They said the invention of guns made it possible to fight a war without bodily contact with your adversary. Then as artillery technology developed, wars could be fought without even eye-contact. Recently, in Iraq, the war was fought virtually, without even seeing the enemy on the radar screen. Now, in the case of SARS, the enemy can only be seen using electronic devices, microscopes, laser detectors and television receivers. Not knowing where, when and how the enemy will attack can drive defenders to distraction. The choice us to remain a highly guarded, live to the extent of your nerves, or to simply ignore it. What else can you do?
After over 4 months continuous work in China, I almost delayed my planned trip back home to Thailand at the end of March as I was told that I might run into lengthy interrogation and medical inspection on my arrival at Bangkok airport due to the SARS epidemic in China. In contrast, there was not even one hint of trouble, fear, or panic to be seen on the street of Shanghai. I decided to take the trip at the last minute on a late night flight March 24 and arrived in Bangkok early the next day. It was a smooth sail through to the taxi and back home within minutes. The only new procedure I encountered was a few medical personnel handing out a name card sized advisory.
Two days later, as the WHO medical expert from Italy died in Bangkok, succumbing to the SARS virus that he contacted during his missions in China and Hong Kong, the Thailand government imposed lengthy airport medical inspections for travellers from China, causing hours of delays at Bangkok's Don Muang International airport. Two days later, as an old Hong Kong Chinese recently returned from Hong Kong died of SARS in Haad Yai, Southern Thailand, the Thai government imposed a 14 days home-quarantine requirement for all Thais returning from SARS infected areas. The directive subjected violators of the self-quarantine to a 6 months jail term or 10,000 Baht (USD$220) fine. At the same time, tourists from these countries were required to wear masks at all times for the first two weeks of their stay. Police sealed off the Bangkok hotel where the SARS victim was thought to have stayed during his one night stopover in Bangkok. It turned out later that they had shut down the wrong hotel.
Nervousness in Bangkok and other parts of Thailand rose daily with reports of increasing number of SARS deaths around the world. Walking pass the private clinic where our family has entrusted their medical care since my childhood, I saw my doctor, Dr. Amnuay, as he was about to get into his car. Upon hearing that I had just returned from China, Dr. Amnual very professionally and instinctively produced a handkerchief and slowly covered his nose and mouth with it. He went into the car before hearing that I had been back for more than 2 weeks already.
My daughter, who had just completed a Masters degree in Environmental Science from Chulalongkorn University explained the reason for her lateness in an appointment with me: "...I had to change my route, in order not to pass the Bangkok Chinatown streets. Too many tourists from China and Hong Kong might have visited those streets." After two weeks self-imposed home stay, I decided to take my children to a large shopping center for a short stroll and dinner. As we sat having our dinner, the TV in the food center continuously showing announcements, advisories, and news about SARS. Suddenly, the program was abruptly changed to "Animal Planet". Noting the sensitivity of the store management's fear of scaring away the would-be patrons, we decided to leave the shopping center for home via the shortest possible route after finishing our meal and washing our hands. The taxi driver complained, "People have over-reacted - you are only my second customer since 5 p.m. today."
The SARS panic reached its height in Thailand after reports of seven more suspected cases in addition to the two "imported" cases. Theaters, entertainment places, and shopping centers in Bangkok emptied. Masks started appearing with higher frequency.
Malaysia promptly issued an entry visa ban for tourists from China. Facing such unpleasant treatment, in retaliation the Chinese government issued an order prohibiting its citizen's from taking organized tours to Thailand, Malaysia and Singapore.
As the Thai tourism business - one of the main exchange earners of the country - started feeling an impact from these impromptu government actions, the Thai government decided to send a Deputy Prime Minister to China to explain the Thai action in hope that the Chinese government would lift its travel ban. Thailand's multi-billionnaire Prime Minister offered guarantees that Thailand was safe from SARS and pledged a bait that any foreigner getting infected by SARS from Thailand during the festive month of April would be rewarded one million baht in compensation from the PM himself.
On April 13, a day before my scheduled return trip to Shanghai, I called up a friend in Shanghai about the SARS situation in Shanghai in order to decide whether to delay that trip. Ellen almost blasted my eardrums with her laughter:
"...WHAT? You crazy?! There's nothing in Shanghai now except one or two over-sensitive people walking around wearing mask."
I was assured that there was no impact on life in Shanghai whatsoever. I flew back re-assurred. The clearance through Shanghai Pudong airport was also very expedient. There were some advisory messages on Shanghai TV programs encouraging exercises, keeping warm and getting plenty of rest as a measure for building up one's immunity. There were no excitement or panic to be seen. I bought the body temperature measuring device and a bottle of Vitamin C for a friend from a drug store with ease.Around this time, suspicion expressed through various foreign news sources on Beijing's exclusion of some of military and other hospitals from WHO experts' SARS inspection tours. At a news conference on April 19, the Deputy Minister of Public Health, revealed that there were 346 cases of SARS, not 37 as earlier reported, plus over 700 more suspected cases, in Beijing. Altogether, the number of confirmed or probable cases in Beijing was well over 1000.
The dismissal of the Minister of Public Health and the capital city's Mayor were reported almost immediately after that news conference. Fear and panic immediately blanketed the minds of many of the inhabitants of this capital city. Many migrant workers and university students opted to flee the capital for their rural homes in search of safety from SARS.
Shanghai was immediately stricken with fear as the WHO team flew from Beijing to Shanghai. The city's immigration flow to and from Hong Kong and Guangdong is not much different from Beijing - thus it was feared that the number of actual SARS cases in Shanghai may well have been similar to Beijing. At the time it was almost impossible for any one to believe in the officially reported number of two infected cases and seven suspected cases. City life suspended as the citizenry anxiously awaited the outcome of the WHO team's inspection.
As I emerged from two days of a training course on Friday, April 25, just before the WHO's press conference, I was told by the organizer that my training for May and possibly June would have to be cancelled or delayed because the city had just announced the prohibition of all non-essential gatherings of people such as meetings, conferences and seminars. Thank God, at least, I had finished this one, allowing myself the necessary income to pay my rent. The organizer foresaw at least a dozen fully booked training programs cancelled, if they could not hold any training seminars for the next two months.
With the revelation of the seriousness of SARS in Beijing and China as a whole, and with the appointment of Wu Yi - a deputy prime minister to head the national task force against SARS - this most populous nation of the world embarked on one of the biggest nationwide mobilizations since the Sinoi-Japanese war. A public knowledge campaign and a program of detection and preventative measures were activated from the household and village level right up to the national level. The speed of these programs proved, in a way, some benefits in people-organization at all level in China since the take over of the Chinese Communist Party 54 years ago. The response was swift with a strong tone of patriotism. Unavoidably, practices to stop the spread of this deadly disease varied according to the situation of each locality.
Airports, rail stations, long-distance bus stations and river and sea ports immediately went into high gear in the attempt to detect the entry of suspected SARS infected persons and quarantine them. Due to the 14 days incubation period of the coronavirus, there is no way to detect most would-be SARS carriers. The defense against this invisible enemy has proved to be a difficult task. Some transit towns and cities issued orders banning long-distance transit travellers from disembarking their boats, trains or buses. In many cases boxed food was served on the long-distance buses instead of allowing the passenger to eat at the bus terminal's restaurants. There were no reports on how "calls of nature" were handled. Drives and passengers were advised to wear mask throughout their trips. They were also required to take body temperature checks at the start and at the end of their journeys.
A young lady worker at one of the KFC establishments told me that staff were required to wash their hands with soap every hour and wear masks through-out their working hours. I returned one day to find the north gate to my apartment complex locked with a note annoucing the closure of the gate in order to reduce traffic flow of people passing through our area. Signboards featured warnings and informative messages about SARS and preventative measures plus a Chinese herbal formula to re-inforce the importance of body immunity as advised by the local herbal medicine authority. That same formula was also shown repeatedly on TVs and in short messages on mobile telephones.
As the number of infected persons rose in Beijing, the city felt increasingly numbed by fear. There were rumors time and again that the capital would be shut down. Supermarkets in Beijing experienced grocery and dry-food shopping splurges. Shelves emptied as people begin to prepare to quarantine themselves or for the likelihood of being restricted to isolated zones. Most schools were closed. For some, teachers turned to the Internet to continue their lessons to the students. As the number of infected persons in Beijing surpassed 1,000, all entertainment places including internet cafés were order to close. Wedding receptions were prohibited in Beijing as another precautionary measure, thus, delaying the knot-tying for many couples.
Finally, on April 25, the WHO team affirmed the effectiveness of Shanghai's SARS pervention work. WHO experts noted that no major flaws were found in the city's medical records and reporting systems. They also complimented Shanghai for the city's thorough and fast moving work. As at the time of this press conference there were 2 cases of SARS and (by then) 18 cases of suspected infected persons.
As the WHO team left the city for Beijing, the inhabitants of this metropolis of 17 million people did not ease up at all. It had become a fashion to outdo others or oneself in the wisdom of using preventative measures. Returning from downtown Shanghai one evening, I was surprised to find the rush hour air-conditioned bus relatively empty, comparing to the jam-packed non-air conditioned ones. Airconditioned bus fares are double those of regular buses, but the newly affluent Shanghai people never seemed to mind that extra yuan during rush hours before. As I boarded the airconditioned bus and paid my two yuan fare, I discovered that the air conditioning was off and all of the windows were open, as advised on T.V. At least the cushioned seat on the airconditioned bus was, as usual, more comfortable than the regular bus. What's more, it felt almost like a private limousine.
An order was posted that all school students would have only one day of holidays for May Day instead of four days and no students would be allowed to leave schools or universities during the holiday. The Shanghai Public Library reduced opening hours and suspended all book loans in order to cut off the means of disease transmission. During a popular TV forum program, a caller asked: "...Is it safe for me to wear shorts or skirts while going out?...".
In Shanghai stores, stocks of medical masks, disinfectants, Vitamin C and the most popular Chinese herbs were completely depleted. TV programs began to advise citizens to use proper agents for disinfecting and hand cleaning. Citizens were advised not to use some of the strong acidic disinfectants for hand-washing for fear that some over-anxious towners would scrub their hands raw while trying in desperation to "kill off" suspected traces of SARS that they might have contacted while being outside their own homes. Nine companies charged for hoarding medical masks and disinfectants and those attempting to sell the items at four to 5 times their normal prices were prosecuted and their names were announced on TV.
Suddenly at the Shanghai Teacher's Training University's sport ground, new bodies were turning up for exercise. Exercising was strongly recommended by public media in addition to nutritious food and good rests as a way of preventing SARS attacks. Warning and informative messages about SARS detection and prevention appeared at the entrances and many signboards of the university. A week after the Beijing press conferences, all universities were ordered closed to outsiders, including users of the university sport grounds. As the tension and fear heightened, I noticed a new message being posted on the University's signboard. It was titled "How to Maintain Your Mental Hygiene Amid the SARS Epidemic." This said it all about the typical state of mental hygiene during the week past.
One of the WHO expert was surprised by the detail and promptness of the work of the Shanghai medical team. They discovered that, after admitting the first SARS patient, the officials immediately took the patient's two children from their school and isolated them along with another 162 or so people who had had contact with the infected person. All of these were within a day or two from the discovery of their first case of SARS.
As I sit down to study the statistics of SARS spread and impact in China, I notice two clear paths in the spread of the epidemic - home-going migrant workers from Guangdong Province during the Chinese New Years holidays, and the Kowloon-Jiujiang-Beijing railroad. Particularly, the number of SARS cases reported in Beijing, Hebei, and Anhui were probably linked to travellers on the approximately 24-30 hours trip in the airconditioned trains operating between Kowloon in the Hong Kong Special Administrative Region (SAR) and the capital city of Beijing. The highest number of cases remain at both ends and the main station in between of Guangzhou. Cases in the economically poorer provinces of Sichuan, Shanxi, Hunan, Hubei, and Anhui were probably related to returning migrant workers.
As I write, a scene is being played out on TV where one key road junction is being sealed off by police while at least nearly a dozen medical personnel arrive in two ambulances in their full SARS battle-gear approaching a person shivering under a blanket under an elevated road. The body temperature check of the person revealed a normal body temperature. After some preliminary questioning of the potential patient, they take him on a stretcher to the hospital. As the traffic returns to normal after nearly half an hour, the report comes from the hospital that the man, an unemployed migrant laborer from Jiangsu Province, was cleared of any suspicion of SARS and was allowed to go home.
Said one of the medical personnel involved - "...Well, take it as a rehearsal of an emergency case, then it's not all that bad..."
