Seasonal SARS?

In the holiday rush, few Americans took note of China's announcement on Dec. 27 that a 32-year-old television producer in the southern province of Guangdong had exhibited symptoms of SARS, the new, fast-spreading respiratory disease that claimed nearly 800 lives last year.

But on Jan. 5, the bad news became official: SARS was back. Chinese health officials confirmed their earlier suspicions, and some experts began talking about a recurring SARS "season," much like the annual appearance of colds and flu.

Stung by criticism that it had responded too slowly to the initial SARS outbreak, China acted quickly to calm international fears this time around. Officials closed street markets that traded in wild game and ordered the slaughter of an estimated 10,000 civet cats, a weasel-like animal whose meat is believed to have medicinal qualities. An analysis of the corona virus found in the Guangdong SARS victim showed it was genetically similar to the virus discovered in civet cats.

"The provincial government of Guangdong ... ordered immediate shutdown of the local wild animal markets and kill all civet cats before Jan. 10, in an urgent measure to contain a possible outbreak of severe acute respiratory syndrome," trumpeted the state-run Xinhua News Agency, adding pointedly that the World Health Organization had decided it was "perfectly safe for members of the public to travel to Guangdong Province."

The approval of the World Health Organization is crucial: Asian economies reeled early last year after the WHO urged foreigners to avoid China, Hong Kong, Taiwan, and other hard-hit countries. Indeed, it was only in response to such international pressure that China admitted the extent of its SARS problem and took drastic steps to halt its spread. Among those steps was a much-heralded ban on the sale and breeding of civet cats, raccoons, and other exotic animals. The creatures came under early suspicion because many of the first SARS victims were chefs at the wild-game restaurants popular throughout southern China.

Last October, however, China quietly lifted the ban on civet cats, saying there was insufficient evidence linking the animals to the SARS outbreak. Some scientists at the time deplored the government's decision, warning that it could lead to a renewed flare-up in the cold winter months. Their warnings went unheeded.

If SARS becomes a seasonal phenomenon like the flu, it could be much more than just an annual nuisance. Already, influenza kills about 36,000 Americans each year, or about 5 percent of those infected. The mortality rate for SARS, however, is closer to 15 percent, and no vaccine has yet been developed to protect against the respiratory illness.

While China wrestled with its new public health threat, American doctors continued to struggle with an old one. Though five states reported sharp declines in new cases of flu, the Centers for Disease Control warned that the nationwide infection rate was still on the rise. Some 42 states continued to report widespread outbreaks, and nearly one in 10 doctor's visits involved "flu-like illnesses"-enough to qualify as an epidemic. The fatality rate also continued to rise: By the last week of 2003, 9 percent of all deaths across the country were attributed to influenza or pneumonia.