"That was before we even called it SARS," said Shen Zhuang. "We called it Guangdong Respiratory Disease. At the time, nobody thought that it would be as contagious as it turned out to be. People thought it spread the same way as other viruses, getting weaker with each generation, and that by the third-to-fifth generation it wouldn't have the ability to infect anyone. We also didn't think it would reach as far as Beijing, as it was from so far away. You can't blame anyone for thinking that at the time, because none of us had any idea what SARS really was!" Shen Zhuang's words reflected the general understanding of experts in Beijing at the time.
"But at the Beijing Bureau of Health and its affiliated disease prevention departments, after the reports from Hong Kong and Guangdong, we didn't let our guard down." Shen took out materials from the Beijing Bureau of Health for me to look at. The first was a report written to superiors after Beijing's first official diagnosis of SARS—a patient known as Ms. Yu. In the last paragraph it says:
"Considering that this incident occurred during the convention of the Lianghui, that the patient is believed to have travelled to Guangdong, and it is highly suspected that they have been infected, inability to treat the patient without delay could cause particularly severe consequences."
The second report was the "Beijing Bureau of Health SARS Response Plan" . It had quite a few pages. It proposed a three-level alert system of measures in response to a small-scale, medium-scale, and citywide epidemic. This response plan was written on March 8th and compiled by Shen Zhuang in response to research presented at an emergency meeting of a number of leaders of the city's Bureau of Health that afternoon.
At around that same time, a leader at the bureau hurriedly pulled Shen and his colleague He Xiong aside.
"You two! Whatever measures you adopt, you need to sort out the situation with those patients from Shanxi at the 302 Military Hospital before midnight tonight. When you're done, report to the bureau immediately."
Shen understood the leader's nervousness over the possibility that the patients could be infectious. At 10 pm, Shen and He Xiong, the Beijing CDC deputy director, arrived at the 302 Military Hospital. As they entered the first floor corridor, when doctors heard that they had come to investigate the family of patients from Shanxi, they were handed masks and told, "now that you're here, you're on your own." The doctors then moved to another ward. Left alone, Shen and He looked at each other in dismay.
"When you went in," I asked him, "what help did they give you, other than the masks?"
"Nothing," he replied. "There wasn't even protective clothing."
Walking through the ward corridor, Shen made a note of his surroundings. It was completely empty, with only the Shanxi family taking up three rooms. At that point, Shen understood and made a record of Beijing's first transmission of SARS, and the basic situation of the outbreak in the patient's family. In technical terms, he made the family the subjects of an epidemiological survey.
The Yu Family
According to family members, the patient, Ms. Yu, was 27. She was a resident of Taiyuan in Shanxi. She dealt in precious stones, and in February of that year had gone to Guangdong for a business trip. As she was leaving home, her mother phoned a colleague of hers who was working in Guangzhou, inquiring as to what the SARS situation was over there. The colleague answered very clearly:
"It's all rumors. There's nothing to worry about."
"Still," her mother replied, "it's best to be on guard."
Her father prepared her a few packs of isatis root granules, a traditional Chinese cure.
And so Ms. Yu departed for Guangdong. On arrival, she remembered her father's warning, and asked a taxi driver what the SARS situation was.
"I drive so many people all over the place every single day," sneered the driver, "and look at me. I'm healthy as a horse."
Every person she asked confirmed it: everything was fine. She put her concerns at the back of her mind. She wasn't going to let it bother her. On February 22nd, she took a car from Shenzhen to Guangzhou. She began to feel a bit feverish. On the 23rd, she flew from Guangzhou to Taiyuan. She was running a temperature of 38.8℃.
That day, Ms. Yu checked into a hospital in Taiyuan. Worried, she asked the doctor whether she could have contracted SARS. The doctor laughed.
"Don't make a mountain out of a molehill! It's quite unlikely that you'd contract SARS." A little while later, the doctor came back with the results of an X-ray and a blood test. "It's nothing to worry about. Just a cold."
But the fever that this "cold" had given her didn't let up. Something didn't feel right to Ms. Yu.
"What's wrong with me?" she gripped her husband's hand and begged. "Please, help me!"
Her husband clenched his jaw. "We can't waste another minute. I'm taking you to the best hospital in China."
This decision would be the one that snatched her from the jaws of death. But Beijing would ultimately pay a dear price for it.
Shen Zhuang's superiors gave him two duties: first, to clarify the patient's medical history in order to stop the spread of the disease at its origin; and second, to get the people surrounding the patient who had not contracted the disease to leave Beijing and return to Shanxi immediately.
"CDC staff should also, as a matter of course, clarify the entirety of the patient's medical history, in order to facilitate maximum containment. And at the time, getting the people around the patient who had not contracted the disease to return to Shanxi made absolutely no sense. At the time we were still unsure whether SARS had an incubation period, or whether patients were infectious during that incubation period. All we knew was that SARS was infectious, and we couldn't let the patient infect other people." Shen Zhuang felt helpless.
