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Su returned home from his shopping trip running a fever. Having read nothing about a mystery illness in his area, he assumed he had a cold and never thought to visit the doctor. When his temperature still hadn't fallen by Jan. 20, he checked into his local hospital. Three days later, as his breathing failed, medical staff transferred him to Zhongshan No. 2 hospital in Guangzhou.
Although the delegation of Guangzhou doctors had earlier determined the Heyuan outbreak was atypical pneumonia, the information was not widely disseminated. Su's doctor at Zhongshan No. 2, Li Jianguo, didn't know what he was dealing with. "I felt this was a new disease but I didn't know what," says Li. Eight days later, Su died—but not before passing the disease to his younger brother, Su Qingshan. He has recovered, but he is angry his family wasn't informed of the outbreaks. "If the media had covered the disease earlier, do you think we would have waited four days to go to the hospital?" he asks. "We thought it was just a normal cold."
Behind the scenes, bureaucrats were becoming alarmed as the number of infections climbed into the hundreds, prompting government officials to begin notifying anxious doctors of the new disease. Following an investigation into the Zhongshan outbreak by the Guangdong provincial health bureau, a bulletin went out to doctors in Guangzhou on Jan. 28. It was an accurate summary of the facts then at hand: an atypical pneumonia was spreading especially quickly among hospital staffs and showed "characteristics of epidemic disease." Officials recommended isolating patients who showed symptoms, and urged hospital staffs to wear masks and to sterilize areas where patients were treated. "Doctors recognized early that they had a problem and tried to deal with it head-on," says Breiman of the WHO. "It was an appropriately timed response."
Through February, as they groped in the dark for a treatment, doctors at the army-run Zhujiang Hospital in Guangzhou tried regimes for several established diseases that show similar symptoms—other well-recognized forms of atypical pneumonia such as Legionnaires' disease, chlamydia pneumonia and mycoplasma pneumonia, which are caused by bacterial infections. They tried steroids to reduce inflammation in the lungs—swelling of airways due to a runaway immune response is how SARS kills—and antibiotics to stem the spread of bacteria in the respiratory system. Nothing worked (reseachers later determined SARS was caused by a virus, not bacteria).
On Feb. 28, the Zhujiang Hospital finally received a memo from Beijing identifying the new disease as mycoplasma pneumonia—a cause the doctors had already ruled out. "Many of us thought differently but kept silent," says a doctor at Zhujiang Hospital. Better communications, he says, would have helped doctors understand what they faced more quickly. "Only a small group of people knew how bad it was, and no media was covering it," says Cao, who treated the Poison King at Zhongshan No. 3 Hospital. "We didn't react quickly enough."
The silence was broken, briefly, when Guangdong Province's new party chief, Zhang Dejiang, allowed health officials to hold a Feb. 11 news conference announcing the disease for the first time. During the event, staged to avoid further panics like those in Heyuan and Zhongshan, officials said the outbreak was under control. Huang Qingdao, the leader of the provincial health bureau, announced 305 cases and five deaths. When journalists asked him why he hadn't reported the Heyuan outbreak faster, Huang said "it was fine not to tell the public" about the disease because he wasn't legally required to do so. The government did not release updated statistics on the outbreak for another month.
Guangdong newspaper editors who chaffed at the blackout thought they had the green light to publish after the news conference. They had plenty of material—journalists had been working on the story all along. "We told our reporters to write their stories and hold them for the day we could run them," says an editor for a major weekly in Guangzhou. A raft of articles quickly broke, some of them raising questions about the way the government handled matters. The Xin Kuai Daily even ran a long interview with a local professor, Cai Lihui, who noted that after the 2001 attacks on the World Trade Center, and as anthrax letters passed through the U.S. postal system, the U.S. government released as much information as it could. By contrast, he said, "the way the government has dealt with atypical pneumonia shows its inability to deal with a crisis." Two weeks later the government reimposed the media ban, which stayed in place until March.
By then the Poison King had passed through three hospitals, the Zhongshan Hospital No. 2 and No. 3 and the Guangzhou No. 8 People's Hospital, infecting up to 90 workers. After a recovery that doctors consider miraculous, they discharged him in late-February. On his way out, he knelt before them and presented a thank-you banner. According to the WHO, none of the people who caught the disease from him then re-transmitted it to anyone else. But researchers are still trying to determine if a retired nephrologist named Liu Jianlun who worked occasionally at the Zhongshan No. 2 Hospital had contact with the super spreader. They do know that Liu began showing flu symptoms on Feb. 16, running a high fever. Five days later he visited Hong Kong to attend a wedding and checked into the Metropole Hotel. There, he is believed to have infected several people who then began the widespread transmission of SARS around the world. Liu died on March 4. At last count, SARS has killed 116 people and infected 2,890 worldwide.