False positives are possible.
Reports from across the world reveal that
the disease varies widely. Viruses which
have RN/\ as their genetic material mu­
tate frequently, and it is possible that the
sars virus is still changing.
Considering this, Parrikar has good
reason to hope that Varde's case is a false
alarm. Goa depends heavily on tourism.
and as the South-east Asian experience
has shown, sars is the death knell for the
industry. Domestically too it would spell
bad news for a tottering tourism industry.
Subhas Goyal. chairman. STIC Group of
Industries, warns against unnecessary’
panic. "This is an isolated case. Canada
has sars but no one has stopped going to
Canada. More than 20 countries across
the world have sars cases. Why should
people stop coming to India?” he asks.
To be fair, the administration is taking
all precautions to keep the virus at bay.
Incoming passengers are being screened
and some labs at Nico have been up­
graded. However, according to Sanjay

TESTING FOR SARS

A cutting-edge technique is being used to detect SARS
BLOOD

URINE

-------- —

SPUTUM

The RNA, primers and certain enzymes and chem
icals are placed into a PCR plate. Using the poly­
merase chain reaction (RT-PCR), the unique RNA
pieces are amplified sufficiently for detection
MULTIPLE COPIES
OF ONA PIECES

GEL WITH ONA,
VIEWED UNDER
UV LIGHT

Samples are taken from the patient

Tb'* virus

certain unique
stretcher
within a
gene. This
is used to
detect its
presence

CORONA
VIRUS

Tags, called
primers, mark
the unique
gene stretch
in viral RNA

virus, which belongs to the family which
causes chicken pox and mumps, has also
been found in some sars patients.
Barely hours afterSwaraj announced
the first sars case in India. Parrikar and
his Health MinisterSuresh Amonkar met
journalists again to say that thecase may
be a false alarm and that there had been
a “mismatch" between clinical and lab
findings. The samples would be sent, they
said, for a second opinion to Nicu.

VIRAL
RNA

PCR PLATE

Why the confusion? Apparently.
Varde suffered only mild symptoms. His
wife and father, who were in close contact
with him, show no signs of illness.
Neither do any of the medical staff who
had nursed Varde at Goa Medical College.
raising doubts about the accuracy of the
tests conducted at Ntv. Niv Director
A.C. Mishra, however, stands by the re­
sults of his institute, "sars covers a wide
spectrum." he says. "Varde's is a mild

The amplified genetic material can
be labelled with a dye and viewed
under UV light
Malik, secretary-general. Indian Medical
Association, more awareness of the dis­
ease is essential, especially among private
practitioners. "Almost three-fourths of
the patients in India go to private practi­
tioners and it iscsscntial for them to be in­
volved with the Government." he says.
This may or may not be the beginning
of a sarsepidemic in India. But India is no
stranger to epidemics. This won't be the
first, and it won't be the last.

Despite hundreds of diets, nutritionists and
slimming centres, there is considerable
confusion about what constitutes the right
diet in Indian food
■ by Shefalee VASUDEV

hirty-two-year-old suhasini nindrajog is con­
sumed
with diet
dieting.
Overweight
by of
about
10 kg. she
dreams
blood
group
to depressive
weeks
just bananas
and
milk.
She seems
to be among
those whose
purses
are the only
things
incessantly
a pencil-thin
figure.Dr
NindrajogAtkins'
has tried
every
thing
fromofthe
globally "Ifamous
diet
to a­
that lose weight
at—
slimming
centres.
cat salads,Robert
boiled, steamed
foods.
don't snack and even skip meals at times." she says. "But nothing works.
Besides. I feel lethargic all the time."
Quite in contrast. Neeraj Bhalla. a fit looking 39-year-old. says he eats
all the time. "Because food is for eating," reasons Bhalla with a satiated
smile. He starts his day with two cups of tea. followed by a breakfast of
stuffed parathas, curd and pickle, a big lunch ("I eat out almost everyday")
and a heavy dinner with al least one non-vegetarian gravy dish. "In
between meals. 1 eat what I like—pastries, chocolates, aloo bhujia or
biscuits—but I don't put on weight nt all."
Both Nindrajog and Bhalla arc on polarised trips in life, but it seems
that the desired results of their eating pursuits have got mixed up. While
Nindrajog suffers from excessive water retention. Bhalla is one of those few
lucky gluttons who are genetically predisposed to being lean, besides
having a high basal metabolic rate (bmr) that helps them burn morecalo-

T

52

INDIA TODAY ♦ APRIL 2S. 2<K) J

Food Myths
• MYTH: Zero-fat diets are best.
FACT: Fat from some source is necessary.
• MYTH: Crash dieting makes weight loss faster.
FACT: Crash diets can lead to permanent organ
damage and loss of lean muscle and tissue.^
• MYTH: Vegetarians can’t build muscle. "

FACT: Vegetarians derive protein required to build
muscle from grains, pulses and soya bean.
• MYTH: Giving up smoking increases weight.
FACT: Only if cigarettes are replaced with food.
• MYTH: Bananas are fattening.
FACT: There is only half a gram of fat and
95 calories in one banana.
• MYTH: Diabetics should completely avoid
potatoes and rice.
FACT: Prescribed proportions are safe.
• MYTH: Alcohol is good for the heart.
FACT: Alcohol has empty calories which turn into
fat. Ethyl alcohol in alcoholic drinks increases
blood pressure and weakens heart muscles.
• MYTH: Curd, sour foods, astringent fruits and
banana are cold and can induce cough. Nuts, dry
fruits and honey, being warm, cure common cold.
FACT: There are no hot or cold foods, individual
allergic reactions strengthen these myths.
Pl.otograph by BANDEEP SINGH. Locator. courtesy: MAURYA SHcHATON HOTEL ana TOWERS

Page 1 of 4

Community Health Cel]
From:

<ciddsf@vsni.com>

To:
Sent

<pha-ncc@yahoogrouos. com>
Wednesday, May 07, 2003 3:51 PM

Subject:

[pha-ncc] SARS

This miqht be of interest to some

Amit

SARS: How Much of a Threat?

Amit Sen Gupta
The SARS (Sudden Acute Respiratory Syndrome) epidemic has struck fear in
country governments, practitioners and whole populations across the globe.
It has made global headlines and seems to have even overshadowed the human
tragedy that is unfolding in Iraq. While we debate on how large a threat
SARS is we should not lose sight of the fact that, till the beginning of
May, there nave been 5,600 reported cases and 372 deaths due to the
epidemic. Contrast this with over 2,000 or almost six times the number of
deaths taking place in India alone in a single day due to Tuberculosis.
Further, in this one day 3,b00 people would die of Malaria, most of them
children in Africa. How the SARS epidemic will progress is open to
speculation, as is the question how large a public health threat SARS will
be in the future. What we do know is that it is a new infection, which can
be extremely virulent, and can cause deaths in over 5% of those who are
infected. While SARS needs to be tackled -with caution and speed we should
also not lose sight of the fact that influenza epidemics caused by mutant
starins (also caused Dy the same family of viruses called coronavirus that
causes SARS) have been known to aopear suddenly, cause a large number of
deaths, and
steam.

How such epidemics appear suddenly is explained by the capacity of viruses
to mutate that is to change their genetic characteristics. The human body,
when infected by a certain virus, fights the virus by producing what are
called antibodies against the infection. These antibodies remain in the
system and confer partial or total immunity against subsequent infections by
the same virus. Thus, if a virus has been around for a long rime, most of
the people in the community have some for of immunity against the virus like immunity against the common cold. So even if infections occur, they are
not very serious and such viruses do not cause epidemics. This phenomenon,
where most people in a community have immunity to a certain disease-causing
germ is called "herd immunity". Tn the case of a new mutant virus, such herd
immunity docs not exist. As a result the disease is able to spread and
assume epidemic proportions. Over lime, as more people gel infected, herd
immunity develops in the community and the epidemic dies down and the
disease expresses itself as isolated cases.
What is SARS?

Lets us now turn to what we know about the epidemic. In November, 2002, an
outbreak of atypical pneumonia (i.e. pneumonia that is not caused by known
causative organisms and has atypical features) was reported in Guangdong
nrovince in southern China. Tn late February, 2003, such cases were first
’-epo'-ted outside China, .in Hanoi, Vietnam. Tn March, 2003, a WHO officer
Carlo Urban! first drew global attention to the outbreak after examining
cases in Vietnam and coined the name sudden acute respiratory syndrome or
SARS. Carlo Urban! himself died of the infection within 3 weeks of his
.4c,

5/8/03

Page 2 of 4
drawing the world’s attention to the epidemic.

we know now that one illness caused by SARS usually begins with a fever,
sometimes associated with chills or other symptoms, including headache,
general feeling of discomfort and body aches. After 2 to 7 days, SARS
patients may develop a dry cough that might be accompanied by or progress to
the point where insufficient oxygen is getting to the blood. In 10-20 % of
cases, par.ienr.s will require mechanical venr.i 1 ati on wi r.h a machine. The
incubation period (i.c. the period between the time of infection and the
manifestation of symptoms) is typically 2 to 7 days though isolated x'eports
have suggested an incubation period as long as 10 days. SARS. is spread by
close person-to-person contact including through touching the skin of other
people or objects that are contaminated with infectious droplets and then
touching one's eye(s), nose, or mouth. This can happen when someone who is
sick with SARS coughs or sneezes droplets onto themselves, other people, or
nearby surfaces. People are most likely to be infectious (i.e. capable of
infecting others) when they have symptoms, such as fever or cough. However,
it is not known how long before or after their symptoms begin that patients
with SARS miaht be able to transmit the disease to others.

We also know now that SARS is caused by a previously unrecognised
coronavirus —coronaviruses are a group of viruses that have a halo or
crown-like (corona) appearance when viewed under a microscope. These viruses
are a common cause of mild to moderate upper-respiratory illness in humans
and are associated with respiratory, gastrointestinal, liver and
neurological disease m animals.
These viruses do not last a long time
outside the body - generally not more than three hours.
Several new laboratory tests can be used to detect the SARS-associated
coronavirus (SARS-CoV). These include the detection of antibodies to the
virus in the patient's blood, detection of DNA of the virus in samples taken
from the patient's blood, sputum, etc. and culture of the virus. All these
tests arc expensive and they arc not always conclusive. So the diagnosis of
SARS depends on a combination of such tests, identifiable symptoms in the
patient, and a history of contact with someone known to have SARS.

Globalisation and SARS
The SARS epidemic and its subsequent handling, curiously, points to both the
threats posed by globalisation and its potential advantages. Globalisation
leads to transnationalisation of public health risks. A major effect, in
recent years, has been the-resurgence of communicable diseases across the
globe - the most recent exnression being SARS. Every phase of human
r’viliset-inn that has seen a rapid expansion in exchange of populations
across national borders has been characterised by a spread of communicable
diseases. The early settlers in America, who came from Europe, carried with
them small pox and measles that decimated the indigenous population of
Native Americans. Plague traveled to Europe from the orient in the middle
ages, often killing more than a quarter of the population of cities in
Europe (like the plague epidemic in London in the fifteenth century). This
is a natural consequence of exposure to local populations to exotic
diseases, to which they have little or no natural immunity.
Today, what incubates in a tropical rainforest can emerge in a temperate
suburb in affluent Europe, and likewise what festers in a metropolitan
ghetto of the global North can emerge in a sleepy village in Asia - within
weeks or days. The SARS epidemic, for example, which started from China, may
have festered in its place of origin and run out ils course if lhe rapid
exchange of people across countries had not taken place. When such rapid
spread takes place, t’nose that are most badly affected are the poorest that
live in developing countries, because their immunity is compromised by under
nutrition and because they have little or no access to health facilities. We
must not forget the backdrop — in the last twenty years TMF/WB mandated

5/8/03

Page 3 of 4

policies have devastated public health facilities in virtually every
developing country. It is a moot point whether this epidemic would have
reached current proportions if China had not chosen to drastically privatise
its health facilities in the last decade. In fact China's privatisation of
the Health Sector, today, is almost as widespread as in India.

In the 1560s scientists were exulting over the possible conquest to be
achieved over conrmunicanie diseases. Forty years later a whole new scenario
is unfolding. AIDS is its most acute manifestation. We also have resurgence
of cholera, yellow fever and malaria in Sub-Saharan Africa, malaria and
dengue in South America, multi-drug resistant T3, plague, dengue and malaria
in India. We also see the emergence of exotic viral diseases, like those
caused by the Ebola and the Hanta virus and now SARS. We thus have a
resurgence of "old diseases" compounded by the emergence of new ones.
Globalisation that forces migration of labour across large distances, that
has spawned a huge "market" on commercial sex, that has changed the
environment and helped produce "freak" microbes, has contributed enormously
to the resurgence. We talked of the random mutations that produce new
viruses. The oace of such mutations is increasing due to environmental
degradation as microbes are exposed to hitherto unknown conditions.
Response of the Scientific Community

The response of the global scientific community to the SARS epidemic also
points to the potential that true globalisation has in tackling human
misery. In 2001, the worj.d hearth Organization (WilO) established an epidemic
alert and response program to enable coordinated responses to emerging
epidemics, and in early March of this year, the WHO used this program to
start an international collaborative investigation into the nature of SARS.
The results of this international
labor^t-inr have been the astoundmgly
idpiu

idcilLlfICduiOn

Ox

a

xxKOxy

cuxOxOQxC

agent

(x.6.

IQcHuifICdtiOD Ox

the

virus r.har. causes SARS) and the dissemination of clinical infomar.ion with
unprecedented speed. The information already gleaned about the SARS virus
will help in the development of an accurate diagnostic Lest and antiviral
drugs. A. speedy test could be available soon, according to the WHO, which
coordinated the work or 13 laboratories around the world. "The pace of SARS
research has been outstanding," said Dr David Heymann, WHO's executive
director of communicable diseases. The work of the laboratories and WHO has
been dedicated to Dr Carlo Urban!, the WHO scientist, who first identified
the virus in Hanoi and subsequently died of SARS.
The speedy response to SARS shows what can be achieved by global scientific
collaboration. It also shows that such collaboration is manifest today only
when, the developed world sees a threat to its own population. The potential
exists, but under imperialist globalisation this potential is fettered by
the narrow interests of developed countries. Why else have we not seen such
a high degree of collaboration when it comes to diseases that continue to
plague the developing countries - like Malaria or Tuberculosis.

Comic Spectacle m India
The handling of the threat of a SARS epidemic in the country has been
typically inept. We see a comic spectacle unfold before us as the Indian
Government blunders along. h'irst there was a flurry of "positive” SARS cases
reported from across the country. We were told that these cases hao been
“confirmed" by r.ne Nar.ional Tnsr.i tnr.fi of Virology. Then, suddenly,
Mrs.Sushma Swaraj gleefully announced that wo had boon mistaken all this
while because Lhe WHO now says that none o£ these "confirmed" cases are
actually cases ci SARS. Did we require the WHO to tell us this? The WHO has
no surveillance, treatment or diagnostic facilities in tne country. It
relies on data provided by the Indian health authorities. How is it that the
same data told two entirely different stories? It is obvious that the
handlin'? of the suspected cases innored standard practices, which any

5/8/03

Page 4 of 4
competent medical practitioner should be aware of. If the National Institute
of Virology had "confirmed" cases, how did they suddenly turn out to be CARS
free after the WHO declared them to be so? It is clear that what the NIV had
declared as confirmed were not confirmed cases. The NIV had not followed
standard protocol - now available globally and even accessible to anyone who
has access to the internet ~ while labeling cases to be SAMS positive.

If we can misdiagnose patients as "SARS positive" we are equally capable of
misdiagnosing patients as "SARS negative". In other words, we arc by no
means geared to Lackle the SARS epidemic if and when 1L reaches India.
Epidemic control is not achieved by holding press conferences and stationing
masked doctors at airports. Epidemic control requires a high level of
preparedness of the public health infrastructure. This infrastructure has
been systematically dismantled in the last 12 years of economic
liberalisation. The government has taken the lead in delegitimising this
infrastructure and today very few people have faith in the public health
system. In such a situation do not expect SARS cases to be detected and
treated by the public health system. We can only hope that the doddering
edifice of our bublic health infrastructure is not called upon to deal with
a real SARS epidemic. Tf that happens, it is doomed to fail.

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5/8/03

G PUBLIC HEALTH

The SARS epidemic
Even as the SARS virus arrives in India, with the first case being
reported from Goa, laboratories under the WHO continue to
explore ways to counter the rapidly spreading disease.
R. RAMACHAMDRAN
VV'T’ITH the spread of Severe Acute
W Respiratory Syndrome or SARS, a
hitherto unknown atypical form of
pneumonia, to more and more countries
as a result of international travel, India
could not have escaped for long. Since
February 26, when the first case was de­
tected in Hanoi. SARS has spread to 27
countries, including India. I he first case
of SARS in India was identified on April
\ 16, in I’rashccl Varde, a 32-ycar-old mi™ / rinc engineer from Goa. He had travelled
to Hong Kong and Singapore - both
categorised as SARS ‘affected areas’ or
hot zones - before returning to India on
April 1.
A diagnostic test based on the Po­
lymerase Chain Reaction (PCR) done by
the Pune-based National Institute ofVirology (NIV) confirmed the presence of
the SARS virus in samples of the paj
tient’s blood, sputum and urine, which
were sent by the Goa Medical College
Hospital (GMCH) where:he was being
treated. In a press briefing on April 17,
officials from the Health Ministry said
that all the samples were found to be
positive for the SARS virus. However, it
is curious that even though the samples
indicated the presence of the virus in the
blood stream, the patient showed no
clinical symptoms characteristic of the
’ 4
disease - high fever, cough, breathing
"
difficulty and, most importantly, signs of

;

i

i

pneumonia or respiratory' distress syn­
drome in a chest X-ray.
Thus, the Indian SARS case, with an
apparent mismatch between clinical
symptoms and the diagnostic test, is a
unique one. Since the cause or the aetiol­
ogy of the disease was unknown till
about four weeks ago, the case definition
has been done solely on the basis of clin­
ical symptoms specified by the World
Health Organisation (WHO). Of the
3,461 suspected and probable SARS
cases reported worldwide so far, the
WHO has recorded the Indian case as
one that has recovered.
Diagnostic tests are being developed

after the causative agent was identified
recently as a hitherto unknown form of
coronavirus, a family to which the com­
mon cold virus belongs. But ail the three
different tests - Enzyme-Linked Immu­
nosorbent Assay (ELISA), Immunofluo­
rescence Assay (IFA) and PCR - seem to
have their limitations. A PCR test that
was developed in early April by the Cen­
tres for Disease Control and Prevention
(CDC) of the . nited States is stated to
be effective oi: in the early stages of the
disease.
However, with the isolation and ge­
netic sequencing of the SARS virus,
primers - pieces of genetic material that
are specific to a given virus and arc the
key pieces for a PCR test — have been
made available to laboratories around the
world by the Hamburg-based BernhardNoclir Institute for Tropical Medicine
(BNI), one of the laboratories in the
WHO consortium for research on SARS
aetiology. Arcus Biotech, a Hamburg­
based firm, has developed a real-time,
ready-to-usc PCR diagnostic kit that us­
es primers. The company has offered to
supply these kits, which became available
since April 14, free of cost to laboratories
participating in rhe WHO network of 13
laboratories from 10 countries. No Indi­
an institution is part of this network.
Therefore, in all likelihood, rhe NIV test
is based on the primer sequences that
were made available by the WHO on its
website.
According to Kumar Rai, head of the
communicable diseases wing at the
WHO’s Regional Centre in New Delhi,
as diagnostic tests are still being devel­
oped, there is also a high probability of
the test indicating a “false positive” re­
sult. Christian Drostcn, the BNI scien­
tist who was responsible for identifying
the primers and developing the PCR
test, said: “The case definition of SARS
does not include findings in PCR. Re­
sults of PCR can be used to complement
clinical diagnostic evaluation. However,
tests have not been validated for confir­
mation of cases or exclusion of the dis­
ease." Therefore, it is unclear why the

WHO decided to confirm the Indian
case, which is based entirely on the PCR
test, as an instance of SARS.
RASHEEL Varde, his wife and his
father had sailed from Hong Kong,
where they stopped for four hours on
March 26, to Singapore, where they
spent a couple of days. On April 1, the
three arrived in Mumbai, where they

P

spent a couple of days, before reaching
Goa on April 4. On reaching Goa,
i’rashccl developed fever and cough and
on April 8 he went to a private medical
practitioner, who referred him to the
medical college hospital. There, he was
kept under observation from April 10 to
12 in an isolation ward and was treated
with antibiotics. The treatment was ef-.
fcctive, and since his X-ray did not reveal
any pneumonia patch, he was dis­
charged. Although the hospital had sent
his samples to NIV for testing, by the
time the test results became available on
April 14, he had been discharged.
And in a strange and inexplicable
move, on April 14 it was decided that he
I'llONI I.INI'. may v. rim.r

SARS patients across several countries
has been isolated consistently by several
network laboratories. The virus lias been
demonstrated to cause disease in African
green monkey kidney cells (Veto cells)
and Rhesus monkey kidney cells
(FRhK-4 cells), which was found to be
inhibited with serum from SARS conva­
lescents. Significantly, signs of reactivity
with the new coronavirus, namely the
presence of antibodies', could not be de­
tected in the serum samples of several
non-affcctcd individuals in the .U.S.,
Canada and Hong Kong.
ORONAVIRUSES belong to a vi­
ral family called Coronaviridac,
which infect vertebrates, especially
warm-blooded vertebrates, including
mammalian species such as human be­
ings, cattle, cats, pigs, and rats, and a few
avian species such as turkeys and chick­
ens. The SARS virus has never been seen
in humans before. In fact, its genetic
make-up shows that it is only “distantly
related” to known coronaviruses. It is not
known whether it existed in other species
earlier and jumped species recently, or
whether it is an entirely new virus. “The
WHO and the network of laboratories
dedicate the detection and characterisa­
tion of the SARS virus to Carlo Rubani,
the WHO scientist who first alerted the
world to the existence of SARS in Hanoi
and who died from the disease in Bang­
kok on March 29,” a WHO release said.
This definitive determination was
particularly important because earlier
evidences from different laboratories
suggested that the pathogen could be an
unknown paramyxovirus. Indeed, Cana­
dian researchers (Frontline, April 11,
2003) isolated a relatively new paramyx­
ovirus, known as human mctapncumovlrus (hMPV). 'I'hc finding was supported
by some other laboratories in the net­
work. In medical science, it is difficult to
understand the aetiology of a disease in
terms of two pathogens. According to
the WHO, hMPV and antibodies
against hMPV have been found in the
serum samples of some SARS patients.
Evidence of dual infection with hMPV
and the new coronavirus has also been
found. But the significance of hMPV in
SARS remains uncicar. Perhaps hMPV is
in the nature of causing opportune in­
fections, making the aflliction worse.
David Heymann, Executive Director
of the Communicable Diseases Cluster
of the WHO said: “Because of an ex­
traordinary collaboration among labora­
tories from countries around the world,
we now know with certainty what causes

C

Nuns and worshippers wear masks to protect themselves against SARS, while
attending Good Friday mass at Hong Kong’s Catholic Cathedral of the Immaculate
Conception.

would be quarantined for 10 days, after
he was allowed to mingle with the gener­
al public for two days. He was readmit­
ted to the GMCH on the night of April
16. However, on April 18, Goa Chief
Minister Manohar Parikkar announced
that Prasheci would be discharged as he
had been “cured” of SAKS. So far, Prashecl’s wife and father, who had been with
him all along, have not developed any
symptoms. However, post-diagnosis,
they were advised not to be in his prox­
imity.
There arc several unanswered ques­
tions. Why did he sec a doctor four days
after he developed fever? Who were the
people he came in contact with before
being kept in the isolation ward on April
10? Did he develop fever in Mumbai or
on die way to Goa? What was his mode
of travel from Mumbai? These questions
assume importance if the chain of pos­
sible transmission from him to others is
to be traced. According to the WHO,
FRONTLINE. MAY 9. 2003

there is no evidence to suggest that the
human-to-human transmission occurs
by means other than air-borne droplets
of cough, sneeze and so on.
The first indication of the SARScausing virus being a coronavirus came
from research work done in Hong Kong
on March 21. This was confirmed by
researchers at the CDC. However, defin­
itive proof can be obtained only after
verifying Koch’s Postulates, which stip­
ulate four conditions for a pathogen to
be the causal agent. The micro-organism
must be found in all cases of the disease,
it must be isolated from the host and
grown in pure culture, it must reproduce
specific symptoms when introduced into
a susceptible host/ and it must be re­
isolated in the experimental host. The
work at the Erasmus Medical Centre,
Rotterdam, particularly relating to ani­
mal models, led to the definitive proof
that the coronavirus causes SARS.
According to WHO, the virus from

At present, I long Kong,
SAI’S." He added: "Now we
can move away from methods
with 1,327 cases and 69 deaths
as of April 18, is the hardest-hit
like isolation and quarantines
and move aggressively towards
area. Healthcare workers con­
modern intervention strategies,
tinue to become get infected
including specific treatments
and hospitals are overwhelmed
and eventually vaccination.
by the growing number of pa­
He noted that if the vaccine or
tients. A large cluster of 268
drug was to be developed by
SARS cases has been reported
the private sector, it would
from a single high-rise apart­
want to be certain that the dis­
ment block called Amoy Gar­
ease was a permanent resident
dens Estate! It is the first
in human beings, in order to
known instance of a possible
recover its investment. There­
environmental spread of the
fore, it had to be funded wholly
SARS virus. The vast majority
by the public sector or in part­
of the cases have been traced to
nership with the private sector,
vertically linked apartments in
he said. “The history of treat­
a single building. This pattern
ing viral infections showed that
of transmission, according to
anti-viral drugs were very diffi­
the WHO, indicates that the
cult to develop, and even dten,
disease has moved out of the
the)' had an effect only very
healthcare setting and is now
early when the virus level was
occurring within the commu­
nity. HpitlemiiilogiMs Investi­
low,” he observed.
gating the peculiar outbreak
Going by the rapidity with
released a report on April 17,
which the disease is spreading,
identifying the environmental
SARS appears to be the first
route as the source of the large
severe and easily transmissible
cluster of cases.
disease of the 21st century,
As of April 15, 321 Amoy
Heyniann said. Although the
residents had been affected. In­
causative agent of SARS has
vestigation has identified a sew­
been identified in a remarkably
age contaminated with the
short span of time, the poten­
SARS virus as the probable
tial of the disease was not clear,
source of exposure. According
particularly whether it would A tourist visiting tho Groat Wall of China on the outskirts of
become a permanent infectious Boljlng on April 21. All evidence points to the disease having to the report, a 33-year-old
man, who developed sympdisease; he said. All evidence first appeared In tho Guangdong province of China.
instance of what it has termed "super­ toms of SARS on March 14, visited a
points to the disease having spread from
the Guangdong province of China. The spreaders", in which one person from the relative in the apartment building on the
outbreak seems to date back to Novem­ province is thought to have infected as same day. His symptoms included diar­
ber 16, 2002, when an initial case was many as 100 other persons. The phe­ rhoea and it is believed that the virus
nomenon of a “super spreader", which is from his faeces was transmitted through
reported in Foshan city.
the sewage route. The rapid sprcatl to
not a medical condition, dates back to
other residents has been atlrihuied to de­
the early days of the outbreak when
HEN a global alert against SARS
was issued on March 12, it was SARS was not identified as a disease re­ fective U-traps in bathrooms, the ampli­
hoped that SARS would not spread quiring special precautions of isolation fying effect of bathroom exhaust Ians, a
throughout Asia and the rest of the and infection control. In the absence of cracked sewer vent pipe, and an aero­
world. According to him, until the sit­ such measures, a large number of health
dynamic effect in a lightwell to which
bathroom windows opened. Laboratory
uation in mainland China, which had workers, family members, relatives and
1,482 cases, became clear and a number visitors to the hospital were exposed to investigations confirmed the presence of
the SARS virus in a swab from the toilet
of key questions were answered, the fu- the virus by a single unprotected case.
lure of the disease would not be known.
A “super spreader” has been traced in
bowl in the bathroom of a SARS patient,
Since April 3, four WHO reams have Singapore too. The report expressed par­ but not in numerous other environmen­
been working in Guangdong, Beijing ticular concern on the situation in Beij­ tal samples. The study found no epide­
and other major cities of the country to
ing, where there could be underreported miological or laborator)' evidence that
cases. According to the WHO, the sit­ the SARS virus was transmitted by air,
assess the situation.
An interim report on the Chinese uation in Beijing’s military hospitals has water, or infected dust aerosols. “It is
been the source of many reports about reassuring that speculations about a pos­
situation was prepared by the WHO on
April 9. I he report concluded that while
the real magnitude of SARS in the Chi­ sible airborne transmission have not
been borne out by the evidence available
the health system in Guangdong respon­ nese capital. On April 13, President Hu
ded well to the outbreak, ail other prov­ Jintao appeared on state television and
to date," the WHO said.
According to Heyniann, although
inces were less equipped to cope with the expressed concern about the situation.
He has appealed for "accurate, timely the last decades of the previous century
severity of the challenge.
witnessed die emergence of several new
In Guangdong, the team found an and honest reporting" of cases.

W

124

I'UON I'lJNIt, MAY 9, 200.1

diseases, SARS seems to present a partic­
ularly serious threat to international
health. Although SARS has a low mortal­
ity rate - 4 per cent - its clinical and
epidemiological features remain poorly
understood. Except lor the Human Im­
munodeficiency Virus-Acquired Im­
mune
Deficiency
Syndrome
(HIV-AIDS),
most
diseases
that
emerged during the past two and a half
decades, or became endemic in new ge­
ographical areas, have features that limit
their capacity to pose a major threat to
international public health. Diseases
such as avian influenza, and those caused
by the Nipah virus, the Hcndra virus and
the Hanta virus failed to establish effi­
cient human-to-human transmission.
Others such as Escherichia coli
O157:H7 and variant Creutzfeldt-Jakob
disease depend on the food chain for
transmission.
Although outbreaks of the Ebola
^haemorrhagic fever have been associated

with high fatality rates - 53 per cent in
Uganda to 88 per cent in Congo - per­
son-to-person transmission requires
close physical exposure to infected blood
and other bodily fluids. Moreover, pa­
tients suffering from this disease cannot
undertake travel. In contrast, SARS,
whose mode of transmission has been
likened to that of Ebola, is emerging in
ways that suggest great potential for rap­
id international spread. Epidemiological
data indicate that the gestation period for
SARS is two to 10 days (an average of
two to seven days), which gives ample
time for the infectious agent to be trans­
ported from one city to another through
an asymptomatic air traveller.
The Indian case and that of a patient
travelling from 1 long Kong to Vladivos­
tok, have highlighted the emergence of
•another international path for the virus,
liutncly the sea-route. Since the foci of
the disease seem to lie in the West Pacific
rim, it is surprising that even the WHO
had not considered this as an important
epidemiological factor. Should SARS
continue to spread, the global economic
consequences - already estimated at
around $30 billion - could be enormous.
However, the outbreak of SARS has
demonstrated how well die WHO can
tackle a newly identified disease. The in­
ternational collaborative research effort
in understanding the cause of SARS was
put together by the WHO in record
lime. The WHO believes that the sys­
tem, which is now in operation can be
applied to other pandemic outbreaks, in­
cluding the release of a biological agent
in an act of warfare or terrorism.
IUONT1 INK. MAY •>. 2W

n PUBLIC HEALTH

A reluctant battle
against polio
Uttar Pradesh accounts for 64 per cent of the polio cases reported
worldwide, but its Chief Minister, Mayawati, is honoured with the
Rotary International award for her "outstanding personal
contribution" towards eradicating the disease from the State.
PURNIMA S. TRIPATIU
' I *
1 HE World 1
Ith Organisation
1 (WHO) has <! wribed Uttar Pra­

desh as the “epicentre of polio epidemic''
in die world. As per WHO estimates,
the State accounts for 64 per cent of all
polio cases reported worldwide. In com­
parison with 2001, the State registered a
sixfold increase in the incidence of polio
in 2002. According to the WHO, the
sharp increase was because of a decrease
in the number of polio eradication cam­
paigns that year. Besides, the campaigns
that were conducted failed to reach near­
ly 15 per cent of the targeted population.
Launching the third phase of rhe na­
tional pulse polio campaign on April 7,
WHO Director-General Dr. Gro Har­
lem Brundtland said: “Eighty-three per
cent of all new polio cases arc now found
in India. Uttar Pradesh, in particular,
should be the number one priority in
order to stop the transmission of the
polio virus around (he world."
According to WHO estimates, In­
dia’s record in polio eradication is worse
than that of countries such as Bangla­
desh. (Bangladesh has been declared ‘po­
lio free’.) India tops the list of seven
countries, where polio is still widespread.
India and Nigeria arc the only countries
that have registered increases in the
number of polio cases. The other coun­
tries where polio is prevalent are Egypt,
Pakistan, Afghanistan, Niger and
Somalia.
According to the WHO, in 2002,
the epidemic spread across northern In­
dia and to hitherto polio-free States such
as Maharashtra, Gujarat and West Ben­
gal. In January 2003, a child was para­
lysed by polio in Lcbonan for the first
time in nearly 10 years. Genetic se­
quencing of the virus confirmed that it
originated from Uttar Pradesh, WHO

sources said. According to Rotaty In­
ternational, even in Bulgaria, which was
declared polio free, cases were reported
in 2002, and genetic analysis of the virus
revealed it was from Moradabad in Uttar
Padesh.
Given the State’s poor record in
dealing with the polio epidemic, it was
rather surprising that Rotary Interna­
tional conferred the Paul Harris Fellow
award on Chief Minister Mayawati for
her “outstanding contribution" towards
eradicating polio. The award, which in­
cludes a certificate, a gold medal and a
Rotary pin, was presented to her by rep­
resentatives of Rotary International and
the United Nations Children’s Fund
(UNICEF), at her official residence on
January 20. Mayawati, who became
Chief Minister only in May 2002, said
that eradicating polio would continue to
be her government’s priority. However,
government officials seem to be at a loss
for words when asked to elaborate on
Mayawati’s 'personal contribution' to
eradicating polio. Even Rotary function­
aries arc unable to explain why the State
had registered a sixfold increase in polio
cases in 2002, despite the Chief Minis­
ter’s "outstanding contribution".
A senior Rotary functionary, who
has been associated with the pulse polio
campaign, said the award had been con­
ferred on the Chief Minister to “motiva­
te” her to take more interest in the polio
eradication campaign. A Rotaty member
said: “The increase has not been due to
mismanagement at the government lev­
el. There arc other factors responsible for
it. One is the people’s apathy to such
campaigns, which lack credibility. Be­
sides, misinformation about the polio
vaccine being administered is also greatly
responsible for the increase." According
to him, an alarming factor was the resist­
ance of people belonging to the minority

I MEDICINE

A mystery killer
An unidentified form of killer pneumonia, originally suspected to be a variant of influenza, is reported
from various parts of the world. The World Health Organisation is gearing up to face the challenge.
R. RAMACHANDRAN

been reported in Ireland, Italy, Slovenia,
Spain, Switzerland, the United Kingdom
and the United States, but diey have not
been classified as ‘affected areas’ as there has
been no evidence of local transmissions in
these regions. Cases have been reported in
Australia - in New South Wales and West­
ern Australia - too but the WHO figures
do not reflect these. “This syndrome,
SARS,” said Gro Harlem Brundtland, Di­
rector-General of the WHO, “is now a
worldwide health threat.” The rapidity
with which infection is spreading — with
the cumulative figure of cases numbering
167 on March 17, 219 on March 18, 264

person appears to be an important source
tlirough which the disease spreads.
SARS was originally suspected to be a
variant of influenza, given the outbreaks of
A(H5N 1) or ‘bird flu’ and A(H9N2) in the
region in recent times, the latest being cases
of ‘bird flu’ that were reported in Hong
Kong in February. While influenza has
been ruled out, the dose of the new patho­
gen needed to cause SARS, which is stated
to be less infectious than the former, has
not been determined.
The speed of international travel could
contribute to the rapid spread of the dis­
ease. Countries with significant interna­
tional traffic passing through them
need to be vigilant. The DirectorateGeneral of Health Services (DGHS) of
the Government of India has mobil­
ised a contingent of doctors at airpons
to monitor incoming passenger traffic
and to handle cases according to
WHO guidelines.

VER the past decade, a number of
viral diseases, both vector-borne and
zoonotic, have emerged in South-East Asia
and the Western Pacific region (map on
facing page). While vector-borne diseases
primarily infect human beings although
they are transmitted by other organisms,
zoonotic diseases occur primarily in the
lower animals but sometimes infect human
beings too. The locus of the current out­
break of killer pneumonia, an atypical or
unusual form of the disease that progresses
rapidly to cause severe respiratory distress
and consequent death, also seems to lie
in this region.
The symptoms
The disease has spread across con­
tinents in a matter of days, and evi­
dence seems to suggest drat the
infection was transmitted worldwide
High fever (+38° C)
chiefly from the Hong Kong Special
Dry cough
Administrative Region of China. It re­
ached there possibly from southern
Shortness of breath,
HE chief symptoms of SARS in­
mainland China, and was transmitted
difficulty in breathing
clude die rapid onset of flu-like
to various parts of the world through
Changes in chest
high fever above 38°C (100.4 °F) cou­
international air travel via Hong
X-rays indicative
of
pled with one or more symptoms of
Kong, a major traffic hub. However,
respiratory illness, including cough,
unlike the earlier epidemic outbreaks
shortness of breath, difficulty in
in the region, this particular disease is
breathing or hypoxia or chest X-ray
virulent and the spread of infection is
(CXR) findings of pneumonia or acute
rapid. The aetiology or the cause has
respiratory distress requiring assisted
not been identified definitively yet —
Other symptoms that might be associated:
breathing on a respirator. Early lab­
a step necessary for developing die ap­ headache, muscular stiffness, loss of appetite,
oratory findings may include low pla­
propriate diagnostic test and determin­ malaise, confusion, rashes, diarrhoea.
telet count (thrombocytopenia) and
ing a treatment regimen. Preliminary Severe Acute Respiratory Syndrome (SARS)
low white cell count (leucopenia).
a Pneumonia-like illness: possible source Paramyxovirus
investigations seem to indicate that the
a Incubation period: seems to be 3 to 6 days
SARS may be associated with oth­
pathogen maybe a new virus.
a Contagion: seems based on close contact with infected
er symptoms, including headache,
The first case of the disease, which
person, especially aerosolised droplets and
muscular stiffness, loss of appetite, ma­
has been called Severe Acute Respira­
bodily secretions.
laise, confusion, rashes and diarrhoea.
tory Syndrome (SARS) by the World
Source: World Health Organisation/Local medical authorities.
CXR is, at present, the key tool to
Health Organisation (WHO), was re­
ported in Hanoi, Vietnam, on February 26 on March 19, 306 on March 20, 350 on distinguish between suspected and prob­
and within a month hundreds of people March 21 and 386 on March 22 — is able cases. The incubation period is short,
have been infected. As of March 22, 386 alarming at first sight. However, according estimated to range from two to seven days,
people across 13 countries were suspected to the WHO, SARS seems to be transmit­ with a period of three to five days being
to have been infected, and 11 of them had ted only through very close contact with an more common. The person should have
infected person. Cases have occurred al­ either had close contact with a person sus­
died (table on page 113).
While the ‘affected areas’ include the most exclusively among health workers pected of suffering from SARS or should
Canadian city of Toronto, China’s Guang­ treating or caring for SARS patients, family have travelled to an area reporting cases of
dong province, the Hong Kong Special Ad­ members and the like. There is no evidence SARS within 10 days of the onset of symp­
ministrative Region, Taiwan, Singapore so far of its spread through casual contact. toms. Some patients respond to treatment
and Hanoi, Hong Kong accounts for the Close contact with aerosolised droplets but others remain critically ill. Broad-spec­
largest number of cases (222). Cases have from the bodily secretions of an infected trum antibiotics have not proved to be ef­

O

T

no

FRONTLINE. APRIL 11. 2003

fective in halting the progression
although on different floors.
of the disease but the intravenous
The only case in Thailand,
administration of antiviral drugs
which was reported on March 15,
such as Ribavirin seems to have
was that of a health worker who
some effect.
had travelled from Hanoi to Thai­
The first reported case was of a
land on March 11. Apparently, he
person who fell ill shordy after ar­
had come into contact with the
riving in Hanoi from Shanghai
index case in Hanoi. The Taiwan­
and Hong Kong. After he was adbased unit of the CDC has deter­
mined, several members of the
mined that cases in Taiwan can be
hospital staff developed similar
traced to those who had travelled
symptoms. The person died on
to the Guangdong region.
Marell 13 after being transferred
to Hong Kong. Almost all the
HE linkages indicate that
cases reported to date in Vietnam
Hong Kong is the main
have had to do with direct contact
source of infection worldwide. It
with the hospital where the first
has now been learnt that the doc­
case, or the index case, was treated.
tor was from Guangdong and had
The first cases in Hong Kong
come into contact with a possible
were detected on March 12, when
SARS case. However, it is not yer
20 health care workers developed
clear how the doctor contracted
symptoms of SARS. On March
the infection.
19, an epidemiological break­
In the Table provided, there
through was achieved when offi­
are blank spaces against China al­
cials of the Hong Kong
though it is believed to have re­
Department of Health succeeded
ported cases with SARS-like
in tracing the origin of the infec­
symptoms. This is because it is not
tion in the region and identified
yet clear whether the cases of atyp­
the index case in the city’s Prince
ical pneumonia diagnosed in
Adapted from. JS Mackenzie et.al. Vol 7, No.3, June 2001, Emerging Infectious
of Wales Hospital. “In an out­ Diseases. Centres for Disease Control and Prevention, U.S.A.
Guangdong in November 2002,
standing example of detective
were in fact SARS cases. The out­
work,” as the WHO put it, the epidemiol­ as were his wife and mother-in-law; he was break had peaked in mid-February but re­
ogists determined that seven people who said to have come into close contact with a mained confined to that region. Also,
contracted SARS had stayed in or visited reported case of SARS in Singapore.
Chinese authorities are yet to report to die
Hotel Metropole in Hong Kong’s Kow­
German health authorities were noti­ WHO the exact number of such cases. But,
loon district between February 12 and fied and the three passengers were trans­ it seems that the outbreak in Guangdong
March 2. The seven persons investigated ferred to an isolation unit in Frankfurt as may well be of SARS.
included three visitors from Singapore, two soon as the flight landed. The specimens
According to the WHO, die Chinese
from Canada, one person from South Chi­ investigated in Marburg and Frankfurt am authorities have issued a summary report
na and a resident of Hong Kong.
Main yielded evidence that the new virus with data on the diagnosis and manage­
The investigation revealed diat all the was the causative agent. Viral structures ment of 305 cases, including five that re­
seven persons had either stayed in or visited were found in the blood plasma of the sulted in deadi, which is being analysed. It
the same floor of the hotel. The Hong mother-in-law, indicating that a state of vi­ was found out diat in'two of the cases of
Kong resident was believed to be the index remia had set in. However, there has been death, there was chlamydia infection. The
case, who subsequendy infected other early no evidence of any further transmission of WHO expects this analysis to contribute to
cases in the outbreak. He had visited an the disease in Germany.
the understanding of SARS and possible
acquaintance, a doctor from southern
Cases in Canada have occurred essen­ links among the various outbreaks. Should
mainland China, and had stayed at the ho­ tially in two extended family clusters. At a link be established, die WHO hopes that
tel from February 15 to 23. The Chinese least one member of both rhe families had the data on a single outbreak invoking the
visitor, who became sick a week before stay­ travelled to Hong Kong a week before largest number of cases to date, might boost
ing at the hotel, is considered to be the developing the symptoms. Investigations international efforts to establish effective
original source of the infection.
in Hong Kong revealed diat they were die treatment guidelines.
Infections in nearly all odier parts of same people who had stayed at the Met­
Apparendy, the Chinese Ministry of
the world, including the case in Vietnam, ropole. Cases in the U.K. and elsewhere Health has requested support from an in­
appear to have some link to Hong Kong. in Europe have been linked to travel to ternational team. A five-member team con­
For instance, on March 13, Singapore re­ affected areas or contact with SARS cases. stituted by die WHO, comprising
ported SARS in people who had recendy The 22 cases in the U.S. essentially con­ specialists drawn from institutes participa­
returned from Hong Kong. Investigations stitute three clusters, according to the ting in the WHO’s Global Outbreak Alert
in Hong Kong revealed that diey had Centres for Disease Control and Preven­ and Response Network (GOARN) left for
stayed at the Metropole.
tion (CDC). The source of infection in China on March 21. GOARN has a sixOn March 15, a physician from Singa­ all the three clusters can be traced to per­ member team in Hong Kong and a ninepore boarded a flight from New York to sons who had travelled to SARS-afFected member team in Vietnam to assist in epide­
Singapore via Frankfurt, accompanied by areas in Asia. Two of the 22 cases are miological investigations.
his wife and mother-in-law. He was unwell, reported to have stayed at the Metropole,
Investigations by scientists in Germany
FRONTLINE, APRIL 11, 2003

ill

and Hon® Kong based on throat
diagnostic test. However, researchers
Cumulative number of reported suspected
swab and sputum samples of pa­
at Health Canada’s National Micro­
arid probable cases of SARS
tients have indicated that the causa­
biology Laboratory in Winnipeg re­
______ from February 1 to March 22,2003.
tive agent is probably a new virus
ported on March 22 that they have
Cumulative
Local
belonging to the paramyxoviridae Country
number of Number
found evidence of human metaof deaths
transmission
case(s)A
family of viruses. This has been con­
pneumovirus (hMPV), a newly dis­
Canada
2
Yes
9
firmed by investigations in Singa­
covered pramyxovirus , which was
pore and two more laboratories China +
isolated by Dutch scientists from
Germany
2
None*
0
under GOARN. Previous tests con­
children with respiratory, tract dis­
Hong Kong
222
7’*
Yes
ducted in a number of top laborato­ Special Administrative
ease in June 2001, in specimens
Region of China
ries failed to detect any known
from six of the eight cases they are
Italy
2
0
None*
bacteria or viruses, including the in­
studying.
Republic of Ireland
0
1
None*
fluenza virus, recognised as the cause
Although it is known to cause
Singapore
44 ■
0
Yes
for pneumonia or respiratory symp­ Slovenia
respiratory disease in humans, in­
1
0
None*
toms, and known to be widespread Spain
cluding some cases of pneumonia, at
1
0
None*
in the most affected geographical ar­ Switzerland
the time of discovery hMPV showed
7
0
To be determined
eas. The failure of all previous efforts Taiwan
6
0
Yes
a different transmission pattern and
4
0
To be determined
seems to suggest strongly that the Thailand
was much less severe than the SARS
2
0
None*
causative agent may be a novel United Kingdom
agent. WHO has said diat “at this
United States
22
0
To be determined
pathogen.
point, it cannot be ruled out that an
Vietnam
63
2
Yes
Viruses in die Paramyxoviridae
entirely different virus from another
Total
386
’ 11
family include common, wellfamily may be responsible for the
Notes:
known agents associated with respi­ It is possible for the status of a reported case to change over time.
SARS outbreak”. This is because ear­
ratory infections such as respiratory SARS is a diagnosis of exclusion. This means that
lier, this particular paramyxovirus
whenever a known cause is found that could fully account lor a patient's
syncytial virus (RSV), and childhood clinical
had been ruled out by some
condition, this patient should no longer be
illnesses, including the viruses that considered to be a case of SARS
laboratories.
Chinese authorities have reported suspect and probable cases in
cause mumps and measles. Some of +The
Scientists in the Department of
Guangdong province. Figures are being updated.
these are widespread, in particular A Cumulative number of cases Includes number of deaths.
Microbiology of the University of
■ No documented secondary transmission in-country.
RSV, particularly during winter.
Hong Kong, have been able to iso­
No affected areas.
Particles of these common viruses • •One death attributed to Hong Kong Special Administrative Region of
late and culture die virus outside the
could be detected while screening China occurred in a case medically transferred from Vietnam
patient. Using a special cell line, the
specimens. Therefore, the possibility Source: World Health Organisation ____
vims was isolated from die lung tis­
that tests for the SARS agent are de­
sue of the index case in Hong Kong.
tecting such “background” viruses rather fatal diseases in a number of animal hosts, This is a major step towards die develop­
than die true causative agent cannot be including humans. Most odier viruses in ment of a rapid diagnostic test.
ruled out.
the family tend to infect only a single ani­
Indeed, scientists in Hong Kong have
Indeed, Wolfgang Preiser, of the JW mal species. No treatment was available for devised a basic test, relying on the tech­
Goethe-University in Frankfurt am Main, cases caused by both these viruses.
nique of neutralising antibodies, and were
one of the centres that found clues to the
So far, evidence has been gathered es­ able to detect tell-tale antibodies in sera
SARS pathogen, has cautioned against ar­ sentially on the basis of observation of the taken from eight SARS patients. The con­
riving at any firm conclusions as yet. He virus partides through an electron micro­ sistency of these findings indicates diat the
said: “These preliminary results only indi­ scope. The possibility of molecular differ­ test is reliably identifying SARS cases. This
cate a suspicion. Furthermore, even if die ences between the new virus and the “hand-made” test will be developed further
presence of a paramyxovirus was con­ paramyxoviruses such as the Hendra and into a more sophisticated diagnostic test.
firmed, it is not clear at this stage whether Nipali viruses, is strong. Therefore, the ad­
The achievement will facilitate the am­
this might represent the causal agent of vanced polymerase chain reaction (PCR) plification and nucleotide sequencing of
SARS or rather a coincidental finding.” technique may not immediately reveal the portions of the viral genome, which will
The isolation of similar microbes from ad­ virus. But similar findings by several inde­ help determine its relationship with other
ditional cases of SARS will be necessary. It pendent laboratories indicate diat SARS known paramyxoviruses. “This is not just
is to achieve this diat WHO’s GOARN set might involve a new strain of some light at die end of the tunnel. This is a
up 11 laboratories in 10 countries on paramyxovirus.
real ray of sunshine,” remarked Stohr. Fur­
March 17.
“More and more laboratories are find­ ther steps would include more cell culture,
ing paramyxoviridae virus,” said Klaus and more trials in animals. “In essence, we !
N recent years several new paramyxovi­ Stohr, a virologist of the WHO who is are turning around information usually .
ruses have been discovered. Paramyxovi­ coordinating GOARN’s multi-centric lab­ generated in months or years within hours i
ruses are known to infect only vertebrates. oratory efforts to identify die causative and days,” Stohr said.
Predominant among the paramyxoviruses agent. “What is promising is that many
The other important concern of the
are die Hendra virus and the Nipali virus, other paramyxoviruses can be excluded. So WHO is to assist vulnerable countries in
two related viruses isolated from bats in we have a paramyxovirus-like particle the event that die disease continues to
Australia and South-East Asia, which were which is not any of the known paramyxovi­ spread. Up to now, cases have occurred in
responsible for the outbreak of severe dis­ ruses.” According to him, one of the lab­ countries that are well-equipped to institute
eases among human beings during the oratories has been able to isolate and culture WHO-recommended precautions, includ­
1990s. These two are unusual in the family die virus outside the patient. This is a major ing isolation and ‘barrier nursing’ practices,
in that they can infect and cause potentially step towards die development of a rapid to prevent the spread of die disease.

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