Ten years ago this February, a Chinese doctor unwittingly passed a deadly virus to 16 other people, beginning a global outbreak that would affect travel worldwide and change the way we respond to communicable diseases.
The outbreak of the as-yet-unknown virus, which later became known as Severe Acute Respiratory Syndrome (SARS), began in November of 2002 in Guangdong province. The virus is believed to have been transferred to humans from civets, nocturnal mammals resembling a cross between a cat and a mongoose. In China they are bred for their scent glands and eaten as a delicacy.
On February 21, 2003, 64-year-old Liu Jianlun, who had treated people infected with SARS in Guangdong, attended a wedding in Hong Kong, even though he had a fever. He stayed for one night at the Metropole Hotel on the ninth floor. During that one-night stay, he infected 16 other people on the same floor. Those people in turn spread the virus to Singapore, Canada and Vietnam, as well as spreading it further in Hong Kong.
SARS traveled the globe more widely and swiftly than any other disease in recent decades. Unlike other viruses that incapacitate victims within hours (thus limiting the likelihood of spread via travel), people infected with SARS often felt well enough to go about their business for the first week or so, during which time they were mobile and contagious.
SARS hit health care workers particularly hard. They were in close contact with those who were most ill, and because they didn't yet know what they were dealing with, they didn't take the necessary precautions to avoid transmission.
SARS (designated SARS-CoV) belongs to the coronavirus family, which is also responsible for the common cold. SARS symptoms include a sudden, high fever, chills, cough, headaches, muscle aches, and difficulty breathing. Infections and lung damage can occur. Most patients develop pneumonia. About 10-20% of victims also suffer from gastric distress.
By the end of June 2003 when the outbreak was declared over, there were 8,456 cases in 30 countries, resulting in 809 deaths — a mortality rate of about ten percent.
The very real threat of a pandemic such as SARS has caused us to change our thinking and preparedness in regard to communicable diseases. Airports learned to screen passengers for fever if they came from affected countries. Global companies developed policies and procedures concerning travel to affected regions.
There is greater awareness regarding what steps people can take to avoid contracting viruses. Hand sanitizer has become ubiquitous in public places, and facemasks are no longer just for health care workers. In fact, at the height of the epidemic, 90% of Hong Kong residents wore facemasks in public places.
Recently a new SARS-like virus has emerged. Known as novel coronavirus, or NCoV, there have been 12 confirmed cases and five deaths.
The virus appears to have originated in the Middle East. However, a citizen of the United Kingdom who had not traveled there but who had close personal contact with someone who did was the most recent victim, providing evidence that the virus is being transmitted person-to-person. Such transmission appears to be difficult, however, with only two of the 12 cases involving person-to-person transmission.
Although it does not appear we are looking at another SARS epidemic, WHO is continuing to monitor the situation closely.