China: SARS - an epidemic of bureaucracy and globalisation
27 April 2003

The disease SARS (Sudden Acute Respiratory Syndrome) was first recognised eight weeks ago. Already some 5,000 cases of have been reported and nearly 300 people have died of the virus. The true figure is likely to be much higher due to lack of identifying and reporting of cases in the parts of China where the disease first occurred.

Last week the Chinese government admitted there had been ten times more cases than they had previously told the World Health Organisation, and that the first cases were seen as early as November last year. They confirmed there had been 346 cases in Beijing alone, but did not confirm or deny WHO reports that a further 1,000 people were being observed with suspected SARS.

While the Chinese authorities blamed, and sacked, the national minister of health and the mayor of Beijing, the responsibility for the cover-up lies with the whole bureaucratic, Stalinist-like caste that still rules capitalist China.

As with the Chernobyl nuclear plant disaster in Ukraine in 1986 a bad situation is made infinitely worse by a repressive and sealed-off bureaucracy that is incapable of admitting to its errors in front of its population and hence compounds a public health nightmare by not taking the obvious and quick measures that can contain the impact of the catastrophe.

China was not willing to report cases for fear of scaring off foreign tourists and investors. But eventually it was forced to be more open since information about the scale of the outbreak was getting out by way of mobile phones and email, which even these bureaucrats cannot fully control.

In part due to this major cover-up, which has delayed international efforts at control, cases have now been reported from 28 countries. Internationally people are being advised not to travel to some parts of China (Hong Kong, Beijing, Guangdong and Shanxi provinces) or to Toronto. In Singapore, China, Hong Kong and Toronto draconian measures have been introduced to try and halt the spread of the disease.

Why has this disease caused such alarm?

This is not the first new disease to hit humans in recent years ö dozens have been identified in the last decade alone. Public health experts have been anticipating a severe new infection like this for some years ö either a highly virulent influenza virus or another such as this coronavirus.

Because of globalisation, any new disease will not be confined to one or two countries or even regions while experts come to understand it. International mobility, particularly through air travel, means any new bug can be round the globe within hours of the first cases. This creates an enormous challenge for public health systems, and there are no easy answers to this kind of outbreak.

The quarantine measures adopted in Singapore by its autocratic government have been rightly criticised as repressive, but any public health intervention to contain SARS would entail restrictions on mobility until the way the virus is transmitted becomes more clear, and a there is a test for people who are carrying the virus but not yet ill.

Around one in 20 people who get this disease are dying, and there has been a major death toll amongst nurses and doctors. The pessimistic view suggests that this could be a major new pandemic dwarfing AIDS. This seems very unlikely given the strict controls now in place, and the rapid scientific progress already in identifying the virus (it has happened within weeks, it took years to properly identify HIV), the sequencing of the genome of that virus (nearly complete), developing a test (nearly complete) and the availability of anti-viral agents that will help treat those with the disease.

But against this relative scientific optimism, strict public health measures themselves have an impact back on the globalised world that made them necessary; the travel restrictions in Hong Kong are likely to cause a 20 per cent drop in the provinceâs GDP growth rate. Torontoâs mayor has reacted fiercely to the international restrictions on travel, fearing a major impact on the local economy.

SARS was not invented by globalisation but its impact has everything to do with the way modern capitalism functions. Effective public health measures are impeded by bureaucracy and fears of the effect the virus has on investment and profits.