Severe acute respiratory syndrome social impact

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Social Impact

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#### Canada

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Most conferences and conventions scheduled for Toronto were cancelled, and the production of at least one movie was moved out of the city. On 22 April the Canadian Broadcasting Corporation reported that the hotel occupancy rate in Toronto was only half the normal rate, and that tour operators were reporting large declines in business. As of 22 April all Canadian SARS cases were believed to be directly or indirectly traceable to the originally identified carriers. SARS was not loose in the community at large in Canada, although a few infected persons had broken quarantine and moved among the general population. No new cases had originated outside hospitals for 20 days.

Nonetheless, on 23 April the WHO extended its travel advice urging postponement of non-essential travel to include Toronto. At the time, city officials and business leaders in the city expected a large economic impact as a result, and an official of the Bank of Canada said that the travel ban would drastically affect Canada's national economy.

On 29 April, WHO announced that its advisory against unnecessary travel to Toronto would be withdrawn on 30 April.

The U.S. Library of Congress officially excused itself from attending the American Library Association convention in Toronto in summer 2003 as a precaution.

In 2005 and 2006 The Rumoli Brothers[1] (a comedy duo based out of Toronto) put on SARSical; a musical that explored the lighter side of the epidemic and poked fun at the media's over-reaction to the 43 deaths that occurred in Toronto.[2]

#### The Chinese World

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Severe customer drop of Chinese cuisine restaurants in Guangdong, Hong Kong and Chinatowns in North America, 90% decrease in some cases. Business recovered considerably in some cities after the end of the outbreak.

##### Hong Kong

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Some members of Hong Kong Legislative Council recommended editing the budget for increased spending on medical services.

Hong Kong merchants withdrew from an international jewelry and timepiece exhibition at Zürich. Consulate Genera officials enforced a full body check of the 1000 Hong Kong participants that would be finished 2 days before the end of the exhibition. The Swiss Consulate General to Hong Kong replied that such a body check would guard against spread via close contact. A merchant union leader alleged probable racial discrimination towards Chinese merchants, as the exhibition committee allowed the merchants to participate in the exhibition but not to promote their own goods. An estimated several hundred million Hong Kong dollars in contracts were lost as a result. However, exhibitors from Hong Kong were not barred from selling their products in their hotel rooms.

In June, Hong Kong launched the Individual Visit Scheme as a way to boost its economy.

##### China

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The 2003 FIFA Women's World Cup, originally scheduled for China, was moved to the United States. On March 30, the International Ice Hockey Federation (IIHF) cancelled the 2003 IIHF Women's World Championship tournament which was to take place in Beijing.

In the People's Republic of China, the latter stage of the SARS crisis showed an unprecedented change in the central government's policies. In the past, rarely had officials stepped down purely because of administrative mistakes, but the case was different with SARS, when these mistakes caused international scrutiny. This change in policy has been largely credited to President Hu Jintao and Premier Wen Jiabao. At the heart of the crisis, Hu made a high-profile trip to Guangdong and Wen ate lunch with students at Peking University. Some analysts believe the crisis was a blow to former CPC chief Jiang Zemin, who stayed out of the national spotlight during its duration, and whose political allies, such as Health Minister Zhang Wenkang, were fired for irresponsibility and wrongdoings during the SARS crisis. Zhang was replaced by Wu Yi.

##### Mainland China and Taiwan

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Both Mainland China and Republic of China/Taiwan were dealing with SARS epidemics at the same time, and the political status of Taiwan (cross-strait politics) inevitably complicated the way the disease was handled. Since the People's Republic of China insisted on representing the 23 million Taiwanese people in the WHO by itself and forbid the ROC government's participation, Taiwan, which was one of the most endemic areas in the world, did not receive direct advice from WHO. Even though the ROC government actively reported the situation to WHO, the authority received SARS information only through the WHO website.

The ROC claimed that the lack of direct communication with the WHO precluded proper handling of the disease and caused unnecessary deaths on the island. On the other hand, the PRC claimed that video conferences held between her experts and Taiwanese experts already facilitated information distribution and improved the way SARS was being treated in Taiwan; the ROC government denied this.

The ROC further advocated its own seats in WHO and used the case of SARS to illustrate the importance of having Taiwan included in the global health monitoring system. However, the PRC saw this as a politically motivated move towards Taiwanese independence. During the WHO general assembly, the People's Republic of China fiercely snubbed the proposal for Taiwan's participation. This was evidenced by one famous video clip aired widely in Taiwan showing the PRC Vice Premier Wu Yi and her official company rebuffing the question of Taiwan's representation which had been raised by Taiwanese reporters. Under pressure from the PRC, Taiwan was excluded from several major SARS conferences held by WHO. WHO eventually sent its experts to Taiwan to conduct inspections at the end of the SARS endemic; however, the PRC claimed the credit.

##### United States: Epidemic of Fear

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SARS illustrated that responses to a deadly epidemic can occur far beyond the region experiencing actual infections, particularly in the age of the Internet. In the United States, only eight people had laboratory evidence of SARS infection, and most of these people contracted the virus abroad (CDC 2004). However, mainstream media reports fixated on the possibility of a domestic epidemic, and often used metaphors that described SARS as the product of Chinese “culture.” [3] The ubiquitous media image of Asians in facemasks and emails circulating rumors of domestic infections in Chinatowns across the country helped to establish the association between Asian peoples and SARS infection.

A national survey conducted by the Harvard School of Public Health revealed that by mid-April, 93% of Americans had heard of SARS. Further, the survey showed that fourteen percent of Americans nationally avoided Asian businesses. [4] While the latter is not an overwhelming statistic, many Asian communities began reporting losses in business and tourism, indicating that a larger percentage of people in areas near Asian communities might have avoided Asian businesses.

New York City’s Chinatown was particularly hard hit, as rumors of local infections circulated fear around the community and many Asian Americans felt stigmatized in the general public. Even without a local epidemic, SARS caused economic damage to Chinatown’s economy that was already struggling from the nearby terrorist attacks of 9/11. Tourism plummeted as the public avoided what they perceived as an infected space and people. Restaurants in particular suffered losses after one particular rumor reported that a local restaurant owner had spread SARS to his employees before dying. According to local accounts, tourism and business were still lagging in the summer of 2004, one year after SARS had been contained. [5] Even without a single infection, Chinatown was quickly identified as a site of contagion and risk. Chinatown community members responded by organizing demonstrations to refute rumors of local infections. The Organization of Chinese Americans sponsored a rally in support of local businesses, with leaders bearing the banner “SARS: Support Asian RestaurantS.” Senators Hillary Clinton and Charles Schumer publicly dined in Chinatown restaurants, surrounded by reporters who publicized the events.

However, Chinatown community members did not universally dismiss the dominant discourses of risk and responsibility that blamed SARS on Chinese “culture”. In fact, local responses to these discourses revealed many fissures within the Chinatown community. Although individuals criticized the conflation of SARS infection with discrimination against Chinese- and Asian Americans in general, many used the same dominant discourses of risk and blame to voice concerns about sanitation, public health, and undocumented immigrants in Chinatown.[6]

### Laboratory Mishandling

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Improper handling of the live SARS virus caused the infection of two researchers in Singapore and one in Taiwan. The discovery of the infection of the Taiwanese researcher, who was visiting Singapore before he was diagnosed as infected, caused Singapore and Taiwan to quarantine 92 people.

## References

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1. ↑ "harlettes.com". Retrieved 2013-03-05.
2. ↑ "NOW Magazine". Retrieved 2013-03-05.
3. ↑ Eichelberger, L. (2007) SARS and New York's Chinatown: The politics of risk and blame during an epidemic of fear. Social Science and Medicine 65(6):1284-95
4. ↑ Blendon, Robert J., et al. (2003) Project on Biological Security and the Public, Harvard School of Public Health: SARS Survey. Boston: Harvard School of Public Health
5. ↑ Eichelberger, L. (2007) SARS and New York's Chinatown: The politics of risk and blame during an epidemic of fear. Social Science and Medicine 65(6):1284-95
6. ↑ Eichelberger, L. (2007) SARS and New York's Chinatown: The politics of risk and blame during an epidemic of fear. Social Science and Medicine 65(6):1284-95

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