REPORTING ABOUT SARS

It is held that the delay in reporting the severity of the SARS epidemic and the extent of its spread in the spring of 2003 helped to derail any plans that Jiang Zemin may have had to perpetuate his power beyond his retirement, in that it was persons allegedly sympathetic to him who conspired to suppress the news and were later punished for this. The affair helped burnish the image of the new leadership by Hu Jintao and Wen Jiabao, strengthening their hand against Jiang’s alleged “Shanghai gang.”

There is probably a solid core of truth to this interpretation. But the piece translated/paraphrased below, by the Director of the Institute for Journalism and Communication in the Chinese Academy of Social Science, contends instead that the problem should not be traced to suppression of news by the government. Rather, that the delay in reporting on the epidemic came first from a disagreement among specialists concerning its precise nature (meaning, allegedly, that had there could have been no guarantee of the accuracy of any reports concerning the disease) and later by the way in which the responsibility for policy and reporting on policy remained isolated in individual bureaucratic “systems,” which adhere to different rules and do not readily communicate with each other. Most of the cases in Beijing were handled in the military hospitals under the larger military system, while responsibility for notifying the public concerning epidemics was with the Ministry of Health. Under the standard operating procedures during what is now called the “atypical era” (after “atypical pneumonia,” the first name assigned to the disease in China), there was no procedure for the military system to talk to the health system. The dispute concerning the nature of the disease was also affected by bureaucratic factors: the “national level” authorities reached an erroneous conclusion, while the doctors who had made the correct diagnosis were mere “provincial level” authorities. The essay may be partly intended to defend the record of Jiang and his people, but this “organizational process model” may also indeed explain at least part of the poor initial handling of the epidemic. Professor Wang Yukai, a proponent of political reform, has written that the “serious problems brought about by the domination of the public policy process byt government departments” are among the major issues reform has to address (see Renmin Wang, May 25, 2007).

Yin Yungong

SCIENTIFIC REFLECTION ON NEWS TRANSMISSION DURING THE ERA OF “ATYPICAL PNEUMONIA”

September 2006

Ever since the appearance of “atypical pneumonia” (ATP) a good many scholars have been reflecting on the transmission of news during that period, coming to about the same conclusions. There are two main points: The first is that there was a collective silence of the media; and the second is that the root of that collective silence was government control and suppression of the news. These two conclusions seem to have become settled opinion. Commentators discussing that era continue to bring up these two conclusions to this very day.

But do these two conclusions fit the facts? With the passing of time people are able to understand more and more and in looking back on conclusions reached in the past inevitably come to find things worth further discussion. There is, then, the need for further reflection.

I

During the APT period, on 1 April 2003 the Work Office of the Ministry of Health convened a conference of specialists at the Debao Restaurant in Beijing’s Xizhimenwai district. I was startled to discover that the journalism scholars attending were ignorant of the PRC Regulations Concerning Communicable Illnesses and other relevant authoritative rules. Isn’t it ridiculous that without even preparing themselves with the proper legal background they should natter on about the silencing of the media? In researching a question one should first find out what kinds of material are available. It is definitely wrongheaded to throw around accusations if one has not taken the trouble to inform oneself. Therefore, we should stress that reporters need to prepare their reports according to law and their rights to investigate and to report must be carried on within the scope of the law. There should be no encouragement or instigation of the media to break the law. If one should touch against the high tension wire of the law in order to gain public favor or win the cheers of the crowd, there is in reality nothing to praise in that kind of reporting behavior. Even less is it anything glorious. Our media frequently propagate the idea that we are a country of laws, and so they themselves should behave as exemplars in obeying the law.

At that meeting I asked the press spokesman for the Ministry of Health: Is it primarily the media or the Ministry that is responsible for the delay and hesitation in reporting ATP in Guangdong? That spokesman thought for a while and said, “I think it’s mainly us, the Ministry of Health. In terms of the law on the reporting of disease, it is the Ministry of Health that has responsibility in the first instance. If there is an error in the first step, there are bound to be errors in the subsequent ones. If there is no action taken on the first link, there is no way to act on the subsequent ones.” We see from this that the silence of the media was a consequence of the blocking of the first step by the Ministry of Health.

2

There was a similarity to the first appearance of ATP in Guangdong and that in Beijing. For example, there seemed to be a media silence in both places, in fact an indefensible delay. The difference is that the delay in Guangdong came from a lack of clarity that an epidemic was developing, while that in Beijing was the result of a scientific conclusion.

On 18 February 2003 Central Television broadcast this news: The National Epidemiological Center as announced that SARS is related in its origins to chlamydia. This conclusion carried a great deal of prestige since it was the result of research by Professor Hong Tao, of the Chinese Center for Disease Control and the China Academy of Engineering. On 13 February the 72-year old Academician Hong Tao saw an ATP sample for the first time. In two specimens of lung tissue derived from autopsies and sent from Guangdong the Academician discovered chlamydia. Coming from one who held the highest positions in the state medical research units, the conclusion that SARS was the same as chlamydia carried indisputable authority.

However, there are always those who refuse blindly to follow authority. The day after all the major state media reported that “SARS Is Chlamydia,” on 19 February the mainstream media in Guangdong—the Southern Daily, the New Express, and the Southern Capital News—all published reports declaring: Guangdong medical specialists doubt the conclusions reached in Beijing (the report in the Southern Daily won the first prize for news reporting in 2003). Medical specialists in Guangdong, headed by Zhong Nanshan, believed chlamydia could not explain many phenomena they had observed bedside, and so they could not accept the authoritative viewpoint. They continued to maintain that it was highly probable that the origins of SARS were with a corona virus.

In this manner there emerged two entirely separate understandings of SARS, with each side believing it was correct and the other side wrong. There was authority on both sides, albeit Academician Hong Tao was an authority at the national level while Zhong Nanshan was an authority at the provincial level. Regardless of whoever was wrong or right, the key question was: is SARS a form of chlamydia or is it caused by a corona virus? This was not merely a struggle over which viewpoint was correct; even more important was that the truth or falsity of either claim would have a direct effect on how patients would be treated.

“When the gods fight, ordinary people get hurt.” This saying fits in a most lively manner the special conditions and the attitude of the general public during March and April of 2003. The different conceptions about SARS led to a big struggle in the medical world, something which, from the viewpoint of scientific research, is entirely appropriate. However, at the same time SARS was spreading rapidly, and the popular masses were very eager to find out: just what kind of illness is SARS? Is there an effective cure for it? How can SARS be prevented or kept from becoming worse? The media of the time had no reports on questions such as these. It was not that the media had no way of making reports nor that they were unable to report; even less was it a matter of improper controls over news reports. It was rather that the media received no reliable information from the state’s most authoritative health authorities. And the state’s health administrative organs had to wait until a reliable decision had been reached by medical science. But the medical researchers all stuck to their own points of view and did not reach any consensus. The actual situation was this: the state administrative organs were waiting for a final conclusion from the scientists as were the Center’s highest leadership stratum, which meant that the media and the general public also had to wait for the scientists to come to a conclusion. It was not until 14 April that General Secretary Hu Jintao, at a meeting of medical specialists in Guangzhou, said “we must cooperate in making a joint attack and find the cause of the disease as soon as possible.” We see from this that the complexities of SARS as an illness led to differences of opinion among specialists and they were very slow in coming to a consensus. It was this that made the media of the time seem so helpless. This is the real reason for their “collective silence.”

On 16 April 2003 the World Health Organization announced that it had definitive proof that the cause of SARS was a corona virus. Following this Academician Hong Tao put effort into reading the results of the research conducted at the Military Hospital Science Institute and changed his original opinion. On 19 April the Ministry of Health accepted the results found by the WHO. On 20 April the Ministry took on an entirely new attitude concerning ATP. Following this, the media, too, took on an entirely new attitude in the face of a public that was urgently awaiting some news.

3

It is certainly necessary to reflect on the transmission of news during the ATP period, and even more necessary to reflect on it in a scientific manner. It is necessary to show that such reflection is going on, but even more necessary to conduct the reflection in such a way that it penetrates to the basic layers. My own opinions are as follows:

One, we should treat new illness correctly. SARS was a new disease that humanity had not previously experienced. Ordinary people had not seen it and not even medical specialists had ever heard of it. A certain responsible person in the Work Office of the Ministry of Health once told me: each year throughout the world there crop up various diseases that appear without warning and disappear without a trace. In 2002 there were 20-some persons in the entire world who showed symptoms similar to SARS. Most of these were in southeast Asia, and 17 were within China’s borders. In 2001 there were only a handful of persons in the entire world who had SARS-like symptoms. The Health Ministry frequently comes across similar situations. It is not really so strange that it should first assume in 2003 that SARS also would quickly disappear. It did not anticipate that it would take new forms or become so virulently infectious.

Secondly, new illnesses should be reported according to law, and we should avoid leaving the media without information for long periods of time. In reporting illnesses, the media should certainly know the law, understand the law, act according to law, obey the law. All of this goes without saying. But the reporting of ATP teaches us that if the media are kept waiting without any information, rumors are bound to spread throughout society and the public will not be satisfied with the information they have. How should we get out of this fix in the transmission of news? At present there have already been some changes in how news is reported. For example, people have noted that according to Article 23 in the PRC Law on Prevention of Communicable Disease is incompatible with the swift transmission of information. The bitter experience of the ATP era made people realize it is necessary to change the rules of the game. The administrative departments of the Ministry of Health and legal specialists also realize that gaps in the specification of how has responsibility for transmission of news do not lead to timely reports. They are working together to amend Article 23 as well as other problematical articles. On 28 August 2004 a new Third Chapter, Article 38 for the Communicable Disease Law was passed setting out new rules on publicity to be given to new diseases. The law stipulates: “The health administrative organs under the State Council are responsible for the timing of the release of reports concerning diseases that are national in scope. The health departments of the provinces, autonomous regions, and municipalities directly under Central rule will determine the timing of release of reports for their relevant jurisdictions.” This clearly defines the sphere of competency respectively of the State and the localities in ordinary times, without either infringing on the powers of the other. The Regulations also stipulated: “During the spread of an epidemic disease, the health administrative departments of the State Council are responsible for transmitting the news of the epidemic; and they may also authorize the relevant departments of the provinces, autonomous regions, and municipalities directly under the Center to transmit the news. News concerning epidemics should be timely and accurate.” This clearly specifies the scope of authority concerning the transmission of news during extraordinary times and the relations of authority between the State and the localities. This clearly indicates that during extraordinary times, the local governments have no authority to transmit news of epidemics unless they have been authorized by the Center.

The 35^th Article of the new “PRC Law on the Prevention of Communicable Disease” stipulates: “If the departments of the PLA concerned with health matters, they should make a report to the State Council Ministry of Health.” This was not present in the old regulations, and reflects the new lessons learned after the experience of ATP. Everyone knows that when ATP was spreading in Beijing, the majority of patients were treated in the PLA General Hospital, the PAP Headquarters Hospital, the PLA Hospital 304, all under the jurisdiction of the army; some were also treated in the local hospitals. Patients were being treated in two different systems, but the Ministry of Health had the authority to report only those being treated for SARS under the Health system. This brought about the condition that was later called “false reports, no reports.” Indeed, even if the Ministry of Health had known how many SARS patients were being treated in the military hospitals, under the rules prevailing at that time it would not have been able to report those numbers. They would have to be reported through the health organizations of the military. But because there were then no relevant laws or regulations, there was no one with the authority to get the numbers from the military; nor could the military authorities report on the numbers being treated under the Health system. This gap has been plugged by the new PRC Law on the Prevention and Treatment of Communicable Diseases. According to the new law, if the military medical system should discover evidence of an epidemic, it must report this in a timely fashion to the State Council’s Ministry of Health, and the latter may communicate the information nationally. This means the destruction of the systems as fortresses isolated from each other, and allows the complete, speedy, and accurate transmission of news concerning epidemics.

Thirdly, there were errors in the correct recognition of the root causes of SARS. We must understand that whenever a new disease appears among mankind, it must be understood in a scientifically correct fashion. But this is extraordinarily difficult and extraordinarily complicated. It cannot be denied that during the APT era a superstitious reverence for authority caused error and delay in the correct identification of the disease and the search for a proper treatment. But it is also necessary to understand that scientific research almost all the time involves differences of opinion and contention. We must allow scientists to knock opinions back and forth; we must allow them to make mistakes.

Unlike Academician Hong Tao, Zhong Nanshan was on the frontlines, at patients’ bedsides from beginning to end. He had plenty of scientific data as well as personal experience; this made him confident of his own judgment and gave him the courage to challenge authority. After the ATP scare had passed, Wang Zhicai, the moderator of the CCTV program “Face to Face” interviewed Zhong Nanshan, asking him how to make the choice between authority and truth. The authority here was a reference to Academician Hong Tao. This program received a first prize as the best news program of 2003.

Fourthly, we need to continue to perfect the system of reporting sudden major events. The new law concerning the communication of information about epidemics does some of this. But we must also understand that some issues remain unresolved. For example, when a new disease appears and there are different opinions about it, should this be reported or not? If everything should be reported, what should be the major stress? How should we treat errors in the reporting? Also, should the media convey the process of argument to their audience? If scientists, for selfish reasons or out of pride do not agree with the reports, how should the media treat this? So forth and so on.

Fifthly, students of the news must have a serious, careful, and professional attitude in their research on sudden outbreaks. Facts prove that we scholars of the news did not understand much of what was going on behind the scenes during the ATP period, and this was the cause of mistaken conceptions. Some time has now gone by, and much of what was hidden then has now come to light. We can review our analysis of that time and continue doing what we did right while correcting what we did wrong.

Here there is also an issue of comparative research. During the ATP period, on 25 February 2003 there were explosions in the student dining halls at both Peking and Tsinghua universities, and the news media were quick to report these. In looking at this observers might ask: The government controls the media and covers up reports of ATP; how come, then, it allows the publication by the mainstream media of news of the dining hall explosions and does not cover this up? Could it be that the some kinds of negative influence are greater than others? There is no way to know. Also, ATP was discovered in Singapore toward the end of March that year, but Prime Minister Go Chok-tong did not report this for another two weeks. Think about it: in a tiny country like Singapore, bad news can spread to every corner in a single day. Why, then, didn’t Singapore’s media and people question the government about how slow it was in making this announcement? There certainly must be a reason; it’s just that outsiders don’t know what it is. As it seems now, there are also certain hidden factors in our health administrative organs being so slow in coming forth with the news, but there is no way to reveal them to the public. Therefore, certain researchers can go only by impressions and issue their own know-it-all conclusions. If researchers would go more deeply into the whys and do a little comparative research, get to know a little bit more about the law, think a bit more about how the system works, then perhaps the conclusions would accord a little more with the facts. They might be more scientific and less prone to error.

Shanghai Normal University Journal, No. 4, 2006; Xin Hua Wenzhai, 23 (December 5), 2006