Mission #1

As the Chinese prepared for the congress, the WHO sent in the mission it had proposed on February 20. The team arrived in Beijing on February 23. They were senior officials: Dr. Oshitani, the WPRO regional advisor on communicable diseases, Dr. Keiji Fukuda from the US CDC’s influenza division, and Dr. Masato Tashiro an influenza expert from Japan’s National Institute of Infectious Diseases. While admitted into China as WHO temporary advisors, they hoped for meetings with Chinese health officials. On February 24, WHO-Beijing faxed terms of reference for the team to MoH, asking for meetings in Beijing, plus Fujian and Guangdong provinces.

The ministry on February 27 gave permission, but for Beijing only. WHO could not dispatch a team to Guangdong without approval; even if the individuals traveled to Guangdong, without official permission no one would speak to them. As WHO-Beijing officer Chin explains it: “If the Chinese government is not opening up, doesn’t allow you to travel, we cannot simply say I’m going to go to investigate. That’s a non-starter.” [14]

Dr. Chin on securing travel permission.

Dr. Daniel Chin

Only on March 3 was the team finally able to meet with officials at the Ministry of Health. On March 6-7, it visited the China CDC, where it was given clinical, epidemiological and laboratory information about Guangdong (and a potential avian flu outbreak in Fujian). Schnur recalls the team querying: “Do you have the equipment and reagents to do tests for new influenza viruses?” The Chinese accepted an offer of training, equipment and reagents from the US CDC to improve capacity for virus testing. But while there was much discussion about influenza as a possible cause, Dr. Hong Tao, a senior CCDC official, continued to advance the February 19 view that it was chlamydia . [15]

Chlamydia . “The Chinese kept talking about chlamydia ,” recalls Bekedam. He had been trying for two weeks to determine if there was any basis to the chlamydia claim. But he had found no one prepared to defend that hypothesis: the global experts he consulted “came back and said it’s absolutely not possible.” Even Chinese experts were “giving either hints or telling me that they were not happy that the China CDC was thinking it was chlamydia,” he says. Yet his efforts to persuade CCDC to abandon the theory were fruitless. He knew what the problem was: the official advancing the theory was too senior to be contradicted. “Here, if the professor or whoever is the most senior person says something, the level of discussion is not sufficient for good science. And that was happening,” he observes.

Guangdong didn’t agree with it, Shanghai didn’t agree with it. The universities didn’t agree with it. It was just unfortunate that somehow within the system they didn’t have enough possibilities to discuss [it].

Meanwhile, on March 6, Singapore reported cases of atypical pneumonia (travelers who had been in Hong Kong). Then on March 7, the team in Beijing received an urgent phone call from Vietnam. Says Schnur: “You heard this shouting and screaming in the background. It sounded like total chaos.” WHO’s Dr. Carlo Urbani was reporting from Hanoi that a strange respiratory disease had infected 12 staff in a hospital treating one patient.[16] He asked for additional personnel. Dr. Oshitani flew to Hanoi on March 10; Dr. Fukuda to Hong Kong.

[14]  Author’s interview with Dr. Daniel Chin in Beijing, November 2, 2012. All further quotes from Chin, unless otherwise attributed, are from this interview.

[15]  Unbeknownst to WHO and the international community, Chinese scientists on February 26 had isolated a coronavirus from Guangdong patients which made it clear the disease was not chlamydia. The scientists did not share this information with WHO. Source: WHO, SARS, p.9.

[16]  Dr. Urbani himself died of SARS on March 29.