Severe Acute Respiratory Syndrome

SARS Communication in China

SARS began as a cogent illustration of noncommunication, as the highly controlled Chinese media denied or suppressed information about the outbreak. Denial is often the first reaction to nascent outbreaks, and in China this is made worse by a system that prizes stability and is structured to conceal information, especially about infectious diseases that are classified as state secrets. Following the index case seen in Guangdong Province on November 16, 2002, the first media mention of the story does not occur until January 3, 2003. A brief dispatch in the Heyuan Daily denied rumors of an epidemic and asserted that there was no need to buy preventive medicines. This singular message was spawned by the perception that people in Guangdong were alarmed, as there was a demand for vinegar and antibiotics, with attendant shortages and price hikes. Effectively, in the absence of any official coverage, rumors had spread about a mysterious illness that was making medical staff sick. The Chinese have learned that the truth is usually worse than authorities acknowledge, but by now people were less dependent on official sources of communication. Besides word-of-mouth, obviously a very old form of conveying rumors, the spread of information was abetted by somewhat sporadic Internet posts as well as text messages, which are more difficult for authorities to control. In the ensuing months, communication about SARS in China was intermittent, with brief spots of coverage followed by more extended periods of imposed silence. Thus the January 3, 2003, dispatch is followed by a month in which the virus is not covered in China. A news conference on February 10 acknowledged the problem, mostly by reassuring rather than informing. At the same time, reports of the outbreak were sent to the WHO, but then another month ensued in which public communication was repressed. Local health authorities further impeded communication as they were for the most part reluctant to admit the presence of the disease, much less their difficulties in managing it. The spread of SARS to Beijing was initially denied and the number of cases was systematically underestimated throughout China. Even more problematic, perhaps, was the dearth of communication among hospitals and local and national authorities. A specialists report, deemed top secret, was completed January 21 but not circulated to health authorities or workers. Information tended to flow upward to higher authorities, but communication downward was purposively limited and there was almost no horizontal communication. Urgent requests for information from Hong Kong and the WHO were largely ignored, and medical samples taken from patients were not sent to foreign experts. Clearly, there were more deaths than need be due to the lack of communication to hospitals and frontline medical staff.

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