Severe Acute Respiratory Syndrome (SARS)

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• Severe Acute Respiratory Syndrome (SARS)
• Caused by previously unknown virus, coronavirus
  (SARS-CoV).
• No direct cure, no vaccination.
• First appeared in Southern China in 11/2002.
• Recognized as a global threat in March 2003.
• Infected, 8,098 death, 774.
• Symptoms and signs of SARS
• Incubation Period 1-2 weeks.
• High fever 100.4F gt38.0C, Chills, headache,
  shortness of breath, diarrhea etc. Dry,
  nonproductive cough after 2 to 7 days.
• In 10-20 of cases, patients require ICU,
  (mechanical ventilation).
• Source U.S. CDC

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• Ways of Spreading
• Close person-to-person contact. Examples include
• Sharing eating or drinking utensils,
• Close conversation (within 3 feet),
• Physical examination, and any other direct
  physical contact between people such as kissing
  or embracing.
• Source U.S. CDC

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The SARS Outbreak in China
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First Cluster of Cases
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Health Workers at High Risk
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Health Workers fell to victims of SARS
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SARS was spread to Hong Kong February
21, 2003
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News Conference, Hong Kong
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SARS AFFECTED AREAS (More than 20 countries)
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• The SARS Outbreak (11/20027/2003)
• Infected
  Death
• World 8,098
  774
• China 5,327
  349
• Hong Kong 1,755
  299
• Canada 251
  43
• US 27
  0
• Source WHO

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• Fatality Rate
• Average Fatality Rate 14 - 15.
• Fatality ratio depending on the age group
  affected
• lt24 years-----------------------lt1
• 25 to 44 years------------------6
• 45 to 64 years-----------------15
• gt65 years---------------------gt50
• Source WHO

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Entering Beijing

• Ms. Xu make a trip to Guangzhou on February 18,
  2003.
• Ms. Xu was transferred to the Military 301
  Hospital on February 28, 2003 and set off the
  epidemic in Beijing.

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The 10th NPC that elected the New Central
Government, March 2003
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Failure of the Digest Method
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Minister Zhang, Beijing is Safe!, April 3
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Dr. Jiang, Zhang was not truthful!
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Wedding During the Outbreak
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Beijing Panic
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New Government and New Approach after April 20,
2003
Mr. Hu, the President Mr. Wen, the
Premier

• OPENLY Launched the Campaign on SARS.
• Minister Zhang was removed.
• 3. Enacted Laws on SARS.

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Footnotes Two Approaches

• New Open and transparent approach
• Traditional black-box or relax-outside-intensi
  ve-inside approach---dealing a crisis behind
  closed doors
• Liu, p 51-52

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New Laws, May 2003

1. SARS Measures by the Ministry of Health
2. SARS Regulations by the State Council
3. Interpretation of Criminal Law Art. 114.
4. Re-print the Law on Infectious Diseases (PTID,
   1989)

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SARS Laws Contents

• SARS Reporting System
• Treatment
• Prevention

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SARS Laws-1 Reporting System

• Reporting (Vertical, from bottom up)
• Releasing (horizontal)
• Announcing (Vertical from top down)
• Whistleblowers Rights
• Legal Responsibility

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(No Transcript)
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SARS Laws-2 Treatment

• Designated Hospitals
• Not to refuse to admit SARS patients
• Financial aid to the uninsured

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Dispatched to Beijing SARS Hospital, May 2003
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SARS Laws-3 Prevention

• Students, Migrant Workers
• Rural Areas, social riot
• Public Transportation
• Intentional Spreading SARS, Art. 114.
• Water Resources, food supply

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Victory, June 24, 2004 Direct Economic Loss 18
Billion
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The new SARS laws are not a breakthrough

• Law on the Prevention and Treatment of Infectious
  Diseases (PTID) set forth rules of epidemic
  control in 1989. The law is still in force.
• Information Reporting
• Prevention
• Treatment
• Legal Responsibility

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Why PTID was ignored during the SARS outbreak?

• Local officials are appointed by the government
  at high level.
• Not accountable to the local people.
• The sole goal set by the central government is
  to increase GDP.
• Top priority in the localities is to grow economy
  by all means.

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Challenges Ahead

• AIDS 840, 000
• Drug addicts 740,000
• Schistosomiasis 843,000
• TB 6,000,000
• Massive food poisoning

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Conclusion Regulating Epidemics in China, Law as
an Antidote?

• PTID revised, August 28, 2004
• Will PTID be implemented next time?

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Questions to think about

• 1.      Why did local and central governments in
  China cover up the initial information about the
  SARS epidemic?
• 2.      In time of crisis, which system works
  better, federalist or centralist?
• 3.      Will the new International Health
  Regulations (IHR) be fully implemented in China?
  If not, why?
• 4.      How could we draw some lessons from SARS
  epidemic to make the hurricane response system in
  Texas more effective?