Coping With SARS in China

JULIAN MANYON:

All morning, ambulances moved in and out of one of Beijing's biggest hospitals as medical officials carried out the latest government orders in China's battle against SARS. The plan: to clear the hospital of ordinary patients and make room for more expected victims of the new killer virus.

The police looked on as the sick and injured were helped on their way to other places, where they will be cared for during the emergency. Staff at this giant medical facility have been told that within 24 hours, their hospital will be entirely devoted to SARS patients. For them it's a chilling prospect. What it means is that they will be effectively in quarantine, unable to visit friends or family until the disease is under control. As the hospital prepared for its dramatic new role, staff members were understandably fearful.

HOSPITAL WORKER (Translated):

Of course I'm worried, because we have to be in close, direct contact with the patient. It's very high risk.

HOSPITAL WORKER (Translated):

I'm not really frightened. It's our responsibility as medical workers to do it.

JULIAN MANYON:

One reason more hospitals are needed is because some of those originally chosen failed to prevent the spread of SARS infection within their walls. Today the World Health Organization said that China still faces a difficult struggle to contain the virus.

HANK BEKEDAM, World Health Organization:

The public health system in China has been under-funded for the last 20 years, and I do believe that this public health system is barely ready to deal with a disease like SARS.

JULIAN MANYON:

Some other countries can now claim to be getting on top of SARS. But for China, and in particular its capital city, the battle against this virus is still a frightening journey into the unknown.

GWEN IFILL:

To tell us more about the medical, political and economic fallout of SARS in China, I'm joined by Ming Wan, an associate professor of public and international affairs at George Mason University. He is also an Asian policy fellow at the Woodrow Wilson Institute.

And Joan Kaufman, director of the AIDS Public Policy Project at Harvard's John F. Kennedy School of Government; she was based in China for ten of the last 23 years. Professor Wan, what do you know of the extent at this point of SARS in China?

MING WAN:

It's a very serious public health crisis. As your lead to the story indicated, according to the latest statistics, China now has over 3,000 cases of probable cases of SARS, and 140 dead, and it has spread to 26 of the 31 provinces, autonomous regions and municipalities directly under the state council. Beijing alone, I heard today, there are 9,000 people being quarantined.

GWEN IFILL:

If 9,000 people are being quarantined in Beijing, yet in other countries they are saying the incidences of SARS have peaked, why are the numbers continuing to grow there?

MING WAN:

I think part of the reason is that the Chinese government's initial cover-up. I think that, to a large extent, in places like Beijing, the fact that it didn't share the information early on with the public and health workers aggravated the problem.

GWEN IFILL:

Professor Kaufman, let me ask you that question as well. Why do the numbers keep going up in Beijing?

JOAN KAUFMAN:

Well, I think what we're seeing, uh, a certain amount of catch up, in that the early reporting was the actual number of cases was not honestly reported. And I think what you're seeing now as a result of early under reporting and the ineffective contact tracing and infection control that wasn't done properly in the first phase. So now, belatedly, proper policies are being put in place, but it's harder to understand the actual extent of infections, and to really understand who may have acquired the infections and where they have taken them in the country.

GWEN IFILL:

Through your work with AIDS on the continent, Asian continent, but especially in China, you have had extensive experience dealing with the Chinese healthcare system. What is it about that health care system that might have exacerbated the spread of SARS?

JOAN KAUFMAN:

Well, I think the problem is not necessarily the healthcare system, but the control of information about health that, you know, shouldn't be treated, really, as a state secret. I think when people know they're at risk, especially medical workers and others, they can take the proper protective measures. I think what's happened is that you've got, in Beijing, people who should have been isolated were not, and people thought there was no major problem in Beijing, so suspected cases were not treated properly. So this has spread.

And I think the worrisome situation now is that whereas the urban health facilities are reasonably good, the rural health facilities have really deteriorated substantially over the last 20 or so years. There are fairly, they're independently financed by local communities, more or less. So poor communities have sort of worse quality care, and I think you see real variations in the quality of care around the country. And it's worrisome about the potential to really deal appropriately with the epidemic once it's outside of the major urban centers and hospitals, where you have a more sophisticated set of healthcare workers and health organizations.

GWEN IFILL:

Professor Wan, let's pick up on that point. How much of a danger is there that this disease will not be confined to either just the rural areas or the big cities where they are better able to cope, or actually will begin to spread because of a lot of travel between the two?

MING WAN:

Yeah, there is a real danger. And there are two or three millions of migrant workers in Beijing alone, and many of them have returned to their hometowns.

GWEN IFILL:

They're migrant workers who come just to work in the city and then go home.

MING WAN:

Right. And there is also reports there are lots of college students from Beijing universities have returned to their hometown. The Chinese government has been trying to tell them to stay at school. But there is no effective measure to stop them from doing that, so many of them have returned.

GWEN IFILL:

So quarantines aren't working, they're building this huge hospital north of Beijing which is supposed to be just for SARS patients, that's not going to be enough to keep people from going back and forth?

MING WAN:

The Chinese government has announced several occasions where have people have been quarantined, some buildings, hospitals and neighborhoods. But they can't quarantine Beijing and the whole city – there are check-up points around Beijing, but from what I've heard people who man those check-up points do not know what they're going to do with people who are leaving the city, because they don't really have the proper authority to do that.

GWEN IFILL:

Professor Kaufman, let me ask a naïve question. Many Americans look at the socialist system in China and assume that there would be healthcare for all, that that would be one of the benefits of a socialist society. Why is it that people in rural areas are not in a position to get the same kind of care that people in Beijing would be, or Shanghai?

JOAN KAUFMAN:

Well, I think what you see in the last 20 years is that the health system has, the rural health system has become completely privatized. It's not socialist medicine any more; when the commune system ended in the late 1970s and early 80s, the mechanism for health insurance and subsidy for the health facilities really disappeared. And there was much less transferring of money down from national to provincial to local to subsidize universal healthcare. The barefoot doctor era is surely over, it hasn't existed for quite some time. The richer areas still have some reasonable level of care, and in the urban areas people are covered by health insurance through factories or if they work for the government, their work unit provides health insurance.

But you don't have such arrangements in the rural area, which it's basically a private family farming system now, and actually the cost of catastrophic health care, of a major health event is one of the major reasons for families falling into poverty. I think you see this happening with the AIDS epidemic in certain parts of China where people are selling all their assets and their major breadwinner, you know, is no longer able to work. And people are just falling into poverty because of the high cost of medical care.

People tend to therefore use local clinics, village clinics, which are, you know, they exist, which is good, it's better than in many places in the world, and there is a reasonable level of sort of curative care for simple problems you can get there. And most drugs are available also. But the level of care, the sophistication of care is quite low, and it's on a fee-for-service basis. People don't go and seek care at higher levels because they simply can't afford it.

GWEN IFILL:

Professor Wan, there has been much discussion, generally accepted at this point, that one of the reasons this spread so quickly and the reason we didn't know it was spreading was because of political considerations. Is there a political element in the way that China has attempted to or not attempted to control the spread of SARS?

MING WAN:

The SARS crisis has huge political implications for China, and depending on how the crisis plays out it may either trigger a political crisis or serve as the catalyst for further reform, including some type of political reform. Two weeks ago you could have asked me and my answer would be that there is real potential that this public health crisis might evolve into a political crisis.

GWEN IFILL:

When you say political crisis, you mean change in leadership?

MING WAN:

No, it may be an internal fight between the leaders and an example would be 1989, the Tiananmen incident, and in China if you base it on reasonable experience, including Tiananmen incident, and you need two key ingredients to have a political crisis: first, you have major social unrest or mass protest, second, you have a serious division. We think the leadership, which creates a vacuum in the center and allows the institution get out of hand – two weeks ago, it did not look very good because we knew the disease was spreading, and at the same time the central government wasn't doing anything. Naturally people wonder either the new government was not capable of meeting its very first test, or there might be serious division.

GWEN IFILL:

What do you think now?

MING WAN:

The situation has improved considerably, and as you know (ph), two very senior officials, the minister of health and Beijing's mayor, and has mobilized the country's resources to fight this disease. And for the past few days the other seven members of the standing committee of the politburo have also spoken out. At least right now in appearance there is a united front.

GWEN IFILL:

Professor Kaufman, finally do you think things have to get worse before they get better?

JOAN KAUFMAN:

I think they certainly will get worse before they get better. I think at this point the level of cases suspected cases is expanding very rapidly, and has most certainly moved beyond, you know, the urban, moved beyond Beijing. As people have said, it's in just about every province. I think it will expand for a while.

I do think that the government has really stepped up and tried to do the right thing at this point. But the lack of information so far has created almost a panic effect, or a real panic effect, and you've got people who really are reacting to rumor and trying to move, and in a sense undermining the attempt at containing the epidemic.

GWEN IFILL:

All right. We'll be following that, Joan Kaufman and Ming Wan, thank you very much for joining us.

MING WAN:

Thank you.