SARS to Swine Flu

Swine influenza was only recently raised to the status that all infections covet… pandemic! As such, the only real literature available on the topic deals with relatively boring stuff like transmission, symptomology, prevention, and treatment. We must be careful then, not to overlook the big picture issues of economic, social, and psychological impact that this disease may have on vulnerable populations. In the wake of a wave of global fear and government mobilization against swine flu, it may be helpful to look back and make sure we’ve learned the lessons of a similar public health concern, i.e., SARS.


The SARS epidemic of 2003 was a global crisis whose origin, unlike that of swine flu, can be traced to the belly of the Chinese rooster. Hong Kong was one of the most hard-hit regions by the disease, and serves as the geographic focus for editors Arthur Kleinman and James Watson, who, in SARS in China: Prelude to Pandemic?, have compiled a series of essays that successfully illuminate the economic, social, and political impacts of SARS on the former British colony. Issues of national sovereignty, the interconnectedness of the globe, and future public health crises are all addressed using an ethno-epidemiological approach. Current discourse on China’s political environment, as well as the culture of inter-disciplinary (medical, social, economic, psychological, etc.) communication places this volume at the cusp of evolution regarding internal and international foreign policy implementation.

The ten essays in Prelude to Pandemic? elucidate the various experiences and affects of SARS (severe acute respiratory syndrome) on the Chinese people. Moreover, in synthesis, they offer a perceptive glance at what the future holds may another epidemic surface. Low and behold, one has. By partitioning the book into four parts, each with two or three component essays, Kleinman and Watson create a highly readable book that appeals to the widest possible audience. By covering everything from the epidemiological background of the outbreak, to its political and economic consequences, and finally globalization issues, the contributing authors are able to demonstrate a vast pool of sources that include first-hand accounts, newspapers and periodicals, WHO reports, and Internet documents, to name a few.

In part three of this book, which examines the social, moral, and psychological consequences of SARS, two essays alone manage to provide a quite comprehensive view on what it must have been like emotionally to live in Hong Kong during the 2003 outbreak. In the first piece (the one I have chosen to focus on in this post), written by Dominic Lee and Yun Kwok Wing, the two disciplines of psychology and medical anthropology are combined to present both a quantitative and qualitative analysis of how the general public responded to SARS. Sources include author-guided research, participant observation during outpatient sessions at the Prince of Wales Hospital, and materials collected from newspapers, radios, books, photos, Internet chat-room discussions, et cetera. The authors provide discussion on the reactions of the general population, as well as special interest groups including pregnant women and SARS patients. Interestingly, some text is devoted to the description of a ritual that had become common in SARS-affected Hong Kong, known as the “undressing procedure.” This rite of private space developed from the distinct segregation between “dirty public space” and a “clean personal environment.” In terms of the psychological impact that SARS had on the Hong Kong populace, this demarcation of personal space seems to be most significant, as it echoes the practices of neighborhoods, hospitals, regions, and the whole Chinese nation. Dirty and clean were assigned labels of utmost importance, as they signified the often artificial boundary between control and chaos. One of the greatest analytic strengths of this piece is the focus on what would normally rest at the periphery of an investigation into the psychological response to trauma – the resilience and maturation of those who transcend crisis. Eventually, Lee and Wing are led to question the basis of the half-million strong July 1, 2003 demonstration. This assessment and questioning of Hong Kong’s sociopolitical landscape offers unique context that may explain any positive effects that SARS, or a future outbreak, might have on Hong Kong society.


Despite the analytic edge presented by Lee and Wing, some limitations do exist. First, the authors repeatedly express the “extremely challenging” nature and difficulty of their work, describing it as “no simple task” and admitting that recorded experiences are “truly beyond words.” This type of confession does nothing except to set the authors up for failure, priming the reader to expect error. Perhaps in accordance with these initial declarations of inadequacy, Lee and Wing fail to mention that their Face Mask Index may be flawed – As the methodology of this study called for the surveying of persons walking outside, no weight was given to the fact many people chose to stay indoors all the time, or as much as possible, like the 37% of women in another study that reported they did not go outside during the SARS epidemic, or did so only rarely. This same finding calls attention to the mobilization of half-a-million people on July 1, 2003. How did people simultaneously negotiate amongst themselves the strong urge for clean personal space and the desire for protest at the height of SARS? No probable answers to this glaring inconsistency are provided by the authors, leaving room for a second essay that might also include the medium-range psychological implications of the outbreak.

Anyway, as swine flu continues to spread both in terms of severity and areas affected, it will be interesting to see the way governments and their citizens react. More interesting, however, will be to see if we have learned from the past. For instance, have we learned this lesson? Or how about this one? Or how about this 160-page one?