Deadly Lessons From SARS Spur Global Reaction to Bird Flu

China’s government is pledging openness in divulging details of a deadly bird flu outbreak, saying it won’t repeat mistakes made during the SARS outbreak a decade ago that delayed response to the global contagion.

Any doctors who fail to disclose cases promptly and accurately will be prosecuted, Liang Wannian, an official at China’s National Health and Family Planning Commission, told reporters in Beijing yesterday. The briefing came in response to an escalation in reported infections caused by the new H7N9 flu strain: About half of the 28 illnesses recorded so far occurred during the past two weeks.

As concerns mount, flu samples have been shared with laboratories around the world for studying and preparation of a vaccine, in case the virus starts spreading among humans. The response is in contrast to SARS, or severe acute respiratory syndrome, in 2003, when China was criticized by the World Health Organization for its lack of cooperation in the first weeks of the global outbreak, which killed 774 people and caused almost $40 billion in economic losses.

“We are working in a very open manner,” Liang, who heads the country’s H7N9 task force, said at the briefing convened with the WHO. “In some areas, we have also invited the WHO to provide support, for example in analysis of the virus. We hope to maintain this very close cooperation.”

Shanghai Deaths

Chinese authorities are investigating two family clusters, in Jiangsu and in Shanghai, to see if human-to-human transmission occurred although there is no evidence yet that the virus is spreading between humans, the WHO said today. SARS by contrast was easily transmitted by droplets produced when an infected person coughed or sneezed.

All confirmed H7N9 cases occurred in eastern China -- in Shanghai and in the provinces of Zhejiang, Jiangsu and Anhui. Shanghai, the financial capital, has been hit hardest, with 13 infections and five deaths. Nine deaths have been recorded nationally.

China also widened its surveillance of the virus to the national level, ordering local governments to collect tissue samples from birds at poultry markets throughout the country, according to a statement the Ministry of Agriculture posted on its website.

Meeting Daily

Stocks closed higher in Shanghai today, after a slump yesterday that was led by airlines on concern infections may become more widespread. While the WHO has yet to issue travel advisories to China, Taipei-based Phoenix Tours International Inc. had 20 percent of its travel packages to eastern China canceled because of the outbreak.

“China has been exemplary,” Gregory Hartl, a spokesman for the Geneva-based WHO, said in an interview with Bloomberg Television yesterday. “China has shared information pro-actively. We talk with them on an hourly basis. We meet with them daily.”

China has increased its capacity to respond to emerging infectious pathogens since SARS. Doctors dispatch more than 16,000 patient-case notes daily for vetting by the Chinese Center for Disease Control and Prevention, said Feng Zijian, the agency’s director of public health emergency.

The data underpin surveillance for health threats in a country whose list of deadly pathogens include the H5N1 avian flu strain and drug-resistant tuberculosis.

‘Critical Role’

At the agency’s headquarters, inside a tightly secured building in suburban Beijing, medical reports from across China flood dozens of flat-paneled computer screens manned by analysts mining for patterns of illness that could herald the next lethal outbreak.

“No country, whether developed or developing, can say that it’s fully prepared for another infectious disease outbreak similar to SARS,” Feng said in an interview in Beijing last month. “What I can say is that China’s preparedness and ability is much improved.”

China’s vigilance and response to emerging disease is crucial for global health security, said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations in New York.

“China plays a critical role,” Huang, a China-born political scientist, said in a telephone interview. “It has one-fifth of the world’s population and one-seventh of the world’s disease burden.”

Old System

The density of humans and food animals, especially in southern China’s Pearl River Delta region, facilitates the exchange of exotic viruses. That gave rise to the so-called Asian influenza pandemic in 1956, the H5N1 strain of avian flu - - which isn’t easily transmitted between people -- 40 years later and to the SARS coronavirus in late 2002, the year China created its CDC in Beijing to monitor disease threats.

Before the agency was formed, China’s doctors sent case reports to local health departments by post, which were then forwarded to municipal and provincial authorities, who would finally notify government officials in Beijing a month later, said Feng, who joined the CDC to head the child immunization program, and moved to the emergency response team during SARS.

‘Straight Answer’

“When SARS first unfolded, we called local officials every day and no one would give us a straight answer,” said Henk Bekedam, who ran the WHO’s Beijing office from August 2002 to 2007. After several months, China’s communication improved and it became one of the best countries to work with, he said.

“In 2004, I met Wen Jiabao. He said to me, ‘Before SARS we only knew only one abbreviation: GDP. Henk, you know what other abbreviation we know now? CDC.’”

The Information Department of the Foreign Ministry, which handles interview requests for Chinese state leaders, didn’t immediately respond to faxed queries about comments attributed to Wen, who stepped down last month as premier.

China’s flu laboratory joined an international network of WHO collaborating centers a couple of years ago and has been “intensely engaged with the investigation” of H7N9, Michael O’Leary, WHO’s current representative in China, said at yesterday’s briefing.

“The capacity is now high in China and the investigation is of a high quality, and the information is being shared readily,” O’Leary said.

Within two weeks of the first reports of the unusual flu cases, China’s CDC identified the strain and shared details of its genetics so other countries could be alert for cases and manage them accordingly, said Jeremy Farrar, director of the Oxford University Clinical Research Unit in Vietnam.

“That’s invaluable to protect China and the rest of the world from any future epidemic,” Farrar said in an interview. “It’s a completely different approach from 10 years ago.”

Wake-Up Call

By mid-2005, China created a mechanism for all 2,800 counties to report bird flu outbreaks to the Ministry of Agriculture in Beijing via the Internet, Joan Kaufman, a lecturer in social medicine at Harvard Medical School, wrote in a 2009 Center for Strategic and International Studies report on China’s capacity to manage infectious diseases. Communications linking county hospitals with the disease reporting system of China’s CDC were also created.

“SARS was certainly a wake-up call for China,” said Linfa Wang, head virologist with the CSIRO Australian Animal Health Laboratory in Geelong, Victoria state, who was part of a delegation convened by the WHO to investigate the cause of SARS in 2003.

“Politicians and scientists realized they cannot repeat what they did during the SARS investigations,” said Wang, who is also a professor of emerging infectious diseases at the Duke-NUS Graduate Medical School in Singapore.

Move Forward

The operational budget for China’s CDC is now about 100 million yuan ($16 million), compared with a few million yuan a decade ago, according to the center’s Feng. Still, the country lags behind the U.S. in terms of human resources: Feng’s national health emergency team has about 30 people, compared with more than 800 people in similar roles at the U.S. CDC, which operates from campus-style headquarters in Atlanta.

That hasn’t stopped China from being a major partner in global health, Thomas Frieden, the U.S. CDC’s director, said in an e-mail.

“China has strong infrastructure in place -- new buildings and equipment, and well-trained staff,” Frieden said. “I recently visited China to review the 10 years of collaboration and was impressed by how far they have come.”

During the early weeks of SARS, China was accused of obfuscating reports of the illness in state media. Yesterday, Liang, the official at China’s National Health and Family Planning Commission, called on the media and the public to “supervise” the work of hospitals, clinics and bureaucrats and judge whether they have acted lawfully in reporting the facts of the epidemic.

“China is now a partner of the world on this,” said David Heymann, a former WHO assistant director general, who helped helm the agency’s response to SARS. “What happened in 2003 was a lesson and gave China the possibility to move forward.”