China: Painful prognosis

NAN PIN CHEE WAS A BUSY MAN. The head of Missionary Training College of Asia and Hong Kong representative for WEC International, Mr. Chee was known as a quiet and wise leader among the city's large assembly of long-serving missionaries devoted to Hong Kong and mainland China.

The busy life for Mr. Chee and his family ended in March when their sprawling apartment complex in Hong Kong's New Territories came under SARS quarantine. In Amoy Gardens over 300 people came down with SARS, or Severe Acute Respiratory Syndrome. The 54-year-old Mr. Chee, his wife, and their 15-year-old son were among those cases. All three were hospitalized for weeks as one semi-comatose day ran into the next, characterized by high fever, painful wracking coughs, and other pneumonia-like symptoms.

From the confinement of their hospital beds, the family used cell phones to keep in touch with one another, along with a daughter who is studying in Scotland. Hospitalization for SARS can typically last six weeks, one phase in a lengthy recuperation from the spectral virus that has launched a six-month panic in Asia and many other parts of the world.

But during his hospital stay, Mr. Chee grew worse. He developed liver complications and spent four weeks in intensive care on a ventilator after both lungs collapsed. By mid-May his wife Eleanor was well enough to go home. Their son Matthew, still in the hospital, was well enough to remember to send flowers on Mother's Day, a custom that belonged to Mr. Chee. "Mom, I just had to send you these flowers because Dad was unable to do so. I know he would want you to have them," read a note delivered by church friends, along with two bouquets.

A week later Matthew was discharged. But Mr. Chee never made the turn toward recovery. He died on May 17, less than 24 hours after Matthew's discharge.

During those last hours both wife and son were able to be reunited with him, "talking to him, telling him all those things we wanted to, crying together and praying," Mrs. Chee wrote to friends in an e-mail sent a few hours after he died. A native of Malaysia (his wife is from New Zealand), Mr. Chee was the first long-standing mission leader to die of the virus.

Health experts say the outbreak of SARS has peaked. When Hong Kong passed its first day with no new cases on May 24, the headline in one Chinese-language newspaper declared, "Hong Kong smiles again." But for many Asians, the downhill slide of SARS continues to bring more grief-both personal and economic-than relief.

Hong Kong is a quieter version of its once-boisterous self. The city of 7 million, a special administrative region of China, was hardest hit per capita, with 1,730 cases and 270 deaths reported through last month. Hong Kong has had 20 percent of the world's SARS cases, but 36 percent of SARS deaths. An open border and high population density have bolstered the casualty rate even though the numbers appear to have topped out.

In the worst days of SARS, hotels, hospitals, and complexes like the 19-building Amoy Gardens, where the Chees lived, all came under quarantine. At Amoy, city officials packed off affected residents for a 10-day isolation at a holiday camp. Health officials discouraged city-goers from using public transportation and joining large gatherings. They encouraged residents to wear surgical masks everywhere and to bathe and launder clothing after every public outing. Also ubiquitous: commercials advertising the ratio of bleach-to-water, 1:99, for brewing a proper home disinfectant.

Now, say Hong Kong residents, life is returning to normal. And it isn't. Schools have reopened, but most will have classes until mid-summer because of days missed due to SARS. Restaurants are busy again, but not to the level of their former bustle.

Many businesses face new regulations as city officials try to clean up practices that could lead to the spread of SARS. On May 29 the government announced "hygiene rules," which Chief Secretary Donald Tsang admitted were "draconian." Under the new measures Hong Kong residents could be fined $750 and receive a criminal record for spitting (a popular public practice among Chinese) and littering. He said authorities will monitor street food vendors and may ban the sale of live poultry.

The city has also mapped out a six-month plan for inspecting and refurbishing public housing after an investigation of Amoy Gardens concluded that the outbreak there likely resulted from faulty sewage pipes and improper ventilation fans.

World Health Organization travel advisories for Hong Kong mean tourism is at an all-time low. That's bad news not only for hotels, restaurants, and retailers but also for Hong KongÐbased corporate interests that rely on international business travelers. For some, the economic ripple from SARS is only beginning. Cathay Pacific Airways informed its employees last month that they must take one week unpaid leave each month. "The confidence of the local people, as well as potential tourists, needs to be built up," said longtime resident Bonnie Buckner.

Church workers face their own cutbacks. Many churches suspended gatherings and trips across the border to the Chinese mainland. OMF International, like many mission agencies, called off recruiting short-term mission teams from the United States and canceled summer camps where they were to teach. Despite declining numbers of SARS cases, it will take time to reignite routines.

Testimonies, however, remain vigorous. Over 600 people attended a memorial service for Mr. Chee at Ling Liang Church May 31. Half wore face masks. Mr. Chee received a posthumous doctorate in theology, having completed the defense of his thesis just prior to his illness. Hong Kong church leaders, in addition to the family, gave testimonies of Mr. Chee's faith and his effect on Asian missions. "He was loved around the world as he had a heart for missions," said Mrs. Buckner.

In the aftermath of the virus's grip on the city, residents have discovered new heroes: health workers who willingly treat SARS patients, knowing they too could be infected. The city's first public hospital doctor to die of SARS, Joanna Tse, 35, received a state burial at Gallant Garden, a cemetery reserved for those who die in service to the public. She was the first woman buried there, and Hong Kong's highest official, Chief Executive Tung Chee-hwa, attended her memorial service.

Unlocking the secrets to what causes SARS remains difficult. Hong Kong researchers theorize it may have begun in animals. Last month they found evidence of the SARS virus in three types of small mammals, including the civet cat, which is a delicacy eaten by some Chinese. SARS antibodies found in workers who handled exotic meat at the same market in southern China lend support to the theory.

Improving SARS treatment also has defied a rapid breakthrough. The current recommendation to doctors: Treat SARS with known antibiotics and antiviral drugs that are successful with other types of pneumonia, apply steroids in some cases, and pray. A WHO fact sheet to physicians concludes helplessly, "At present, the most efficacious treatment regime, if any, is unknown."

Conquering the unknowns is the main reason public-health officials will gather later this month for another global conference on SARS, to be held in Kuala Lumpur with over 400 health workers and SARS experts. They hope to discuss new treatment prospects and agree on further ways to control the spread of the virus.

But just as reported cases waned in Asia, health authorities in Toronto reported an outbreak of 20 possible new cases, prompting a new travel alert for Canada's largest city, more questions about where the virus is getting its start, and when it will end.