Transparency a key lesson learned from Sars outbreak in mainland China
Sars taught China many lessons, one of the most important being that increased transparency would have made handling the epidemic much easier, says former Ministry of Health spokesman Mao Qunan.
Ten years ago, after mounting criticism from governments around the world and the World Health Organisation, which were concerned about a possible cover-up of the severity of severe acute respiratory syndrome, the government changed its policy and revealed the true severity of the outbreak.
On April 19, 2003, Premier Wen Jiabao warned that local officials who failed to report Sars cases in a timely and accurate manner would face severe consequences.
A day later, health minister Zhang Wenkang was dismissed and the ministry started to release daily updates on the epidemic.
"In retrospect, if we had disclosed information earlier we would have handled the situation better, but we did not have any experience," Mao said.
The ministry did not have a direct reporting system for infectious diseases at the time and did not have exact information to report to the public, he said.
"The information we got in the ministry was fragmented," Mao said. "We now know that panic and fear was more likely to spread among the public about such an unknown disease, but we did not have a standard public disclosure channel and the information we gave was not complete before the daily reporting [started]."
The ministry ordered all hospitals at county level or above to report to disease prevention and control departments, but it was difficult because there was no effective data collection system.
"There was the chance of incorrect figures or missed cases because we did not have a direct reporting system and everything was calculated by hand," Mao said. "It was not an easy task. Once, a reporter asked me after a report came out why the numbers did not add up."
At first, the daily report contained just a brief statement about the number of new cases, the death toll and the number of people who were receiving hospital treatment.
The ministry then began providing extra information, including an analysis and details of preventive measures. The updates were released every day for more than two months until the epidemic was under control and public attention had faded.
By the time that Beijing announced that the battle against Sars was over, in August 2003, more than 5,200 people had been infected and 349 had died.
The ministry learned its lesson from the slow response to Sars. Six years later, in April 2009, it stepped up surveillance almost immediately after the WHO issued an outbreak notice for swine flu, declaring it a "public health emergency of international concern".
Flights from Mexico, where the outbreak began, were cancelled and thousands of international travellers were quarantined on suspicion they had contracted the virus. Schools were closed and medical teams were sent onto arriving international flights to take the temperatures of passengers.
The measures were so strict that the mainland was criticised for going too far.
The WHO later declared swine flu a global pandemic but it was not as deadly as feared.
Mao said at one stage he was asked if he was telling the whole truth during the publicity drive to combat swine flu but says: "We were not certain about how serious the disease was at that time."
He said China was not taking any chances and had kept preventive measures in place to avoid a repeat of the Sars epidemic.