Getting to Guangdong

When MoH sent over its first reports of SARS on April 1, the information “looked quite reliable,” says Bekedam. But apparently the Chinese government was still conflicted about the wisdom of sharing information, because in early April Bekedam was summoned to the Ministry of Foreign Affairs. “They made the point that they were not happy,” he says. “They really felt that I should convey to the director general [of WHO] that they were working very hard on the issues, and that they were very serious.”

In Geneva, WHO decided on drastic action. For weeks, it had resisted pressure to issue travel bans for areas affected by SARS. Until now, it had given only travel “advice.” But on April 2, it published the most stringent travel advisory in its history for Hong Kong and Guangdong: consider postponing all but essential travel.[23] Whether by coincidence or not, that day the Ministry of Health finally gave permission for a WHO team to visit Guangdong.

On April 3, the latest WHO mission flew from Beijing to Guangzhou for a five-day visit. The mission leader was Dr. Robert Breiman, a CDC infectious disease specialist working at the time in Bangladesh. Its other members were Dr. James Maguire of the CDC-US, Dr. Wolfgang Preiser from Goethe University in Germany, Dr. Meirion Evans from the UK, plus Schnur and Dr. Li Ailan from the WHO-Beijing office. Geneva-based WHO press officer Christopher Powell had also insisted on joining the mission and was, reports Schnur, “key, because we were just inundated with the press.”

That evening, Minister of Health Zhang for the first time mentioned SARS on national Chinese television.  He reassured the nation that the disease was under control, and acknowledged that Beijing to date had 12 SARS cases and three deaths. The mission went well. “We had good discussions with the technical people at the provincial CDC,” recalls Schnur. “They pulled out all the guidelines they had issued going back to January… They were first class, very good.” The guidelines, issued February 3, included a preliminary case definition for atypical pneumonia, and recommendations on how to prevent its spread.[24]

Three consulates (Guangzhou had 22 commercial consulates) had requested that the team meet with them during their stay. Schnur decided to ask the local Health Bureau to help brief the consular officials.  The Chinese accepted, and together with Schnur and James Maguire they presented their report that Guangdong had done a professional and effective job of curbing the outbreak, including isolating cases. Schnur was able to introduce the deputy director of the health bureau to the consular group, initiating a relationship that endured after the team departed.

The group held several press conferences to deal with the intense interest in SARS. Hong Kong reporters made a special impression, recalls Schnur: “Very tough. They’re resistant, they’re knowledgeable, intelligent, they are sharp, they do their homework, and they ask good questions.” The press wanted to know, for example, why Schnur wasn’t wearing a face mask. He responded that in a city of 8 million like Guangzhou, the chances of contracting SARS were minimal—but that every individual had to make his own risk assessment. 

On the morning of Wednesday, April 9, back in Beijing, the mission presented its findings to the MoH. It said Guangdong had responded well, but expressed fears—based on their earlier Beijing-CDC visit while awaiting permission to visit Guangdong—that Beijing was not as well organized to deal with SARS.[25] The team presented a work plan for preventing the spread of SARS within China, including better surveillance, infection control and reporting mechanisms. It recommended that only specially designated hospitals be allowed to accept SARS patients. The mission members also requested permission for a WHO team to visit Beijing medical establishments.

ILO death. While the mission was in Guangdong, the WHO-Beijing office had learned on April 4 that a 53-year-old staff member of the International Labor Organization (ILO) had been admitted to the infectious diseases hospital in Beijing. Because the official had no known contact with a SARS patient, it seemed unlikely at first that he had contracted SARS. But when WHO staff member Chin visited the patient at ILO’s request, it was clearly SARS. The source of the ILO official’s infection was unknown and caused much anxiety among the international community in Beijing, which feared that the disease might be much more widespread than reported. Only later was it learned that he had caught SARS while sitting next to an infected person on a flight from Bangkok to Beijing. On April 5, he died—the first reported case of a foreigner dying of SARS in China.[26]

[23] Several governments had already independently issued travel advisories for their citizens.

[24] Kleinman, Watson, p. 36.

[25] Ibid, p.39.

[26] The ILO tried to airlift him out, but for several days was unable to find an aircraft willing to fly someone with SARS. By the time they had one in the air, he died.