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Superspreader of sars { May 29 2003 } Original Source Link: (May no longer be active)
http://www.washingtonpost.com/wp-dyn/articles/A51223-2003May28.htmlhttp://www.washingtonpost.com/wp-dyn/articles/A51223-2003May28.html
A 'Superspreader' of SARS
How One Woman Touched Off Beijing Outbreak
By Philip P. Pan
Washington Post Foreign Service
Thursday, May 29, 2003; Page A01
TAIYUAN, China -- She had been running a 104-degree fever for nearly a week, and the city's best doctors were stumped. They suspected the 27-year-old businesswoman was suffering from a new flu rumored to have appeared in southern China, but knew nothing about how to treat it. So the patient and her family decided to go to Beijing.
It was a simple decision, the woman recalled recently, because the nation's best hospitals were in Beijing, only 250 miles to the northeast. Her husband and a friend rode with her in the ambulance, while her mother and a doctor followed in a car. The trip took nine hours, including a delay caused by a flat tire.
At the time, in late February, the Chinese government was still trying to hide the outbreak of the disease now known as SARS. There was no way the woman, who asked to be identified only as Yu, could have known she was carrying the new virus or predicted that Chinese authorities would later say she was the first person to bring SARS to Beijing.
Neither she nor her companions wore masks, gloves or other protective gear on the journey. And when she checked into the People's Liberation Army No. 301 Hospital after midnight on March 1, the staff seemed equally uninformed and unprepared. The hospital placed her in a general ward with other patients, she said, and the doctors and nurses took no special precautions while examining her.
Thus did the world's worst outbreak of severe acute respiratory syndrome begin. Yu passed the virus to her family and friends, to other patients and doctors and nurses, who then spread the disease to countless others in Beijing, eventually undermining the government's coverup and prompting a crisis that has shaken the ruling Communist Party. As of yesterday, SARS had infected 2,514 people in Beijing and killed 175 of them.
Other people brought SARS to Beijing, too. But authorities say this daughter of urban intellectuals in impoverished Shanxi province was the first "superspreader" to arrive in the Chinese capital. She and her family were treated in three hospitals, and all three emerged as early centers of the epidemic.
Now the outbreak appears to be slowing, and Beijing's Patient Zero is back home in Taiyuan, the provincial capital of Shanxi. A slender young woman with long, black hair, Yu appears to have made a full recovery, though her eyes are slightly puffy, perhaps from tears. The disease killed both her parents, and on the sleeve of her white blouse is a black button with a Chinese character, a traditional symbol of mourning.
"What we've been through is misery and misfortune that we never could have expected," said Yu, who asked that only her surname be used to protect her privacy and make it easier to speak freely.
She emphasized that she was not criticizing the government. But her story highlights much of what went wrong in the early stages of the SARS outbreak in Beijing, and she said she hoped people in China and elsewhere could learn from it. "I hope our miserable experience will not befall others. I hope our experience will serve as a warning to society," she said. "Sometimes, fixing things after a bad result can be a good thing."
Yu still can't figure out how she was infected with SARS. But the details of her February business trip to southern Guangdong province are still fresh in her mind: the long flight from Taiyuan, the taxi rides in the bustling border city of Shenzhen, the clean, air-conditioned hotels in Guangzhou.
Reports of Atypical Pneumonia
Before making the trip, she had heard reports of an atypical pneumonia spreading through Guangdong. The government denied it was serious, and her mother, a Taiyuan journalist, called colleagues in the region and was told there was nothing to worry about. Still, Yu and her brother avoided crowds and stayed in clean places.
A few days into the visit, though, on Feb. 22, she began to feel feverish during a bus ride from Shenzhen to Guangzhou. She said she considered going to a hospital, but her husband was worried and persuaded her to fly home the next day.
In Taiyuan, she told doctors at several hospitals that she might have been infected with the atypical pneumonia in Guangdong. But because the government was continuing to play down the outbreak, the doctors were skeptical.
"They thought it was a cold and gave her normal antibiotics," recalled Yu's husband, who asked to be identified only by his surname, Chen. "The health workers were very responsible, but it's a pity. They didn't have information about SARS."
Chen said he called one of Guangzhou's largest hospitals to ask about the new illness, and was told it could be a form of chlamydia. Chinese officials promoted that theory for weeks, in part because such a disease would be less serious than one posed by a new virus. But Yu tested negative for chlamydia.
Meanwhile, her fever was getting worse, and she was getting weaker, unable even to eat. On Feb. 27, the director of the respiratory department at the Shanxi Province People's Hospital concluded the situation was serious, moved Yu to a special ward and ordered staff to wear masks when treating her.
The next day, Chen decided to take his wife to Beijing, and the doctor agreed to accompany them. By then, according to state media, Yu had infected at least 11 people in Taiyuan. The city now has more cases of SARS than any other in China besides Beijing and Guangzhou.
Ignorance and Coverup in Capital
The family arrived in Beijing in the middle of the night, and went to the No. 301 Hospital, a well-known military facility that has a special ward for senior government officials but is also open to the public.
If a new virus was spreading through China, certainly the doctors at this hospital would know about it, Chen recalled thinking. But he was wrong. "The illness appeared in Guangdong last November. How could a national-level hospital not receive the necessary notice?" he said.
Yu said the hospital waited three days to transfer her from a room she shared with other patients to her own room in the respiratory ward. Chen credited a young doctor who searched for information about the new illness on the Internet. But the virus was moving quickly.
Both of Yu's parents came down with fevers. They tried to hide the fact, hoping not to upset their daughter. But on March 4, Yu's mother was admitted to the No. 301 Hospital. Her father flew to Beijing and checked in, too.
On March 5, Yu and her parents were moved to the People's Liberation Army No. 302 Hospital, because it specializes in infectious diseases. But Chen said the ambulance driver and medical staff took no safety precautions during the transfer.
Frustrated, he called a major state-run newspaper in southern China from his hotel room the next day, hoping to raise an alarm about the disease, he said.
"We said, 'This disease is very dangerous and infectious. We hope the media will warn society,' " he recalled. "But the woman said, 'We've heard about this disease. We have it in Guangzhou. But we can't help you.' "
At the time, Chinese authorities had imposed a ban on reporting on the new illness. The National People's Congress, China's legislature, had just opened its annual session in Beijing. The meeting was of particular importance because it marked the beginning of a new government, with a new president and premier, and as a result negative news reports were forbidden.
Meanwhile, in a room in the No. 302 Hospital, Yu watched her father and mother, both in their early fifties, grow weaker. It became so difficult for her father to breathe, he was forced to sleep sitting upright to avoid violent fits of coughing. On March 6, a team of doctors performed a tracheotomy, but he died the next day.
Yu's husband came down with a fever next, as did friends who had accompanied the couple to Beijing. She also received bad news from home: Her year-old son, her brother and her brother's wife also had fevers. They all flew to Beijing and were admitted to the hospital.
Tensions at the Hospital
At first, Yu said, the hospital put her son in her room. But she objected, saying the child might not have the infection, and persuaded the hospital to put him in a separate room. There were other clashes with hospital staff. Chen said some doctors and nurses avoided them, showing up only a few times a week to demand payment of their medical bills. But he said others risked their own health to help them.
Yu and her husband were in opposite rooms, and they communicated by speaking loudly from their beds and letting the sound carry across the hallway. They also watched television, and saw Chinese officials continue to deny the epidemic.
"We were all scared at the beginning, but when we were all lying down, there was nothing to be afraid of," Chen said. "Maybe we were just exhausted."
Yu said she never suffered serious pain or coughs, only a fever, aches and general weakness. After a few days, she and some of the others began to show signs of recovery, and doctors said they wanted to transfer them back to Taiyuan. The family resisted, arguing that they should be moved only if they had fully recovered. But the hospital wouldn't back down, saying the beds were needed for other patients.
By then, the virus was spreading among the hospital's staff, some of whom had tried to save Yu's father. On March 11, the chief of one of the respiratory wards collapsed, according to state media, and three doctors and two nurses also contracted the disease over the next three days.
It was snowing heavily on March 15, but doctors insisted on transferring Yu and her son to a hospital in Taiyuan. They departed at 4 p.m., but because of the weather, did not arrive until 6 a.m. And while the ambulance made its way along the mountain roads, Yu's mother died in the No. 302 Hospital. That same day, the World Health Organization issued its first global warning about SARS.
It is unclear how many people Yu infected before leaving Beijing; epidemiological work in the city has been haphazard. One state-run newspaper reported at least 22 doctors and nurses infected with SARS in the No. 302 Hospital during that first month and "several" cases among the staff at the No. 301 Hospital, but gave no information about cross-infection of patients.
State media also linked a major outbreak at the Youan Hospital in Beijing to Yu because her uncle was admitted there on March 12. At least 12 doctors and nurses at that hospital were infected, including a visiting doctor from Inner Mongolia who carried the virus back home, causing an outbreak that has infected as many as 100 people.
On April 9, Jiang Yanyong, 72, a retired surgeon at the No. 301 Hospital, accused the Chinese government of covering up the SARS outbreak, citing scores of cases at military hospitals and the death of Yu's parents. Days earlier, the Health Ministry had said there were only 12 cases of SARS in Beijing, and most of them were from Shanxi.
Chen was still at the No. 302 Hospital then, though his condition had improved. On April 11, he said, he asked when he would be discharged and was told he needed to wait seven days after his symptoms had disappeared. But the next day, the hospital suddenly released him. Two days later, state television announced that "more patients from Shanxi" had recovered and were being sent home.
On April 20, the Chinese government finally admitted a coverup, fired the health minister and the mayor of Beijing, and launched a public campaign against SARS.
For Yu, life is slowly returning to normal. Some people have posted messages on the Internet blaming her for the epidemic, but many more have sympathized with her. And while a few acquaintances and neighbors have been avoiding her, others are no longer afraid to see her.
Yu said she isn't convinced she was the first case of SARS in Beijing, but she tries not to dwell on it. "It doesn't matter," she said. "We're fine now."
© 2003 The Washington Post Company
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