China Syndrome: The True Story of the 21st Century's First Great Epidemic [Paperback]

There are a growing number of books coming out on the threat that viruses pose to the human population. China Syndrome is one of the latest, and it stands favorably with the best in the genre. It tells the story of the virus itself, the people who were struck down by it, and the people whose task was to track the virus down and stop it before it burned through a big part of human civilization.

Reading China Syndrome was like having a front row seat in watching how a deadly virus can claw a devastating toehold into our lives, leaving us defenseless as there is often nothing we can do about it. You learn about what makes a virus so deadly. But what is even more interesting in this account is the story of how big of a role government can play in either stopping the virus or allowing the virus to continue its destructive path.

In this case, the government was China's. It's amazing to learn of the officials incompetence, self-centeredness, and willful negligence to the Chinese and world populations at large, all to protect their own image. The arrogant incompetence of a few could have easily led to a great human catastrophe. If you are interested in the topic of threatening pandemics, then you surely should put China Syndrome on your must read list.

I admit approaching Karl Greenfeld's CHINA SYNDROME with a certain degree of skepticism, not about the course of SARS or the research to discover its cause and source, but about the atmosphere created in China by the first great epidemic of the 21st Century. Writing from his Time Magazine base in Hong Kong, I wondered whether Mr. Greenfeld could really capture the various levels of uncertainty, disbelief, helplessness, fatalism, paranoia, and outright fear I experienced living and teaching in Suzhou (about 50 miles west of Shanghai) throughout the winter of 2002 and the spring and early summer of 2003.

Having now finished CHINA SYNDROME, I give the author a perfect 10 for his presentation of the scientific research associated with the hunt for the nature of SARS and its causative virus, a 9 for his detailed rendition of the SARS story at its epicenter in Guangdong Province and nearby Hong Kong, and an 8 for his discussion of SARS in Beijing and Shanxi Province. In each of these areas, Mr. Greenfeld does an outstanding job tracing the arc of the disease from Fang Lin, a meat cutter in one of Shenzhen's exotic animal markets and one of the disease's first suspected cases, to the final suspected case a year later, a thirty-two year old television reporter in Guangdong, with 884 dead and nearly 8,500 infected as the epidemic ran its course. Along the way, we meet a wide-ranging cast of characters, including China's most famous physician, Zhong Nanshan, WHO researcher Dr. Carlo Urbani in Vietnam, the family of Anna Kong in Hong Kong's Amoy Gardens residential complex, one of the outbreak's most virulent sites, Dr. Jiang Yanyong, who blew the whistle on Beijing's false reporting of SARS in the nation's capital, and Hong Kong microbiologists Malik Peiris and Guan Yi, who isolated the SARS coronavirus and identified its host source.

Mr. Greenfeld presents the story of SARS as a series of short vignettes, each centered around one of the players in the SARS story: victim, carrier, doctor, nurse, politician, epidemiologist, microbiologist, WHO member, or his own family. These short, newspaper length snapshots create a sense of immediacy and intimacy; following one on another, they trace out very effectively the multiple simultaneous threads of the SARS story line. The author has clearly done an immense amount of research and interviewing, delivering each person's slice of the story with telling personal details that make these individuals come alive. Rather than being an academic historical accounting of a nearly tragic pandemic, CHINA SYNDROME reads as a story of medical fear and confusion, of scientific drive and frustration, of political calculation and obfuscation, and of selfless (and sometimes tragic) heroism in the face of an unknown danger. And there most certainly were heroes in the SARS battle. Guan Yi literally risked his life to smuggle infection samples out of mainland China; Dr. Jiang Yanyong risked his career to expose Beijing's lies about the seriousness of SARS within the mainland and has since suffered house arrest; Carlo Urbani sent early samples of the infection to the WHO before he, too, died of SARS, effectively giving the entire planet a head start on isolating the virus. The actions of these three men alone certainly saved the lives of countless thousands and helped gain understanding of the disease and how to combat it.

Mr. Greenfeld's story makes all too clear just how fragile and precarious is the line separating civilized society from debilitating viral pandemic. Those front lines are manned by a small cadre of dedicated epidemiologists, microbiologists, and health professionals, including those at the U.N. World Health Organization. It is only by their collective knowledge and vigilance that future pandemics will be minimized or prevented. One cannot read CHINA SYNDROME without experiencing a sense of dread over how close we came in 2003, how lucky we were, and how likely it is that another, perhaps even more virulent virus, can attack us at any time. Equally scary is the realization that China's government appears not to have learned its lesson from the SARS experience, that a handful of self-serving technocrats were, and still are, willing to put the entire planet at risk for the sake of their own political self-preservation.

As for the author's ability to convey the degree to which SARS shut down life in China, I give him only a 4. The dread atmosphere created by SARS receives rather short shrift in the book. Even in cities like Suzhou, where no cases of SARS were reported, life and commerce came to a near halt. Every stranger was suspect, every cough was an alarm, every public surface a risk of infection. I hope I never again experience something that so closely duplicated the atmosphere of Camus's THE PLAGUE, and I was not even living in a city where SARS was present. The fear of its arrival was enough by itself, and Mr. Greenfeld falls a bit short in conveying just how powerful this fear was. I was also mildly disappointed to not see tables or charts showing the number of infections and deaths by country and by province within China at different time intervals; these would have added greatly to the story by illustrating more precisely how, and how widely, the disease actually spread.

On balance, however, I credit Mr. Greenfeld with a meticulously researched, highly readable, and well-told story that will make you realize how much of a bullet we dodged and how easy it would be for the next epidemic to be far worse. I highly recommend CHINA SYNDROME to anyone interested in epidemiology and the prospects for a future global pandemic.

Having been involved in the SARS epidemic laboratory testing working group at CDC in Atlanta I was very interested in the way this book tells the tale of how it all came about. These things start with rumors, samples come in, testing is done and the results reported. So much for the lab work. Then the medical journals report the epidemiology - nice if you are an epidemilogist, but dry otherwise. We very rarely get a richly detailed account of the whole story. Mr. Greenfield does that here and does a great service in that he shows the real world of infectious disease - which most people don't want to think about. The descriptions are excellent (I will never approach a "wild flavor" restaurant as long as I live!). The tension is kept throughout the book, much as the tension in the lab when the outbreak is happening - round the clock lab work, constant talks with collegues around the world, competition to see who can get it first. It's all there.

The only complaint I have is that he gets many details of the lab work blatently wrong and so I wonder sometimes about the details of other things he presents. This may seem minor, but if he is trying to present an authoritative view, then he has to be reasonably correct in all aspects. If I see many glaring mistakes in the areas I have intimate understanding of, then how can I trust what he says about things I don't know much about?

Even with these concerns over all the book is very good and captures the essence of how an outbreak proceeds and the real human carnage that occurs behind the headlines and dry news copy.