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size=3>SARS wreaks havoc in Shanxi province
By Miao Ye

SHANXI PROVINCE, China - Most news stories regarding the spread of severe acute respiratory syndrome (SARS) focus on the Guangdong-Hong Kong area, which has been hit the hardest by the epidemic so far. Beijing is also becoming more of a story, with rumors of 100-200 cases or more. But what about Shanxi province in central China?

Economically less important than Guangdong or Beijing, Shanxi has proved itself conducive to the spread of SARS; it could plausibly serve as a springboard for the virus to make inroads into northwestern and northeastern China, which are less socially stable than the areas where SARS infections have been most numerous. In Shanxi province's Qingxu county, primary-school classes are suspended and restaurants have closed indefinitely. In just one hospital in the provincial capital of Taiyuan alone, there are more than 40 SARS patients.

Owing to its SARS situation worsening significantly in recent weeks, Shanxi has become a major source of concern. On Tuesday the province announced that it had 82 infected patients, 20 times the infection rate in March. As of Tuesday seven people had died. However, as an Asia Times Online reporter has witnessed, Shanxi's SARS situation is much more serious than can be gleaned from these official numbers - Qingxu county on the outskirts of Taiyuan is in essence paralyzed.

Schools, restaurants closed
The outbreak of SARS in Qingxu county is possibly the most serious in China. Before ATol's journey to the county, people who were aware of the situation there warned that Qingxu now finds itself in a bizarre time, and that unless you absolutely must go, you should not visit Qingxu. People our reporter met spoke of SARS affecting a great portion of Qingxu's population, including the chairman of the local political consultative conference, his driver, the party committee secretary of Mayu town, and so on.

It was apparent upon arrival in Qingxu county that there were virtually no pedestrians on the street. The few people outside said that the number of people venturing outdoors had dropped noticeably a few weeks ago, but since then it has also noticeably decreased. The hospitality industry has already been hurt by SARS - numerous restaurants simply closed their doors for an "extended holiday". Local hospitals have been affected as well, nobody dares see a doctor. Locals say that at most, hospitals have two or three patients a day. It is believed that there have been at least 30 suspected SARS cases and three deaths in Qingxu.

The earliest case of SARS in Qingxu county is said to be the party committee secretary of Mayu town, who was infected while in Guangdong province in February on official business. Then in March the chairman of the local political consultative conference went to visit SARS patients in Beijing, during which he was infected with SARS. Due to the severity of the SARS epidemic, Qingxu county closed all of its kindergartens, primary schools and high schools, but not graduate schools, for half a month starting April 6.

Qingxu county has drafted a "blacklist" of the more than 30 people suspected of being infected with SARS. The list has been distributed throughout the county so people who may have been exposed to SARS can take appropriate measures. SARS infections were discovered in a dormitory at 11 Tonghu Street - now the large building is empty. People who used to live in the building are feared to have been infected with SARS, but they have all left, fanning out in every direction to live elsewhere.

It is said that the worst period in Qingxu's SARS saga so far was during the end of March and the beginning of April. During that time, the entire county was gripped by panic. Many people were constantly ingesting traditional Chinese herbal remedies and getting special protein injections to boost their immune systems. The injections were on sale at every hospital and clinic.

In fact, in early March the World Health Organization (WHO) had already listed Shanxi as an affected area, with four SARS cases. As of Tuesday the number had reached 82 cases. Shanxi constantly declared the spread of SARS to be under effective control, yet the number of cases increased by a factor of 20 in one month. In our reporter's opinion, it is possible that things in Shanxi will get much worse.

Taiyuan hospitals hit hard
In Taiyuan, the only area officially recognized by the province as being affected by SARS, it is uncommon to see people wearing surgical masks. Life is proceeding as it normally does. On Taiyuan's bustling streets and in its crowded restaurants, one gets the feeling that there is no way that SARS could exist here. Indeed, the local media's mantra has always been "Taiyuan is safe". On the surface, Taiyuan's SARS situation appears to be non-problematic, but in reality it is disturbingly serious.

According to a doctor at Taiyuan Medical University Hospital, his university-affiliated hospital alone has already treated more than 40 SARS patients, and it is not even a hospital specializing in SARS. At the Taiyuan Municipal Infection Hospital it is even more serious. A hospital source said, "Now it seems on the surface as if there is no SARS problem in Taiyuan. On the street you can't find people wearing surgical masks, people are going about things as they always do. But I know that if three people have died, the actual situation is certainly much worse."

The earliest case of SARS in Taiyuan was a woman surnamed Li of Shanxi Shangbao, a provincial business publication. In March she went to Guangdong on official business, and in Taiyuan her diagnosis was inconclusive. Li went to Beijing for medical treatment, and her parents were infected while they cared for her, both of whom ultimately succumbed to SARS. During her treatment, 10 others were infected. Li has recovered from SARS. Afterward, many businesses in Taiyuan began to take SARS seriously - distributing Chinese medicine to employees and even disinfecting offices - but shortly later a so-called "super-spreader" infected more than 40 people.

In schools, hospitals, nurseries and other public places it seems that nothing is terribly different from normal. There is a large portion of Taiyuan's population that is still unclear about whether SARS is affecting Taiyuan. This is because people are bombarded by official declarations that SARS is under effective control. They are only gradually starting to take precautions; moreover they are becoming numb to SARS talk. There are also some Taiyuan residents who justifiably believe that if SARS is serious, all the preventive measures should be the responsibility of the government. Individuals should be cautious, but in the end children must go to school, adults must go to work. One Taiyuan student's pragmatic parent said, "Studying is still more important [than worrying about SARS]. Other people's children are still going to school. Do I just make my child stay at home and rest?"

Initially, when Shanxi announced only four cases, WHO already designated the province as an affected area with localized transmission. Considering that since then Shanxi's total infections have risen steadily, WHO's assessment was extremely accurate and timely. It would be beneficial to both Shanxi and China for the province to be opened to WHO experts before SARS becomes a much bigger problem.

Translated by Christopher Horton.

(©2003 Asia Times Online Co, Ltd. All rights reserved. Please contact content@atimes.com for information on our sales and syndication policies.)

Source: World Health Organization
Date: 2003-04-17

Coronavirus Never Before Seen In Humans Is The Cause Of SARS; Unprecedented Collaboration Identifies New Pathogen In Record Time

GENEVA (April 17, 2003) -- Today, the World Health Organization announced that a new pathogen, a member of the coronavirus family never before seen in humans, is the cause of Severe Acute Respiratory Syndrome (SARS). The speed at which this virus was identified is the result of the close international collaboration of 13 laboratories from 10 countries. While many lines of evidence have found strong associations between this virus and the disease over the last weeks, final confirmation came today.

“The pace of SARS research has been astounding,” said Dr. David Heymann, Executive Director, WHO Communicable Diseases programmes. “Because of an extraordinary collaboration among laboratories from countries around the world, we now know with certainty what causes SARS.”

The successful identification of the coronavirus means that scientists can now confidently turn to other SARS challenges. For example, various laboratories continue to work to unravel the genetic information of the SARS virus and compare the sequences obtained from viruses in different parts of the world. Experts are gathering at WHO this week to map future work on SARS.

“Today, the collaboration continues as top laboratory researchers have come to WHO to design the next steps, a strategy for transforming these basic research discoveries into diagnostic tools which will help us to successfully control this disease,” said Heymann.

This collaboration has brought together leading scientific expertise, and was established after WHO issued a global alert on SARS on 12 March 2003. The priority has been to find the cause and to develop diagnostic tests. Two laboratories in China recently joined this network of laboratories from Canada, France, Germany, Hong Kong Special Administrative Region of China, Japan, the Netherlands, Singapore, the United Kingdom, and the United States of America.

“Today, the first part of the mission of our network has been fulfilled, as researchers have both detected a hitherto unknown virus and established it as the cause of SARS. The new coronavirus has been named by WHO and member laboratories as “SARS virus, ” said Dr Albert Osterhaus, the Director of Virology at Erasmus Medical Center in Rotterdam. Erasmus completed the work to definitely prove that the new coronavirus causes SARS.

Over the past three weeks, due to the urgency surrounding the worldwide threat to health of SARS and early indications this was a new member of the coronavirus family, research has proceeded under the assumption that SARS was caused by a new coronavirus.

The 13 laboratories have been working on meeting Koch’s postulates, necessary to prove disease causation. These postulates stipulate that to be the causal agent, a pathogen must meet four conditions: it must be found in all cases of the disease, it must be isolated from the host and grown in pure culture, it must reproduce the original disease when introduced into a susceptible host, and it must be found in the experimental host so infected.

Credit for the coronavirus findings, which definitively pinpoints the cause of SARS, is attributed to the 13 laboratories, working in conjunction with WHO.

“The people in this network have put aside profit and prestige to work together to find the cause of this new disease and to find way new ways of fighting it,” said Dr Klaus Stöhr, WHO virologist and the coordinator of the collaborative research network. “In this globalized world, such collaboration is the only way forward in tackling emerging diseases.”

WHO and the network of laboratories dedicate their detection and characterization of the SARS virus to Dr Carlo Urbani, the WHO scientist who first alerted the world to the existence of SARS in Hanoi, Vietnam, and who died from the disease in Bangkok on 29 March 2003.