- The Washington Times - Thursday, May 29, 2003

TAIPEI, Taiwan — The spirit of rock ‘n’ roll still seems to transcend the fear of SARS on ladies’ night at Carnegie’s dance bar on Taipei’s tony An-Ho Road.

As is traditional, more than two dozen patrons danced on Carnegie’s long bar, and the room was packed shoulder-to-bobbing-shoulder earlier this month.

But all is not well, said Bob Marshall, the bearded British expatriate manager, as he pressed an electric thermometer to the foreheads of two 20-somethings applying for entrance.

“This isn’t nearly the crowd we normally have,” he said. “Usually at this time on Wednesday, there’s a line of people halfway down the block waiting to get in.”

Even so, almost no one is wearing a surgical mask, currently required in Taipei of airline flight attendants and policemen standing at entrances to government buildings.

“This is all a charade, really,” Mr. Marshall deadpanned as he checked an ID. “The only reason we’re doing this [checking temperatures] is because the public demands it. The fact is that somebody with the [severe acute respiratory syndrome] virus could come in here and infect everybody and not come down sick for two days.”

Mr. Marshall’s fatalism is in marked contrast to the upbeat pronouncements of every public official interviewed during a weeklong visit as the epidemic spiked. “We will conquer SARS; we Taiwanese are pioneers. We have shown time and again that we can meet up with hardship, adapt and survive. That’s Chinese philosophy,” said the buoyant Bruce Liu, an official of Taiwan’s international-tourism bureau.

Despite such optimism, Taiwan’s SARS crisis threatened to whirl out of control this month.

President Chen Shui-bian urged the people to prepare for a long fight against SARS. “A tiny spark can set off a bush fire,” he said.

Two weeks ago Dr. Twu Shiing-jer, Taiwan’s Health Department chief, resigned to take responsibility for the rapid spread of the disease. The government replaced him with Dr. Chen Chien-jen, a respected epidemiologist who studied at Johns Hopkins University in Baltimore.

Since March 14, when the first SARS cases were reported in Taipei, this island country of 24 million has seen the number of cases surge to 660, with 81 deaths as of yesterday. Taiwan reported 65 new cases on May 22, a one-day record, and 55 new cases on May 23, making its epidemic the world’s fastest-growing.

In the last weeks of May, the epidemic spread to a smaller Taiwanese island and two more hospitals were fully or partly shut down owing to the discovery of new cases. Dozens of doctors, nurses and health care workers have been infected, overwhelming the nation’s medical system.

The key to the virulence of this disease continues to elude the nation’s best medical minds.

At Taipei’s Mackay Memorial Hospital, investigators scrambled to discover how seven doctors and nurses, all taking full precautions against infection, had developed SARS-like symptoms.

The SARS epidemic on the Chinese mainland had already illustrated for people in Taiwan the deadly consequences of an authoritarian policy of treating epidemics as state secrets.

The epidemic began in November in the mainland’s Guangdong province, but the People’s Republic of China refused to report truthfully about its spread for four months. As of yesterday, the PRC has had 5,325 people infected with SARS and 327 deaths.

Beijing’s penchant for putting politics ahead of public health has had a devastating effect on Taiwan, which has the world’s third-highest rate of SARS after China and Hong Kong — a PRC entity where the count was not hidden and stood as of yesterday at 1,732 infected, with 273 deaths.

Taiwan does not have access to the technical resources and expertise of the World Health Organization (WHO), a United Nations-affiliated agency. It has sought observer status for seven years, but was again rebuffed May 19 at the annual WHO conference in Geneva. The WHO has granted observer status to nonstate entities such as the Palestinian Authority and the Order of Malta.

U.S. Secretary of Health and Human Services Tommy G. Thompson supports Taiwan for membership. He told the WHO in Geneva: “It’s good for all countries small, large, developing and developed to have as much information about this [SARS] disease as quickly and currently as possible. That’s what the observer status would give, and that’s why it’s important for Taiwan to have it.”

The PRC resisted admission of Taiwan to the WHO, arguing that the island is a province of China and cannot be admitted to any international body, lest this be taken as a recognition of national sovereignty.

The WHO, which expelled Taiwan in 1972 after the United Nations granted its seat to Beijing, chose not to consider the issue at a 10-day meeting of its general assembly that began May 20. It has sent only strictly limited help, including some test kits. PRC officials argue that the People’s Republic alone has authority over the health care of those on Taiwan.

But this week, the Canadian House of Commons took the unusual step of supporting a motion, against the wishes of Prime Minister Jean Chretien’s administration, that Taiwan be granted WHO observer status, Reuters news agency reported from Ottawa.

Tuesday’s motion from the opposition Canadian Alliance said the SARS outbreak shows “that health issues transcend political borders” and called on the government to actively support Taiwan’s wish to be granted observer status.

The motion passed 163-67, with many members of Parliament from the ruling Liberal Party voting against the government, Reuters said.

“We saw Liberals actually putting people ahead of petty politics,” said Alliance MP Stockwell Day. “The fact that now the Parliament of Canada has supported Taiwan’s request … is a significant sign that we care about the people of Taiwan.”

How much of a difference would it have made if Taiwan had been allowed WHO observer status before the SARS outbreak? Would lives have been saved? Absolutely, say Taiwan physicians and health officials.

With information the key to identifying and containing the disease, withholding information about the epidemic with which mainland Chinese provinces were suffering was a deadly omission, said Dr. Chen Tzay-jinn, former director of Taiwan’s Center for Disease Control.

“The problem is that on any given day, as many as 20,000 people in Taiwan report to clinics and hospitals with symptoms of cold or flu,” said Dr. Chen, a graduate of National Taiwan University’s School of Medicine who also has a master’s degree in public health from Harvard University.

Only a few are probable SARS victims, but finding the true SARS cases and avoiding misdiagnoses is the challenge for doctors in Taiwan.

Since every month as many as 10,000 Taiwanese citizens return to the island from jobs and businesses they run on the mainland, information about where the virus was spreading would have made a difference, according to Dr. Chen.

“When Taiwan had the fourth case of SARS [in mid-March], we requested many times that China tell us in which provinces there are the most cases.

“The response was nothing,” he said. “If we had been members of the WHO, we would more easily have had the data about which provinces were affected.”

Dr. Chen says the WHO has experts who could help Taiwan identify weaknesses in its methods of quarantine and containment. In addition, the WHO sponsors weekly videoconferences for epidemiologists to share the latest information on new epidemics.

Physicians from Taiwan are shut out of these meetings, Dr. Chen said.

This subtropical island is no stranger to epidemics.

“During the 50-year occupation of the island by Japan, more Japanese soldiers died from disease than from battle,” said Wu Shuh-min, a physician at Taipei Municipal Hoping Hospital.

Nonetheless, Dr. Wu noted, Taiwan’s highly developed medical system has succeeded in eradicating almost all infectious diseases there, including smallpox, rabies and malaria.

In 1998, an enterovirus epidemic swept the island and killed scores of children, but WHO resources were unavailable to Taiwan.

“The WHO had tracked a similar outbreak in Malaysia in 1996,” Dr. Wu said. “Had we had access to the information they had collected in 1996, we could have known more about the incubation period of the virus and the speed of transmission, and their experience in treatment, the sort of medicines we could use and their experience in isolating the victims.”

During that outbreak 80 victims died and more than 400 were hospitalized.

In the current SARS epidemic, the WHO sent an investigative team to Singapore only days after the virus erupted there. But, according to Michael M.C. Lai, a University of Southern California authority on the SARS microbe, the WHO did not send physician investigators to Taipei until May 3, and the first SARS diagnostic kits from the WHO arrived in Taiwan only on May 9.

Dr. Lai, an M.D. and Ph.D. who is a professor of molecular biology and immunology at the USC medical school, said the WHO’s reluctance to help Taiwan directly in mid-March when it asked for help contributed to worsening the outbreak.

“It is true that Taiwan was complacent and they were not prepared for the SARS outbreak. They thought they had the disease under control when the second round of infections started April 21,” he said. “However, the WHO investigative teams could have spotted the weaknesses in the public health infrastructure.

“Had the WHO sent in experts early, the recent outbreak could have been prevented.”

Douglas Burton is an associate editor of Insight magazine, a sister publication of The Washington times.

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