Viewing China through the SARS lens:

I wrote your name in the sky, but the wind took it away. I wrote your name in the sand, but a wave washed it away. I was just worried about you and let out a few dry coughs, The SARS-prevention group took me away.

From SARS-related jokes that cropped up across China to discrimination against SARS patients to a slamming shut of international doors pried open by globalism, the SARS epidemic revealed as much about Chinese culture and society as it did about biology and public health, authorities gathered at Harvard said Wednesday (Sept. 10).

What it revealed is a China that is modernizing as its middle class expands and grows more affluent, and one that also fosters the crowded agricultural practices that allow diseases like SARS, or severe acute respiratory syndrome, to spread and cross the species barrier from animals to humans.

Authorities from a variety of disciplines attended the conference, “SARS in China: Economic, Political, and Social Consequences,” held at the John F. Kennedy School of Government. The conference, which featured speakers from fields as diverse as anthropology and economics as well as medicine and public health, was sponsored by the Fairbank Center for East Asian Research.

“We’re using SARS to open a window on Chinese society,” said conference co-organizer Arthur Kleinman, Rabb Professor of Anthropology, professor of psychiatry, and Presley Professor of Medical Anthropology. “We’re as interested in what SARS tells us about China as what China tells us about SARS.”

The conference featured discussions of economic and political consequences of the epidemic, the epidemic’s social and psychological consequences, and globalization and cross-cultural issues.

Harvard Provost Steven Hyman, who helped open the conference, said the epidemic highlighted an “extraordinary paradox.”

Hyman said while the science that fought the virus showed far greater coordination and technical prowess than, for example, when AIDS first came on the scene in the early 1980s, the public health response still relied on age-old strategies such as quarantine.

While the quarantines, travel restrictions, and other measures ultimately proved effective, Hyman said they also require a balancing act between fears of spreading the disease and other rights, such as privacy and the right to move freely.

In China, Kleinman said, fear of the disease appears to have won out. Social stigma surrounding SARS was common, with some doctors refusing to treat SARS patients, one doctor being refused a haircut, family members being cut off from contact with infected patients, and even violence erupting near treatment facilities.

While the quarantine proved effective, Kleinman said that ultimately authorities need to find ways to make such actions less subject to stigma, since people fearing being stigmatized by a disease will be reluctant to seek treatment and risk spreading the disease further.

Humor sparked by the epidemic cast a new light on China’s growing middle class, according to Hong Zhang of Colby College. Zhang studied Web sites that posted more than 150 SARS-related jokes for what they could tell her about China. The jokes ranged quite broadly in content, encompassing political and social humor that had not been seen in previous crises.

The jokes themselves, Zhang said, are quite funny in Chinese due to wordplay and cultural references, but sometimes didn’t translate well into English. One was a list of ways to die from SARS, including being poisoned to death from traditional remedies and suffocating from wearing a face mask. One had to read all the way down to number 10 to find that one could actually die from contracting the disease.

Zhang attributed the broad content and diverse sources to China’s growing middle class that is increasingly using the Internet and cell phones to communicate. Though the new technology creates a public space out of reach of the government, the Chinese government also got in the act, actually posting a list of jokes – minus those with political overtones – on an official government Web site.

Though authorities discussed other aspects of the epidemic, they didn’t ignore the science around SARS. The cooperation of the international scientific community led to rapid identification of the disease agent, as well as to rapid decoding of its genome. Through those actions, scientists could quickly tell that the disease was spread by a corona virus, similar to those that cause the common cold in humans, but unrelated to human corona viruses.

That led to a search for other hosts, which proved fruitful in recent weeks, when the virus was found in civet, raccoon, dogs, and other animals for sale as food in south China markets. Further research is needed to determine whether the virus is present in wild populations of the animals or whether the animals could have contracted it while in captivity.

The conference’s timing was particularly apt, as the first case of SARS since July was confirmed in a man in Singapore this week. While that was described as an isolated case, it raises the question of whether SARS will be back.

Megan Murray, an assistant professor in the Harvard School of Public Health, said that many common respiratory viruses disappear during the warm months only to reappear during cold and flu season. Scientists assume the viruses reappear from some reservoir, but they’ve never been able to find one. This raises the question whether SARS, like the common cold, will be back with the winter months.

“Will we see it return? Only time will tell,” Murray said.

If it does return, it will be seeing a changed world from the one the first SARS outbreak encountered, according to Fairbank Professor of Chinese Society and Professor of Anthropology James Watson. Watson, the conference’s co-organizer, said that SARS did as much as the Sept. 11 terrorist attacks to stiffen borders around the world.

Gone, he said, is speculation about a new type of multinationalism in a world of soft borders where people with multiple citizenship move freely. Speculation as recently as 1999 that the technological revolution would lead to a diminishing of national boundaries has all but disappeared, he said, and looks quite dated today.

SARS furthered the border-closing process begun with 9/11 and, for a short time during the height of the epidemic, pushed it to an extreme where nations were looking very closely at who they let in.

“SARS makes open, porous borders even less likely,” Watson said. “I’d argue that as painful as 9/11 was, it produced nothing like the complete, utter, and indiscriminate clampdown of SARS.”

Watson said the response of Chinese officials to the disease shows that, though the nation is more open than it has been, it still has a ways to go to catch up to international standards and expectations.

Watson said he plans to have research presented at the conference published late this year or early next year in a book that would be targeted at health officials, policymakers, and others with a general interest in SARS.