There may be some minor footpaths along the way, heading to other alternatives, but they can't be discerned at this moment. At this writing, 108 cases of H7N9 flu, as the new virus has been dubbed, have been confirmed, and one asymptomatic carrier of the virus has been identified. Twenty-two of the cases have proven fatal, and nine people have been cured of the new flu. The remainder are still hospitalized, many in severe condition suffering multiple organ failures. As the flu czar of the World Health Organization (WHO), Dr. Keiji Fukuda, tersely put it to reporters last week, "Anything can happen. We just don't know."
On this tenth anniversary of China's April 2003 admission that the SARS virus had spread across that country -- under cloak of official secrecy, spawning a pandemic of a previously unknown, often lethal disease -- Beijing finds itself once again in a terrible position via-a-vis the microbial and geopolitical worlds. In both the SARS and current H7N9 influenza cases, China watched the microbe's historic path unfold during a period of enormous political change. And the politics got in the way of appropriate threat assessment. (...)
I covered the SARS epidemic in Hong Kong and throughout mainland China, and there are more than a few aspects of the current H7N9 situation that provoke feelings of déjà vu. As was the case in 2003, Beijing now has new leaders, President Xi Jinping and Premier Li Keqiang, who assumed office on March 14, 2013. As was the case with SARS in 2003, information regarding the new H7N9 flu did not start to flow publicly until after safe installation of the new leadership. And during the months between the Communist Party's closed meetings that selected Xi and Li and March 14th, the country was rocked by scandals, including murder and billions of dollars' worth of financial shenanigans, pitting one Communist Party faction against another. Both the SARS and H7N9 outbreaks unfolded in atmospheres of political intrigue and secrecy.
Today, with the future path of the new influenza still uncertain, Beijing faces conundrums similar to those it confronted after publicly admitting to SARS. May Day, one of China's biggest travel holidays, is approaching. Travel restrictions might be warranted to prevent nationwide spread if the virus is now thought to be geographically confined, and if further evidence shows that people can act as carriers and transmitters of H7N9. But the economic and geopolitical consequences of clamping down on social mobility are profound, particularly now that China's economic growth is slowing.
In 2003, Beijing warned the public to limit travel, but did not actually barricade the capital and set up health checkpoints in all of the nation's train, bus, shipping, and air travel stations until it was too late. I watched tens of thousands of fearful migrant workers and students -- impelled by rumors of forced quarantines targeting those without permanent Beijing residency papers -- flee the capital by trains over the days between the April 20 admission and May Day holiday, taking the SARS virus to every region of the country. Having lost control of geographic spread, China had no choice but to assume the entire country was infected, and create an extraordinarily expensive, nationwide response. I witnessed construction of Xiaotangshan SARS Hospital, a 1,500-bed quarantine facility erected in only eight days, complete with isolation rooms, dedicated sewer and water filtration systems, negative air pressure flow, and state-of-the-art nursing stations. That astounding feat was repeated all over the country, with quarantine hospitals built in five to 10 days in every region. As I traveled around China by car, I was stopped roughly every 50 miles by police and subjected to thermometer checks. Any individual anywhere in the country that evidenced a fever was immediately placed in one of the newly erected quarantine facilities, and would remain there indefinitely -- no visitors allowed. In Beijing, such fever stations were ubiquitous: Anybody with an abnormal temperature was immediately packed off to a military-run quarantine site or Ditan Hospital for Infectious Diseases, where even the doctors and nurses were on lockdown, forbidden to see their families for weeks. Knowing that the virus was spreading inside of hospitals, terrified physicians and nurses jumped out of windows and patients hid in their homes until May 15, when the central government declared it a high crime, punishable even by death, to hide or spread SARS cases.
That is how by July 5, 2003, China stopped SARS -- with a nationwide find-the-fever campaign that could not possibly be executed in a country that places civil liberties above the rights of the state. I have often thought about the fever stations I encountered in the mountains of Shanxi, where coal truck drivers were compelled to submit to fever checks while people in bio-containment space suits sprayed antimicrobials all over their vehicles' cabs. I've tried to imagine such fever stations positioned along America's superhighways: Visions of angry drivers pulling shotguns on public health nurses and highway patrol officers always dance thru my head. Few countries could today manage a nationwide fever/quarantine campaign akin to China's SARS effort.
Indeed, I'm not sure the China of 2013 could pull off the feat it executed in 2003. Thanks to Weibo, China's equivalent of Twitter, and dozens of other Internet-posting possibilities, very little about this flu outbreak has remained secret for long. Any perceived violation of patients' rights or individual dignity is getting a virtual shout-out. And though President Xi and top health officials have already noted that travel over May Day might be unwise, and Hong Kong has signaled anxiety about the pending tsunami of mainland visitors, possibly bringing H7N9 their way, it seems unimaginable that today's government could close the perimeter of any major city, let alone Shanghai, the epicenter of H7N9, with population of some 23 million people.
by Laurie Garrett, Foreign Policy | Read more:
Image: STR/AFP/Getty Images
