How the Chinese Spread SARS

Communist China’s long obsession with secrecy is one cause of the present SARS (Severe Acute Respiratory Syndrome) crisis. This passion for secrets—protected by lies—can involve events more than forty years ago, and it is heightened by a conviction common to all Communist countries: any disaster, natural or man-made, can reflect badly on the Party, the government, officials, and of course all citizens. Low-ranking officials who cannot conceal secrets will not rise through the hierarchy, and the highest officials hesitate before telling some or all of the truth.

China’s law on informing the public about disease is plain. According to a law jointly promulgated on January 23, 1996, by the Ministry of Public Health and the State Bureau for the Protection of State Secrets, “highest level infectious diseases” are classified as “highly secret.” This secrecy extends from the first occurrence of the disease until the day it is announced.

This is why throughout the spring most Chinese Web sites and forums that referred to SARS were usually blocked, although rumors circulated about the disease and its rapid spread. China’s minister of health, Zhang Wenkang, and Beijing’s mayor, Meng Xuenong (among many others), assured the public that there was no danger and that SARS was under government control. Both officials have recently been removed from office and the regime now says it is giving out accurate information about the disease. (As of April 30, according to the World Health Organization, there had been 3,460 cases in China, with 159 deaths, while 1,332 people recovered.) A Shanghai doctor, an expert on epidemic diseases, expressed a view familiar in official circles when he said, “You foreigners value each person’s life more than we do because you have fewer people in your countries. Our primary concern is social stability, and if a few people’s deaths are kept secret, it’s worth it to keep things stable.”

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How did secrecy lead to the spread of the disease? According to John Pomfret, the experienced China correspondent of The Washington Post,

In the southern Chinese province of Guangdong [where SARS first appeared], the health department received a “top secret” document from a government health committee on Jan. 27 that contained disturbing information about a new pneumonia-like illness spreading in the region.

Instead of declaring a health emergency, Pomfret’s medical informants told him, no action was taken

because there was no one with sufficient security clearance [because epidemics are a national secret] to open it…. [Eventually] a bulletin was sent to hospitals across the province. But few health care workers were alerted because most were on vacation for the Chinese New Year….

In the meantime, the illness, known as severe acute respiratory syndrome, or SARS, was infecting hundreds of patients, moving throughout China and spreading to Hong Kong and 16 other countries. Chinese officials waited more than three months to acknowledge the extent of the illness….1

The results of this secrecy for international inspection were devastating. Hospital staff members in Beijing told Pomfret that SARS patients had been moved out when WHO officials were visiting.

This is what Dr. Jiang Yanyong was up against when he wrote to journalists on April 3, just after Pomfret filed his report. Because he flouted the secrecy law and contradicted two high officials, Dr. Jiang is a new hero in China. The former director of surgery at Army Hospital 301, the most elite such institution in China, where top leaders like Deng Xiaoping spent their last days, Dr. Jiang wrote to journalists that he could no longer keep silent about the epidemic. Although he is retired, his colleagues at a Beijing military hospital had informed him that they were treating sixty SARS patients and that seven had already died. When he heard Zhang, the minister of health, declare that in all Beijing there were only twelve SARS cases and that only three people had died, Dr. Jiang wrote, “I couldn’t believe what I was hearing. As a doctor who cares about people’s lives and health, I have a responsibility to aid international and local efforts to prevent the spread of SARS.”

Besides the general aversion to telling the truth, the regime during March had another reason for concealing the SARS crisis: the installation that month of the new Party General Secretary Hu Jintao and his Politburo Standing Committee colleagues as the supreme national leaders. According to Dr. Jiang, the Health Ministry cautioned hospital officials “that Beijing now had cases [of SARS] and that in order to ensure stability as the nation’s two annual legislative assemblies got underway, hospital officials were forbidden to publicize what they had learned about SARS.” In fact the secrecy has now badly damaged the reputations of Hu and his closest associates. “Beijing lost the entire month of March in the fight against SARS, and now this is the consequence,” said Henk Bekedam, chief of the Beijing office of the World Health Organization.

Dr. Jiang may have had another, more personal, reason for defying the Party and risking his liberty to tell the truth about SARS: the killings on June 3 and June 4, 1989, in Tiananmen Square. That “incident,” as it is still officially called in China, is dismissed nowadays as no longer politically important, according to some Western China-watchers. In 1999, according to The New York Times, Dr. Jiang told fellow graduates of Yanjing University, once China’s most prestigious university, that while he had always believed in the Party, he recalled the wounded and dead in his hospital on the night of the killings. One of the dead, Dr Jiang said, was the son of army officers. But on the night of June 3, scores of wounded were carried into his emergency room and many were dead by morning. “In my wildest dreams I never imagined that something like this could happen,” he said. “A Government should never do such a thing. That is counterrevolutionary.”

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On April 20, exactly twenty-two weeks after the first SARS patient appeared, in Guangdong province, the Politburo Standing Committee “warned against the covering up of SARS cases and demanded the accurate, timely, and honest reporting of the SARS situation.” The proclamation went on to say that officials “will be held accountable for the overall situation in their jurisdictions.” Does this mean that “a new openness” has appeared in China, as some observers have suggested? Before the warning, a Guangdong official had stated— anonymously—”Beijing has decided that SARS should be handled mainly from the point of view of safeguarding China’s international prestige and credibility.”

In China almost any “negative” phenomenon is politically sensitive. Chinese journalist friends have described to me how potentially politically embarrassing stories must await a “red top advisory”—instructions from the Party on how a story should be presented or ignored. Among the stories that have been suppressed are accounts of the numbers of people who starved to death between 1959 and 1961, of the Chinese athletes caught using drugs at international competitions, of many riots and demonstrations by angry rural and urban workers, of the numbers of people with AIDS, and above all of what happened in Tiananmen. In recent years, a few brave newspapers have attempted to engage in investigative reporting of such traditionally taboo subjects, but they always risk being disciplined or being closed down. It is only since the Politburo’s declaration that SARS must no longer be concealed that the official Chinese press has begun genuine reporting and honest comment on the subject. Until that permission “from above,” the SARS story, when it was covered at all, was usually treated as an example of “unfriendly” or “anti-China” propaganda. (Some American China experts also took this view.) Most Chinese Web sites which discussed SARS as a serious threat were shut down.

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Has anything changed, then, because of SARS? The dismissal of a minister and the mayor of Beijing for doing their jobs badly, as opposed to being corrupt, is indeed highly unusual. So is the self-criticism of Liu Qing, the Party’s top official governing Beijing, for supplying late and wrong data on SARS. (Liu is aware that Beijing will be the site for the 2008 Olympics and that its reputation could suffer because of SARS.) It is also a good sign that, so far as we know, Dr. Jiang will not suffer for having revealed the truth about SARS, unlike past medical experts who were punished for telling the truth about AIDS.

The fact remains, however, that the government’s reversal was dragged out of it by international humiliation and a degree of internal pressure. The World Health Organization now warns that because of the Chinese delay there may be a nationwide epidemic in China, with possibly catastrophic consequences, certainly for Asia, where the Hong Kong economy is now in crisis, and others may follow.

A sign that the real lesson—that the truth should be told about “negative” events—has not been learned came recently. According to the New York– based organization Human Rights in China, three labor activists in northeastern Liaoning province, who led large-scale demonstrations there in March 2002, have been taken into police custody so that they cannot meet American diplomats and journalists visiting the city of Liaoyang, where the demonstrations took place. This has long been the Chinese practice with respect to human rights matters, and so it remains.

What happened in Liaoning had its echo in Beijing. Just before the officials in Beijing reversed their position on SARS, patients with the disease were put in taxis and buses that drove around Beijing in order to ensure that World Health Organization visitors to the city’s hospitals would not see them.

  1. Washington Post Foreign Service, April 3, 2003.
Epidemics, SARS, State Secrets