Liu Yumin*

Since severe acute respiratory syndrome (SARS) epidemic broke out in China, especially since it spread to Beijing and other parts of the country in April from Guangdong and Hong Kong, the leadership of the Party and State called upon the Chinese people of all ethnic groups and the leadership at all levels to scientifically bring the epidemic under control and minimize the losses caused by SARS.

The central leadership of the Party and State gives the people's health a top priority

On May l3 addressing the National Working Conference on Preventing and Treating SARS held by the State Council, Premier Wen Jiabao urged the departments concerned to strengthen supervision and prevention of the disease on all public transit systems, airplane, train, ship, bus and entry-exit ports. He also called on all transportation terminals to quarantine any virus victim without hesitation, and valuable treatment and knowledge should be publicized to the rest of the country so as to insure the people remain alert to the epidemic.

On May 17 addressing the Standing Committee of the Political Bureau, General Secretary and President Hu Jintao urged the government departments and health authorities at all levels to accurately report the SARS cases and keep the public informed. He said that the prevention and control of SARS should be based on four principles of early detection, timely reporting, rapid quarantine, and immediate treatment. The fight against SARS is a formidable task and may take some time, but we will win with the concerted efforts throughout the country.

The central leadership including President Hu Jintao, Chairman Wu, the Standing Committee, NPC, Premier Wen Jiabao, and Chairman Jia, the National Committee, CPPCC, etc. has urged officials to give the people’s health and lives a top priority. They all take inspection tours to the provinces where there are SARS cases or suspect SARS cases, and to make sure that prevention and treatment measures are fully taken so as to bring the epidemic under control and minimize the losses caused by SARS. The overal1 measures taken by the Party and State are as follows:

SARS Prevention and Treatment Command established and special funding allocated

On 23 April, Premier Wen Jiabao chaired a meeting of the State Council and decided to set up SARS Prevention and Treatment Command led by Wu Yi, Vice Premier and Minister of Health, so as to unify the work for preventing and treating SARS cases and probable cases throughout the country. The meeting also decided to set up a special fund of 20 billion yuan RMB to help pay for those rural SARS patients and probable patients and those hospitals and clinics with purchase of some necessary medical instruments in the poverty stricken areas. According to a report from the State Council by l5 May, the central government had already allocated 4.3 billion yuan for the efforts to fight SARS epidemic in the rural areas, among which 2.3 billion Yuan is used for building medical infrastructure, such as Xiaotangshan quarantine hospital for SARS patients only, in Changping District in North Beijing. The l,000-bed hospital was finished in 7 days of hard work by nearly 7,000 construction workers working round the clock.

Legal framework for tackling public health crises established

Premier Wen Jiabao signed a decree issuing the Regulation on Public Health Emergencies on May 9th.

The Regulation aims to establish rapid-deployment mechanism and enhance the government’s ability of handling emergencies, and to strengthen the chain of command. The Regulation requires the State Council and provincial governments to establish contingency headquarters to co-ordinate efforts of all relevant departments.

The Regulation has also established the monitoring, early-warning and reporting systems, which is fast, multi-channel and well-coordinated, and has put heavier responsibility on provincial governments.

It stipulates that the provincial governments must report emergencies to the State public health authorities within an hour of receiving emergency reports, that any individual or organization has the right to report emergencies to the government and has the right to accuse officials of not performing their duties or not performing their duties according to laws and regulations, and that government agencies and officials will be held responsible for hiding or delaying emergency information or giving false information. Criminal liabilities will be applied if their conduct is deemed to have broken the law.

Premier Wen Jiabao said that the newly enacted Regulation on Public Health Emergencies is a major step towards ensuring that China handles health crises according to law, and called for the establishment of a national fast-deployment mechanism to handle public health emergencies and promote the law as a powerful weapon to defeat SARS. He a1so called for local governments at all levels to estab1ish contingency headquarters to co-ordinate the efforts of relevant departments in order to beat the deadly SARS virus and future public health crises.

"A public health emergency is a social issue that has a great impact on the country" said Song Ruilin, Vice-Director of the Department of Science, Education, Culture and Health with the Legislative Affairs Office of the State Council. In stead of using vague terms such as "timely" and "immediate1y”, the regulation has set that provincial governments must report emergencies to the State public health authorities within an hour of receiving reports of an emergency.

International Cooperation with WHO

Since early April as SARS epidemic began in North China, we have had close cooperation with the World Health Organization (WHO) whose experts have been on several inspection tours to the area. Besides, Beijing Municipal government had also set up WHO representatives offices inside the government building. On the one hand, they assisted China to control the epidemic and recommended the WHO revise and improve its publicized standard of diagnosis of SARS based on the Chinese standard throughout the world.

The WHO had provided active technical support and diagnostic re-agents according to the suggestions made by experts from both sides.

Beijing had adopted a number of approaches that are both innovative and unique to control SARS, James Maguire, leader of the WHO expert team, said April 16, 2003, “ We have seen a tremendous amount of efforts by Beijing over a very short period of time, extremely impressed by the hard work and commitment of health officials and health care workers during visit to the facilities."

During an exclusive interview with Xinhua on April 21, Jeffrey McFarland said that "it is very encouraging to see that al1 sectors of the health care system are reporting every day all the probable cases," stressing that it is the "only way" to understand the magnitude of the epidemic and 'trusts their efforts".

Alan Schnur, another WHO expert, had proposed four strategies to curb SARS in Beijing, which include surveillance and reporting, hospital management and infection control, community information and contact tracing and good government support, which are taken seriously in Beijing. He also pointed out that "the pub1ic should not be panic, because the chance of getting SARS is very very small, but the public should also be responsible."

Chinese leaders attended international meetings on SARS

Premier Wen Jiabao attended the Special Meeting on SARS of the Leaders of China and ASEAN on 29 April in Bangkok.

The Joint Statement of the Special ASEAN-China Leaders Meeting says, we appreciate the valuable opportunity to brief each other on the measures each country has taken to prevent, monitor, study and treat SARS. China associates itself with the Joint Declaration of the Specia1 ASEAN Leaders Meeting on SARS and expresses its readiness to cooperate with ASEAN to fight the SARS problem.

At the 56th World Health Assembly, Wu Yi, Head of the Chinese Delegation, Vice Premier and Minister of Health, made a speech and briefed the delegates on the China's efforts to bring SARS under control, also extended sincere gratitude to all countries and international organizations for their understanding, moral supports as well as financial, material and technological assistance in China’s fight against SARS on beha1f of the Chinese Government and people.

Commending Advanced Medical Staff

During the outbreak of SARS epidemic, Chinese medical professionals had shown excellent bravery and medical ethics in their daily efforts to fight SARS. Because of their selfless and hard work in defiance of being infected, they had saved many critical patients, but unfortunately some medical staff was infected and among them was Ye Xin, head nurse of Ershadao Hospital in Guangdong City. She was too sick to be cured and sacrificed her life for saving dying patients. Ye Xin together with another 9 Chinese nurses were awarded the Florence Nightingale Prize, the highest honor for nurses, by the International Committee of the Red Cross on May l2 for their outstanding courage and dedication to work.

In the SARS hardest hit areas such as Beijing, Hebei, Shanxi, Inner Mongolia, there are many moving stories that some critical SARS patients are saved by medical staff, who are infected and even lost their lives. However, it is reported that doctors and nurses in many hospitals keep asking to join the SARS task force and they have made outstanding contributions to bringing SARS under control.

Four general headquarter/departments of the People's Liberation Army (PLA) issued a circular May 5 commending Six units and 32 individuals from the military service who had made outstanding contributions in the fight against SARS. These units and individuals were highly lauded for their selfless spirit, lofty professional ethics and selfless devotion in the prevention, treatment and scientific research of SARS epidemic. The circular called on all the servicemen, especia1ly the medica1 staff and researchers to learn from the honored units and individuals so as to make greater contributions to the final victory in the battle against SARS.

Slack officials face punishment in SARS

From April to May, more than l20 central and local government officials in China had been punished in the past two months for their slack reactions in fighting SARS. This disciplinary action covered l5 provinces, municipa1ities and autonomous regions, or nearly half of China’s administrative regions, including Beijing, Hebei, Shandong, Chongqing, lnner Mongolia, and Zhejiang, etc,

“This is the first time China has punished such a wide range of officials who are derelict in their duties in an unexpected calamity," said an official with the Organization Department of the CPCCC. “The punishment decisions, taken as practical measures by China's new generation leadership to improve the government work style, have been applauded by Chinese people and well received by both domestic and world opinion."
Those who were dismissed include high-ranking officials, such as former Minister of Health, Zhang Wenkang and former Mayor of Beijing Meng Xuenong.

China tightens supervision of construction work in rural areas

On May 9, China’s Ministry of Construction issued an emergency circular urging local construction authorities to step up supervision of rural construction work in order to prevent the spread of SARS to rural areas.

The ministry demands construction authorities at all levels to examine the planning and construction of county and town (township) health institutions and hospitals. Preparations must be made for the renovation of medical institutions and facilities at county, township and village levels.

In areas where SARS cases are reported, rural construction workers are prohibited from leaving their work sites without notification and the transfer of workers between SARS affected regions is strictly prohibited.

The circular also ca1ls for the strengthening of preventive efforts at local bus stations, ports and markets, and requests 1ocal construction departments to take measures to safeguard the local working and 1iving environment and report to the local government for the shutdown markets affected by SARS.

Chinese government waives fees for SARS-affected industries

On May 9, the Chinese government announced it would waive or reduce the administrative fees it 1evies on some of the industries affected by the SARS outbreak. The reduction involves more than a dozen categories of fees levied both by the central and local governments. The beneficiaries include restaurants, hotels, trading markets, and tourism, entertainment, civil aviation, road transportation, water transportation, taxi and bus industries, and the fee reduction is effective from May l to September 30.

Rural health fees waived under SARS monitoring system

On May l2, financial pressures faced by rural people during the fight against SARS will be strictly monitored, the Ministry of Finance announced.
Money spent on sterilizing public places and infected sites and vehicle shou1d be shouldered by local government departments rather than rural people or students, ordered the State Council-working pane1 on the reform of rural taxes and fees.
Residents from infected rural areas should not be charged for physical examinations and medical observations, while relevant booklets and materials concerning SARS prevention should be issued without charge. The order forbids any fee collection for the prevention or treatment of SARS.

Chinese farmers keep close watch for SARS

By May l0, More than 90 percent of Chinese farmers are on the a1ert for the outbreak of the flu-like SARS epidemic, though their awareness of virus fighting means varied from region to region, by the National Bureau of Statistics (NBS), which had published on its website the results of a survey on the impact of SARS epidemic on some rural areas in China.
In coastal provinces such as Jiangsu and Zhejiang, 100 percent of the farmers surveyed said they knew SARS had infected certain areas of the country. In Henan province, in the relatively undeveloped central China, over 93 percent of farmers said they had been alerted about the deadly disease.
The survey results showed 92.8 percent of farmers in Tianjin city in north China knew the means that are usually used to prevent and treat SARS. However, about l6 percent of the farmers surveyed in Jiangsu province said they had little or no knowledge of these measures.
More than 80 percent of Chinese farmers learned about the situation of SARS and anti-virus methods through TV and other media, the survey showed.

WHO experts experienced SARS prevention network in rural areas

On May 9, WHO expert team visited a county in northern Hebei province, initiating their first field inspection of anti--SARS work in China's rural areas.
In the morning, two of the four members of the WHO team arrived in Xushui county under-the jurisdiction of Baoding city, 120 km south of Beijing, where they heard the government’s reports on the local reporting mechanism and anti-SARS measures.
Around noon, the experts went to Dongshiduan Township, which comprises l5 villages with a total population of 33,600, and randomly selected a village for inspection. The village has, as introduced by local officials, adopted a "ten-household" supervision mechanism. That means every l0 households have one information collector who is held responsible for gathering SARS-related information among the families, for example, how many have returned from affected areas.
Seeing a bulletin in the village with the names of all the information collectors and migrant workers who have returned home, Maguire asked to see an information collector and then visited a villager who recent1y returned from Beijing and was currently under a l 5-day quarantine at home. Maguire said he was impressed by the "community involvement" of the anti-SARS measures. "That depends on the coordination of all people in the community", he noted.
Meanwhile, another WHO expert, Hiroshi Watanabe, went to the village clinic. He Looked through the body temperature records of all the returnees and inquired in detail about the physical check-up and quarantine measures taken with respect to those people.

Joint efforts at home and abroad to fight SARS
As people in North China are fighting SARS, we have received contribution in money and in kind amount to over 30 bil1ion yuan RMB at home and abroad, which shows people throughout the country and the world offering their support to the SARS epidemic areas.
WHO highly commends the large amount of work carried out by Chinese government in its endeavor to control the spread of SARS, and appreciated the fruitful cooperation with The Chinese government. Mr. D. Heymann, in charge of infectious disease in WHO, pointed out, SARS is a brand new infectious disease, it will take a process for mankind to get to know it, China's experience in fighting SARS has provided a valuable experience for other countries to learn from.
As Statement of the Special Meeting on SARS of the Leaders of China and ASEAN on 29 April in Bangkok recognizes the need for collective efforts in the region and the rest of the world to effectively tackle the challenges posed by the deadly virus, so long as we promote the exchange of information and sharing of experience in respect of SARS control and prevention, mankind will win.

SARS is successfully brought under control

On 24 June, many people in Beijing celebrate Beijing being removed from the WHO's list of SARS-infected areas and list of the travel advisory.
This is not only a relief for the Chinese people, but also a great relief for the world as a whole. China's accomplishment in its struggle against the terrible epidemic is a milestone in the international community's fight against the virus.
The fact that we finally brought it under control and came through it with initial success is because of the strong Party and government leadership plus the solidarity shown by the general public in our battle against SARS, which have convinced us that, united, we Chinese people can surmount the hardships and difficulties on our way forward.