Severe Acute Respiratory Syndrome (SARS)

– Caused by previously unknown virus, coronavirus (SARS-CoV). – No direct cure, no vaccination.– First appeared in Southern China in 11/2002.– Recognized as a global threat in March 2003.– Infected, 8,098; death, 774.

Symptoms and signs of SARS

– Incubation Period: 1-2 weeks.– High fever 100.4°F [>38.0°C], Chills, headache, shortness of

breath, diarrhea etc. Dry, nonproductive cough after 2 to 7 days.– In 10%-20 % of cases, patients require ICU, (mechanical

ventilation). Source: U.S. CDC

Ways of Spreading

Close person-to-person contact. Examples include:– Sharing eating or drinking utensils, – Close conversation (within 3 feet), – Physical examination, and any other direct physical

contact between people such as kissing or embracing.

Source: U.S. CDC

The SARS Outbreak in China

First Cluster of Cases

Health Workers at High Risk

Health Workers fell to victims of SARS

SARS was spread to Hong Kong February 21, 2003

News Conference, Hong Kong

SARS AFFECTED AREAS (More than 20 countries)

The SARS Outbreak (11/2002—7/2003) Infected Death World 8,098 774 China 5,327 349 Hong Kong 1,755 299 Canada 251 43 US 27 0

Source: WHO

Fatality Rate

– Average Fatality Rate: 14% - 15%.– Fatality ratio depending on the age group affected

<24 years-----------------------<1%

25 to 44 years------------------6%

45 to 64 years-----------------15%

>65 years--------------------->50%

Source: WHO

Entering Beijing

• Ms. Xu make a trip to Guangzhou on February 18, 2003.

• Ms. Xu was transferred to the Military 301 Hospital on February 28, 2003 and set off the epidemic in Beijing.

The 10th NPC that elected the New Central Government, March 2003

Failure of the “Digest Method”

Minister Zhang, “Beijing is Safe!”, April 3

Dr. Jiang, “Zhang was not truthful!”

Wedding During the Outbreak

Beijing: Panic

New Government and New Approach after April 20, 2003

Mr. Hu, the President Mr. Wen, the Premier

1.OPENLY Launched the Campaign on SARS.

2.Minister Zhang was removed.

3. Enacted Laws on SARS.

Footnotes: Two Approaches

• New: Open and transparent approach

• Traditional: “black-box” or “relax-outside-intensive-inside” approach---dealing a crisis behind closed doors

– Liu, p 51-52

New Laws, May 2003

1. SARS Measures by the Ministry of Health

2. SARS Regulations by the State Council

3. Interpretation of Criminal Law Art. 114.

4. Re-print the Law on Infectious Diseases (PTID, 1989)

SARS Laws: Contents

1.SARS Reporting System

2.Treatment

3.Prevention

SARS Laws-1: Reporting System

– Reporting (Vertical, from bottom up)– Releasing (horizontal)– Announcing (Vertical from top down)– Whistleblower’s Rights– Legal Responsibility

SARS Laws-2: Treatment

– Designated Hospitals – Not to refuse to admit SARS patients– Financial aid to the uninsured

Dispatched to Beijing SARS Hospital, May 2003

SARS Laws-3: Prevention

– Students, Migrant Workers– Rural Areas, social riot– Public Transportation– Intentional Spreading SARS, Art. 114. – Water Resources, food supply

Victory, June 24, 2004

Direct Economic Loss: $18 Billion

The “new” SARS laws are not a breakthrough

Law on the Prevention and Treatment of Infectious Diseases (PTID) set forth rules of epidemic control in 1989. The law is still in force. – Information Reporting– Prevention– Treatment– Legal Responsibility

Why PTID was ignored during the SARS outbreak?

• Local officials are appointed by the government at high level.

• Not accountable to the local people.

• The sole goal set by the central government is to increase GDP.

• Top priority in the localities is to grow economy by all means.

Challenges Ahead

• AIDS 840, 000

• Drug addicts: 740,000

• Schistosomiasis 843,000

• TB 6,000,000

• Massive food poisoning

Conclusion: Regulating Epidemics in China, Law as an Antidote?

• PTID revised, August 28, 2004

• Will PTID be implemented next time?

Questions to think about

1.      Why did local and central governments in China cover up the initial information about the SARS epidemic?

2.      In time of crisis, which system works better, federalist or centralist?

3.      Will the new International Health Regulations (IHR) be fully implemented in China? If not, why?

4.      How could we draw some lessons from SARS epidemic to make the hurricane response system in Texas more effective?