The key ingredients of SARS

Shalin Hai-Jew

By A Contributor

It is hard to get a true sense of how close humanity may have come to a runaway pandemic.

Karl Taro Greenfield, in “China Syndrome: The True Story of the 21st Century’s First Great Epidemic,” portrays Severe Acute Respiratory Syndrome (SARS) as just that particular virus that could have sparked a destructive swath through humanity.

It was 2003. Greenfield was the editor of TIME Asia. Contrary to the magazine’s reputation, this was a job assignment for those somewhat battered by the world. 

“We had reporters who hadn’t finished high school, editors who had been in and out of rehab, such as myself, and staffers who were still wrestling with nasty substance habits,” he observed. 

The prestigious magazine was restricted from distribution on mainland China because of a news story about the Falun Gong movement that offended a high official in Beijing. 

It would be this ragtag crew that would bring in one of the world’s biggest stories-about an emergent disease with pandemic potential. 

From his HK office, Greenfield traveled to the mainland to cover various stories.  One common destination was Shenzhen, Guangdong Province.  In 2003, it was the Era of Wild Flavor, a time of rollicking free market enterprise after decades of stultifying political wrangling under Maoist communism. Now that the entire country had turned into a “special economic zone” with a liberalizing of trade and private property ownership, the rule in China’s markets was to sell, and the speed of money changing hands was dizzying.

On the streets, there were plastic surgeons plying their trade for “cheaper eyes, lips, and breasts, rather than better ones.” There were high-end boutiques selling Louis Vuitton and Dunhill alongside fly-by-night generics which take over retail spaces. 

There were floods of people from the various provinces to the hot trade centers along the coasts, and this mass urbanization left the populace unmoored socially and economically.

Those who have made their bundles of cash were spending it on sparkling conspicuous consumption-bling, name brands, prostitutes, cars, and apartments.  Along with this nouveau riche lifestyle was the consumption of wild animals of “virtually every species on land, sea, or air,” with this Wild Flavor conveying respect (face), luck, and prosperity.

Hunters who bagged fresh and dried tiger penises (from Sumatra), brown bear bladders (from Canada), lizards, camel, dogs, monkeys, and otters, supplied millions of animals to this market annually. The Wild Animal Protection Department at the Guangzhou Forestry Bureau was supposed to regulate the Wild Flavor restaurants, but new ones were opening up all over the city without any oversight.

To fulfill the appetite for fresh meat, these exotic animals were kept stacked in foul cages in public areas.

When an order for a particular delicacy came in, the cooks would dispatch them and create the particular dish. The conditions in the kitchens were grim-with all sorts of animal fluids splashing on the cooks, who were often just new-hires from the migrant pool off the streets.

These wet markets turned out not only to be the “hot zone” from which SARS emerged and apparently jumped from animals into people, but also the potent symbol of rampant development. 

With the shift from government-provided medicine to privatized healthcare, only 13% of the mainland population (the highest of any country in the world) had health insurance. Individuals were self-diagnosing and self-medicating, or occasionally going to the street doctors.

When SARS broke out, these street physicians doled out prescriptions of fungal tea and noodle soup; others diagnosed an imbalance of chi (“life energy” in the Daoist philosophy). While individuals were left to fend for themselves, the government health surveillance system was essentially non-existent.  It had few ways of knowing what infections were making their way through the populace. 

The health infrastructure was poor.  During the rainy season, Shenzhen’s citizens would suffer outbreaks of the snail-borne blood fluke-caused disease schistosomiasis because of the mixing of human sewage with the drinking water. The author notes: “Recently throughout the Pearl River Delta, there have been measles epidemics, meningitis outbreaks, and waves of dengue fever, malaria, and encephalitis.”

Embedded in this mass of humanity were a few scientists and public health workers who strove to protect human and health against the potential rampages of a zoonotic disease. “With their territory flush against influenza’s hottest zone, China’s Guangdong province, Hong Kong’s medical and scientific community must be ever vigilant against new influenza strains and possible species jumpers,” he explains.

Greenfield opens “China Syndrome” with a scene in Penfold Park, Kowloon, HK, China. It is November 29, 2002, and there were birds dying. Nearby, the Hong Kong Jockey Club and Sha Tin racecourse houses some $140 million worth of thoroughbreds. A prior outbreak of equine influenza (in 1992) had resulted in 600 infected thoroughbreds and the cancellation of seven races and $128 million in lost income.

Unusual animal die-offs were brought to the attention of the Tai Lung Veterinary Laboratory of the Department of Agriculture, Fisheries, and Conservation. This office’s necropsy lab (which is a Bio Safety Level III lab) conducted autopsies of “4,000 birds, 750 fish, 200 pigs, and 250 dogs and cats every year”.  More than 50% of the lab’s budget went to influenza because of the outsized fear of an avian flu outbreak, a hemorrhagic fever that reduced chicken coops “into a mass of goop and feathers in just two days.”

In the 1997 avian flu outbreak in Hong Kong, this virus jumped species into people and killed 33 percent of those it infected. Fortunately it was contained to just 18 human cases in Hong Kong then, but it resulted in the slaughter of more than 3 million chickens and ducks and cost their economy about $1 billion.

The fear was that H5N1 was going to gain a genetic foothold, swap genes (reassort), and emerge as contagious as the human flu but with the morbidity of avian flu. 

With 24 million chickens a year coming into HK from the PRC, health professionals were on the front line to keeping avian flu from jumping off into the world through global air travel

Shalin Hai-Jew works at Kansas State University and resides in Manhattan.









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