Listening to SARS

Some thoughts on what the SARS in Beijing might mean for the rest of the world, with a focus on the United States.

• Information can't be controlled. During the period before the amazing press conference on April 20 (somewhat sanitized transcript at: http://www.chinaembassy.se/eng/47200.html), rumors abounded, some of which were even more extreme than the reality (which was extreme enough). The lack of reliable news about the real situation didn't equate to a lack of news or a lack of worry, but rather to a real flurry of stories, some of which turned out to be true and others not. Information leaks; I'm not sure that it leaks any more or less in China than in the United States. If something like SARS came along and were classified as "terrorism" or "biological warfare," I wonder whether the U.S. government wouldn't make the same mistakes that the Chinese government did in trying to control what people knew about it.
  
• At the same time, official announcements do make a difference. Although everyone knew there were far more cases of SARS than the official announcements, it was still shocking to hear that there were something like 20 times the number announced. Perhaps an analogy can be found in the United States' economic situation. Despite creative accounting, "everyone knows" that the government is piling up debt at a phenomenal rate, and that we will shortly face the need to pay for the retirement of an enormous demographic bulge (see, e.g., Scott Burns:

  http://www.dallasnews.com/business/scottburns/columns/2003/stories/0504dnbusburns.70724.html ). Yet I suspect that many people will still feel at least some surprise when that day of reckoning finally comes and they learn that they won't be retiring quite as soon as they expected.
  

• Times of stress are not times of change. I've read several predictions that the coverup of SARS will lead to demands for a new governmental and social system in China. I'm skeptical, because under the stress of dealing with an immediate epidemic, people are more likely to become more cautious and conservative. At the same time, there's a Chinese expression: "qiu hou suan zhang -- sorry I can't get Chinese to work in this software -- "We'll settle accounts after the autumn harvest") that suggests that the political consequences of this experience are likely to come down the road.
  

• The problem of central authority. China has problems that stem from too much central authority (no checks and balances) and too little central authority (local authorities don't necessarily pass information to the center or accept directives from the center). Outsiders typically push the government to decentralize and devolve power, but I suspect that the current pressure to bring SARS under control will, if anything, work to increase the power of the central government. Mark Twain observed that Americans have freedom thought and freedom of speech and the good sense not to use either of them. Contagious diseases bring issues about the real limits of freedom into a far sharper focus than otherwise.
  

• How long can you hold your breath? Over the past few days it's been interesting to watch Beijing slowly come back to life. Quite a few people fled as soon as the true situation on SARS was revealed and others, like students, are restricted to their campuses. The increase in traffic has been striking, given that there has only been a modest improvement in the number of SARS cases reported every day. I would guess that a week is about as long as people are willing to give up their accustomed lives without any kind of continuing direct evidence that they need to do so.
  

• People are not good at estimating risk. It has long been known that humans are not very good at estimating the risk of different kinds of activities, dramatically over-estimating the risks of some dramatic events (e.g., airplane crashes) and underestimating the risks involved in more mundane activities (e.g., taking a shower or driving). It's clear that something like this is going on with SARS. A diminishingly small number of people have come down with this illness, and it probably ranks low compared with other risks of living here. I thought I saw more traffic accidents in the first few days after people started wearing face masks, and saw the aftermath of one very sad incident, where a bicycle was left by the road where it had been struck by a taxicab. On the back of the bike was a small bag containing the packets of Chinese medicine that schooles and factories were handing out. A poignant reminder that it's easy to overlook one risk in trying to adjust to another.
  

• Viruses evolve, too, and that may be good news for the United States. One of the best articles on disease I've ever read concerned the work of Paul Ewald at the University of Louisville

  (http://www.theatlantic.com/issues/99feb/germs.htm ). The relevant part of his argument is that natural selection works on diseases as well as on organisms, so that they will tend to be less virulent in settings with better sanitation (because otherwise they will kill their hosts before they can be transmitted). I hope so!
  

• The U.S. is not prepared to deal with something like SARS. Stopping the spread of a disease requires interfering with the free movement of potentially infected people. This is very unpleasant. For example, I live on a campus in Beijing with about 10,000 students. One of the smartest things they've done (although students really hate it) is to divide the students up into smaller groups and limit where they can eat, bathe etc. This turns a potentially infected pool of 10,000 people into smaller units that need not infect each other. In the U.S., I work on a campus with about 40,000 students. I wonder if we would be prepared to take steps like this? Hopefully we won't need to, but there's no reason to think that something even more contagious than SARS isn't coming down the road.
  

• Excess capacity is the key to adaptation. One of the late Stephen Jay Gould's arguments (I think in The Flamingo's Smile, although I don't have access to that now: http://www.powells.com/subsection/BiologyStephenJayGould.html) is that redundancy is one of the keys to evolution. For example, it is because we don't need to walk on them that our hands could evolve into the complex structures with which I'm typing these words. The U.S. medical system has systematically tried to weed out excess capacity over the last decade or so. The theory has been that the more doctors you have, the more medical tests they'll order, etc. The more hospital beds you have, the more sick people will be in them. To some extent it's worked, but if we're confronted with a disease that requires hospitalization and isolation of many people, I worry that the system will quickly come crashing down.
  

• There are important "network efforts" in health care. The term "network effect" refers to the fact that some artifacts become more valuable the more other people who have them, in contrast to most goods. For example, my telephone becomes more valuable as more other people have them, because I can call them if I choose to do so. In a world of contagious untreatable diseases, your health status becomes urgently important to me, because of the possibilty that your disease will turn into mine. 
  

•  Overcoming the distance. A Chinese student sent me an email message recently that included the evocative phrase that "distance is respect" in these strange times, because one needed to think carefully about the possibility that they might carry a disease that would make others sick. Internet technology can provide a way to overcome this distance. The possibility that this kind of physical isolation might become part of the life experience of American students is a good reason to build up the networking infrastructure that would allow education to go on in cases like this.
  

I hope that the hopeful evolutionary argument based on Paul Ewald's ideas (I don't know if he would agree with this conclusion) will carry the day, and that the United States will not be faced with the kind of rampant contagious illness that Beijing is experiencing. Even better would be the discovery of the viral equivalent of penicillin, a panacea that would give us 50 years or so of respite from such disease. But I don't think we can count on either of these happy outcomes, and this suggests a real need for considering how our own communities would be prepared to respond to an event like the SARS epidemic.

 

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3:36:14 PM  #  

Electronic Access to Academic Information during the Quarantine Time

During this strange SARS period in Beijing, I've been working to arrange access to academic journals for students in Beijing whose classes have been suspended and who are limited to their campuses.

I'm very pleased that the

• Society for Research in Child Development (http://www.srcd.org/) and the
• Psychonomic Society (http://www.psychonomic.org/)

have given final agreement, and several other groups and publishers have agreed in principle to do this.

More information on this site, which I'll update as this develops:  http://www.psych.uiuc.edu/~kmiller/SARSsite/index.html

 

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2:28:21 PM  #  

Forbidden City visit

If you are in Beijing this Spring, and not quarantined, it's actually a great time to be a tourist. Yesterday afternoon, my wife and I took advantage of the beautiful weather to tour the Forbidden City. I can never remember a time when it was so empty. The picture belows gives some sense of how quiet, majestic, and deserted it was:

This would ordinarily be the busiest time of year, but we saw perhaps a couple of dozen tourists during our whole visit. The audio tours were discontinued, out of fear that the headsets could transmit SARS, and many of the side exhibits and souvenir stores were closed. The exhibits in the Forbidden City are actually not that impressive, particularly compared to the museum in Taiwan where most of the contents were removed: http://www.npm.gov.tw/. But the site itself continues to be amazing.

One sign of the times that caught my eye was this bit of trash in the creek that flows through the front of the Forbidden City (the creek itself is shaped something like a drawn bow), which contains one of the newly popular disposable plastic gloves (it probably washed down there from somewhere upstream in the recent rains).

The weather continues to be amazingly clement, with highs in the 70s and clear weather. So all the people who are spending more time outside exercizing are experiencing a beautiful Spring to counterbalance the fear and rumors of disease.

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1:01:41 PM  #  

8 -- Diligently exercise

Last in a series of translations of advice on SARS from a poster plastered all over Beijing. This panel relates to the most obvious change in people's behavior as a consequence of SARS (other than the huge drop in the number of people out and about). Many more people are exercizing than before. Badminton and pingpong are still very popular, but the most noteworthy increase is in jogging and other aerobic activities, because they were relatively rare before. On campus at Beijing Normal University, large groups of students converge on the main soccer field in the morning and evening, and a student up on a stage leads them through a series of exercizes that look like a cross between Taichi and aerobic dancing.

One of the delights of visiting a big Chinese city has always been to go running early in the morning, because you pass groups of people doing Taichi, folk dancing, waltzing, sword exercises, walking backwards, and anything else you could think of. Now there are more, and there seems to be a new emphasis on aerobic exercise, although if I really translated the poster correctly, I'm not sure that 5-10 minutes of exercise is really going to accomplish much...

 

Here's what the poster says:

Diligently exercise

Pay attention to getting a balanced diet, an appropriate amount of activity, adequate rest, stable emotions, dress appropriately for the weather, strengthen your health and resistance, get regular outdoor exercise, breathe fresh air, strengthen your physical constitution, get moderate physical exercise,  increase your lung capacity, by:

 

Every day persist in getting 5-10 minutes of exercise that causes deep abdominal breathing in order to strengthen your lungs, abdominal muscles and lower back, increase breathing capacity. Swimming can also clearly improve lung capacity.

 

The cartoon shows a couple running.

 

The man says: Exercise more!

The woman says: Strengthen your body!

 

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10:15:53 AM  #