Tapping the Source — page 2

Politically, though, Guangdong has acted as shamefully as Beijing—and those mistakes have cost the rest of the world. The province dithered in January when it first identified the virulent new atypical pneumonia that would later be labeled as SARS, losing a chance to stop the disease in its tracks. Even after Guangdong had set up its efficient response system, officials there failed to share their expertise with Beijing and Hong Kong, and misrepresented the extent of the deadly new disease. Although the WHO is "pretty satisfied" with the way the outbreak has been handled medically, "that's distinct from how it was handled politically," says Peter Cordingley, WHO's Asia spokesman.

	Photo Essay: SARS Outbreak

But infection-control methods alone seem unlikely to account for the SARS tally gap between Guangdong and neighboring Hong Kong, the latter having recorded over 130 more cases in only a month-and-a-half, with a fatality rate that's significantly higher than Guangdong's reported figure of 3.5%. Dumb luck plays a part. Guangdong officials say the province hasn't suffered a single explosive outbreak along the lines of Amoy Gardens in Hong Kong, where 321 people were infected, possibly via contaminated sewage, in a matter of days. That sudden mass of seriously ill patients spread SARS through the local community and overwhelmed hospitals, directly leading to more infections among health-care workers.

It's also possible that Guangdong natives have built up herd immunity to SARS, which occurs when a significant percentage of a population has developed antibodies against a specific disease, slowing its spread. But Malaysian microbiologist Dr. Lam Kai Sit notes that "with SARS, the incidence is so low there cannot be much immunity in the general population." Herd immunity could be aided by large instances of asymptomatic infection (infections with no sign of disease), but scientists have no way of knowing if such cases exist without using wide-scale diagnostic tests.

A more likely, and frightening, possibility is that the unstable SARS coronavirus has mutated since it left Guangdong, perhaps into a more virulent and contagious form. Scientists at the Beijing Genomics Institute announced last week that there were significant genetic differences between coronavirus samples sequenced from patients in Guangdong and in Beijing. In Hong Kong, doctors believe the virus may have mutated when it infected Amoy Gardens residents, who suffer unusual symptoms (including severe diarrhea) and have a higher fatality rate. Says Dr. Michael Lai, a coronavirus expert at the University of Southern California: "As the virus responds to different environments, different strains will emerge."

That possibility weighs on the minds of Guangdong's health officials, who know the province is just one superspreader away from a new outbreak. If SARS returns, it could spread rapidly among the province's 31 million migrant workers, who live in cramped dorms and enjoy few health services. "Even just one case a day is a problem," says Chen Rongchang, vice director of the Guangzhou Institute of Respiratory Disease. "One person could easily pass SARS on to 10 people, and then to a hundred. The virus is not dying out." Fortunately, neither is Guangdong's will to stem the tide on this deadly disease.

—With reporting by Neil Gough and Bryan Walsh/Hong Kong and Jodi Xu/Guangzhou

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