On the Trail of an Asian Contagion

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She is one of the lucky ones, though the 55-year-old woman lying in her narrow metal bed in the pneumonia ward of Guangzhou's Nanfang Hospital doesn't look it. Ye Qitian's breath comes in ragged gasps, her gray-white hair is bedraggled, and she can only open her right eye halfway as she speaks to visitors. On a rainy afternoon last week, the Chinese housewife says she is recovering from what her doctors have identified as atypical pneumonia, a mysterious disease that has plagued southern China for months and is suspected to have erupted into the outside world in late February. In the space of two weeks, at least 10 victims have died and hundreds more have fallen ill in places as far afield as Hong Kong, New York, Rome and Toronto.

The mother of three attempts a game smile. "I'm going to be okay," Ye insists. Her condition has improved recently, and Ye has even managed to walk around the ward a few times. But just down the hall is another victim who symbolizes the damage this still dimly understood disease can do. The 43-year-old man has been in the hospital for a month. Now, he lies unconscious, the only sound in his room the hiss and puff of the respirator keeping him alive. A nurse lifts the sheet, revealing a wasted, waxen-yellow body. "He will probably die," says a duty doctor impassively. "We've used all the resources of the hospital, but his chances are very slim."

Doctors at the Nanfang Hospital may have done all they can, but Chinese medical officials have not. World health authorities are frustrated with China's secretive officials for keeping quiet so long about an epidemic that appears to have first struck in Guangdong province back in November. After months of media blackout, Beijing now maintains that the worst has passed. Only five patients in China have died, they say, while 305 have fallen ill with atypical pneumonia—a figure that dates back to mid-February. But forays into several hospitals in the provincial capital, Guangzhou, show that at ground zero new victims are still falling ill and dying. One local doctor estimates that the true figure of those afflicted is probably double the official statistic. Across the country, in cities as far-flung as Nanjing and Beijing, medical staff are whispering that a strange pneumonia is also popping up in their hospitals—contradicting China's claim that the disease is confined to Guangdong.

Still, Chinese health-care workers are unwilling to talk too openly; one Shanghai doctor reports that local hospitals were warned by municipal officials last Thursday not to speak to any media, even the state-controlled Xinhua News Agency. This muffling was mandated to quell public panic over the outbreak, says a Guangzhou journalist, whose newspaper received a gag order directly from the Central Propaganda Bureau in Beijing: "The party's biggest fear is social instability."

Speed and accurate information are critical in defeating such outbreaks, and critics say Beijing's silence has had deadly consequences. In 1997, when a previously unknown strain of avian influenza killed nine in Hong Kong, the government's swift move to quarantine patients and cull more than a million chickens was widely credited with halting the spread of the disease. The risks of an uncontrolled viral outbreak are catastrophically high: with its tens of millions of pigs, poultry and people living in close proximity, southern China has long been one of the world's most lethal breeding grounds for killer viruses.

Now that the disease has escaped its national borders, Beijing has more to worry about than just containing domestic panic. With cases of what has been formally dubbed Severe Acute Respiratory Syndrome (SARS) cropping up in no fewer than 13 countries, Chinese officials are coming under intense international pressure to allow foreign access to medical records, perhaps even to the patients themselves. Yet, as of last weekend, all the Health Ministry had offered up was a skimpy two-page document. Officials from the World Health Organization (WHO) would like to send a team of experts to southern China to investigate. But although Chinese authorities finally approved visas for a WHO team last Friday, they have not yet given the team approval to visit Guangdong, nor have they indicated what medical records they will hand over. "We'd like to see more case-based data—lab results, what treatment was given, what worked," says Alan Schnur, team leader of communicable-disease control in Beijing for WHO. "We might turn up something unexpected by looking at the data."

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By passing on information such as which drugs worked best on the mainland, Chinese officials might have saved other researchers from weeks of agonizing trial and error. Dr. Ronald Low, microbiologist in chief at Toronto's Mount Sinai Hospital, believes that earlier Chinese disclosure of case histories could have accelerated development of a treatment. Low says that since his hospital started administering the antiviral medicine ribavirin, patients have stopped dying. "So far, all the patients on this treatment are still alive," he says, "and most of them are showing improvement."

Doctors outside China were scrambling last week to pin down how the pathogen is transmitted—critical in stopping the disease from spreading further. After painstakingly tracing patients' histories, scientists have deduced that the disease is probably spread through direct contact with bodily fluids, such as phlegm. Here again, cooperation from Chinese authorities might have helped. As long ago as Jan. 21, an official internal advisory—issued to doctors in Guangdong and later obtained by Time—laid out how the disease appears to be transmitted. "Given that the explosion of the epidemic was mainly in the same area and some patients passed on the disease to family and doctors gathered in the hospital ward," the report states, "we think the disease is passed through breathing in flying particles of saliva."

That conclusion is reinforced by SARS cases outside China, which have almost all involved relatives and caregivers of the victims. One frightening exception to this pattern of transmission is the outbreak at the Metropole Hotel in Hong Kong's down-at-the-heel Mongkok district. Six ill-fated guests on the hotel's 9th floor appear to have caught the disease from semiretired medical professor Liu Jianlun. He is believed to have been solely responsible for carrying the disease from Guangdong into Hong Kong in mid-February, after reportedly catching it while treating patients at a Guangzhou hospital. Scientists think Liu, 64, came into close contact with his fellow guests at the Metropole either while waiting for an elevator or riding from his room to the lobby. That would have put them within range of a sneeze or a cough—enough, it seems, to have turned them into a deadly squad of virus bearers who would disperse the disease all over the world.

One unsuspecting carrier thought to have caught the virus at the Metropole was Chinese-American businessman Johnny Chen. He left Hong Kong for Hanoi on Feb. 24, quickly fell ill and was evacuated back to Hong Kong, where he became the disease's first known fatality outside China. While in Vietnam, he infected at least 61 others, many of them medical staff at the Hanoi hospital where he was treated. Another Metropole guest, an elderly tourist from Canada, carried the disease back to Toronto. There, she infected five family members, including her son, who in turn infected two others. Mother and son died earlier this month. Three Singaporean tourists at the Metropole returned home with the illness, and a 26-year-old Hong Kong man caught it while visiting a friend at the hotel. He went for treatment at the Prince of Wales Hospital and is believed to be the first link in the chain leading to most of the territory's 200-plus infections. With so many cases concentrated in Hong Kong, travel agents are reporting a slew of cancellations by tourists who had been planning to travel to the territory. Other stricken nations are also running scared: many students in Vietnam are staying home from school because parents are fearful of exposing them to the disease.

Amid the gloom and uncertainty, there has been some hope. WHO scientists say they are increasingly confident that SARS is one of a family of microbes known as paramyxo-viruses, which includes the pathogens responsible for measles, mumps and the Nipah virus, which killed 105 people in Malaysia four years ago. On March 21, WHO announced that intensive efforts among 11 laboratories had produced the first potential diagnostic test for SARS, which up until now could be identified only by its symptoms. "This is not just some light at the end of the tunnel," says WHO virologist Dr. Klaus Stöhr, WHO is coordinating the laboratories' efforts. "This is a real ray of sunshine."

Such news is an enormous relief for doctors around the world. But experts are warning against complacency, particularly when the extent to which SARS has already spread remains a mystery. Kitty Fung, a microbiologist at the Chinese University of Hong Kong, says it's currently impossible to say for certain if efforts to contain the disease within the territory's Prince of Wales Hospital, where the bulk of the SARS victims are being cared for, have been successful. That's despite the fact that much of the huge hospital has been shut down. Stretches of the hospital's normally bustling corridors are eerily empty and reek of disinfectant. Everyone from security guards to janitors wears thick, double-layered face masks; many of them also don disposable gowns and hats for further protection. Despite such precautions, says Fung, the disease may already have spread far beyond what medical authorities first expected. "There seem to be more and more cases popping up, and we don't know how many more will appear. I doubt this will be over any time soon."