The endemic disease has drawn journalists from all over China rushing to Anhui province, many of whom asked the same question: "Why Fuyang again? Why are children the victims, again?"

"The city seems to have become synonymous with disaster," sighed a professor from Fuyang Teachers Training College, referring to a series of high profile, negative incidents that had taken place there since 2003.

Fuyang is a historical town that used to be more known for its famous poets and scholars of Chinese antiquity. Today, its name evokes memories of scandals, and the city is eyed suspiciously by outsiders.

A Troubled City

A child in Fuyang being treated for the disease

In 2003, the same year Fuyang was struck by SARS (Severe Acute Respiratory Syndrome), it was discovered that local infants were dying due to consumption of sub-standard milk powder. Infants relying on it suffered from malnutrition that led them to develop abnormally large heads. Ultimately, 189 infants were affected and 12 died. Subsequently, local authorities seized 55 kinds of milk powder.

"The poisonous nature of the milk powder was not the only contentious point, but also the way local government handled the situation and blocked information, which drew widespread criticism," said the above professor who wished to remain anonymous.

Towards end of 2003,  Fuyang again attracted negative publicity. The infamous corruption case of Wang Huaizhong – former vice-governor of Anhui province and a former Chinese Communist Party secretary of Fuyang city – was sentenced to death for accepting huge sums in bribes. He was executed on February 12, 2004.

The following year, a sweeping corruption case involving judges of Fuyang Intermediate People's Court startled the nation. The case led to the imprisonment of two chief justices and over a dozen of presiding judges and deputy judges. Later, three of the Court's successive chief justices, Shang Jun, Liu Jiayi and Zhang Zimin were also sentenced to jail.

"At that time, many out-of-town friends and colleagues often called me and asked: Why are bad things happening in Fuyang again? I was speechless, and could only resort to self-deprecating humor," recalled a health officer.

Vigilance and Distrust
Perhaps all the criticism and ridicule targeted at scandal-hit Fuyang have fueled the mood of distrust in the city, where residents have become wary of the authorities and outsiders.

On the morning of April 28, when taking this reporter from the railway station to Fuyang hospital, a taxi driver named Liu repeatedly asked: "Will more children die from the disease [EV71]? The government told the media that the disease wasn't contagious, they told the truth, didn't they?"

Despite the government's assurance, the suspicious Liu said he advised relatives and friends with children of schooling age to stop attending classes for the time being, "just to be on the safe side", as he put it. 

Vigilance penetrated every corner of Fuyang. When the reporter checked into a hotel and chatted up with a receptionist on the impact of the disease on daily life, the girl turned tense immediately. "I am sorry, I wasn't aware of the matter," she replied.

The reporter's quest to locate the house of the second victim – one-year-old Jia Shuaishuai who died from EV71 - was met with coldness and scrutiny. The reporter was interrogated by a middle-aged man upon entering the village where Jia's family resided, and was followed by the man thereafter.

When the reporter tried to ask a villager for directions, the woman simply ran away without answering after receiving a glare from the man who was tailing behind.

A source later told the reporter that authorities had ordered village communities, especially villages where deaths had occurred, to refrain from making "irresponsible remarks".

"Once the superiors learn about an information leak, they will trace back to those responsible," said the source, who asked to stay anonymous.

In fact, the vigilance level aimed to block information was similar to that applied five years ago when the "fake infant milk powder" scandal took place, according to another journalist who had covered the incident.

Name Clearing Needed
"We are doing our best to improve the situation, preventing and controlling the disease. The process takes time. I urge the media to consider the complexity and difficulties of the current situation, and be objective, factual and positive in your reporting about Fuyang. Please, I urge you all."

Those were the words of officials from Fuyang's health department during a press conference held on April 29.

One local official confessed: "We have been criticized a lot but we still have a lot of work to do. We too hope to work in an environment where public opinion is favorable and facilitates our job to cope with emergencies."

Since emerging in March, the disease has been detected in other regions of China, such as Guangdong, Zhejiang, Hubei, Hunan, Jiangxi and Shanxi provinces. Beijing was not spared. The number of nationwide infections has totaled over 10,000. The most susceptible victims are children below the age of six, and especially those under the age of two.

The Fuyang local government has been criticized for downplaying the issue in the early stages, failing to disclose information in time and warn the public to take precautionary action, and thus, has been blamed for the spread of the disease.

"Negative incidents have turned Fuyang into a wounded city, the scars left behind by them are beyond measure," said the above mentioned professor.

He said Fuyang residents' self esteem and confidence were dented along with the city's declined reputation. Its stained name in turn affected investors' confidence to bring about economic development in Fuyang. He added the local government must rebuild the good name of the city if any changes were to be made.

Background: Timeline for EV-71 Cases

March 27: The first victim succumbed to the disease in hospital in Fuyang; in the following two days, another three children died from the illness.

April 15: Local media first reported about the illness but officials referred to it as respiratory one instead of an infectious disease. Kindergartens and schools remained open.

April 16: The Health Ministry dispatched a team of experts to Fuyang.

April 23: The cause of the illness was ascertained as enterovirus-71.

April 25: Local government publicized the finding through local media.

April 27: Xinhua News Agency made public about the infectious disease and its condition to the whole nation.

Background: Official Interpretation

After the outbreak of hand-foot-mouth disease in Fuyang city, the Health Ministry dispatched two teams of experts and assigned 35 medical staffers from Hunan and Hubei provinces to Anhui province.

On April 29, the Health Ministry held a news conference to announce the findings of the third investigation into the cause of death. At the event, three ministerial officials answered queries from journalists about the situation in Fuyang. The officials were Qi Xiaoqiu, director of the Ministry's Center for Disease Control and Prevention; Rao Keqin, Director of the Statistics Information Center, and Deng Haihua, director of the Information Office. Below are excerpts of the Q&A from the press conference:

Question: The EV-71 cases that broke out in Fuyang had infected over 1,000 children in a very short time. How did that happen? Was it partly due to flaws in the disease control and prevention system?

Qi Xiaoqiu: The EV-71 virus has yet to be listed as an infectious disease requiring official reporting system. However, we have treated the matter as an emergency and submitted reports to higher authorities. In Chinese law, 37 types of infectious diseases are classified into three categories for monitoring. The hand-foot-mouth disease is common in China--for example, it broke out in Linyin of Shandong province last year but didn't spread to the whole nation.

The local provincial and municipal health authorities are in charge of treating hand-foot-mouth disease, while the central government provides supportive role such as skill transfers. Judging from the recent years' experiences, we are considering to strengthening the monitoring and control mechanism for EV-71. 

Questions: Director Qi said the disease would not spread to the whole country, but we have learned the disease had spread to Henan province. Are there new measures to control the disease?

Rao Keqin: It is not as simple as having one death case in March and then alerting the whole nation. There are about 6 million deaths every year, and if we were to publicize of each case, wouldn't we create fear and social instability? 
In epidemiology, we must trace the sequence of the event, from its origin, through its phases of development before drawing a conclusion. Therefore, when some media reported that the disease has spread from Anhui to Henan, we have yet to ascertain that, because to conclude that we must first prove a link between the cases in Anhui and Henan. The word "spread" cannot be use loosely just because the disease occurred in two different places around the same time; unless the case in Henan can be traced all the way to Anhui as the source of disease. 

Questions: There was a time gap between late March (when the first victim died from the disease in hospital) and April 23 (when Xinhua News Agency released information about the disease to the public). Some suggested that this led to missing the best opportunity to control and cure the disease. Was negligence involved?

Deng Haihua: The State has enacted clear laws and procedures in making public endemic diseases and emergent public health cases. As to the case [in late March] you mentioned, we shall not make irresponsible remarks by only based on media's reports, we must first check and confirm with the local health authority.

Rao Keqin: What does epidemic mean? When one patient died, that cannot be term as epidemic. In medical term, epidemic refers to the outbreak of a disease regionally or nationally, infected a certain number of people within a certain timeframe. Only when cases of the disease have accumulated to a certain degree it becomes epidemic

Therefore, if the first hand-foot-mouth case took place in March, it was not called epidemic. In reality, we are doing daily monitoring against infectious disease and emergent public health cases. We receive between 20,000 and 30,000 case reports daily, in other word, we have some six million case reports every year.

The medical staff in Fuyang hospital had reported to the Anhui health department immediately upon the deaths of three children from unknown disease. I think the reaction was prompt, and the following process to ascertain the virus involved also take time, and finally, identified as EV-71.