Olympic-sized viral swap fest?

China now admits what everyone knows already knows. It had a death from H5N1 in November of 2003, a full year before its "official" first case (The Guardian). In fact everyone also knows that there was H5N1 in February of that year when the disease was diagnosed in Hong Kong in a family just returned from a visit to Fujian province. That occurred at the outset of China's now infamous SARS cover-up. As interesting, the Chinese explanation for why the case not been reported earlier, was it had been misdiagnosed as a SARS case. This may in fact be what happened but it raises another question: why wasn't the SARS case reported? The SARS outbreak had stopped by mid summer and, to our knowledge, no other cases were reported except a suspect one in a TV reporter in December 2003. The misdiagnosed case was in a soldier of the Peoples Liberation Army (PLA) and hence was treated in the separate military hospital system, the very system implicated most deeply in the SARS cover-up earlier in the year.

Parallels with SARS are instructive. The disease almost certainly started in south China and by the time it had spread to many other countries around the world the Chinese were still reporting very few cases. There was widespread suspicion they were covering up the disease but accurate information was difficult to come by. You can get a chilling account in Karl Taro Greenfeld's book, The China Syndrome, which for all its virological errors (mostly minor) is a wealth of information by a reporter who was on the scene and part of the team that broke the story of the cover-up for Time magazine.

Truthful reporting about a disease outbreak of global significance (first thought to be H5N1) was secondary to the Chinese regime's paramount goal of political stability. SARS occurred during a delicate moment of transfer of power from Jiang Zemin to Hu Jintao and amajor disease outbreak was not the proper background for this important event. But there was also uncertainty in the division of power between the old leader, Jiang, and the new one, Hu. Jiang's powerbase was in the PLA and Hu adroitly used the blown cover-up to clean house and consolidate his own power and support. From that perspective, China's commitment to openness was part of a political tactic. The subsequent failure to disclose a SARS case at a time when Hu's control was established reinforces this and also suggests the Chinese are covering up -- intentionally -- the severity of their H5N1 problem.

What's their reason for doing so? We see three. An entrenched habit of information control from on high and a timidity at all lower levels of the bureaucracy. Even minor disclosures in a society where disease outbreaks are officially considered state secrets can bring on severe consequences. Second, political stability is still the paramount objective and it is intimately tied to economic issues. Third, there is an important event that would be threatened by labeling China a hotbed of bird flu virus. Beijing is scheduled to be the host of the 2008 Olympics. This is a powerful incentive for a cover-up.

It should also be a powerful incentive for the rest of us to take a hard look at China. Beijing will be a potential swap fest for viral exchange for peoples around the world. Olympic sized.