SARS: SYMPTOMS, ORIGIN, THE 2003 OUTBREAK AND COMBATING IT

SARS

SARS (severe acute respiratory syndrome) is a deadly pneumonia-like disease that appeared in China in 2002 and spread across China and into Southeast Asia and North America in the winter and spring of 2003, killing several hundred people, scaring many more and disrupting economies and travel plans around the globe. SARS was given its name by the World Health Organization (WHO) after it was first reported to the organization by an Italian doctor in Vietnam.

The 2003 SARS outbreak killed 774 people and infected at least 8,273 people in more than 30 countries, according to the World Health Organization. Higher death tolls had been listed. Investigation found some of the deaths on these lists were the result of other causes. The disease died out later in 2003.

SARS is caused by a corona virus, which is also connected to about a third of all cases of the common cold. The SARS corona virus is very deadly, killing almost 10 percent of the people who get it. About half of those who have died form it so far are over 65.

SARS turned out to be relatively easy to deal with---compared to the threat of a major pandemic presented by bird flu---because it sickened people immediately, This allowed victims to be easily identified and and contained before they infected ti many people. This allowed a prospective pandemic to be reined in relative easily and quickly.

Economies throughout Asia were hit by the SARS outbreak, SARS cost the Asian economy an estimated $36 billion. Many of the measures put in place after the 2002-2003 SARS outbreak were implemented to varying degrees during the H1N1 flu epidemic in 2009 and helped Asian nations

China was accused of covering up the SARS outbreak during its early stages. It is widely believed that if the Chinese authorities had been more aggressive fighting the disease, more forthcoming with information and had invited the World Health Organization to infected areas, SARS would more likely have been isolated and contained in its early stages before it was allowed it to spread. and hundreds of lives could have been saved.

Dr. Lawrence K. Altman wrote in the New York Times “In the SARS outbreak, attention focused on the role of Himalayan palm civets in transmitting it after scientists identified the virus in this species and in a raccoon dog sold in markets in Guangdong. But WHO officials and scientists elsewhere cautioned that these species were most likely only intermediaries in the transmission, largely because no widespread infection could be found in wild or farmed civets. So the teams assembled a variety of specialists, including veterinarians, virologists and ecologists, to determine the virus' reservoir, or hiding place.” [Source: Lawrence K. Altman, New York Times, September 30, 2005]

Source of SARS

The SARS virus jumped from horseshoe bats to masked palm civets to humans. Dr. Lawrence K. Altman wrote in the New York Times in 2005, “The SARS virus has long been known to come from an animal. Now two scientific teams have independently identified the Chinese horseshoe bat as that animal and as the hiding place for the virus in nature.The bats apparently are healthy carriers of SARS. In Asia, many people eat bats or use bat feces in traditional medicine for asthma, kidney ailments and general malaise.[Source: Lawrence K. Altman, New York Times, September 30, 2005]

“The finding is important in preventing outbreaks of SARS and similar viruses carried by bats because it provides an opportunity for scientists to break the transmission chain. One team from China, Australia and the United States reported its findings in the online version of Science. The other team, from the University of Hong Kong, reported its findings in the Proceedings of the National Academy of Sciences. [Ibid]

SARS now appears to join a number of other infectious agents that bats can transmit. Over the last decade, bats have been found as the source of two newly discovered human infections caused by the Nipah and Hendra viruses that can produce encephalitis and respiratory disease. "It's pretty pleasant to see two teams that did not know each other reach similar findings," Dr. Lin-Fa Wang, a virologist at the Australian Animal Health Laboratory, said. After collecting hundreds of bats from the wild and from Chinese markets, each team reported identifying different viruses from the coronavirus family that are very closely related to the SARS virus.

Wang said his group focused on bats largely because of the team members' earlier pioneering work on the Hendra and Nipah viruses. After obtaining fecal and blood samples, the scientists released the bats into the wild or returned them to the markets. The specimens were tested for a variety of viruses that infect animals. Lab analysis of the coronaviruses' makeup provided strong genetic evidence of the close relationship between those found in the bats and the SARS virus.

Although it is logical to assume that the bat viruses infected the animals in the live markets to cause the outbreak, the studies were not planned to prove that point. "The genetic relationships do not tell you anything mechanistically about if or how the virus moved from the bats to civets and from the civets to the humans," said Dr. Donald Burke, a virologist and professor at Johns Hopkins. "It's not a perfect story yet. But until I see otherwise, the working assumption will be that this is the reservoir species."

On the changes that took place to make the SARS virus so deadly, Donald G. McNeil Jr., New York Times wrote in the New York Times: “To give a sense of how important? a tiny change in cellular material? can be: switching just one of the 1,255 amino acids in the SARS virus protein that attached to cells in the masked palm civet allowed it to attach to human cells. After that discovery, the Chinese government ordered that all the 10,000 civets in captivity in Guangdong be killed, thus probably wiping out the disease everywhere except in bats. [Source: Donald G. McNeil Jr., New York Times, March 27, 2007]

SARS Symptoms and Treatment

SARS victims develop a sudden, very high fever and suffer infections and damage in their lungs. Symptoms included chills, headaches, and muscles aches. Those with severe cases develop a dry cough and have trouble breathing. There is no effective treatment. Drugs that work on similar diseases don’t work of SARS. About 10 percent to 20 percent of SARS patients need a ventilator. The virus also affects the digestive system. Some victims suffer from severe diarrhea. Some carry the virus but show few symptoms.

One man who had the disease told the Los Angeles Times, he felt sick and had a fever and stayed home from work. When his fever rose to 102̊ F he checked with a doctor who sent himhome with some flu medicine. When his temperature rose to 104̊ he went to the emergency room of a hospital but was discharged after nothing turned up on a chest X-ray. After that he had severe diarrhea and his fever persisted he visited the same emergency room.

The SARS victim began getting nervous when he was switched to intensive care and the patient next to him died and the dead man’s relatives began screaming with grief. “There were a few days when I felt I wasn’t going to make it. I though I might die, too.” Finally after 12 days the fever broke and he recovered.

SARS can be transported like cold virus through the air on exhaled vapors or by touching surfaces that have come in contact with these vapors. SARS is cairned mostly on relatively large mouth-emitted droplets that generally no more than 1.5 meters. If they were carried on smaller droplets that could be carried further through the air the disease could have spread much more than it did.

Origin of SARS

The first known SARS case appeared in November 2002 in Foshan, a gritty southern Chinese city, near Guangzhou (Canton). Health officials became alarmed in January when it began appearing in cities around Guangzhou such as Shunde, Heyuan ad Zhongshan. By early February there were 305 cases and five deaths in Guangdong.

Some people think that SARS may be a disease that jumped from animals to humans, possibly in a market where wild animals are sold to be eaten. One of the earliest victims, who died in December 2002, was a seller of snakes and birds who worked at a market in Shunde, a small city about an hour from Guangzhou. Among the other early victims were food handlers, chefs and their families.

Describing the animal market in Shunde where the victim worked, Elisabeth Rosenthal wrote in the New York Times, “In hundreds of cramped stalls among the stink of blood and guts, wholesale food vendors tend to veritable zoos that will grace Guangdong Province’s tables: snakes, chickens, cats, turtles, badgers, frogs...And, in summer, sometimes rats, too...The cages are stacked, one on top of another, in cages that serve as seats, card tables and dining quarters for the poor migrants who work here. On a recent morning, near stall 17, there were beheaded snakes, disemboweled frogs and feathers flying as a half-alive headless bird was plunked into a basket.”

Civets and SARS

There is circumstantial evidence that SARS originated with civets, nocturnal mammals closely related to mongooses The SARS virus and corona viruses found in humans are 99.8 identical to the SARS virus and corona viruses a found in Himalayan, or masked, palm civets, racoon dogs and hog badgers sold for foodat the market in Shenzhen, China. Researchers also found antibodies to the virus in the blood of 20 wild animal traders and 15 workers who slaughter the animals. .

Although this evidence is good it is not conclusive. And even if it is true it does not offer any clues on the how the disease may have passed from civets to humans. The SARS virus is found in booth civet feces and human feces. Some heath officials speculated that the disease was spread to humans by contaminated civet feces.

Around Guangzhou, civet meat is eaten in a stew as a winter time delicacy said to be rich in yang, an energy source that helps keep one warm. The meat is also braised, roasted and added to soups. The animals are served at restaurants, sold at markets and raised in breeding farms. Small-time civit breeders earn $200 a month, considerably more than the could earn from farming.

Spread of SARS From China to Hong Kong and the World

The spread of SARS on a global scale began in Hong Kong in late February 2003 when a Chinese doctor with disease passed it on to 10 others while attending a conference in Hong Kong. Hong Kong lies just 80 miles from Guangzhou, and near other places where the disease began. Each day more than 400,000 people cross the busy border between Hong Kong and China.

On February 21, a Chinese doctor and a professor of respiratory medicine, who had treated people with SARS in the Guangzhou area, came to Hong Kong to attend a nephew’s wedding even though he had a fever. He stayed on the ninth floor of the Metropole Hotel in Hong Kong, where he infected at least 16 people---including a woman from Toronto, another Canadian and an American businessman on his way to Hanoi and three young women from Singapore---who spread the disease internationally. The Chinese doctor was treated at the Prince of Wales hospital in Hong Kong, setting off a huge outbreak there.

The Toronto woman returned home and infected her son and at least five health workers. Within weeks 140 people had the disease in Toronto. The three Singapore women became ill when they returned home and were each treated at separate hospitals. Two of them didn’t infect anyone. But the other, Esther Mok, infected at least 90 people. She survived. Among those that died were her mother and father.

The American businessman was treated at the Vietnam French Hospital in Hanoi, where he spread the disease to 20 health care workers, including Carlo Urbani, an Italian doctor, who was the first to report the disease to the World Health Organization. Urbani ordered a number of preventive steps to be taken, but ended up dying of the disease. On March 15, the WHO issued a worldwide alert for a new diseases, which it called SARS.

Afterwards, cases of SARS started popping up around the globe. The were a number of cases in the United States. Places like Finland and Poland had small outbreaks. Altogether 30 countries were affected. SARS gained momentum through March and April and peaked in early May. The disease was spread widely by so called “super carriers” who transited the disease much more than most of those who had it. All of the cases in Toronto were traced to the woman who had visited Hong Kong. A number of victims were health care workers who contacted the disease from patients.

Impact of SARS

SARS had a worldwide impact on trade and the travel industry. Worldwide demand for oil was affected to such a degree that members of OPEC held an emergency meeting. Even international flights to places in Europe and Japan, where no cases of SARS were reported, were affected. The outbreak is estimated to have cost the global economy $50 billion largely because of cuts in travel and trade from Asia.

In countries affected by the disease, growth declined, export-oriented companies saw their orders drop; small businessmen, shop owners and market vendors saw their sales and incomes plummet due to lack of business. Particularly hard hit were airlines, hotels are other business in the tourism trade.

In countries affected by the disease, people were scared to go out. They didn’t go shopping, eat at restaurants, or attend movies. Vacations were canceled. People avoided places with the disease. Some chose to socialize over the phone rather than in person. Many wore masks whenever they went out. The custom became so widespread that wearing masks became a fashion statement, with Hello Kitty and Betty Boop versions selling particularly well.

Health care workers were particularly affected by SARS. In Hong Kong, they made up a forth of all cases. Of these 55 percent were nurses and 15 percent were doctors, some of whom died. People were taken off the SARS watch list if they went two weeks without showing symptoms.

SARS in China

SARS killed 349 people in China in 2002 and 2003. Around 5,500 people got the disease. Most of the cases were in Guangdong and Beijing with cases also reported in Shanghai, Shanxi, Inner Mongolia, Hunan, Sichuan, and Guangxi. News of SARS appeared in Hong Kong, Taiwan and Thailand before much news came out of China even though the disease originated in China. By the time the government finally released news about it SARS had spread all over China.

During the SARS outbreak growth in China slipped by three percent. Countries around the world slapped restrictions on Chinese crossing their borders. Chinese students were banned from universities in the United States. The border between Russia and China was closed. Many airlines canceled fighting going into China.

Opportunists sold products purported to ward of SARS, hand lotions that purportedly boosted the immune system and herbal teas with ingredients such forsythia and honeysuckle. Companies worked overtime to produce enough bleach and disinfectants to meet demand. The price of some herbal medicines increased tenfold. The People’s Liberation Army released a whole line products, including vehicle-mounted clothes washers designed to disinfect contaminated clothing.

SARS in Beijing

Beijing was perhaps hit harder by SARS than any other place. There were 2,531 cases and 191 deaths. The disease all but shut down Beijing. At its peak, the streets and many buses and trains were empty. People stocked up on disinfectant. Marriages were postponed. The May Day parade in Tiananmen Square was canceled. Schools closed for 1.7 million children, many of whom where not allowed to go outside by their parents.

Hospitals and dormitories where the disease had appeared were quarantined and strict rules were implemented to make sure no one left. “Building bosses,” “door watchers,” and other informers were told to report cases of people who looked sick. Roadblocks and checkpoints were set up on roads leading out of Beijing. One family told the Washington Post they were stop 20 times on a 600 miles trip from Beijing to Nanjing and then assaulted by men in maska and white smocks, who quarantined the house where they were staying.

Not everyone complained. One American art dealer told the New York Times, “Beijing was wonderful during SARS. Romantic, beautiful. The sky was clear, for once. Everything shut down. There was no smog, or dust or traffic jams. No tourists. No cars.”

SARS Elsewhere in China

The most cases outside Beijing were found in Guangdong (the southern province where Guangzhou is found) and the northern province of Shanxi. In the Guangzhou area, animal markets were closed down. In Shenzhen a man was diagnosed of having SARS after he attended a wedding with 940 guests. All 940 guests, including all 508 inhabitants of a village, plus all the employees who worked at the wedding, were tracked down and quarantined.

In April riots broke out in the town of Chagugang near the northern coastal city of Tianjin over rumors that a local school would be turned into a ward for SARS patients from Tianjin. Cars were overturned, construction equipment was smashed and a hospital was raided. Tianjin had seven death and 149 cases of the disease.

SARS in Hong Kong

Hong Kong had the second highest number of SARS cases after China, with 1,755 cases of the disease and 299 deaths. Particularly alarming was an outbreak of more than 200 cases and 35 deaths in the Amoy Gardens housing estate in Kowloon, the single largest outbreak of SARS. According to an analysis published in British medical journal Lancet, the outbreak was mostly likely caused by roof rats tracking infectious material throughout the upper floors of the apartment building and not by direct person-to-person contact.

Hong Kong was crippled by the SARS outbreak for about two months beginning in late March 2003. Schools were closed for seven weeks. Hotel bookings dropped by 90 percent and flights were canceled. Unemployment rose to record highs. All kinds of business were hurt. Theaters showed films to empty houses. Restaurants had no customers. Exports dropped.

People suspected of having SARS were ordered not to hug or kiss anybody for a month. “1/99" commercials on television advised people to disinfect their houses with one part bleach and 99 parts waters. Caged birds were released in hopes that they would end the scourge. The Rolling Stones canceled two concerts (but the donated $50,000 worth of surgical masks). The Hong Kong Rugby Sevens went ahead as scheduled but France, Italy and Argentina didn’t participate.

Rich people fled infected areas, traveling abroad or taking out rooms in expensive hotels. Some purchased expensive protective clothing that made them look as if they were preparing for a biological weapons attack. Other refused to leave their rooms and had everything delivered to them. Parents pulled their children from school and hired private tutors for them.

People without money who lived in infected apartment in Kowloon didn’t have such posh options. Hours after it was determined that SARS might be spread through the sewage system, all the residents were told to pack up and were quarantined to “holiday camps,” former military barracks, and fed “bento box” meals three times a day.

Fallout and End of SARS in Hong Kong

SARS was a blow to an economy that had yet to fully recover from the Asian economic crisis of 1997-98. The economy contracted and unemployment climbed to 8.7 percent. At one point 30 percent of the flight to Hong Kong and 45 percent of Cathay Pacific’s flights were canceled. Departing passengers at the airport had their temperature taken, Those that had a fever were not allowed to leave. Passengers on Cathay Pacific flights were required to wear masks. To get economy going, the government offered tax breaks, loans and shot-term janitorial jobs,

Mishandling of the SARS epidemic by Hong Kong and Beijing officials fueled calls for political reforms and more democracy. SARS is believed to be one the reason why protest in in Hong Kong early July 2003 were so large.

Hong Kong was taken off the SARS list in late June, 2003. A report on the SARS epidemic issued in October 2003, blamed health care officials but not leaders and authorities. Critics of the government asked why was “no one was culpable.” When a suspected SARS case materialized in Guangzhou in December 2003, infrared scanners were set up at the train station to check people arriving from China for fevers. Those that had fevers were double checked with ear thermometers.

SARS in Taiwan

Taiwan had the third highest number of SARS cases after China and Hong Kong. It officially had 37 deaths and 346 cases of SARS. The government had earlier reported that there were 180 deaths and 665 cases but a more careful look at these cases revealed more than 300 people who were thought to have the disease in fact didn’t have it.

SARS arrived later in Taiwan than it did in other places, but it spread quickly once it arrived there. SARS was initially confined to Taipei and later spread across the island and gained a major foothold in the southern city of Kaohsiung. In early July 2003, Taiwan was taken off the SARS list. It was the last country removed from the list.

SARS spread more widely than it otherwise should have because ashamed disease-suffers hid the fact they had the disease and health care workers were not as cautious as they should have been. Most of the people who came down with SARS were health care workers and 90 percent of SARS cases were traced to transmissions at hospitals . Large scale infections were reported at two hospitals, with the cases at one hospital originating from the other. A doctor and two nurses were killed at one hospital. Some hospitals were fined for covering up the disease or being slow about reporting cases.

A SARS case was reported in December 2003 after the outbreak was over. The victim was a medical researcher who studied SARS at Taiwan National Defense University. It is believed that he got the disease while cleaning a contaminated medical machine in the lab where he worked. He reportedly didn’t wear gloves and a mask when he cleaned the devise.

Restrictions During the SARS Crisis in Taiwan

During the SARS outbreak in Taiwan hospitals were closed and many doctors, nurses and health care workers were quarantined. People who had contact with SARS patients were ordered not leave their houses for 10 days. Visitors from and Hong Kong and China were banned. Taiwanese nationals that visited these places were quarantined for 10 days after their return. Those that had a temperature above 100.4̊F were taken away in an ambulance.

All subway riders in Taipei were ordered to wear mask. Video cameras were placed in the homes of quarantined people to make sure they didn’t sneak out. A thousand soldiers with training in chemical warfare were placed on call and house-to-house searches were conducted to find quarantine breakers after stay-at-home orders were given to 10,000 people. Around a dozen hospitals were shut down. To make sure cases were reported, the government ordered hospitals to report anyone with high fevers. Doctors failing to report cases faced prison sentences of up to seven years. China Air was also scolded for not grounding two flight crew members with SARS after they developed symptoms of the disease.

Taiwanese didn’t like the restrictions. Many under quarantine defied the restrictions. Nurses and doctors quit en masse out of fear of catching the disease. To keep low paid nurses from leaving they were offered “danger pay” of $143 a day, quite a jump from their usual $700 a month salary. Taiwan health minister was fired for not handling the outbreak better.

Wearing face masks with a variety of designs became all the rage. They appeared with Hello Kitty, canine teeth, Calvin Klein logos and messages like “Kiss Me I am no Danger.” The most sought after masks were 3M N-95 masks, which filter out 95 percent of all particles. They normally sell for $1 for a box of ten but were selling for $5 a piece. There were reports of drug stores illegally stockpiling them and thefts of shipment from abroad.

SARS hurt the economy of Taiwan but not so badly. Factory production and growth slumped as orders and exports fell. Growth for the entire year was around 3 percent, a point down from what had been projected for the year if there was no epidemic.

Taiwan had to battle SARS pretty much on its own without international help. The epidemic drew attention to the fact that Taiwan is not a member of the World Health Organization but should be (it wasn’t because of objections by China). Taiwan rejected help from China, which offered to send SARS specialists and medical supplies to Taiwan.

SARS in Singapore

Singapore had the forth highest number of SARS cases after Hong Kong, China and Taiwan. It had 238 cases of SARS and 33 deaths. One doctor at Tan Tock Seng Hospital, were the disease spread from, told the New York Times, “We were very lucky; We got our first case before the phrase “SARS” was coined. We used no protective gear. We had her in a room with five other patients. And once the infection has taken hold in a hospital like this, it is very difficult to control.” Dozens of people at the hospital became ill. A cardiologist was among those who died.

The Singapore economy was hit hard by SARS. Hotels had a 80 percent vacancy rate. Singapore Airlines was burdened with flight cancellations and empty planes. Businesses that rely on tourism such as restaurants and retail outlets saw a dramatic drop off in business. It took about a year for these businesses to fully recover.

A SARS case was reported in August 2003 after the outbreak was over. The victim was a medical researcher who was studying SARS at a hospital. He caught the disease in a lab accident blamed on poor training. He was doing research with a West Nile virus sample which somehow got contaminated with SARS. His case was relatively mild. He survived didn’t infect anyone else.

Battling SARS in Singapore

Singapore was praised by the World health Organization for it handling of the SARS crisis. Schools were closed, strict quarantines were put into effect, severe restrictions on traveling in and out of Singapore were imposed, companies and banks segregated workers according to their exposure to SARS, Some companies required their employees to make their temperatures every couple of hours and report the results to their superiors. Taxi drivers were told to drive with their windows open and turn off their air conditioning.

People under quarantine were required to report regularly in front of web cameras and in some cases wear electronic bracelets so their movements could be monitored 24 hours a day. People who broke the quarantine could be fined $5,800 and imprisoned for six months. Those that didn’t obey the quarantine restrictions were placed in a drug rehabilitation center that served as a jail. People caught lying about the disease in anyway could be fined $10,000 and imprisoned for six months.

Singapore’s three main broadcasters set up an all-SARS channel, which offered nothing but news and information about the disease. Thermal scanners were used to screen new arrivals at the airport for fevers. A special tent annex was attached to Tan Tock Seng Hospital and turned into the main screening center for SARS. The hospital itself was emptied except for essential staff, many of whom were required to wear full-body protective gear. Some wore scuba-like outfits with their own breathing apparatus. Patients with the disease were kept in rooms with their own ventilation systems.

The Catholic Church of Singapore suspended confessions in booths and instead granted a “general forgiveness” to all faithful. Rumors circulated that Indian people were immune from the disease and that smoking cigarettes, drinking alcohol and abstaining from pork also helped ward off the disease.

SARS in Vietnam and Thailand

Vietnam was one of the first countries to be struck by SARS and it was also one of the first to control it and stop it from spreading. Five people died and 63 people came down with disease. All of them could be traced to a single person.

Vietnam was lucky in that the disease was introduced by a single person, an America who brought it from Hong Kong, and the disease he was quickly diagnosed as something unusual and steps were taken quickly to isolate it and keep it from spreading. Vietnam was declared clear if SARS in April 2003. The first country to be declared free of the disease after the outbreak.

The American businessman was treated at the Vietnam French Hospital in Hanoi, where he spread the disease to 20 health care workers, including Carlo Urbani, an Italian doctor, who was the first to report the disease to the World Health Organization. Urbani ordered a number of preventive steps to be taken, but ended up dying of the disease. On March 15, the WHO issued a worldwide alert for a new diseases, which it called SARS.

Dr Urbani, the WHO’s representative in Hanoi, was one of the first specialists to raise the alarm on SARS. He fell ill on a flight to Bangkok, and died in the city. Dr Christiane Dolocek, a researcher in Saigon, told the Times of London: “Carlo persuaded the hospital in Bangkok to close and he stayed in it and died. He had three little kids and was a lovely guy....When you’re dealing with an unknown agent and you don’t know whether it’s going to be like SARS, where a high proportion of healthcare workers came down with it, and you don’t know if you’ve got a treatment for it, it’s very scary. [Source: Anjana Ahuja, The Times, October 30, 2006]

During the SARS outbreak, Thailand was struck by a few cases in the early stages of the epidemic but managed to avoid being hit with a lot of incidents as was the case in China, Hong Kong and Taiwan. As of late April 2003, Thailand had 8 cases of SARS and 2 deaths. During the SARS outbreak, visitors arriving from affected countries were required to get a mandatory health check and wear face masks during the duration of their stay.

SARS put a damper on the tourist industry in Thailand. During the peak of the SARS scare tourist arrivals were half of what they normally were. To waylay fears, the government announced it would give $100,000 to any tourist who catches SARS. Thai Airlines said it would pay $100,000 to anyone who caught SARS while flying with the airline.

SARS Concerns in Japan

There was great concern about SARS in Japan during the SARS outbreak in 2003. Even so not a single SARS case was reported. The nation was put on high alert. People arriving from countries with SARS cases were screened when they arrived in the country with a devise that visually measured their body temperature (SARS sufferers have fevers).

Concerns were raised when a Taiwanese doctor came down with SARS after traveled around Japan for a week as part of a group tour. Every place he visited, every mode of transportation he took and every person he was known to have come in contact with was checked out and in many cases sprayed with virus-killing chemicals.

SARS was big news. There were stories about it everyday in the newspapers and on television. Plans to boost tourism in Japan were dealt a serious blow. Airlines and travel companies lost a lot of money as the SARS scare occurred during the busy Golden Week and summer vacation season.

Combating SARS

Because there was no effective treatment for SARS the strategy to fight it consisted primarily of isolating people with the disease quickly and quarantining anyone that came in contact with them. Tracking down people SARS was another top priority. Passengers at airports arriving from affected countries were screened. Some had their temperature taken with a special strip of tape applied to their forehead. Other were checked with an infrared device that picked up heat. In some countries offices were set up to follow rumors of people with suspicious, high fevers or other symptoms of the disease. Following rumors turned out to be an important element in the fight against SARS

To prevent themselves from getting SARS, health care workers were required to wear goggles, multiple layers of masks, gloves and uncomfortable, waterproof, full-length body suits. As a precaution against spreading it, they were quarantined and in some cases prevented from seeing their own families. Those that were allowed to be with their families often wore masks at home, ate separately and used different bathrooms and bedrooms than other family members.

In January 2004, China okayed human testing for a SARS vaccine made from a dead sample of the virus. Beijing said that tests using the vaccine on animals had been effective. In April 2004, researchers at the National Institute of Allergy and Infectious Diseases in Albany, New York announced it had developed an experimental gene-based SARS vaccine that was effective on mice.

Inaction and Cover Up of SARS in China

China was criticized for not doing more to stop the SARS outbreak and not releasing information about the disease in a timely fashion. Officials at the World Health Organization (WHO) were angry that more wasn’t done to determine the source of the SARS virus and study how it was transmitted between animals, including humans, in the early stages if the outbreak. After a number of cases were reported in the early stages of the outbreak, it seemed like that numbers of cases were tapering off. But that was not the case.

Authorities in Guangzhou province and Beijing covered up the disease after it first appeared in each of those places by under reporting or failing to reported SARS as the appeared in hospitals. The government reacted the way it did, some analysts have suggested, because it believes that maintaining social stability has precedence over the well being of individuals. Doubts were raised about the humanity of the government. There were even some calls for political reforms

Jiang Yanyoung, a high-ranking military doctor and Communist Party member, blew the whistle on SARS cover-up and in the process became a folk hero in China. In a letter addressed to top leaders, which was also released to the international news media, he reported that many Beijing hospitals, including the one he worked at, were under reporting the number of SARS cases they had.

After the news of cover up came out, the government broke a pattern of never admitting mistakes and publically apologized for failing to inform the public about the disease earlier. Officials that were involved in the cover up---including the health minister and the mayor of Beijing---were sacked.

Later Jiang and his wife were detained and placed under house arrest. Jiang was forced to undergo brainwashing study sessions and wrote a daily “thought report” after asking the government to reappraise the Tiananmen Square pro-democracy protests.

Combating SARS in China

Once the government decided to do something about SARS they pulled out all the stops. Roadblocks were set outside infected areas. Men in white smocks, masks and goggles fanned out across the nation with disinfectant spray. People with even the slightest hint of a possibly of carrying the disease were quarantined to their homes. Fines for spitting were raised and enforced. Harsh punishments were set for anyone who broke the SARS restrictions

In the early stages of the SARS outbreak people stocked up on disinfectants and avoided public transportation. As the crisis worsened streets emptied, restaurants were closed and entire neighborhoods and factories were quarantined. An effort was made to prevent millions of migrant workers from returning to their hometowns. Employers of migrant workers were told not to fire them even with business slacking off and offered tax breaks and other financial aid.

Schools, libraries and other public buildings were closed. Additions were quickly added on to hospitals to accommodate extra sick people. In the rural areas, villagers set up barricades to keep out people suspected of having the disease. The Chinese government threatened to execute anyone who caused death or injury by deliberately spreading SARS and suggested it might apply this policy to SARS patients who violated quarantine orders.

Studies later showed that government overreacted in some cases and quarantined too many people. Other measures---including the suspension of foreign adoptions and marriages between foreigners and Chinese---had dubious effectiveness. Chinese were allowed to marry other Chinese.

SARS is Contained and Then Returns in China

Another SARS prevention poster In July, 2003, the WHO declared that SARS had been contained around the world after no new cases had ben reported for three weeks. The disease disappeared almost mysteriously as it arrived. The most effective means of controlling it seems to have been the quarantines and isolation.

In December 2003 SARS returned. A 32-year-old man came down with it in the Guangzhou area The man lived in a house with some rats. The case was mild and he survived. Some believed there may have been a connection between the disease and the rats. There were four other cases. Of these, one had contact with civet cats---a waitress that worked at a restaurant where wild animals were served.

This time the government was better prepared and ready to take action. The patients were quickly quarantined. Travelers and health care workers were screened. Hotels required patrons to have their temperatures taken before they checked in. Travelers at train stations and bus terminals had their temperatures checked with ear thermometers.

In April 2004, two confirmed cases of SARS and four suspected cases were announced. The victims were believed to have contacted the disease through a lack of safeguards at the National Institute of Virology, a laboratory in Beijing where research on SARS was being done. Again, the government acted quickly. Five hundred people were quarantined. They were mostly people who had come into cotact with the victims.

One victim died---a woman who got SARS from her daughter, who in turn got from a nurse at the laboratory. A researcher at the laboratory passed SARS on to the nurse. She in turn infected her roommate and then her mother (the one who died), father and aunt when she visited her home town in Anhui. Most of people who were quarantined either came in contact with the nurse in Beijing or Anhui.

Civet Cat Culling Campaign

In early January 2004, as part of the anti-SARS campaign, the government ordered the slaughter of all palm civets, hog badgers and racoon dogs in the Guangzhou area. Thousands were killed but many escaped because the were hidden by owners and animal traders. Chinese health officials in goggles, white smock and masks raided markets and breeding farms and seized animals that were killed by electrocution, boiled to death or drowned in disinfectant and then incinerated. A campaign to get rid of rats was also launched.

About 10,000 animals were killed, In addition to the cull, roadblocks were set up to make sure no one was smuggling animals out of the region. People who worked in the animal markets where civets were sold had their blood tested, sometimes several times. Those who hid animals were threatened with fines of up to $12,000.

The measure came eight months after palm civets, hog badgers and racoon dogs at a Guangzhou market had been found carrying a virus almost identical to SARS. Instead of acting quickly them, suspicions were raised about the quality of the data. Not long after the civet cull the ban on selling civets was lifted and markets were again filled with the animals. Many scientists believe the killing of all these animals may do more harm than good. Little is known about SARS and its transmission and studying these animals may provide some insights into the disease. There was little evidence that killing animals provided much help.

The SARS outbreak brought attention to the consumption in civet cat in Guangzhou Even after the SARS outbreak business was good at the First Village of Wild Food restaurant in Guangzhou. One customer who was eating civet cat told the New York Times, it tastes “very good, very good.” When asked if was worried about SARS he said, “It’s no big deal.”

SARS-like Virus Detected in Middle East

In September 2012, AP reported: “Global health officials are closely monitoring a new respiratory virus related to SARS that is believed to have killed at least one person in Saudi Arabia and left a Qatari citizen in critical condition in London. The germ is a coronavirus, from a family of viruses that cause the common cold as well as SARS. In the latest case, British officials alerted the World Health Organization of the new virus in a man who transferred from Qatar to be treated in London. He had recently traveled to Saudi Arabia and was treated in an intensive care unit after suffering kidney failure. [Source: Maria Cheng, Associated Press, September 24, 2012]

“WHO said virus samples from the patient are almost identical to those of a 60-year-old Saudi national who died earlier this year. The situation has raised concerns ahead of the annual Hajj pilgrimage, which brings millions of people to Saudi Arabia from around the world. Health officials don't know yet whether the virus could spread as rapidly as SARS did or if it might kill as many people. "It's still (in the) very early days," said Gregory Hartl, a WHO spokesman. "At the moment, we have two sporadic cases and there are still a lot of holes to be filled in."He added it was unclear how the virus spreads. Coronaviruses are typically spread in the air but Hartl said scientists were considering the possibility that the patients were infected directly by animals. He said there was no evidence yet of any human-to-human transmission. [Ibid]

“No other countries have so far reported any similar cases to WHO, he said, and so far there is no connection between the cases except for a history of travel in Saudi Arabia. Hartl said the first patient may have had an underlying condition but it probably didn't make him more susceptible to catching the virus. Other experts said it was unclear how dangerous the virus is. "We don't know if this is going to turn into another SARS or if it will disappear into nothing," said Michael Osterholm, a flu expert at the University of Minnesota. He said it was crucial to determine the ratio of severe to mild cases. Osterholm said it was worrying that at least one person with the disease had died. "You don't die from the common cold," he said. "This gives us reason to think it might be more like SARS," which killed about 10 percent of the people it infected. [Ibid]

“Britain's Health Protection Agency and WHO said in statements that the 49-year-old Qatari national became ill on Sept. 3, having previously traveled to Saudi Arabia. He was transferred from Qatar to Britain on Sept. 11 and is being treated in an intensive care unit at a London hospital for problems including kidney failure. Respiratory viruses aren't usually known to cause serious kidney problems. In Qatar, Mohammed bin Hamid Al Thani of the Public Health Department said the patient was in Saudi Arabia for Ramadan during the summer and fell ill after returning to Qatar. Doctors could not immediately identify the virus and decided he should be treated in London. A public health official, Abdullakef al-Khal, said there is no indication that the patient's family or others were infected. [Ibid]

“David Heymann, chairman of the Health Protection Agency, said the new virus didn't appear that similar to SARS. "It isn't as lethal as SARS and we don't know too much about its transmissibility yet," he said. "If people are getting infected, they aren't getting serious disease." Heymann said none of the health workers involved in treating the Qatari patient had fallen ill. Saudi officials said they were concerned that the upcoming Hajj pilgrimage could provide more opportunities for the virus to spread. They advised pilgrims to keep their hands clean and wear masks in crowded places.”

Image Sources: Wikimedia Commons

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.

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© 2008 Jeffrey Hays

Last updated November 2012

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