Worry mounts over Sars spread in China's provinces

China, where the government has admitted the number of Sars cases in Beijing is far higher than disclosed previously, may be facing a very big outbreak in its provinces, the World Health Organisation said yesterday.

The disease - which has killed more than 200 people and infected about 4,000 in 25 countries - is spreading, with the Philippines saying it may have suffered its first Sars death, more fatalities in Hong Kong and more infections in Singapore and India.

But experts are particularly worried about China, where leaders have admitted the health-care system is poor in the countryside where 70 per cent of its 1.3 billion people live.

Late yesterday, China said 193 new cases had been reported since Friday, taking the nationwide tally to 2,001. The official Xinhua news agency said 13 more people had died of Sars in the same period, raising the total to 92.

"If you do not have the resources to deal with Sars, I think we're going for a very big outbreak in China," Henk Bekedam, the WHO representative in China, told Reuters.

"I think it will be quite a challenge to contain Sars within China, especially those provinces which have very limited resources," he said.

"We hope that the provinces will be ready," he said. "Otherwise you might have in all the provinces at least 100 cases, and then you can make up the arithmetic."

China has 31 provinces, regions and major cities. Premier Wen Jiabao, in a speech made last week and published yesterday, said the health system was so inadequate an epidemic could spread "before we know it" and "the consequences could be too dreadful to contemplate".

Cases of the Severe Acute Respiratory Syndrome have now appeared in various parts of China, including the northern region of Inner Mongolia, the eastern province of Zhejiang and Guangdong and Guangxi in the south.

A day after the government said Beijing had under-reported its numbers dramatically - raising the number of cases tenfold to 339 - Bekedam also said the Chinese capital could have many more Sars victims in its hospitals.

Yesterday, the Health Ministry reported via Xinhua a jump in the number in Beijing by another 143 cases to 482 over the weekend and seven more people had died, bringing the total to 25.

"The reason for the rapid increase in Sars patients in Beijing was attributed to the confirmation of certain suspected cases as Sars after further examination," Xinhua said.

Bekedam said the WHO believed half the 402 cases reported on Sunday as classified by the Beijing authorities as suspected Sars could be real cases.

The number of suspected cases in Beijing rose between Friday and yesterday to 610, the ministry said. Several other areas, including the mostly-Muslim western region of Xinjiang and the impoverished northern province of Shaanxi also reported suspected cases, it said.

Fear mixed with anger in Beijing as state media, silenced for weeks as Sars spread, let the floodgates open after the government reported the higher numbers and the health minister and city's mayor were sacked on Sunday for negligence.

Sars is passed in droplets, by coughing and sneezing, but the WHO is not ruling out the possibility that it may also be transmitted when people touch objects such as lift buttons, or that it could be passed on in faecal matter.

The suspected victim in the Philippines was a nurse who had come home from Canada, the only country outside Asia where people have died of Sars since it appeared in China's Guangdong province in November.

Canadian health authorities said on Sunday travellers on a suburban commuter train might have been exposed to Sars, sparking fears the virus could have spread beyond the medical community that has borne the brunt of the illness so far in that country.

It leapt from Guangdong to Hong Kong, the hardest hit place outside mainland China, which reported another six deaths from Sars yesterday - taking its toll to 94, the highest in the world.

Singapore reported six new cases, including three children, taking its total to 184 cases and 14 deaths - the world's fourth highest number of victims. Authorities will quarantine up to 2,400 workers at a huge food market because three people who worked there contracted the virus.

Three more people in India have been diagnosed as suffering from Sars, a state minister said, bringing the number of cases reported there to four.

The disease, fatal in about five per cent of cases and which has no known cure, is also taking an economic toll as people shun airlines, in the knowledge travellers spread it around the world, and stay at home instead of going out shopping and dining.

Singapore Airlines said its SilkAir regional carrier would cut more flights in May, taking its total reduction in services to 35 per week. China's flag carrier Air China said Sars had cut its passenger traffic by 20 per cent.

Financial analysts have downgraded growth forecasts for most countries in East Asia outside of Japan, saying Sars would pose more of a threat to Asian economic growth - mainly from reduced spending, tourism and business travel - than the Iraq war.

China cancelled the week-long May Day holiday to discourage people from travelling and spreading the disease.

Tens of millions of travellers had been expected to fill trains, planes, buses and hotels throughout China, dealing a potential body blow to the turbo-charged economy.