“The season of SARS could be viewed as either an anachronism or a harbinger.”
Over the winter, a new virus emerged, sickening its victims with a severe respiratory illness that manifested with a high fever and a hacking cough. For an unlucky few, the illness degenerated into total respiratory failure as the lungs filled with fluid, and the organs shut down from lack of oxygen. As Lunar New Year approached, the Chinese government continued to insist that the situation was under control, even as cases began to spread. The story is eerily familiar, because we have all been living it. But Karl Taro Greenfeld’s 2006 book China Syndrome is a chronicle not of COVID-19, but of the SARS epidemic caused by a similar novel coronavirus that jumped the species barrier and sickened thousands in 2003 to 2004. At the time, Greenfeld was the managing editor of Time Asia, and based in Hong Kong, the first place outside of mainland China to be affected by the epidemic. The big news story of the year was expected to be the American invasion of Iraq. Instead, Greenfeld and his staff found themselves on the frontlines of reporting on the twenty-first century’s first major epidemic.
Each chapter is headed with the location and date, as well as the number of people estimated to have been infected or dead of SARS. The death rate in these estimates hovers around a chilling ten percent, and also grows in increasing contrast to the Chinese government’s public refusal to adjust their official numbers upward even as people continued to sicken and die. The book is insightful about the cultural conditions that lead to the denial and cover up. Greenfeld highlights the unprecedented transition of power that was occurring in Beijing at the time, as well as the emphasis on saving face and avoiding blame. Particularly telling is the fact that information about a disease outbreak is classified as a state secret in China. It was illegal to disclose this information anywhere but up the reporting line. Greenfeld witnessed a doctor arrested for talking to him about the outbreak, and another doctor that spoke up spent the rest of his life under house arrest. A Hong Kong virologist risked arrest by traveling across the border repeatedly to smuggle samples for his lab, since it was impossible to get any information out of the Chinese Ministry of Health.
Coming in at seventy-three—albeit often short—chapters, China Syndrome does feels somewhat drawn out, especially in the early chapters before the agent of the disease has been identified. As Greenfeld points out, however, the specific agent often isn’t all that important if doctors can treat the disease with existing methods. Investigators were at first highly focused on the possibility of avian influenza, and it is almost halfway through the book before the term “coronavirus” is even mentioned. By comparison, however, it took more than two years for scientists to isolate the agent responsible for the AIDS epidemic. The race for the answer features internal and international rivalries, and more than one false step along the way.
Before you decide to pick this one up, I would issue a warning for a few more graphic parts of the book. It includes descriptions of the conditions market animals live in, and how they are restrained and killed on site at the restaurants that serve them. Greenfeld also describes the liquidation of livestock that occurred once the virus’ host animal was identified and banned from sale. In the medical section, there is a detailed description of intubation that serves to illustrate why the procedure posed such a risk of infection to the healthcare workers who performed it on SARS patients. These don’t form huge swathes of the book, but it is worth knowing they are in there.
There is a definite sense of eerie deja vu in reading this book, from the slowly escalating rumours, and mutters about biological warfare, to the runs on particular kinds of equipment and supplies, to the very timeline and symptoms of the illness itself. Yet perhaps the most eerie part is the unheeded warning that SARS now represents. As Greenfeld details, the Chinese government banned the sale of the animal found to be the reservoir of the virus, and seized and destroyed the existing stock. But the closure of the urban markets where live animals were sold was only temporary, and within months they were back in business, operating much the same as before, with thousands of diverse, defecating, bleeding, doomed animals trapped in close quarters with one another, and the people who sold, butchered, and consumed them. One threat was eliminated, but the conditions for another such zoonotic outbreak remained much as they ever were.
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