Reuters: WHO cautious about China's SARS reports

June 6, 2003

(Clearwisdom.net) WASHINGTON - World Health Organization officials said on Friday they plan to have an explanation next week for an apparent sudden decrease in SARS cases in China.

WHO has been suspicious of China's reported decline, which dropped from thousands in recent months to a just handful in the past week, but has been diplomatic in its questioning of officials in Beijing.

Severe Acute Respiratory Syndrome is believed to have emerged in southern China last November but the Chinese government was accused of remaining quiet until March, when SARS crossed international borders.

More than 8,400 SARS cases have been reported worldwide, nearly two thirds of them in China, and about 775 people have died. On Friday China reported one new SARS case and two deaths from the disease, and for three days this week reported no new cases at all after having logged more than 5,000 in March, April and May.

"China has reported a very rapid decrease in SARS cases and what we need to understand now is why this is decreasing so rapidly," said Dr. David Heymann, executive director for communicable diseases at WHO.

"Is it over time becoming a different disease because of changes in the virus? Are containment measures better (in China) than elsewhere?" Heymann asked during a telephone briefing.

Heymann said all were unlikely and China may have changed the definition of which cases it reports to WHO as SARS. "We will have an answer next week," he said.

"So we don't have any reason to believe that this virus is changing and we don't have any reason to believe it is becoming less virulent or more virulent."

ADMITTED COVER-UP

China's former health minister and the mayor of Beijing were sacked in April after the government admitted covering up the outbreak.

President Hu Jintao ordered more honest reporting of the disease -- and soon hundreds of new cases were reported. But over the past week or so there has been a huge decline.

Yet China's health care system is rickety at best and doctors and nurses have publicly complained they lack the supplies and facilities needed to control the virus -- such as masks and gowns and isolation rooms.

"In China we are asking ... for clarifications about a couple of things. They reported that only 50 percent of cases could be traced back to another person," Heymann said.

That is "very concerning" as everywhere else SARS has been seen, it has been possible to trace each patient to contact with another, or to a place.

"At the same time, we are asking China for clarification on which case definition they are using," Heymann added. "They may not be reporting what all other countries are calling probable cases and what we are calling probable cases."

Hampering this effort is the lack of a good diagnostic test for SARS. WHO said last week current SARS tests were unreliable.

Therefore SARS, which has symptoms resembling many other causes of pneumonia, must be diagnosed based on these common symptoms and on a patient's possible contact with other SARS patients.

Heymann also hinted that China might be frightening people off from reporting to clinics with SARS symptoms.

"You need to build confidence in the population so contacts understand why they are being traced," Heymann said. "When mixed with a civil response which might not be taking into account cooperation and collaboration, then there comes a challenge."

SARS appears to be under control in Taiwan and Canada, Heymann said. "We believe that SARS can be put back into the box," he said. "But it is a time of great danger and we have to intensify efforts everywhere."

http://www.alertnet.org/thenews/newsdesk/N06125028.htm