SARS: Why We Need to Prepare for the Worst

[Dave Farber <dave () farber net>]

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Commentary (04/03/'03)


SARS: Why We Need to Prepare for the Worst

Anthony Cheung (Professor, City University of Hong Kong)

When it comes to health issues, Chief Executive Tung Chee-hwa does not have
luck on his side. A few months after he took office in 1997, the avian flu
broke out, which caused an immense public scare and led to the slaughtering
of 1.8 million chickens. Shocking media images damaged his administration's
popularity. 

Now, less than nine months into his second term of office, Mr Tung must deal
with the outbreak of the more menacing atypical pneumonia, dubbed severe
acute respiratory syndrome (Sars) by the World Health Organisation.

Wisdom in hindsight should not be used to belittle the difficulties and
uncertainties that officials confronting the pneumonia crisis have gone
through. However, with Hong Kong now virtually declared an unsafe city, it
is necessary to ask if we have learned any lessons from the past.

The avian flu outbreak taught us that what emerged as a mutant virus could
also cause, through official mishandling, a mutation in the nature of the
crisis, so that eventually it became a crisis of confidence in the
government's competence.  Overconfidence at the initial stage of the
outbreak, overdependence on narrow professional and administrative criteria
for defining a problem, insufficient information disclosed to an anxious
public and poor co-ordination among departments fuelled public anger and
tarnished the government's reputation.

Mr Tung's second-term government seems more attuned to media spin. There are
those who hoped that he might use the fight against Sars to rebuild his
leadership and popularity, as former New York mayor Rudolph Giuliani did so
superbly after September 11. But crisis management is more about how crisis
is defined and how people perceive it.

As Mr Giuliani put it: "The way citizens would perceive the information they
were getting would be as important as the information itself." Indeed, many
crises in government and business, or battles and wars, are fought on the
basis of information.

Hong Kong's medical personnel were obviously caught unprepared in their
first encounter with patients infected with the virus. They had limited
information and were not helped by tight-lipped health authorities in
Guangdong, where the virus was first found. But once the new virus was
confirmed in early March, how to assess its impact became critical.

From what is known, authorities underestimated the looming crisis. The
initial diagnosis that infection was confined to hospitals and had not
spread to the community - a line held officially for two weeks until the
virus broke out in residential blocks and then offices and public places -
gave it a head start.

This was a repeat of the initial confidence expressed by top officials
during the avian flu crisis that eating chicken was absolutely safe.

Of course, medical judgment has to be based on empirical evidence, and
administrative decisions have to abide by conventional wisdom and procedural
clarity. This might explain why Secretary for Health, Welfare and Food, Yeoh
Eng-kiong, himself a doctor, insisted as late as March 17 that "there is
still not an outbreak".

Similarly, Secretary for Education and Manpower Arthur Li Kwok-cheung, who
is also a doctor, ruled on March 25 that the closure of all schools in the
special administrative region would not reduce the risk of contracting the
virus, despite parents' anxieties.

But by then the crisis had turned into one of public confidence. As the
number of infections continued to climb and conflicting information
circulated even within the medical community, public panic began to dominate
media headlines. 

Thus, Mr Tung's about-face last Thursday, admitting that there was a
widespread pneumonia outbreak and that community-wide measures were needed
to combat the disease, was seen by many as coming too late.

Inter-departmental co-operation is working better this time. The relative
efficiency in identifying the virus should be commended. The fact that many
frontline doctors and nurses are risking their lives, with Hospital
Authority chief William Ho Siu-wai and his colleagues even falling prey to
the virus, has helped the government win back some sympathy.

Former Chinese foreign trade vice-minister Long Yongtu has derided the local
media's "unbalanced" coverage of Sars as harmful to Hong Kong's overseas
image. But he clearly misses the point.

The best cure to information distortion is information itself, which has to
be as transparent, accessible, authoritative and consistent as possible.

Otherwise, just as the pneumonia virus spreads in all directions, the
information virus will also multiply at a high rate.

Crisis management only works if those in charge believe that even a single
spark can ignite a whole forest. One does not need to be reminded of the
story of Mrs O'Leary's cow (which caused fire in a stable that got out of
control and eventually engulfed all of Chicago in the 19th century) to go on
the alert with any sign of a virus attack or public scare. Basing decisions
on the worse-case, rather than best-case scenarios, must be at the heart of
any crisis management strategy.

Other governments have failed similarly in crisis management. Postmortem
evaluation of Britain's foot and mouth disease outbreak in 2001 pointed to
bureaucratic failure, cultural complacency, lack of preparedness and
inadequate risk assessment and contingency planning. Most of what passed for
crisis management was reactive and ad hoc.

More fundamentally, even as science and technology advance, modern society
is not necessarily safer, nor can all risks be predicted and averted.

We have become a "risk society" where science, while solving old problems,
is creating new risks. Human casualties are caused more by industrial and
dietary hazards (including food engineering) than natural infectious
diseases. 

The destruction of humans through digital technology or cyber-terrorism is
much more calamitous than natural disasters.

A hi-tech society can be a high-risk society. The more government leaders
and individual citizens realise the existence of such "manufactured
uncertainties" and the unpredictability of risks, the better prepared they
will be - cognitively, behaviorally and psychologically - to cope with any
risk outbreak. 

Risk causes panic and panic leads to blame. Such a vicious cycle does not
help make our society a safer place in which to live. Educating individuals
to take their own responsibility in facing risks is a much more proactive
way of managing risk.

(This article originally appeared in the April 2, 2003 issue of South China
Morning Post in Hong Kong and is reproduced here with permission from the
publisher) 

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