Date January 24, 2020
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Brown medical anthropologist weighs in on coronavirus in China

As coronavirus spreads to multiple countries, Katherine Mason, an assistant professor of anthropology at Brown, detailed lessons learned from the outbreak of SARS and cautioned against public panic.

Editor's note: Data referenced in this story reflect the most current information as of Friday, Jan. 24. Since the story was published, the Wuhan coronavirus has continued to spread to several more countries, and on Jan. 30, the World Health Organization declared its spread a public health emergency of international concern.

PROVIDENCE, R.I. [Brown University] — In 2001, fresh from college, Katherine Mason seized upon an opportunity to teach English in China. Then, mere miles away from her home and workplace, a deadly virus struck: severe acute respiratory syndrome, better known today as SARS.

“I got evacuated by the program that was sponsoring me,” she said. “When I returned to the United States, my parents tried to quarantine me in my sister’s apartment.”

Katherine MasonBetween 2002 and 2004, SARS killed at least 774 people worldwide and instilled fear in the hearts of Americans early in its spread. But that fear, Mason observed, didn’t strike China as quickly. 

“So many flu-like viruses come through that part of China that they didn’t start panicking until it began to spread all over the world,” she said.

Mason, who had majored in molecular biology, became interested in this cultural gulf between two nations grappling with the same virus. Today, she is an assistant professor of anthropology at Brown and a leading expert on the historical, social and political context of public health in China. Her 2016 book, “Infectious Change: Reinventing Chinese Public Health After an Epidemic,” examines how the outbreak of SARS “reimagined public health as a professionalized, biomedicalized and technological machine — one that has frequently failed to serve the Chinese people.”

Now, Mason has joined millions of medical professionals, scholars and members of the public in closely following the trajectory of another illness — a type of coronavirus that broke out in Wuhan in December 2019 and has since spread to at least six countries, according to the World Health Organization (WHO).  As in the early aughts, she believes medical anthropologists can add crucial perspective to global conversations on epidemics, from SARS to H1N1 to coronavirus.

“I think that it’s just as important to understand the social and political context behind an epidemic as it is to understand the symptoms and causes of the virus,” Mason said. “When it comes to the spread of a virus, government transparency is just as important as good medical care, and public panic is just as detrimental as poor medical care.”

Following news of the first two reported cases of coronavirus in the U.S., Mason answered questions about the virus, the history of China’s public health system and the inverse relationship between government transparency and public panic.

Q: First, what is coronavirus? What are its symptoms?

Coronaviruses are a family of viruses that range in seriousness from the common cold to things like SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). The symptoms are similar to a lot of other respiratory viruses: coughing, fever, sore throat. 

It’s difficult to distinguish among respiratory viruses. One question right now is, is it possible that some people may have been infected with a milder version of this coronavirus that is no more dangerous than the common cold? Another issue is, many people are showing up to hospitals with a fever and are worried that they have this particular virus, but their fever could be due to any number of things.

Q: On Jan. 24, Brown sent out an advisory to its campus about signs and symptoms to look for — to what extent should people worry about coronavirus spreading to the Northeast?

I don’t think we need to worry very much about that right now. Only two cases of this coronavirus have been reported in the United States; one is on the other side of the country, and the other is in Chicago. I think the fact that the WHO has declined at this point in time to declare this a "public health emergency of international concern" — which they did declare for H1N1 in 2009 — is important. That is a sign that this particular coronavirus should not worry people in Rhode Island right now, unless they plan to travel to Wuhan soon.

Q: Does this virus have the potential to affect us as deeply as SARS did?

I think that the world is more ready to handle an epidemic on the level of SARS today. SARS did not end up killing as many people as many imagined it would, but it scared people, and it pushed governments to do a huge amount of behind-the-scenes work to prepare for similar situations in the future. 

Everyone is always worried about the possibility of the sort of global flu pandemic we saw in 1918 and 1919. I think that’s why there’s a certain amount of overreacting happening now — because people don’t want to be accused of underreacting. On the one hand, you could argue that it’s better to overreact, that it protects our health and safety more. On the other hand, you can only cry wolf so many times. If this virus turns out not to be as serious an epidemic as people are worried it is, the overreaction might diminish the extent to which people take future epidemics seriously.

Q: What made the SARS epidemic so serious?

A number of things. First, it had close to a 10% fatality rate, which is quite high. Second, it was new and unfamiliar. And third, the Chinese government was slow to react at both the local and national levels — partly because they were not being forthcoming about how many cases they had, and partly because they didn’t think it was as important as the international community thought it was. They didn’t treat it with real seriousness until a whistleblower at a Beijing hospital revealed that the government had covered up hundreds of fatalities there. Once the cat was out of the bag, they were quarantining whole universities and apartment complexes.

Q: What’s different about China’s response to the coronavirus outbreak today?

The response today has been much swifter and more serious. They are now quarantining entire cities. They are suspending public transit and other travel. The Chinese government is taking some dramatic steps to say to everyone, including its own citizens, “Look, we’re doing something.” When SARS broke out, China got a lot of bad press for their response and lack of transparency, so they want to show the world in as visible a way as possible that they’re taking action.

Q: How has China changed since SARS?

First, the public health system has been completely overhauled. A huge amount of resources were dedicated to building a health surveillance system with a strict chain of command. As in the past, if a doctor in China were to speak to a news reporter about the number of coronavirus cases they’ve seen, they would be in huge trouble. But now there are much stricter rules and better systems for information sharing, and those cases are supposed to be shared with a direct supervisor, then it gets moved up the chain all the way to a central authority. But note that it doesn't always work that way — local authorities often cover up the truth.

Second, the leadership in China is very different today. [President] Xi Jinping is one of the more conservative and purely authoritarian leaders they’ve had in a while. He is more focused on cracking down on internet regulations and the spread of information.

I think those public health reforms, combined with the lack of transparency in this administration, have led to a response to this virus that is starting to backfire. Chinese people know that what the government is telling them is a sanitized version of what’s really happening. When people don’t have reliable, transparent information about what is going on, they might assume the worst case scenario is happening and panic. When people panic, it’s hard to handle. No government has the capacity to handle a city of 11 million people panicking, visiting the hospital and sharing videos from the hospital on social media, which is what’s happening right now in Wuhan.

Q: Here in the U.S., what should members of the public keep in mind as they follow news and social media coverage about coronavirus?

They should not panic. This is not the end of the world. They should know that the videos, photos and commentary they’re seeing say more about the public’s reaction to the virus than about the seriousness of the virus itself. It is tragic that this virus has claimed 26 lives so far, but people should know that most of those who have died had additional health complications, and on a global scale, 26 is not a large number. Right now, this is not as much of a crisis as it is made out to be. That could change, but there is no evidence of a real crisis yet.