- The Washington Times - Friday, April 25, 2003

BEIJING The earliest known case occurred in a merchant in his 40s living in Foshan, a city of 3.2 million an hour's drive from Guangzhou, the capital of southern Guangdong province.
He came down with what is now known as severe acute respiratory syndrome (SARS) on Nov. 16. But it wasn't until early January that Chinese health authorities realized that he and several other people in the region had contracted a mysterious new strain of pneumonia.
By that time, the merchant had gotten over his illness but infected several health workers. The disease spread to hundreds in Foshan, Guangzhou and surrounding areas. Panicked residents, lacking any official information, rushed to stores and bought up stocks of vinegar, thought to be a good sterilizer.
Now Guangdong seems to have contained the disease, but it has spread to more than 20 countries and killed hundreds of people worldwide. Through extraordinary international cooperation, scientists tracked down the killer virus in record time. It is a novel form of the coronavirus a family of viruses that includes those thought to cause the common cold and is believed to have come from animals.
So how did the merchant, a cook and a government official the earliest known cases get infected?
That question still baffles scientists. A team of experts from the World Health Organization, belatedly allowed by China to visit Guangdong this month, looked into these early cases and came up blank.
"We had images of going to a very rural area," said James Maguire, an epidemiologist with the Centers for Disease Control and Prevention in Atlanta and WHO team member. It was "very, very urban."
"They weren't living among pigs and ducks and chickens. These were people living in apartment buildings," he said.
Furthermore, there was no detectable connection between the three cases, and Dr. Maguire doubts even that they were the first. "Patient zero," the first human to contract the disease, may still be undiscovered, or dead.
Guangdong is China's wealthiest province. Directly north of Hong Kong, it is a crowded, industrialized region of 76 million residents. Seventeen of the 100 richest Chinese, according to a list compiled by Forbes magazine, are from Guangdong.
As China's manufacturing powerhouse, the province accounts for more than one-third of the country's total foreign trade and receives one-quarter of the foreign investment.
But just a few miles from the gleaming skyscrapers of Guangzhou (formerly called Canton), are exotic animal markets and farms filled with pigs, goats and ducks. Other more-rural provinces such as Sichuan and Hunan have more livestock, but Guangdong also has a highly mobile population, perhaps more people on the move than anywhere else in China.
Along with the residents of Fujian province to the northeast, the Cantonese have long been among the most outward-oriented Chinese and were among the earliest immigrants to the United States in the 19th century. In addition to its official population, the province is also home to 12 million migrant laborers who come from poor interior regions and often travel back and forth.
Because of the abundance of animals and their proximity to humans, southern China has been characterized as a breeding ground for new viruses. The 1957 Asian flu and 1968 Hong Kong flu, which collectively killed about 2 million people, are thought to have started in the region.
But scientists say such generalizations cannot be made about infectious diseases.
"What might be true of the influenza viruses, where we have a historic basis for saying each of the major new virus types have come out of that part of the world, there's really no basis for extending that to the coronaviruses," said Fred Murphy, a professor at the University of California at Davis and the former head of the National Center for Infectious Diseases at the CDC.
Influenza viruses are genetically different from coronavirus and have a different mechanism for causing disease in humans. Some viruses are mosquito-borne. Africa has been a hotbed for new types of these and the United States has had its share as well. The "Swine flu" scare of 1976 originated at Fort Dix, N.J.
"It's not fair to say southern China is breeding ground for the virus," said Leo Poon, professor of microbiology at Hong Kong University. "This is completely new to science."
Dr. Maguire, the CDC epidemiologist, said it's premature to conclude that the virus that causes SARS originated in Guangdong. He notes that the first cases of AIDS were in North America, but HIV, the virus that causes it, was traced back to Africa.
Farmers around Guangzhou say they are not worried about the disease or working with animals.
"I've been doing this for more than 10 years and have had chickens and ducks, but was never affected by them," said a man named Jiang, a pig farmer who declined to give his full name. "We never got a cold or fever from working with them. Never."
Mr. Jiang said he washes his pigs every day, sterilizes them every other day and boils their food at a very high temperature.
"We keep our pigs clean," he said.
A bird seller was equally skeptical that the new virus could have come from animals.
"Cantonese people eat so many birds every day," said Nie Qun. "If it's true [that birds caused the disease], then the Cantonese wouldn't be able to survive."

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