Wednesday, Nov. 24, 2010

China: Too Little Information

On that afternoon in 2003, Hong Kong looked like a scene from a zombie movie — deserted streets, empty storefronts, even a bus seemingly abandoned in an intersection. I was the only shopper on the fourth floor of the Landmark, one of Hong Kong's most fashionable malls. The shop attendants, wearing surgical masks, leaned on the glass-topped counters and stared vacantly at racks of on-sale clothes; an employee at Kenzo told me the shop was averaging two customers a day. And she was counting me as one of them.

As the SARS virus exploded in early 2003 out of southern China, infecting thousands of people and killing hundreds, it was hard at first to piece together what was happening. We journalists focused on the biological and epidemiological aspects of the outbreak — the symptoms, the number infected, the path of the epidemic, which we traced on maps with our fingers. Yet as we tried to understand, there always seemed to be an obfuscating layer: something or someone was working against comprehension.

There were powerful forces, it would turn out, that from the start were intent on hiding as much about the disease as possible. Those forces permeated the Chinese government, from local functionaries all the way to Beijing. At the time, China's reasons for dissembling about the emerging virus seemed relatively easy to understand: a leadership transition from Communist Party Secretary Jiang Zemin to Hu Jintao was under way, bad news was seen as a threat to economic growth, and it was embarrassing to be seen as the source of a disease epidemic. The mistaken conclusion in the West, however, was that the global outcry over China's SARS cover-up would turn the Middle Kingdom into a more open society.

On the contrary. Rather than showing a country in transition, the SARS episode revealed one far more resistant to change than the West understood. In fact, China's response to SARS offered a virtual guidebook to all the elements of its closed nature, marked by its refusal to own up to domestic problems, acknowledge the human rights of its citizens or deal openly with the media. The ruling Communist Party elite acted in a manner that would become increasingly familiar as more and more global attention came to bear on the world's fastest-growing superpower. When this year's Nobel Peace Prize was awarded to imprisoned dissident Liu Xiaobo on Oct. 8, the Chinese government removed his name from all search engines operating in China and placed his family under house arrest.

It all seems clearer now, but at the time of the SARS outbreak in Hong Kong, we were struggling to understand a new phenomenon, how a modern city experiences an epidemic. In Hong Kong, we would go through all the stages of a typical outbreak response: denial, fear, panic and, finally, rational response. For those of us who stuck it out — and thousands, including my family, fled — the sight of the abandoned city became familiar, but the experience of it remained novel. For a while, you could get a table at any restaurant at any time you wanted — until the restaurants started shutting down. Hong Kong residents stayed in, hoarded staples, hoped for the best and waited for the worst. We dared not clear our throats in the presence of others for fear we would be accused of harboring the virus, whose first symptom was a dry, hacking cough.

I was the editor of TIME Asia, and our initial story asked the most basic question: What is it? At first, we heard vague reports of shops up the Pearl River delta in China running out of vinegar as panicked villagers in the Guangzhou area sought to boil the liquid and breathe its vapor — a home remedy for respiratory ailments — while local mainland newspapers reported that the outbreak was only a rumor.

A News Blackout Takes Hold
Within days, however, the virus seemed to be everywhere. Mainland rumors became a Hong Kong reality as hospitals were overwhelmed with contagious patients who were deteriorating in just 24 hours from high fever to oxygen deprivation. The epidemic was missing from the headlines, however, because the Chinese government had imposed a news blackout. As the first cases were reported on the eve of the Chinese New Year, the province of Guangdong's Communist Party secretary, Zhang Dejiang, shut down media coverage, lest the panic cut down on the huge sums that Chinese spend on food and travel during the holiday festivals. As he explained to his deputy, according to a source who requested anonymity, "If the newspapers are not going to responsibly cover the matter, then why should we let them write about it?" This pattern of local and then national officials' covering up the extent of the outbreak and refusing to share data with international health agencies would be partly to blame for the spread of the virus. It would eventually reach 37 countries and acquire a name: severe acute respiratory syndrome (SARS).

As Zhang enforced his news blackout, other top party officials in the province were receiving an envelope marked "neibu," or "top secret," and signed by the Guangdong provincial health bureau. Inside was a document explaining that the new disease was highly infectious and recommending isolation of patients and other stringent infection-control measures. Medical staff, it went on, should wear masks, goggles and gloves and be aware that the disease could be passed on by airborne particles. In other words, circulating in the Chinese government at that moment was a document that could have told hospitals around the world — and in stricken Hong Kong — exactly what protocols Chinese hospitals had developed as they grappled with this novel virus. Most Chinese doctors and nurses never saw the document, as it was considered too politically dangerous for wide distribution.

Such obfuscation became a recurring pattern: we would hear reports or rumors of cases in certain hospitals, and then the Chinese Ministry of Health would deny the existence of any cases. Our reporters began what we called bombing: walking into a hospital, asking the staff if there were any SARS cases and then counting the number of patients. Meanwhile, World Health Organization officials were repeatedly stonewalled by the Ministry of Health, whose officials, in the words of WHO epidemiologist Hitoshi Oshitani, "still thought they could cover up and the disease would be gone in a few weeks."

The cover-up might have continued if not for the courage of a retired Chinese doctor and party member, Jiang Yanyong, who met with one of our reporters, Susan Jakes, and described hundreds of cases in Beijing hospitals. Yet the Chinese government was still insisting there was no SARS in Beijing. International outrage at this dissembling reached a point at which even the Chinese government felt compelled to act. On the afternoon when I was walking through the deserted shopping mall, I received a phone call from Jakes. She described a press conference at which it was announced that the Chinese Minister of Health and Beijing's mayor had just been purged. At the same time, the Deputy Minister of Health revised the number of estimated SARS cases in China to more than 2,000, up from just 350 the day before. The Chinese government, in part because of TIME's reporting, had for the first time purged a high official in response to international pressure, as opposed to internal machinations. And then it canceled May Day festivities.

Almost as soon as we were aware the disease was in our midst, the virus had already managed to reach Beijing, Toronto, Vancouver, Hanoi, Taipei and Singapore. The disease was confounding in that it seemed to use the hospital system as a vector. As sick patients were hospitalized, the treatment given, usually a nebulizer that could open up clogged lung passages, actually disseminated the virus further. Then, just as quickly as the disease burned into our consciousness, it dissipated. The pandemic that we feared never materialized; the disease turned out to be quite deadly but less contagious than was first believed. Better infection control and strict quarantine of infected patients slowed the onslaught. Scientists at Hong Kong University, led by microbiologists Malik Peiris and K.Y. Yuen, successfully isolated and identified the virus; other heroic doctors in Hong Kong determined through trial and error what was in that top-secret Chinese memo they had never seen. And HKU microbiologist Guan Yi deduced that the virus had emerged in the wild-animal markets of southern China, where hundreds of species are imported to feed the millions of migrant workers who congregate in some of the most crowded cities on earth.

As the virus ebbed, we began to look for the lessons — medical, personal and political. WHO and the U.S. Centers for Disease Control and Prevention gained insight about how to detect a disease outbreak (by following up on rumors) and how to respond (through global cooperation). For those of us living in the stricken city, the rhythm of life returned to normal, schools reopened, our families flew back, the Rolling Stones rescheduled their canceled concerts, and we quickly put behind us what had been a confusing episode. In the political realm, some in the media talked about a new Chinese era, throwing around terms like "China's 9/11," as if the Communist Party had learned the great cost of secrecy and state-controlled media. And indeed what transpired after the cover-up was exposed was a period of relative openness. Partly in response to China's maltreatment of Hong Kong during the epidemic, 500,000 people turned out that July to protest the imposition of Article 23, a new law that could stop the media from reporting on anything considered a state secret. The demonstration, the largest in Hong Kong since residents gathered to support the students at Tiananmen Square in 1989, seemed a harbinger of a newer, more transparent China. Perhaps, we imagined, a long-anticipated opening up was finally happening.

The False Opening
We were wrong. In that giddy post-SARS period, when it was a thrill to be able to dine in a restaurant again, we failed to recognize what had actually just occurred. We had seen the Chinese government fail to level with its people when it mattered most: when a killer was in their midst.

In the years since, the Chinese government's first response to any domestic crisis has been to hunker down behind the great firewall. In the aftermath of the 2008 earthquake in Sichuan, in which nearly 70,000 died and shoddy construction of school buildings caused the deaths of hundreds of children, parents and other citizens who accused corrupt officials of condoning the unsafe buildings were themselves arrested and threatened. The repeated coal-mining disasters of the past decade, which have killed about 50,000 workers, have often gone unreported in the Chinese media. Earlier this year, reporters in Shanxi covering a relatively successful rescue operation — in which more than 100 miners were pulled to safety after a flood in a mine shaft — were still unable to talk with officials or family members. Should there be miners trapped underground in China for months, as there were in Chile, it's entirely possible the world's media will not even hear about it. In 2005 a benzene spill and explosion up the Songhua River from Harbin, a city of 10 million, was initially covered up by the local government. Officials insisted the city's water was still safe to drink, dismissed the spill as "only a rumor" (sound familiar?) and ordered local reporters not to cover the incident. Only after thousands of residents fled the city did government officials admit the spill had polluted the river.

Or consider the lax consumer protections that allowed milk tainted with the toxic filler melamine to be widely sold in 2008, poisoning 300,000 children and killing six infants. Early reports that melamine had been mixed with milk were ignored by regulatory authorities. Even after public outrage forced the government to take measures, only middle-level employees were prosecuted. The initial cover-up prompted one Chinese author, Qin Geng, to say, "This was the interest of the ruling party above everything, even the safety of the people." In each similar case, the government's response was first to deny, then obfuscate and even imprison those who reported the truth. The same failure to regulate and disclose resulted in the export to the U.S. of poisonous toothpaste, deadly toys and toxic drywall.

Why hasn't China opened up, even as trade is booming? Because so much of its success has stemmed from its ability to pursue growth in spite of human collateral damage — and because its ruling elite places its own preservation above all else. While the SARS virus has not significantly recurred, another crisis is likely to elicit a similar response. During SARS, we got a working glimpse of the new China, and it was very similar to the old China: bad news means there will be no news.

Greenfeld is the author of China Syndrome: The True Story of the 21st Century's First Great Epidemic