Customer Reviews

China Syndrome: The True Story of the 21st Century's First Great Epidemic

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There are a growing number of books coming out on the threat that viruses pose to the human population. China Syndrome is one of the latest, and it stands favorably with the best in the genre. It tells the story of the virus itself, the people who were struck down by it, and the people whose task was to track the virus down and stop it before it burned through a big part of human civilization.

Reading China Syndrome was like having a front row seat in watching how a deadly virus can claw a devastating toehold into our lives, leaving us defenseless as there is often nothing we can do about it. You learn about what makes a virus so deadly. But what is even more interesting in this account is the story of how big of a role government can play in either stopping the virus or allowing the virus to continue its destructive path.

In this case, the government was China's. It's amazing to learn of the officials incompetence, self-centeredness, and willful negligence to the Chinese and world populations at large, all to protect their own image. The arrogant incompetence of a few could have easily led to a great human catastrophe. If you are interested in the topic of threatening pandemics, then you surely should put China Syndrome on your must read list.

I admit approaching Karl Greenfeld's CHINA SYNDROME with a certain degree of skepticism, not about the course of SARS or the research to discover its cause and source, but about the atmosphere created in China by the first great epidemic of the 21st Century. Writing from his Time Magazine base in Hong Kong, I wondered whether Mr. Greenfeld could really capture the various levels of uncertainty, disbelief, helplessness, fatalism, paranoia, and outright fear I experienced living and teaching in Suzhou (about 50 miles west of Shanghai) throughout the winter of 2002 and the spring and early summer of 2003.

Having now finished CHINA SYNDROME, I give the author a perfect 10 for his presentation of the scientific research associated with the hunt for the nature of SARS and its causative virus, a 9 for his detailed rendition of the SARS story at its epicenter in Guangdong Province and nearby Hong Kong, and an 8 for his discussion of SARS in Beijing and Shanxi Province. In each of these areas, Mr. Greenfeld does an outstanding job tracing the arc of the disease from Fang Lin, a meat cutter in one of Shenzhen's exotic animal markets and one of the disease's first suspected cases, to the final suspected case a year later, a thirty-two year old television reporter in Guangdong, with 884 dead and nearly 8,500 infected as the epidemic ran its course. Along the way, we meet a wide-ranging cast of characters, including China's most famous physician, Zhong Nanshan, WHO researcher Dr. Carlo Urbani in Vietnam, the family of Anna Kong in Hong Kong's Amoy Gardens residential complex, one of the outbreak's most virulent sites, Dr. Jiang Yanyong, who blew the whistle on Beijing's false reporting of SARS in the nation's capital, and Hong Kong microbiologists Malik Peiris and Guan Yi, who isolated the SARS coronavirus and identified its host source.

Mr. Greenfeld presents the story of SARS as a series of short vignettes, each centered around one of the players in the SARS story: victim, carrier, doctor, nurse, politician, epidemiologist, microbiologist, WHO member, or his own family. These short, newspaper length snapshots create a sense of immediacy and intimacy; following one on another, they trace out very effectively the multiple simultaneous threads of the SARS story line. The author has clearly done an immense amount of research and interviewing, delivering each person's slice of the story with telling personal details that make these individuals come alive. Rather than being an academic historical accounting of a nearly tragic pandemic, CHINA SYNDROME reads as a story of medical fear and confusion, of scientific drive and frustration, of political calculation and obfuscation, and of selfless (and sometimes tragic) heroism in the face of an unknown danger. And there most certainly were heroes in the SARS battle. Guan Yi literally risked his life to smuggle infection samples out of mainland China; Dr. Jiang Yanyong risked his career to expose Beijing's lies about the seriousness of SARS within the mainland and has since suffered house arrest; Carlo Urbani sent early samples of the infection to the WHO before he, too, died of SARS, effectively giving the entire planet a head start on isolating the virus. The actions of these three men alone certainly saved the lives of countless thousands and helped gain understanding of the disease and how to combat it.

Mr. Greenfeld's story makes all too clear just how fragile and precarious is the line separating civilized society from debilitating viral pandemic. Those front lines are manned by a small cadre of dedicated epidemiologists, microbiologists, and health professionals, including those at the U.N. World Health Organization. It is only by their collective knowledge and vigilance that future pandemics will be minimized or prevented. One cannot read CHINA SYNDROME without experiencing a sense of dread over how close we came in 2003, how lucky we were, and how likely it is that another, perhaps even more virulent virus, can attack us at any time. Equally scary is the realization that China's government appears not to have learned its lesson from the SARS experience, that a handful of self-serving technocrats were, and still are, willing to put the entire planet at risk for the sake of their own political self-preservation.

As for the author's ability to convey the degree to which SARS shut down life in China, I give him only a 4. The dread atmosphere created by SARS receives rather short shrift in the book. Even in cities like Suzhou, where no cases of SARS were reported, life and commerce came to a near halt. Every stranger was suspect, every cough was an alarm, every public surface a risk of infection. I hope I never again experience something that so closely duplicated the atmosphere of Camus's THE PLAGUE, and I was not even living in a city where SARS was present. The fear of its arrival was enough by itself, and Mr. Greenfeld falls a bit short in conveying just how powerful this fear was. I was also mildly disappointed to not see tables or charts showing the number of infections and deaths by country and by province within China at different time intervals; these would have added greatly to the story by illustrating more precisely how, and how widely, the disease actually spread.

On balance, however, I credit Mr. Greenfeld with a meticulously researched, highly readable, and well-told story that will make you realize how much of a bullet we dodged and how easy it would be for the next epidemic to be far worse. I highly recommend CHINA SYNDROME to anyone interested in epidemiology and the prospects for a future global pandemic.

Having been involved in the SARS epidemic laboratory testing working group at CDC in Atlanta I was very interested in the way this book tells the tale of how it all came about. These things start with rumors, samples come in, testing is done and the results reported. So much for the lab work. Then the medical journals report the epidemiology - nice if you are an epidemilogist, but dry otherwise. We very rarely get a richly detailed account of the whole story. Mr. Greenfield does that here and does a great service in that he shows the real world of infectious disease - which most people don't want to think about. The descriptions are excellent (I will never approach a "wild flavor" restaurant as long as I live!). The tension is kept throughout the book, much as the tension in the lab when the outbreak is happening - round the clock lab work, constant talks with collegues around the world, competition to see who can get it first. It's all there.

The only complaint I have is that he gets many details of the lab work blatently wrong and so I wonder sometimes about the details of other things he presents. This may seem minor, but if he is trying to present an authoritative view, then he has to be reasonably correct in all aspects. If I see many glaring mistakes in the areas I have intimate understanding of, then how can I trust what he says about things I don't know much about?

Even with these concerns over all the book is very good and captures the essence of how an outbreak proceeds and the real human carnage that occurs behind the headlines and dry news copy.

As I write this, researchers in Alaska are nervously looking at migrating birds that will bring to our continent the bird flu. If it changes its form, as flu viruses do, it might become not a bird flu wiping out our chicken coups, but a virus that spreads from human to human, the next pandemic. We are right to worry about such diseases; human history includes many sad chapters on various plagues, and another one is inevitable. We are making them more likely by our over-use of antibiotics, our overcrowding and our accelerated tendency to shift individual members of our species from one continent to another. As we have bird flu on our minds, Americans may have forgotten SARS, Severe Acute Respiratory Syndrome, sparked by the appearance of a previously unknown virus in China. Only four years ago it infected over 8,000 people, killing about a tenth of those infected. In _China Syndrome: The True Story of the 21st Century's First Great Epidemic_ (HarperCollins), Karl Taro Greenfeld shows himself to be the perfect writer to remind us of this plague and the lessons we might have learned from it. Greenfeld was at the time of the outbreak the editor-in-chief in Hong Kong of the Asian branch of _Time_, and partially through the efforts of his team of reporters the Chinese government's negligent response to the virus came to light.

Greenfeld starts with the reservoir of the virus, in the town of Guangzhou inland from Hong Kong. If you wanted to eat civet cats, regular cats, dog, mountain lion, muskrat, snake, camel, or anything else with meat on it that could be caught and caged, it was available in the markets there. The animals, awaiting a diner's order from the menu whereupon they would be slaughtered and cooked, were jammed into cages, and the cages were jammed and stacked together. The frightened animals, in poor nutrition and health, shed lots of viruses in their bodily fluids and feces, and shared them with each other and with the low-paid chop boys whose job it was to turn the animal into a cookable meal. The illness was a mystery when it started its killing spree in Guangzhou, and a great deal of the book has to do with the Chinese government's eagerness to keep the outbreak mysterious and unknown. Greenfeld's book is as much about Chinese administration and bureaucracy as it is about the virus. The cover-up endangered lives and made the epidemic worse. For example, an initial medical report dated 21 January 2003 (the book covers November 2002 to January 2004), by doctors who could see first hand that the infection rate was increasing, was an excellent summary of the epidemic as it was then known, and contained such practical advice to medical authorities as recommending that those handling patients wear masks, goggles, and gloves. At a time when such information would have been vital to hospitals accepting waves of infected patients, it was labeled "Top Secret".

What worked, eventually, was "old-fashioned Florence Nightingale-style proscriptions", including masks, gloves, quarantine, ventilation, and sealed wards. Hundreds died because such practical measures were not instituted promptly, because to have done so would have been admitting that there was such a thing as a new disease sprouting in China. One would think that China has learned lessons from the incident, but as one Chinese virologist said, "Human lives just aren't as valuable in China. They don't see these matters the same way a politician might in the West." The wild animal markets are still in business, and the purpose of the governmental bureaucracy remains the portrayal of stability rather than the protection of citizens. President Hu and President Bush last year called jointly for openness and cooperation against viral threats, but even after that, China was caught withholding samples of flu virus from infected birds and hiding human bird flu cases. Greenfeld's exciting and detailed look at how the SARS epidemic was handled shows that we have all the makings for another epidemic, perhaps one that will make SARS look benign.

A periodically terrifying, very accessible story of the rise of SARS, its probable origins in the wildlife markets of Southern China, its march through Asia and then around the world, and the Chinese government's attempts to censor and hide the true severity of the disease. I have both personal and professional interests in the ecological impacts of the wildlife trade, and it was edifying to hear Greenfeld's account of how the rise of China's economy in the 1990s led to an "era of wild flavor," in which exotic animals from around the world were thrown together in horrifying wildlife markets, slaughterhouses, and "wild flavor" restaurants. This proves to be an unbeatable environment in which viruses can mutate from one animal host to another, through the relentless pace of viral evolution, and eventually make the zoönautic leap to infect humans.

Greenfeld, who was a journalist and editor for TIME Asia in Hong Kong at the time, makes heroes out of the epidemiologists and virologists who raced to understand the SARS virus and the brave doctors and nurses who treated patients, risking their own lives, while the Chinese government mercilessly censored the story. He intersperses his own story, as he and his family and the journalists he worked with were fearful of their own safety while trying to understand and cover the story. As Greenfeld observes, SARS has by no means been beaten -- it's not clear why the disease roared through China and Southeast Asia in 2003-2004 and has receded since then, since it's still basically uncurable by the medical technologies there. So there is abundant reason to fear another outbreak.

There are some periodic laugh-out-loud moments in the story, surprisingly. For various reasons of political correctness and increased delicacy in the international medical community, for example, it's no longer considered kosher to name a disease after its place of origin. Thus, we'll have no more new diseases like "Spanish flu" or "Ebola virus." But through sheer carelessness or inattention to detail, the coalition of scientists and medical people who named the disease Severe Acute Respiratory Syndrome inadvertently gave it the common nickname SARS - as if they were naming it after the Special Administrative Region (SAR) that the Chinese government now calls Hong Kong and the New Territories, where the disease was first detected. Huh.

Karl Taro Greenfeld (KTG) in his book follows the SARS virus from its early beginnings in Guangdong Province (China) in late 2002 right to its end during 2003. He starts off with the rumours flying around Guangdong in late 2002 and then follows the virus around to wherever it goes. He also covers the science effort to identify it and the efforts to contain it.

KTG calls SARS the first pandemic of the 21st century. Perhaps it should be called the first pandemic which didn't happen. The figures of infected people and casualties he quotes at the beginning of each chapter are an approximation only as KTG admits at the end of the book and I can well believe that because when you read about the virus's impact on China you would think that the casualty figures should be higher.

China comes out badly in all this. As official policy dictates that the virus does not exist, it does not exist and therefore it spreads virtually unhindered until official policy changes, which eventually it did. But guess how many lives could have been saved if official policy had changed faster or if it hadn't been formulated in the first place. When you read KTG's bit on how China works you can see that it will happen again. That's the terrifying bit I took home from reading this book. Imagine a virus that outpaces the speed at which bureaucracy moves. We could be all dead by the time they make up their minds.

Great book. I recommend it to anyone interested in virus outbreaks, which should be all of us; it also provides a look into Asia, and China's bureaucracy, that is hard to come by. If you're thinking about getting it, get it.

This is a very interesting look at the outbreak of SARS, told in a journalistic narrative voice by the editor of Asia's Time Magazine. It takes you through the eyes of many of the doctors and victims involved, and gives a strong sense of the feel of the time, the various cover ups, and how the discoveries unfolded. A quick and interesting read.

A fiesta for infomaniacs. Fascinating microbiology, world history, and an especially nice introduction to China today.

Favorite vignette: Q: Is it possible SARS can be transferred from humans to livestock?

A: You will be held accountable for your words!

My wife read this book first and urged me to do so. I'm glad I did. As a non scientist, I found Greenfeld's writing and analysis very understandable and riveting. From patient zero, a chop shop employee in one of Hong Kong's teeming "Wild Flavor" eateries, to the pursuit of patients in the steppe of China's rural areas, he has put together a concise and chilling treatise on how fragile life in this world can be, and make you wonder when another killer virus will emerge. I recommend this book to every infectious disease specialist out there and any lay person who wants a great summary on the killers that are waiting for their genetic lottery tickets to get punched.