Doctors in Shanghai have faced similar political interference. Early last week, physicians at a hospital in the city's Huangpu district were called in by their superior to discuss a new policy initiative straight from the municipal health bureau. For the past couple of months, doctors had been clandestinely searching the Internet for information about SARS, and they hoped for solid information from their director. Instead, he told them not to wear masks in the hospital, save in isolation wards and a few select diagnostic rooms. The gathered physicians were confused. One top administrator meekly said, "I thought wearing masks was supposed to stop SARS from spreading to medical staff." Their superior responded curtly, "Wearing a mask will scare the patients. We do not want panic, especially since SARS has already been controlled."

Local health authorities can get away with such reckless policies because there's little oversight from above. Health Minister Zhang Wenkang actually ranks lower in the government hierarchy than the Communist Party secretaries of Shanghai and Guangdong. That gives the regional Party bosses far more power than the Health Minister to dictate even medical policies in their fiefdoms. Furthermore, each city's center for disease control (cdc), which is responsible for updating China's SARS caseload, reports first to the local Party boss, then to the Ministry of Health. The head of each city's local health bureau is appointed by local Party cadres, not by the Ministry of Health. That structure means local health workers have little incentive to reveal the true magnitude of the crisis.

	Photo Essay: SARS Outbreak

Even doctors on the front lines have been left in the dark, sometimes to their detriment. At Beijing's You'an Hospital, for instance, nurse Zhang estimates that about half of those in the isolation ward are medical staff from other area hospitals. To complicate matters further, the only people who are officially allowed to diagnose SARS in China are cdc researchers, not the physicians who are treating the patients. "I had a patient whose symptoms clearly seemed to be those of a SARS-positive patient," says a doctor who consults at a hospital in a leafy district of Shanghai. "But after I contacted the cdc, the patient was suddenly transferred without my knowledge and I never found out whether he had the disease or not." The physician presumes the patient did indeed have SARS; otherwise, why would he have been transferred so mysteriously? "We doctors are all left with a lot of questions," he says. "I think it's shameful to not let us know what's going on." That information blackout has resulted in unnecessary deaths as local doctors have resorted to trial-and-error treatments rather than using therapies that have proved relatively effective in other hospitals. Physicians in some Guangdong hospitals, for example, were told by Beijing to treat SARS patients for mycoplasma pneumonia and chlamydia pneumonia, which are bacterial infections, even though they had already found that a combination of antiviral medications and steroids showed better results.

Part of the confusion might be springing from China's accounting methods. Current diagnostic tests for SARS are unreliable at best, and doctors worldwide have had to diagnose primarily by evaluating symptoms and proximity to other SARS patients. But with places like Beijing refusing to acknowledge true numbers of infected patients, it becomes difficult to prove that a person has been near a SARS patient, because those victims aren't supposed to exist in the first place. That, plus a more stringent set of requirements applied before confirming a case as SARS means that many patients who would be diagnosed as having the virus elsewhere in the world are only considered "suspected" cases in China. The English patient at the Shanghai Pulmonary Hospital, for instance, has been quarantined for a week, yet the physicians there have told him there's no way they can tell whether he has SARS. "I've heard that in other countries they're able to diagnose within a few days," he says, between dry coughs. "Why can't they diagnose our cases? It's very strange." (The Englishman's doctor says he is treating the man's case as SARS, although the cdc has yet to confirm the case as such.)

Last Thursday it seemed the Ministry of Health couldn't even agree on its own SARS count. At a press briefing in Beijing, Qi Xiaoqiu, director of the Ministry of Health's Disease Control Department, said China's official SARS statistics include "confirmed and suspected cases." Just minutes later Vice Minister of Health Ma Xiaowei told reporters that the numbers he had stated referred only to confirmed cases. Either way, experts agree that the ministry's reckoning still seems far too low. Mainland doctors fret that with continuing ignorance about the disease, the virus could spread even farther. Misinformation abounds: a Shenzhen-based health official named Zhang Shunxiang warned last week that people shouldn't wear masks because they impede proper breathing and contribute to public panic—contrary to advice given almost everywhere else in the world. State-run newspapers in the mainland suggested that a protein-rich potion containing cicada shells and silkworms could be a SARS panacea. Even more worrisome is the possibility that the disease is making its way into China's estimated 100 million-strong migrant worker community, which has little access to health care. Already, doctors suspect that the first case of SARS in Beijing was a migrant who worked in Guangdong. If the virus is indeed infecting members of China's vast floating population, experts fear it could spread quickly into the country's undeveloped interior. With much of China still in the dark about the killer bug, the worst may be yet to come.

—With reporting by Bu Hua/Shanghai and Huang Yong and Susan Jakes/Beijing

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	Beijing's SARS Attack [April 8, 2003] Doctor and party member insists there are many more mainland cases than authorities report Doing Battle with the Bug [April 10, 2003] The latest outbreak in Hong Kong raises troubling new questions about Asia's killer virus The Politics of Disease [April 10, 2003] Why are some countries more successful in fighting SARS than others? Viewpoint: Cycle of Death [April 10, 2003] SARS is only the latest in a string of epidemics to emerge from southern China More Related Items | Search all issues of TIME Magazine