Return Of A Killer

In late summer, the live-animal markets of southern China are usually buzzing with street vendors and their wares--a flurry of fur, scales and feathers, blood and gore, and the inevitable stench. This year, though, the markets are preternaturally quiet. In the Baiyun district of Guangzhou, half the 290 wild-animal stalls are shuttered. The vendors who remain have plenty of time to catnap, wash their laundry, cook for themselves and lament the long list of delicacies people rarely buy now due to SARS: tufted deer, water dragons, porcupines and crab-eating mongooses. Even the trade in legal animals has dropped off. "I'm near bankrupt," says Luo Aimin, a 56-year-old vendor who's throwing a handful of snakes into a sack. "If SARS comes back, I'm finished."

China's stern measures last winter to combat the SARS outbreak, which included a ban on the sale of 54 different live animals, has taken its toll on the poor farmers, butchers, traders and cooks who cater to the Cantonese taste for freshly killed exotic meat. It would be nice to think that Beijing's efforts have dealt the SARS virus a similar blow. But the evidence suggests otherwise. More likely, scientists say, the virus is simply lurking in civets, raccoon dogs and other animals of Guangdong waiting for colder weather to trigger another outbreak. Last week, Singapore discovered the SARS virus in a lab researcher. He's thought to be an isolated case, but health authorities in China and elsewhere are bracing themselves for another outbreak of SARS, possibly as early as November.

If SARS does make a return, China will most likely be the epicenter once again. That means China's government, and its citizens, will be at the front lines of the world's defenses. "If the disease does return, no one has more to lose than Chinese government officials," says Maria Cheng of the World Health Organization, who recently spent a month in Beijing. "They'll be the first ones to be blamed."

That's not completely reassuring, given that China's public-health sector remains underresourced, and other parts of the bureaucracy don't always sing from the same page. The government has built specialized SARS hospitals and encouraged honest reporting about the number of victims the disease claimed. Over the spring and summer, Beijing kept draconian measures in place, such as mandatory temperature checks at airports and public venues, and discharged its last two SARS patients on Aug. 16. "The Chinese government proved it could respond effectively in a short-term, heavy-handed way," says one Western expert on public-health issues in Beijing. "But whether it's learned the larger lessons remains unclear."

The government is taking steps to prepare for a fall outbreak. The Ministry of Health has ordered provinces to conduct health-emergency exercises--simulating a SARS outbreak and response--by the end of the month. Emergency- and infectious-disease centers are being built in each major city over the next two years. Last week, Beijing issued regulations for an emergency-alert system. The most urgent stage--involving health checks at all entrances to the city--would be implemented as soon as Beijing has 30 diagnosed cases.

Beijing's authority, however, has been less effective in curtailing the animal markets where the virus is thought to have originated. When scientists last May found a SARS-like virus in civet cats and raccoon dogs for sale in Guangdong, Chinese health officials managed to have them banned, along with 52 other animals. Last month the Forestry Administration, which has jurisdiction over the animals, rescinded the ban over the objections of some health officials on the dubious theory that humans were the ones who infected the civets. The real reason may have something to do with livelihoods of thousands of people in the animal trade who've been hurt by the ban. The palm civet, boiled in a pot with ginger and green onions, is considered to be a winter delicacy. "The taste of civet meat is to die for," says a Baiyun merchant, without apparent irony.

If China is going to keep another SARS epidemic at bay, it's going to have to do a better job of improving the personal hygiene of many citizens, too. Even in Beijing, many Chinese still think nothing of spitting noisily in public, dropping trash with abandon, smoking in elevators and eating anything with four legs. Standards of hygiene among China's vast rural population are even worse. Although the government made an effort during the recent SARS crisis to teach citizens to wash their hands vigorously and disinfect their homes, public vigilance has begun to wane. Even the domestic Chinese media, which avoids criticizing the government's handling of SARS, has begun to say so. "Habits of personal hygiene, environmental protection and physical exercise have not been maintained since the end of the crisis," Deng Guosheng, deputy head of a research institute at Tsinghua University, was quoted as saying to the Southern Metropolitan Daily last week. "The heavy cost born by China during the SARS epidemic might turn out to have been wasted."

If scientists could figure out exactly which animals spawned the virus in the first place, the knowledge might help in heading off another outbreak. Civets and raccoon dogs are thought to be intermediate carriers, and scientists aren't sanguine about finding the original "animal reservoirs" any time soon. "It took 50 years to confirm that aquatic birds are the natural reservoir of the influenza virus," says University of Hong Kong microbiologist Guan Yi. "We've only known about SARS for half a year. It could take years... or decades."

Because the virus has already made its way once around the globe, it's probably too late to stamp it out completely. "There must have been undetected chains of transmission," says Danuta Skowronski, an epidemiologist at the British Columbia Center for Disease Control. "So the idea of driving it back into nature becomes kind of moot." Although several labs have promising leads on vaccines, none will be ready before 2005. Whether or not China and the rest of the world can handle another outbreak depends on whether the virus takes a more benign form and joins the ranks of common-cold bugs, or grows even deadlier and less predictable.

Faced with this uncertainty, some Beijing residents cope by going to the theater. A popular stage drama portrays the lives of several Beijing families during the last SARS outbreak. When a resident gets sick, quarantined neighbors bicker and shun those suspected of having the disease. But in the end, they survive by learning to reconcile differences between the generations, rich and poor. The play's cast has received nightly standing ovations. If only the real-life drama has such a happy ending.