Writing between the lines

A great piece of public health reporting, which I have come across in the book The China Syndrome by Karl Taro Greenfeld. I rather like the book which is a good starter for anyone interested in the intersection of public policy/human rights, the public health infrastructure, and epidemiology. It could, however, have a different title, as the lessons can be generalized outside of China. And there was another book or movie by that name, about some lose Chinese nukes or some such nonsense.

At the intersection of science, freedom of the press and political power a lot of very interesting things happen, and it is enlightening to see how people resolve their competing allegiances. A similar dynamic is now playing out in the reporting of global warming, with some saying, basically “Global Warming is only a rumor,” and others showing some evidence, which is being largely ignored by Bush & Co. (Another example of Convergence?)

The book is about the SARS epidemic, with a special focus on how it got started and and personalities involved. In this case, a reporter in China who is aware his work will be censored, still manages to get out all the essential information. This is one of the very first stories about what would later be named SARS (Sudden Acute Respiratory Syndrome) and the reporter does an excellent job, being caught between the reality of government censors and his responsibility to provide information about a matter of overwhelming public iimportance:

From the Heyuan Daily:

The Epidemic is only a Rumor
Jan 04, 2003
by Li Jianhua

The director of Heyuan People’s Hospital announced there is no epidemic. Since yesterday, due to this terrifying rumor of a serious infectious disease, there has been a rush to pharmacies to purchase certain antiviral tonics. This irrational purchasing has driven up prices of these drugs to ridiculous levels; a tonic that usually costs Y10 now costs Y450. Antibiotics have also become more expensive, the price rising to Y30. Yet no matter the price, as of 9 pm, these medicines were sold out at most pharmacies. Until yesterday morning there were long lines waiting to buy these drugs with customers purchasing up to 10 boxes each.

This rumor also has parents keeping children home from kindergarten. Authorities from the Old City Kindergarten told this reporter that not only were many youngsters not in school, but some parents had during the school day taken home those children who were there. In the Central Kindergarten, two classes contained a total of 20 kids, less than half the usual attendance. Kindergarten officials said they had also heard the rumors of a disease but didn’t believe it. But just in case, they added, they had prepared a cold elixir tea to ward off any sickness. Primary schools were not affected. This reporter went to four primary schools and was told that only 10 students stayed home.

People’s Hospital of Heyuan received two patients from Zijin Hospital on the fifteenth of last month. The patients were transferred to Shenzhen and Guangzhou. Specialists from hospitals in Guangzhou were sent to Heyuan to help in the treatment. The Hospital Director said that after the meeting of provincial experts it was proven that the disease is a very common disease: atypical pneumonia. This disease is not infectious and caused by the changing weather. The symptoms are: high fever coughing and spots in the lungs. This disease is not similar to any communicable disease identified by the government so there has been no reason to report it to the provincial authorities.

A doctor on duty at another hospital, the People’s Hospital of Yuanchen, said staff there didn’t receive any notice from higher officials that there was a communicable disease outbreak.

This reporter spoke with the family members of one of the patients and was told the symptoms were high fever and that the patient was conscious and in stable condition. It is worth remembering that it is now in influenza season. There have been several medical staff from Heyuan People’s Hospital who got infected with the disease but the situation is not serious. The Hospital Director has warned there is no reason to panic.

It’s interesting how the censor-required ‘the epidemic is only a rumor’ quotes bookend the article, with the facts sandwiched in between. The contradictions are allowed to exist in the body of the article in between, e.g.: ” This disease is not infectious and caused by the changing weather.” vs “There have been several medical staff from Heyuan People’s Hospital who got infected with the disease but the situation is not serious.” so the message is clear, reading between the lines.

Writing between the lines

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