The State Council Information Office held a press conference Sunday afternoon updating SARS latest developments on the Chinese mainland. The Executive Vice Minister of Health Gao Qiang and Vice Minister Zhu Qingsheng answered questions from both Chinese and overseas journalists.
Foreign journalist: Officials told us at a press conference a fortnight ago that Beijing was safe for the Chinese people as well as for foreigners in China. But the present epidemic situation is becoming more and more serious. Just now you also explained why there were some limitations to the data reported some days ago. What on earth are the problems in Beijing (or in Chinaís health system) that deters you from telling us the truth?
Gao Qiang: SARS has not been fully understood by mankind and an entirely effective therapy is still unavailable. Whatís more, it is very contagious. So I think if a place claims to be safe, that safety is relative. Without good preventive measures, a place that doesnít have SARS today might have it tomorrow.
At our last press conference officials were saying Beijing was safe. I think their words were based on the situation in Beijing at that time Ė when most of the SARS cases were in Guangdong and the epidemic situation in Beijing was limited to very, very small areas. But there have been some changes to the situation in Beijing recently, as you can see in the data I announced just now. SARS cases have been increasing gradually and this reflects that there are some vulnerable spots in the present SARS prevention work. The major problem is: medical institutions in Beijing are subject to the jurisdiction of many departments -- the Beijing municipal government, the Ministry of Health, the military and so on. This loose administration system has caused lack of communication among hospitals: a failure to obtain accurate information on the epidemic and a failure to take very effective quarantine measures to prevent the disease from spreading.
CCTV: In view of the situation you just briefed us on, the present epidemic situation in Beijing is serious. What measures will the central government and the municipal government of Beijing adopt to curb the development of the epidemic?
Gao Qiang: First, I think the most urgent and important matter now for Beijing, as well as for all epidemic areas, is to resort to resolute measures to prevent the epidemic from spreading. We have employed rigorous preventive measures on medical agencies to prevent medical workers from being contaminated. We have adopted rigorous measures on confirmed SARS patients, suspected SARS cases and those who have had close contact with SARS patients. We have taken rigorous measures in observation, surveillance and tracking on airlines, trains, buses and other (public) vehicles.
We have adopted another important measure: the State Council has decided to suspend the May Day vacation of seven days and return to the normal holiday vacation system, to avoid the epidemic from possibly spreading in the movement of large numbers of travelers. I think this measure will result in a great loss of income for Chinaís tourist sector. However, the Chinese government wants to give top priority to the lives and health of the people.
Second: enforce guidance of epidemic prevention work in different areas in the country. The Chinese government has dispatched supervision groups to Guangdong, Beijing, Inner Mongolia, and more recently, to Shanxi, Henan, and Ningxia Hui Autonomous Region. Why did we send a supervision team to Ningxia when there was only one SARS case there? Ningxia is in the west of China where medical conditions are relatively bad and the income level of the local residents there is relatively low. Protecting the vast rural area of west China from being caught by the epidemic is an issue of great concern to the Chinese government.
We want to enhance preventive and surveillance measures in schools, especially middle schools and primary schools, government offices and the military where population is dense. We have taken measures to protect the health of foreigners in China and residents of Hong Kong, Macao, and Taiwan, too.
Third: integrate national medical research resources to tackle the issue and improve medical measures to cure more patients and reduce the mortality rate.
Fourth: set up a medical aid fund for low-solvency patients and farmers. A document issued by the Ministry of Finance, Ministry of Health and Ministry of Labor and Social Security said that those who have economic difficulties in paying the medical bill may receive subsidies from the government. The budget comes from both local and central government. In addition, medical workers should receive medical care subsidies from government revenue as well.
Fifth: further strengthen the cooperation with WHO. While we are holding this news conference, officials from the Ministry of Health are reporting epidemic conditions of both Beijing and other places (in the whole country) to the WHO expert team, aiming to sort a better way out.
SKY TV: You just mentioned that there will be no long vacation this May Day. As we know, 74 million people traveled around China during the last May Day golden week. Does the canceling of the vacation mean, officially, that the Chinese government declares that China is not a safe place to travel in now?
Gao Qiang: The canceling of the May Day holiday aims to further prevent the spread of SARS under the current epidemic situation. We believe strict measures are necessary. We donít forbid all traveling activities. We suggest not to travel too far; local travel is advocated.
Reporter from Netherlands: In the cooperation between the Ministry of Health and WHO, information collection measures are clearly stated, but why are these measures overridden by the Ministry of Health?
Gao Qiang: Due to insufficient awareness of the SARS situation, the information collection system was far from perfect at the beginning. As for Guangdong, they have a better system in terms of reporting and technology, because Guangdong was involved earlier; things are the opposite in Beijing. Besides, the Ministry of Health has not undertaken powerful direction and inspection work in Beijing and this is our problem.
ABC: You just mentioned that the inaccurate figures are due to some mistakes in your work. But is it possible that the Chinese government disguised the epidemic deliberately, in particular those cases hidden from the World Health Organization (WHO) team? Itís been reported that some SARS victims were hidden in ambulances or hotels while the WHO team was inspecting. Do you believe these reports are true? And is there any investigation under way to determine whether SARS cases were intentionally hidden from the public?
Gao Qiang: I think that inaccurate statistics are totally different from deliberate action to disguise the facts. We asked all regions to report the actual figures, and release the facts to the public. No delay, cover-up or missing cases were allowed. Till now, I havenít found any place which has done so. Weíve dispatched some supervision teams to some regions. One of their tasks is to check the actual conditions of the epidemic. Wherever they are, they will punish those who have covered up actual SARS cases and will inform you (the public) in time. If any of you know of such cases, I hope that you will tell me, but the information you offer must be correct.
Taiwan ETTV: I want to ask Mr. Minister, is there any leading official or ministry taking responsibility for SARS? Whatís more, itís said that a SARS peak will come next week, what do you think of the news? Third, the large number of migrants in Beijing makes it difficult to curb the spread of the epidemic. Will Beijing take further measures on non-natives?
Gao Qiang: The main task currently is to take effective measures to curb the spread of SARS, and strengthen medical aid in order to make more patients recover, instead of tracing someoneís responsibility. Now, we are considering strengthening medical work, and perfecting our measures in order to achieve a better result. Just now, the lady asked if there will be SARS breakout: I donít know what the breakout refers to? Since more than 300 SARS cases have been found, I think that itís already serious. Considering that some patients will be excluded from over 400 suspected SARS cases after diagnosis, and some will be confirmed to be infected, the number of SARS patients will increase in the next few days. But it doesnít mean that SARS will spread widely in Beijing. These SARS patients were mainly hospitalized at the end of March and beginning of April. Yesterday, I received Beijingís SARS report, which shows 7 more cases have been found. These cases arenít included in todayís report; we will add them in tomorrowís report.
As an international metropolis, Beijing has a population of over 10 million and daily migrants of 4 million. I think we should take effective measures to prevent the further spread of SARS, and keep normal order in peopleís life and work at the same time. Both of them are wrong if we ignore the spread of SARS or affect peopleís life and work by overestimating the epidemic also. We will adjust our plan according to the actual SARS condition in Beijing to prevent and control it.
NBC: My question is what are the main symptoms of the suspected cases? Does China follow consistent standards with WHO in diagnosing suspected cases? My second question: experts from WHO said a larger number of patients are under close observation in Beijing who were neither confirmed to have caught SARS nor proved to be suspected? Do you have figures for this category?
Zhu Qingsheng: As Executive Vice Minister Gao pointed out just now, SARS is a new kind of disease which started at the beginning of this century and still remains unknown to mankind. In the past months, the Chinese mainland, Hong Kong Special Administrative Region and Taiwan Province, as well as other countries around the world, have diagnosed and treated the disease and studied its cases, but we are still at a stage of exploration. We cannot say all problems relating to SARS are solved. We have had academic exchanges with WHO; Hong Kong and Taiwan of China and other countries recently on the diagnosis and treatment of SARS cases, and suspected cases, through the Internet and other means.
Now in clinical diagnosis we follow three standards: first, the patient has had some activity relating to the epidemic, for example, contact with an infected patient or a history of having been to an epidemic-infected area. Some data is easy to get, for instance, one (team) has been to an area with many SARS cases; while some is not so obvious (to follow), such as taking a bus or going to a hospital. Itís hard to decide whether one is infected by a certain person or a certain environment.
Another aspect is the symptoms in clinical diagnosis: a high fever, dry cough, being short of strength, a shadow on a chest X-ray. To our satisfaction, WHO has announced the discovery of the cause of SARS as a new kind of corona virus.
If one or two symptoms occur, we judge it as a suspected case. China has kept contact with WHO and some other countries and regions where SARS cases are found. The diagnosis standards adopted by Chinese doctors on confirmed SARS cases and suspected cases are basically consistent with those of other countries and regions. We have communicated well and had friendly cooperation with WHO experts during their inspection tour in Guangdong and Beijing; whether in clinical diagnosis or treatment. We reached good consensus on the diagnosis and treatment of the disease. WHO experts also acclaimed Chinaís contribution in this respect. The Chinese mainland has the most SARS cases up to now and is the area which has seen the earliest SARS cases. We should contribute in this respect and may contribute more in the future. WHO experts have conducted investigations in Guangdong Province, south China, and the capital city, Beijing. They have reached a consensus, to a great extent, with the Chinese, on SARS diagnosis and clinical treatment.
China Radio International: Just now Vice Minister Gao said that the Chinese government has set up a medical aid system to treat SARS patients living in poverty or in rural areas. But there are still reports that some patients were refused at some hospitals because they could not afford the payment. Could you confirm this situation?
Gao Qiang: I have also taken notice of the situation you mentioned. This phenomena really exist in some places. But I should think these hospitals have both subjective and objective reasons for actually doing so. For example, some hospitals cannot handle epidemics as they may be only centers for heart disease. If a SARS patient goes there, he might possibly not receive effective treatment. To solve these problems, we have taken the following measures.
First, we have designated six special hospitals in Beijing to treat SARS patients. The publication of the addresses and phone numbers of these hospitals has enabled SARS infectors not only to receive timely treatment, but also prevent the further transmission of the disease.
Second, in some well-equipped hospitals, we have set up isolated and special out-patient service centers for respiratory diseases. The hospitals should give timely isolation, observation and judgment on patients who show symptoms of fever and cough, certainly not the normal cough. Also they (patients) should be reported to relevant public health department. After receiving a report, the relevant department must send out experts, medical workers and ambulances immediately to the spot. If the patients are diagnosed as suspected SARS cases, they should be sent to designated hospitals.
Third, we also put forward strict requirements for the presidents of the hospitals and the discipline they should observe. They should not reject any patients on any excuse, including an economic excuse. If the hospital really has difficulty in receiving patients, it should find a place of temporary isolation for the patient and immediately report the case. The relevant departments will take measures. No hospital is allowed to reject a patient out of its door. If we find any rejection case, we will give them severe punishment. Report of such phenomenon is also welcome by society.
Wang Guoqing: What Gao mentioned just now applies not only to Beijing but the nationwide regions where SARS cases are found.
UPI: Youíre promising to be more open with the numbers of the suspected SARS cases and actual SARS cases; Iím wondering you also mentioned that there will be a daily report. What is the mechanism for that report? And also since youíre going to be open with the numbers, could you perhaps be more open with the numbers of the cost, for example, what the budget is for the Ministry of Health right now, how much money is the budget for SARS, and how is it going to be divided between the central government and local government, especially in the west, which doesnít have enough money?
Gao Qiang: Iím not the full-time information officer of the Ministry of Health, so I canít give such a news conference everyday. I think that information will be released through media organizations. No matter what kind of form it will take, I hope that every journalist who cares about SARS prevention and control in China gets related information. As for the question the gentleman just asked about the capital input in SARS prevention, thatís my special area, because I worked as the vice-minister of finance for many years.
As for the accurate figure of how much money I have and how much money is needed for SARS prevention and control, I can only tell you that itís X. But I pledge that the Chinese government will try to prevent, control and cure the epidemic through both central and local budgets, no matter how much money it will spend. The Ministry of Health and Ministry of Finance have reached a consensus that the Ministry of Finance will give full financial support as long as the expenditure in their budget is reasonable.
After over 20 years of reform and opening-up, China has accumulated a solid economic foundation, and Chinaís fiscal revenue has currently performed very well. In the first quarter of 2003, fiscal revenue increased 26 percent over the same period last year, so the epidemic prevention and control will not be influenced by capital shortage.
Voice of America: I have two questions. First, the mortality rate seems to have gone up a little bit, is it significant to the issue? Secondly, there are many calls and promises for accountability. Are you aware of any official, at the provincial, ministerial or central level of the government, who will be jailed, fired or verbally punished?
Gao Qiang: We are very much concerned with the increase of the mortality rate. We hope it will be zero. But so far we do not have medicine which can effectively kill the virus. Guangdong has developed some effective methods which can cure 80 percent of the patients. The Ministry of Health is now collecting Guangdongís experience in prevention and treatment to popularize it in the affected areas.
In terms of accountability, the Chinese government is responsible to the general public. Weíll try our best to correct and rectify the mistakes and deficiencies in our work. At present, the major task facing the Ministry of Health is to study, with consorted effort, the methods of controlling the spread of SARS.
China Daily: China has a large rural population whose income level is relative low while the medical conditions in the countryside are poor. This may lead to rapid spread of SARS among the rural population. What can the Chinese government do to prevent such a trend?
Gao Qiang: So far, we havenít found a large-scale occurrence of SARS cases in rural areas. But we have been highly vigilant for we know that the result will be very serious if rural areas are affected since Chinese peasants earn relatively less than urban people and medical facilities there are poor and rural peopleís sense of self protection is less than the urban population. I think itís very possible for those rural people who have come to work in the cities to carry the virus back to their home.
To curb the occurrence of such cases, we have adopted the following four measures: First, all transportation tools are required to take strict monitoring and isolation measures. Any persons found having symptoms will be sent to the floating inspection station in the locality. Second, we will give the same treatment to migrant workers in the cities as to its urban residents. Whenever there are cases appearing among them, theyíll receive immediate rescuing and medical treatment. Third, we have urged the rural population to watch out for the epidemic, immediately reporting any suspected cases for timely isolated treatment. Fourth, any peasant who is affected by the epidemic should be sent to hospital for timely treatment. Those people who have financial problems will receive subsidies from local government. If a local government has financial problems, the central government will subsidize the local government.
Far Eastern Economic Review: I have three questions. The first is would you like to give us more information about the cause of the epidemic in Beijing? You just now gave us very large numbers for cases in the city. Can you tell us when the numbers of the cases started to rise dramatically? Can you tell us whether the numbers of the cases each day has began to level off or is still arising and how does the seven yesterday compare to the cases in the last ten days? Could you give us more information about these? And also could you explain why there are so few medical workers affected among the Beijing cases? When in other outbreaks, it seems medical workers have been a much greater proportion of patients. My second question is that you have taken extraordinary measures to get accurate numbers in the city of Beijing. How confident do you feel about the numbers in other parts of the country? Do you feel perhaps the situation in places other than Beijing and Guangdong could be as bad as in Beijing and Guangdong? My third question is: Are you still encouraging the foreign community to come to China as you did during the past few weeks?
Gao Qiang: I donít think the phrase ďto rise dramaticallyĒ is accurate. Just now, I have said that the increased numbers were collected by tens and hundreds of personnel sent by us, taking one week to check out patients scattered in various hospitals. The truth is that the number of SARS cases we have found and reported now has increased.
Five days before, the number was 37, now it is 339, increased by 302. But it doesnít mean the 302 people were infected within the last five days. It could have been ten or twenty days ago and they could be unregistered patients in some hospitals. To check them out is a good sign of our statistic work, but it doesnít mean the situation in the city of Beijing is deteriorating dramatically. As for few infected medical workers in Beijing, I think we should thank the better medical conditions, public awareness, and protection and prevention measures in the city. Just now the lady had some doubts about the accuracy of numbers in local areas; I can tell you that we have sent inspection teams to deal with any cover-ups.
As for whether we are still encouraging international exchange: arenít you staying in China? Monitoring is necessary, but maintaining normal international activity is necessary too. I am not in favor of saying China is the safest country in the world, or that we can promise for you not to be infected by SARS, and I donít agree with any judgment that China is a dangerous country and you are likely to be infected very much here neither. This plague is not exclusive to China. It has broken out in more than twenty countries. We hope that more measures may be taken to protect foreigners and fellow Chinese from Hong Kong, Macao and Taiwan, among whom, five were under medical care in hospitals of Beijing. So far, one Canadian has left the hospital, two Taiwanese are about to be discharged after recovery. Whether Beijing is safe or not, you may judge for yourself.
CNN: First I want you to understand why foreign journalists in China have been suspicious of the Chinese authorities. Over the past weeks we have received distorted information once and then again and the information has misled us and stirred confusion amongst us. For instance, two weeks ago Minister Zhang said the epidemic had been put under control; a week ago, it was said that Beijing had 37 SARS cases, and when we asked whether the 37 cases include cases in military hospitals, you said yes. Why is it so hard to squeeze accurate information from you? President Hu has said that any cover-up, delay or discounted reporting is intolerable. But the data you announced just now is yesterdayís information and you also mentioned that there are seven new cases. Why donít you report all the cases at one time? Is this because you have not attached enough importance to this issue?
Gao Qiang: I think that I have given enough of an explanation to similar questions but if you still donít understand, Iíd like to say more.
Beijing is the capital of China and there are work units of central government, local government and the military. These units are respectively in charge of some hospitals. These hospitals have received different patients. This is an issue then about the Chinese medical system. With the present system it is pretty difficult for the municipal authorities of Beijing to collect accurate and timely epidemic information in a hospital run by the military. President Hu Jintao and Premier Wen Jiabao have sharply noticed the problem and decided to put the epidemic prevention work of all the Party; government and military organizations, public instructions and enterprises under the leadership of the Beijing municipal government. I think with the leadership of this unified system the situation of the previous days will not be repeated.
(China.org.cn April 21, 2003)