But the greatest worry for WHO-Beijing remained the capital. Among other issues, WHO was concerned that Beijing health authorities were not properly tracing those who might have been exposed to SARS, especially in military hospitals. Bekedam says that Acting Vice Mayor Wang Qishan “at a certain moment… made it quite clear to me that he controlled the city, except for a few areas. And one of them was the military… He said, you should appreciate, within the system, it’s very difficult.”

On April 10, MoH gave WHO permission for a mission to visit Beijing hospitals and districts. A group of five, which included a couple from the Guangdong mission, toured Beijing from April 11-15. ^[30] The night before the team went out, it gathered around a speakerphone in a small meeting room at the WHO offices. They called Dr. Jiang—who, says Bekedam, had taken “an enormous risk” with his letter—to learn more about SARS cases in military hospitals. “He was not helpful,” says Schnur. “He said, I can’t talk with you. I have nothing more to say.”

The tour was not encouraging. The first stop was the Beijing Health Bureau (as distinct from the Beijing CDC). “They gave us this very long lecture, basically saying that everything is fine, we’re confident, don’t worry about us. You can go back to your hotel and relax because we have everything under control,” recalls Schnur. “We were a bit upset by this. It was not playing by the rules.” They also met with the Beijing CDC, and asked to see its mapping data for SARS cases in the capital. But the Beijing-CDC epidemiologists said the Health Bureau had the data. “They were not fully happy about the situation, but of course couldn’t complain,” notes Schnur. “It was quite remarkable that they didn’t have all the information at their fingertips. That was unexpected.”

The next step was to visit hospitals. Among others, the WHO team stopped at the Japanese-Chinese Friendship Hospital, where Schnur had heard from sources that there were SARS cases. But hospital officials said there were none. Some hospital personnel seemed to withhold information; others denied having a problem. “We were a bit upset with that,” says Schnur.

In China, if you don’t ask, there’s no need for people to tell you. That’s your fault… But normally, the rules were if we asked the right question, we expected an answer to that. Our team asked the right question and didn’t get the right answer. So that made us a bit unhappy.

What’s more, the government at first refused to allow the mission to visit military hospitals at all. Apart from Jiang’s report, Schnur and Bekedam had been hearing about additional military hospital cases for quite a while. Schnur, with his years of experience in China, had built up a network of trusted sources. If one understood the ground rules, it was possible to learn a great deal through back channels, he explains.

Working in China, one becomes very careful of protecting sources. One can establish fairly good working relationships with people once they understand that you know the rules: that if you put their name up to a higher level as saying something, they can get into serious trouble.

Schnur elaborates on discretion in China.

Various individuals had called Schnur in recent weeks to report a relative who worked at a hospital with SARS cases, or an acquaintance suddenly taken ill. An expatriate health center had also reported its suspicion of more cases. “There were several informal inputs which gave us to believe that the official data was not believable, and that the number of cases was more than we expected,” says Schnur. The government on April 14 raised its count of SARS cases in Beijing to 37 (including four deaths)—but this seemed hardly credible. Schnur had heard unconfirmed numbers as high as 200.

Finally, on Tuesday, April 15, the government relented: it would admit the mission to military hospitals. The team visited Nos. 301 and 309 military hospitals. They found what looked like lapses in hospital management as well as infection control. They also heard about SARS cases. “They were quite open actually,” recalls Schnur. “Not in terms of the number of cases they had seen; that they didn’t tell us. But they did mention that we have some cases.” They also asked for help: the hospital administrators suspected that air conditioning ducts were spreading the disease and wanted expert advice on possible modifications.

On the morning of April 16, the team reported back to MoH on its findings. It noted that surveillance in Beijing was inadequate, and recommended urgent improvement in surveillance, reporting and infection controls. It also said all hospitals should be included in the reporting system. The standard end-of-mission press conference was scheduled for the afternoon.