China Admits Much Higher Number of SARS Cases

ERIK ECKHOLM / NY Times 20apr03

China has had a total of 1,807 confirmed cases of SARS, with 79 deaths

BEIJING, April 20 -- In a rare, blunt and very public admission of failure, the Chinese government said today that cases of a dangerous new respiratory disease were many times higher than previously reported and pledged an all-out and more forthright campaign against the invading virus.

Also today the health minister, who 10 days ago described the epidemic of severe acute respiratory syndrome as "under effective control" and claimed that Beijing had only 22 cases at the time, was fired. So was Beijing’s mayor, who had declared the city safe.

With the bureaucratic shuffling and an apologetic, two-hour news conference by a senior health official, the Chinese government sought to repair its shredded credibility -- at home and abroad -- about the spread of the new, sometimes fatal virus.

Admitting to the existence of a large number of SARS patients in military hospitals, and revealing what he called the first aggressive survey of cases in some 70 scattered hospitals, the health official said that Beijing had 346 confirmed cases of SARS by April 19.

The city's hospitals also held an additional 402 "suspected" SARS cases, a deputy health minister, Gao Qiang, said at a hastily arranged news conference today. He warned that a significant number of the suspected cases are expected to be confirmed.

"The Ministry of Health was not adequately prepared to deal with a sudden new health hazard," Mr. Gao said, seeking to explain the jump in official numbers. "Accurate figures have not been reported to high authorities in a timely manner," he added though he later argued that incompetence rather than deliberate deceit was the main cause.

In an unusual move for such sensitive and embarrassing news, the news conference was broadcast live on a national television channel.

In another sign that the government is taking the SARS threat seriously, officials said they were canceling the seven-day vacation surrounding May Day. International health experts have warned that the mass movement of holiday travelers could spread the disease to far-flung parts of the country. Today, despite the potential economic losses, officials said the vacation would be limited to one day, and encouraged people to stay close to home.

It became apparent that a political as well as a medical drama was unfolding at the outset of the briefing, when Mr. Gao and a second deputy health minister appeared instead of the previously announced speakers, the health minister, Zhang Wenkang, and the mayor and a deputy party chief of Beijing, Meng Xuenong. The removal of the latter two from their posts was soon announced by state media.

The unveiling of markedly higher disease figures as well as the firings, perhaps the first of many, capped a tense week in which China's efforts to play down SARS, especially in Beijing, were assailed by experts from the World Health Organization and questionied by Beijing residents, who through word of mouth began learning of far more patients than officials had acknowledged.

The president and Communist Party leader, Hu Jintao, and the prime minister, Wen Jiabao, spent the week describing SARS as a grave danger to society and sternly warning officials not to cover up any cases. Today Mr. Gao had the delicate task of explaining what he tried to describe as incompetence and mistakes in the city's public health system, despite evidence of deliberate deception in some cases.

How soon the confidence of a fearful and suspicious public can be regained -- and the impact on the fortunes of Mr. Hu, who took over as supreme leader over recent months -- were not yet clear this evening. Some political experts say the building crisis in public confidence over the handling of SARS was approaching that after the military massacre of unarmed demonstrators in June of 1989.

"This is the first time since 1989 that the leaders and the system have come under such close global scrutiny and pressure," said Ding Xueliang, a political expert at the Hong Kong University of Science and Technology.

Today Mr. Hu, in effect, engineered a rare and painful show of public contrition, for which he may gain some respect. But the understatement of Beijing's disease burden began in early March if not before. Officials have privately said that no one wanted to release bad news during the two-week meeting of the Parliament in March, which certified Mr. Hu as state president and Mr. Wen as prime minister, though it is unclear who may have given any explicit orders to ignore SARS.

While the health minister and deputy mayor have lost their jobs for their handling of the crisis, their efforts to minimize or conceal the threat fit into a well-worn Communist Party tradition. But the approach is less tenable in an era of global communications and an increasingly outspoken public and now, the strategy has exploded in the faces of the leaders.

Today, Mr. Gao of the health ministry repeatedly tried to heap blame on the ministry's shortcomings, and to the disarray in Beijing where several political jurisdictions, including municipal, national, military and others, overlap but have not up to now coordinated disease-control efforts. As of today, Beijing city health officials will oversee all anti-SARS measures throughout the urban area, Mr. Gao announced.

Chinese people are accustomed to dissembling by national or local officials, Mr. Ding said, but in this case, the disease is felt everywhere as a personal threat, adding an extra potency to the growing public suspicions.

"Over the weeks, as people saw how the government tried to manipulate information, SARS became a serious political problem for the government as well as a medical one," Mr. Ding said.

In new national disease totals through Friday released today, China has had a total of 1,807 confirmed cases of SARS, with 79 deaths.

Guangdong province, where the epidemic first appeared last fall and where early official secrecy has also been criticized, accounted for 1,304 of the total. Mr. Gao also expressed concern about the spreading reports of SARS in several inland provinces while some outside experts said the case reports from some distant provinces seemed too low.

A major source of error in previous Beijing reports was the exclusion of patients in several large hospitals that are run by the military, but which also hold civilian patients. The angry assertion by a retired military surgeon that more than 100 SARS patients were in the military system and being omitted from public reports was a severe blow to

the government's credibility and today, Mr. Gao revealed that the discrepancy had been still greater. Of 353 SARS patients still in the hospital on Friday, he said, 235 of them were in military hospitals, for reasons no one has explained.

Over the last week, Mr. Gao said, hundreds of officials were dispatched to all of Beijing's hospitals to check for possible SARS patients and whether they had been reported to the city or national authorities. They came up with totals that well surpassed the rough estimate of a World Health Organization team, which on Wednesday caused

consternation here by declaring that Beijing had undercounted and that the total might be in the range of 100 to 200.

Mr. Gao urged the public to understand that the sudden multiplication of cases did not imply a sudden new surge in disease, but rather that the official numbers were catching up to reality. "In days to come, more of the ‘suspect’ cases will be confirmed," he added.

With more complete SARS data only now compiled, Mr. Gao said, the trend in the epidemic is unclear, and he did not say whether new cases each day are still rising.

"I trust that the situation will be much improved following a period of hard efforts," he said. "We will spend as much as it takes to contain this disease."