On the afternoon of 23 April the Ministry of Foreign Affairs held a briefing on SARS for foreign diplomats in China. Assistant Foreign Minister Zhang Yesui chaired the meeting and diplomats from over 130 countries were present. The main points of the briefing is as follows.

   Opening Remarks by Zhang Yesui,
   Assistant Minister of Foreign Affairs

   Good afternoon, ambassadors, ladies and gentlemen and dear colleagues. On behalf of the Foreign Ministry, I would like to thank you for coming to the ministry for briefing this afternoon. The briefing this afternoon is intended to inform you on measures that have been taken by the Beijing Service Bureau for the Diplomatic Missions as well as to provide you with some general information on SARS prevention and access to medical service. The briefing is also intended to provide you with necessary information on the symptoms and signs of SARS and how best to prevent it.

   Professor Zhong Nanshan, Academician, Chinese Academy of Engeneering, President of the Guangdong Research Institute for Respiratory Disease.

   Speech by Qu Wenming,
   Director-General of Beijing Service Bureau for Diplomatic Missions

   I would like to take this opportunity to give you a brief account on what has been done by the Beijing Service Bureau for Diplomatic Missions (DSB) in its prevention work against SARS.

   The leadership of the Foreign Ministry attaches great importance to SARS prevention for foreign diplomatic missions.

   At the beginning of April, DSB set up a “SARS-Related Emergency Team”. Both the general managers of the Housing Service Corporation (HSC) and the Personnel Service Corporation are members of the team. For almost one month, DSB has been in close contact with the Beijing Center for Disease Control and Prevention. The Bureau has already done the following work in its prevention against SARS:

   Firstly, DSB, at the beginning of April, engaged Mr. Tang Yaowu, a well-known Beijing specialist in prevention and treatment of infectious diseases as its special consultant for SARS prevention. In accordance with Mr. Tang’s advice, a lot of work has been done.

   Secondly, ever since the 3rd of April, HSC makes it a top priority to have the public areas cleaned and disinfected on daily basis. The public areas include lobbies, elevators, hallways, passageways, stairways and handrails and so on.

   Thirdly, after learning of the sad news of Mr. Aro’s death from SARS, HSC, on the 7th of April, took immediate action to have the public areas of the Tayuan Diplomatic Office Complex and other buildings sterilized with the advice of the professional personnel from CDC.

   For your information, one Chinese employee from DSB’s Personnel Service Corp. working for Mr. Aro for several days was sent to the hospital right away for isolation and medical observation. On the 20th of April, after being confirmed healthy and free from being contracted, that worker was discharged from the hospital.

   Fourthly, on the 7th and 8th of April, HSC posted notices in public areas of diplomatic residence compounds. The notice informs residents that HSC has taken necessary prevention measures to have the public areas of the diplomatic residence compounds and office buildings disinfected in conformity with the advice of the professional personnel of CDC. At the same time, the tips on SARS prevention and Treatment suggested by the Beijing United Family Hospital and Clinics was also put up with the notice for resident’s reference.

   Fifthly, based on the formula of specialists of Traditional Chinese Medicine, DSB, for four days on the 8th to 11th of April, prepared traditional Chinese herb concoction for the Chinese employees serving in foreign diplomatic missions as one of the preventive measures.

   Sixthly, as from the 8th of April, with regard to the then going on construction projects inside the diplomatic residence compounds, all those that can be postponed have been suspended in order to decrease the floating number of the construction workers. For those projects that have to keep on going, the contractors are required to monitor the health situation of their workers.

   Seventhly, HCS distributed in a timely manner to the residents of diplomatic residence compounds and foreign diplomatic missions the brochure “Guide to SARS Prevention and Treatment” printed by the Beijing Municipal Health Bureau. As another recent precautionary measure, starting from the 15th of April, disinfectant doormats were placed at each entrance of the residence buildings.

   And lastly, DSB held a briefing for foreign diplomatic missions on prevention work against SARS on the 18th of April. The general manager of HSC gave a detailed introduction for preventive measures taken within the diplomatic residence compounds and office buildings.

   In passing, there are two points I must make clear. Point one is about the disinfecting fluid HSC is now applying in the public areas. It is called “84-Disinfectant”. This disinfectant is recommended by CDC. As a matter of fact, it is now widely used in all ministries, hospitals and public places in Beijing. Point two is that HSC has set up an emergency-coping mechanism against SARS: In case of any suspected SARS patient; 1. HSC will immediately report to CDC and MFA; 2. It will act upon the CDC’s advice and by losing no time inform the households of the building; 3. It will assist CDCC to disinfect the building’s public areas and its surroundings. Upon the request of some individual households, HSC will render its service by contacting CDC to have their flats disinfected at their own cost; 4. It will arrange HSC staff working in that building to have medical check-up; 5. It will persuade residents of other buildings not to enter that building.

   It is DSB’s duty-bound to offer a safe and pleasant living and working environment for the foreign diplomatic missions. It is DSB’s duty-bound to do a good job in prevention against SARS. So further efforts will be made. To enhance the prevention, besides soliciting advice and suggestions from CDC, your suggestions will be highly appreciated.

   Taking this chance, I wish to express our thanks for all understanding and cooperation we have received from the foreign diplomatic missions. Thank you.

   Outline of introduction by Professor Zhong Nanshan:

   Professor Zhong Nanshan, by using power point, gave a detailed introduction of causes, main symptoms, criteria for diagnosis, methods of treatment and means of infection of SARS in combination of the practice and research result of his institute in prevention and treatment of SARS. He said that SARS is a new disease and its development has a process. If good prevention measures are taken, chance of infection can be possibly reduced. As to prevention measures, he maintained that two points are important, one is to foster good hygiene habits and the other is to have good ventilation. Proofs show that close breathing contact is a main channel for the spreading of virus. So good ventilation is very important.

   Outline of power point prepared by Professor Zhong

   What is SARS or AP

   1.A disease mainly involved in the lungs with unknown etiology

   2.It has been described in patients in Asia, North America, and Europe since mid-February 2003.

   3.Infectious, no response the aggressive anti-microbial therapy

   4.Different from typical pneumonia (fever, less respiratory symptom, normal or low WBC)

   5.Life threatening in some severe cases

   Epidemic Clues

   1.Family and medical staff clustering

   2.Infected by droplet

   3.Transmission directly and indirectly—hand, clothes, food, water

   4.Latent period 2-11 days

   5.Attenuate infective propensity in the 2nd-3rd generation

   Clinical Symptom & Signs

   1.Flu like symptoms (fever, malaise, fatigue etc.)

   2.In most patient:

   No sore throat

   Less cough

   Less sputum(Bloody sputum occasionally)

   No chest pain

   Short of breath in advanced stage(tachypnea)

   In few cases: Arrhythmia(bradycardia)

   Early Recognition of SARS

   1.Close contact with patients of SARS

   2. Acute onset of fever, chill and fatigue, with no other causes responsible

   3.WBC is normal

   4.Fever progressed with time

   5.Close follow-up the clinical situation and chest X ray

   Diagnosis

   1.Close contact with patients

   2.Flu like symptoms

   3.Infiltrative shadow in chest X ray

   4.Leuchopenia or normal WBC

   5.No response to antibiotics

   Macrolide, Fluoquinolone, B-lactams

   6.No prominent respiratory

   toms including throat


  Efective Treatment could reduce the mortality

   1.Proper use of corticosteroid when indicated

   2.Non-invasive positive ventilation

   3.Good medical care and life support

   Policy and Perspective on SARS

   1. Implementation of infection control policy

   2. Cooperation government

   3. Enough medical resource in Guangdong

   4. Reduction in prevalence and mortality

   5. Research in the potential pathogen

   Education and propaganda in different level

   Prevention

   1.Closely follow those who had contacted patients

   2.Good indoor ventilation IMPORTANT!

   3.Personal hygiene-hand washing change cloth

   4.Prophylactic anti-virus

   5.Ex:Neuramidinase inhibitor of influenza Ribavirin?

   6.Mask

   7.Vaccine

   Prevention of SARS in Daily Life

   1. Good hygiene habit

   2. Room ventilation

   3. Avoid close contact with subjects febril

   4. Wear mask in special situation

   5. Good rest, avoid over-worked or tired

   Q&A

   Q: My first question is, your speech is very clear and informative, can I have a copy of it for my Embassy? Second question, you mentioned biological weapon just now, do you think biological weapon has anything to do with it?

   A: On your first question, my speech is no secret. I would be very pleased to give you a copy and share with you. I don’t know why SARS-related death toll is so high in some countries, even including Canada. It may be because of differences in management, or because SARS is especially toxic there. That’s why I would like to share with the others.

   On your second question, CDC has already made very careful survey and examination and has excluded anthrax, plague, hemorrhage fever and so on. We can definitely say that it has nothing to do with pollutants that are related to biological weapons.

   Q: I have two practical questions. One is regarding the early diagnosis of potential cases. You say that whenever there are flu-like symptoms or fever, we should go and take an X-ray. Are we still talking about fever above 38 degree Celsius? The second question is regarding the disinfectants that are being used in the houses of diplomats and in our diplomatic missions. Could you please give us a bit more details about these disinfectants and what are the potential impacts these disinfectants might have on our health?

   A: On your first question, I have no exact criteria for how high a fever is. Fever is over 37 mostly by mouth. Usually it is over 38 when we call it fever. If the fever persists one day, it doesn’t matter. If it persists more than two days, at this special time, I suggest that you take a chest-ray examination.

   On your second question on the disinfectant the DSB has been using, I’m not coming from the Department of Public Health. I suppose I am a layman about that. But I will follow this recommendation. It doesn’t cause any harmful effect on the human body.

   Actually we have been applying this disinfectant four times a day at the public places, or residential compounds. Once some problem arises, we would invite the special professional personnel to come to disinfect the areas. Last Thursday a foreign friend fell ill. His colleagues were very much upset and we were asked to disinfect the area. So we called the CDC. They sent a special team to that area. They used peroxyaceticacid with a strong smell. That disinfectant is only used by professional personnel, not by DSB staff.

   Q: This morning I heard a rumor that the Chinese government will block the Beijing city border from tomorrow and will firmly control automobiles in and out of Beijing. Is it true or not?

   A: You should direct this question to the briefing organized by the Ministry of Health. As I said, this is a session specially devoted to the understanding of SARS. This question can be best answered by Beijing municipal government.

   Q: First of all, thank you very much for the wonderful briefing. We are all much more educated about SARS. For my own clarification I just wanted to ask whether the disinfection is going to be started in different embassies. If yes, then how frequent is it going to be? Similarly there are a number of embassies where all the staff members live within the embassy compound. So are there also some arrangements for disinfecting these areas?

   A: So far DSB, or the Housing Service Corporation, has only applied disinfectant to diplomatic residential compounds and office buildings, not to the embassy premises yet. In case some embassies have that special request, we can help arrange the CDC professional personnel to come to your embassy for spraying the disinfectant.

   Q: Returning to the question of the disinfectant, I think it would help people deal with any concerns they have about the disinfectant if you could tell us the active ingredients of the 84 disinfectant compounds.

   A: I really don’t know the ingredients. As I said, all the ministries, public places, or hospitals in Beijing or all over China are using this disinfectant. I will take your question to some specialists. Maybe they can give us the ingredients of the disinfectant.

   Q: On disinfection, does alcohol help?

   A: Definitely yes. Use alcohol for sterilization.

   Q: I have a question about access to medical services. In the envelope, there was information saying that any diplomatic personnel should contact one of the three designated hospitals. Does this also go for our nationals? Should they still contact one of the three hospitals if they get the symptoms? There are rumors that foreigners with SARS have been transferred to another hospital, not one of the three? Could you please comment on that?

   A: The three hospitals are the designated hospitals for the diplomatic community people as well as other foreign nationals. These three hospitals are recommended by the Ministry of Health. Those are the places where in emergency cases, you should take your nationals to.

   Q: I read a statement last Saturday’s South China Morning Post from WHO. They say that Vitamin C is very important to prevent the disease. Second, if we stay more, I see most of our colleagues will go to the professor’s institute.

   A: Usually Vitamin C is good for health and improves the inner function, which has been proven. But I don’t know whether it is specially effective for SARS. Generally speaking, it is good to take more VC. It is an antioxidant agent.

   As for your second question, I would be very happy to see all of you after such a long flight. Anyway, in Guangzhou during the trade fair, our hospital received some foreigners and had a good discussion about patients. I would be happy to make suggestions.

   Q: One question which is often raised about disinfection is whether disinfection is effective against droplets which are already on the surface. How long is the disinfectant effective against new droplets that arrive on that surface?

   A: We were told by specialists that this virus usually live 2 to 4 hours. That’s why we apply the disinfectant 4 times a day.

   We can leave the question to some other specialist.

   Q: Have you passed your method of treatment to other hospitals in China? Is WHO using your method?

   A: At the beginning of March when WHO delegates were going to Guangdong, we had some very good exchange. At the very beginning, they were very surprised to see us using corticosteroid in dealing with those patients. I also gave a speech in Hong Kong on my way back from Japan. They use the same method to treat patients and got some quite good results. WHO experts say that we should publish our data. Now we also have a symposium to teach doctors from different provinces on how to deal with the patients. I would like to share the experience with scientists from your countries since this is a disease of human beings. It is impossible to solve the disease just by one country. We have to depend on different technique, molecular biology, epidemiology, etc.

   Q: There is a great concern in one diplomatic compound in Sanlitun because of the fact of having one of the military hospitals just beside. This diplomatic compound has a wall, which separates this hospital where on one side of the wall people are all dressed up in special suits to protect themselves against SARS. On the other side of the wall, you can see children of the compound playing. My questions are: first, is there a risk for children or for everybody in the compound. Second, can you confirm if there are or aren’t any cases right now of SARS in that hospital?

   A: My hospital specializes in treating SARS patients. If your theory is established, I suppose the residents nearby my hospital will all got infected. So if there is no close or short-distance contact, and if ventilation is good, I don’t think there is any possibility of getting infected.

   As for your second question, either the expert or I am not in a position to answer. So I suggest you raise the point at one of the briefings either organized by the State Information Office or by the Ministry of Health. Thank you.