In Chinese Village, Few Clues to Illness

Researchers 'Looking for Magic Bullet'

SHANGLANG, China -- This unimposing village off a provincial highway is an epicenter of the search for severe acute respiratory syndrome, SARS, the sometimes fatal lung disease that has spread to 17 countries on five continents.

Chinese doctors say an employee in the Shanglang government was the first reported case of SARS. But World Health Organization researchers now think they will have to keep hunting for the origins of the mysterious disease. When they realized there is no longer much livestock in town, they said this might not be the first case of the illness, which could have infected humans by "jumping" from another animal species.

"We were looking for a magic bullet," said Chris Powell, a WHO spokesman in Beijing. "We did not find one."

A four-member WHO research team spent the weekend in southern Guangdong province, permitted by the Chinese government to analyze information that may identify the origins of the disease, which is still unidentified and whose earliest cases were traced here last November.

SARS could be a case of a new animal virus affecting humans, similar to a 1997 outbreak of avian flu, said C.J. Peters, a professor of microbiology at the University of Texas and author of "Virus Hunter."

Scientists suspect SARS is caused by a microbe known as a coronavirus. Coronaviruses usually only cause the common cold in humans, but are responsible for more serious illnesses in other animals. Some researchers suspect an animal strain of coronavirus may have jumped to humans to cause the new disease. Guangdong has an environment that appears conducive to such infections, Peters said in a telephone interview from the United States.

"Everybody is so excited by Guangdong because it's there where you have a big pond full of ducks and pigs at the edge of the pond," he said. "A virus gets into a duck, it jumps to the pig. It mutates, the pig excretes it and humans can become infected."

However, there are neither ducks nor pigs in Shanglang. As industrial production has grown, this village of 11,000 residents has shifted from an agrarian to an industrial base. There are now so many factories that the local population cannot fill the jobs. More than 5,000 people from outside the region have been brought here to work.

"We've left agriculture behind," a local official said.

WHO investigators said that SARS moved quickly some time late last year from Shanglang to Foshan, a city of 3.5 million residents, just a few minutes away by highway, infecting 24 and killing two. The disease has now infected more than 2,671 people worldwide, and at least 103 have died. China has more cases than any other country. WHO statistics released yesterday listed 78 dead and 2,207 infected in China and Hong Kong -- all but a few in Guangdong. Last week, the World Health Organization issued the first travel advisory in its 55-year history, urging people to avoid Hong Kong and this region of China.

Chinese doctors said the Shanglang official who contracted the disease was not involved in handling livestock and did not have a pet. He engaged mostly in administrative work in a small two-story office building adjacent to a fish farm. His uncle contracted the disease and infected four health workers, the doctors said.

Robert F. Breiman, the lead WHO researcher in China, said he was "hoping to find a number of agricultural workers" among the earliest cases in Guangdong. So far, he said, the team has found none. However, scientists have discovered that chefs, a shrimp salesman and other food handlers have been prominent among the infected, he said.

"I think it's quite likely that we'll determine there were earlier cases than these," Breiman said.

A chef who handled wild animals was one of the first people infected, said Xie Jinkui, a doctor who treated him in Heyuan, another small city in Guangdong province. Residents of Guangdong are famed for eating monkey brains, snake and cat soup and stir-fried rat, among other exotic meals. Xie said it was too early to say whether such habits could provide a link to tracking the disease.

"I don't think anybody really knows where this disease began," he said.

The social and economic changes that have transformed China over the past two decades complicate the task of uncovering the origin of SARS, researchers said. The highway that links Foshan to Guangzhou, the provincial capital 25 miles to the northwest, crosses through Shanglang. A rail line links Shanglang to Hong Kong, about 100 miles to the east. The Foshan airport has dozens of flights a day with destinations throughout China.

The connections could facilitate the rapid transmission of local diseases. One of the people who contracted SARS was a 26-year-old woman from Shanxi province who was working in Guangdong. She returned home for Chinese New Year celebrations at the end of January infected with the disease and transmitted it to her parents, doctors said. Although the unidentified woman recovered, both her parents died in early March. Several health workers in Beijing also were infected.

An additional factor in researching SARS involves cases of so-called "super spreaders," people who contract the disease and then infect many others. One such case involved a shrimp salesman who infected about 90 people in Guangzhou. The unnamed salesman was treated for pneumonia-like symptoms at three medical facilities in Guangzhou: Zhongshan No. 2 Hospital and city hospitals No. 3 and No. 8. One of those infected was a doctor named Liu from Zhongshan No. 2 Hospital, doctors said. Liu later left for Hong Kong, where he stayed at the Metropole Hotel Feb. 21 to 22 and is believed to have infected several people there who then left the country and also transmitted the disease.

James Maguire, a WHO team member and an epidemiologist from the Centers for Disease Control and Prevention in Atlanta, said that some of those who contracted the disease might also have been infected with other viruses that combined to produce a more virulent effect.

"This phenomenon is one of the riddles of this disease," Maguire said. "This process is going to take a while."