SARS is expected to emerge in China again this winter, but an epidemic is unlikely as the world’s most populous country is better prepared this time round, health officials say.

Severe acute respiratory syndrome emerged in China in 2002, when the communist country was accused of covering up the extent of the virus, contributing to its eventual spread to 8,000 people around the world, 800 of whom died.

“We wouldn’t be surprised to see the resurgence of a small number of cases,” said Julie Hall, who heads the World Health Organization’s SARS team in Beijing.

“But we would be surprised to see large outbreaks. The system is much stronger than before and the detection systems are much higher than before.”

Top Chinese SARS expert Zhong Nanshan warned the virus had made a reappearance in late November or early December in each of the past two years, but he agreed that an epidemic-scale outbreak was unlikely in the country of 1.3 billion people.

“First of all, we have strengthened the strict administration of labs. The tests related to viruses like SARS must be done in specific labs,” Zhong said by telephone from Guangdong, the southern Chinese province where the virus first emerged.

“The second measure is set against wild animals,” he said, referring to China’s ban on the slaughter and cooking of civet cats, considered a delicacy in the south and thought to be the primary source of the epidemic.

But both he and Hall said there could be local resistance to the civet cat ban.

EARLY WARNING

China also has a new protocol on SARS, which calls for designated treatment hospitals and a system of alerts and early warnings aimed at stopping a re-emergence in its tracks, but Hall said it could take time before hospital workers take that to heart.

“You need to empower junior staff to be able to raise the alarm. That didn’t necessarily happen in April, but it highlighted that issue,” she said, referring to the most recent outbreak of at least nine cases, thought to have originated in a laboratory.

“That requires quite a cultural change.”

Health care workers also have the ambiguous example of military doctor Jiang Yanyong, who became a folk hero after exposing China’s cover-up but was then taken into custody and has been living under virtual house arrest since his release.

In other ways though, China’s culture of mass mobilization and its ability to call on a massive state apparatus to isolate areas, for example, may help it to control outbreaks.

But however good its intentions - and officials agree that China learned the hard way the cost of a cover-up - the country is grappling with a health system that has seen limited investment and millions of rural workers who have no access to health care at all.

China has spent $1.5 billion for SARS prevention and control, state media has reported, but Zhong said there was a need for still greater investment.

“We should put in more money, whether in the field of flu prevention, or the improving of the monitoring systems,” he said.

And as with any central directives in China, the weak point is how to ensure enforcement at the local level.

“It’s about awareness and incentives,” Hall said. “Awareness for health care workers is quite high, but whether all the incentives are correct, it’s difficult to say.”