1. Severe Acute Respiratory Syndrome (SARS) –Caused by previously unknown virus, coronavirus (SARS-CoV). –No direct cure, no vaccination. –First appeared in Southern China in 11/2002. –Recognized as a global threat in March 2003. –Infected, 8,098; death, 774. Symptoms and signs of SARS –Incubation Period: 1-2 weeks. –High fever 100.4°F [>38.0°C], Chills, headache, shortness of breath, diarrhea etc. Dry, nonproductive cough after 2 to 7 days. –In 10%-20 % of cases, patients require ICU, (mechanical ventilation). Source: U.S. CDC

2. Ways of Spreading Close person-to-person contact. Examples include: –Sharing eating or drinking utensils, –Close conversation (within 3 feet), –Physical examination, and any other direct physical contact between people such as kissing or embracing. Source: U.S. CDC

3. The SARS Outbreak in China

4. First Cluster of Cases

5. Health Workers at High Risk

6. Health Workers fell to victims of SARS

7. SARS was spread to Hong Kong February 21, 2003

8. News Conference, Hong Kong

9. SARS AFFECTED AREAS (More than 20 countries)

10. The SARS Outbreak (11/2002—7/2003) Infected Death World 8,098 774 China 5,327 349 Hong Kong 1,755 299 Canada 251 43 US 27 0 Source: WHO

11. Fatality Rate –Average Fatality Rate: 14% - 15%. –Fatality ratio depending on the age group affected <24 years-----------------------<1% 25 to 44 years------------------6% 45 to 64 years-----------------15% >65 years--------------------->50% Source: WHO

12. Entering Beijing Ms. Xu make a trip to Guangzhou on February 18, 2003. Ms. Xu was transferred to the Military 301 Hospital on February 28, 2003 and set off the epidemic in Beijing.

13. The 10 th NPC that elected the New Central Government, March 2003

14. Failure of the “Digest Method”

15. Minister Zhang, “Beijing is Safe!”, April 3

16. Dr. Jiang, “Zhang was not truthful!”

17. Wedding During the Outbreak

18. Beijing: Panic

19. New Government and New Approach after April 20, 2003 Mr. Hu, the President Mr. Wen, the Premier 1.OPENLY Launched the Campaign on SARS. 2.Minister Zhang was removed. 3. Enacted Laws on SARS.

20. Footnotes: Two Approaches New: Open and transparent approach Traditional: “black-box” or “relax-outside- intensive-inside” approach---dealing a crisis behind closed doors –Liu, p 51-52

21. New Laws, May 2003 1.SARS Measures by the Ministry of Health 2.SARS Regulations by the State Council 3.Interpretation of Criminal Law Art. 114. 4.Re-print the Law on Infectious Diseases (PTID, 1989)

22. SARS Laws: Contents 1.SARS Reporting System 2.Treatment 3.Prevention

23. SARS Laws-1: Reporting System –Reporting (Vertical, from bottom up) –Releasing (horizontal) –Announcing (Vertical from top down) –Whistleblower’s Rights –Legal Responsibility

25. SARS Laws-2: Treatment –Designated Hospitals –Not to refuse to admit SARS patients –Financial aid to the uninsured

26. Dispatched to Beijing SARS Hospital, May 2003

27. SARS Laws-3: Prevention –Students, Migrant Workers –Rural Areas, social riot –Public Transportation –Intentional Spreading SARS, Art. 114. –Water Resources, food supply

28. Victory, June 24, 2004 Direct Economic Loss: $18 Billion

29. The “new” SARS laws are not a breakthrough Law on the Prevention and Treatment of Infectious Diseases (PTID) set forth rules of epidemic control in 1989. The law is still in force. –Information Reporting –Prevention –Treatment –Legal Responsibility

30. Why PTID was ignored during the SARS outbreak? Local officials are appointed by the government at high level. Not accountable to the local people. The sole goal set by the central government is to increase GDP. Top priority in the localities is to grow economy by all means.

31. Challenges Ahead AIDS 840, 000 Drug addicts: 740,000 Schistosomiasis 843,000843,000 TB 6,000,000 Massive food poisoning

32. Conclusion: Regulating Epidemics in China, Law as an Antidote? PTID revised, August 28, 2004 Will PTID be implemented next time?

33. Questions to think about 1. Why did local and central governments in China cover up the initial information about the SARS epidemic? 2. In time of crisis, which system works better, federalist or centralist? 3. Will the new International Health Regulations (IHR) be fully implemented in China? If not, why? 4. How could we draw some lessons from SARS epidemic to make the hurricane response system in Texas more effective?