China admits Sars struggle

China's authorities have introduced rigorous measures to curb the virus

China's rural health care system is totally incapable of dealing with a major Sars outbreak in the countryside, Prime Minister Wen Jiabao has acknowledged.

In a frank assessment of the country's rural health care system, he said facilities are weak, technical capabilities inadequate and epidemic surveillance systems unsound.

But the warning may have come too late.

The BBC's Rupert Wingfield-Hayes, in Beijing, says there are now worrying signs that the Sars epidemic in the capital has begun spreading to surrounding provinces.

He says Mr Wen is finally saying in public what many health care specialists have been saying in private for weeks.

SARS WORLDWIDE

Known death tolls:

World: 812

Mainland China: 348

Hong Kong: 298

Taiwan: 84

Singapore: 32

Canada: 38

Source: WHO/local authorities

Global update

The Sars outbreak now engulfing Beijing is bad, but if it spreads to China's vast and poor rural hinterland it will be much worse.

Our correspondent says that in many parts of rural China the health care system has simply collapsed and there are growing signs that the battle to keep Sars from spreading there is already being lost.

"We have a lot of doctors, a lot of hospitals - the problem is we don't have enough hospitals and doctors specialising in this field," said Hu Yonghua, director of Beijing University's school of public health.

"In the coming days, we can expect the number of deaths to increase because of health workers' lack of experience."

Mr Hu estimates that only a "very small number" of the 32,000 registered doctors and 34,000 registered nurses in Beijing are trained to handle infectious diseases and severe respiratory problems.

In the final phase of a patient's battle against Sars, intensive care by physicians highly experienced in respiratory problems is crucial.

"If I want to save a kidney, there's a regimen of medicine and treatment to give the patient, including what to do first, what to do next," said Mr Hu.

"For respiratory illnesses, it's a different regiment.

"They have to look at the patient's breathing, lung conditions, and figure out when to use the mechanical respirator. This requires specialist knowledge and a wealth of experience.

"Now, they're learning as they are doing it," he said.

In other developments:

• Health officials in Singapore - which has the world's third-highest Sars death toll - say on Wednesday they need 10 more days to declare that the epidemic is under control

• Police in Beijing detain four people for spreading rumours about Sars on the internet and through mobile phone messages, Chinese Xinhua news agency reports

• The United States pledges to increase technical assistance to China to contain the spread of the Sars outbreak

• European Union health ministers, along with counterparts from 10 candidate countries, draw up proposals to tackle the global spread of the virus

The World Health Organization has warned that the disease has not peaked yet in China, which on Wednesday announced 159 new cases, bringing the total to 4,568 and reported five more deaths, taking the toll to 219.

The WHO says it is sending an investigation team to the province of Hebei, which borders Beijing.

The number of reported cases of Sars there has doubled in the last week.

Quarantine

Officials believe the virus has been carried into the province by migrant workers who fled from Beijing after news of the Sars epidemic in the capital became public two weeks ago.

A WHO official said it was hoped that the team could help prevent a major outbreak in the densely-populated province.

Around 10,000 people have been quarantined in the eastern city of Nanjing in a bid to contain the Sars outbreak.

The fact that so many people have been quarantined there, where there has been just one confirmed case of Sars, is being seen as an indication of how far the authorities are prepared to go to suppress the disease.

Thousands of Sars investigators have been deployed in the Haidian district of China's capital Beijing, which has been worst hit by the disease, in a desperate bid to stop its spread.

The 30,000 investigators will check businesses and residences throughout the area looking for victims and ensuring that measures are being taken to improve hygiene, district official Zhou Liangluo said.

Each household in the district of 2.2 million people has been issued with a thermometer and emergency contact numbers, while offices and businesses have been ordered to install temperature-monitoring systems.