Whatever happened to SARS?

Nearly four years ago, the world was facing the first pandemic of the 21st century, SARS (Severe Acute Respiratory Syndrome), and everyone was scared. For months after a “fatal flu” emerged in November 2002, news of SARS outbreaks and casualties in Canada, China, Hong Kong, Singapore, Taiwan, and Vietnam dominated local and international headlines.

People knew that you could become infected by simply being exposed to someone with SARS, and once infected you might die in a matter of days. Thousands were quarantined. In the streets of Asian cities, if you just coughed slightly, people would run. But then, a mere nine months later, in July 2003, the World Health Organization (WHO) declared that transmission of the virus over.

What happened to SARS and are there lessons to be learned for dealing with other epidemics such as human avian influenza?

SARS infected over 8,000 people worldwide, of which fewer than 800 died - a mortality rate of less than 10 percent, and a far cry from those of other communicable diseases like HIV/AIDS (2.8 million deaths in 2005) and malaria (1-3 million deaths a year).

But the financial costs were high: The Asian Development Bank Asian Development Outlook 2003 Update estimates that SARS cost East and Southeast Asian economies about US$18 billion in nominal gross domestic product (GDP) terms in 2003, and almost US$60 billion in terms of overall loss in demand and in business revenue.

At the height of the SARS scare, airline seats and hotel rooms in some of Asia’s most popular tourist destinations were empty. Air Transport World, the industry magazine, reported that Lufthansa lost each week up to 50 million euros due to SARS and the Iraq war, while Cathay Pacific had to ask its workers to take a month’s unpaid leave. Airports had to purchase thermal imaging technologies to scan passengers’ temperatures, and hospitals constructed isolation rooms. People stayed at home and consumer spending dropped. In the USA newspapers reported that Chinese restaurants and Chinatowns were being avoided.

International scientific cooperation

A WHO publication in 2006 entitled SARS: How a Global Epidemic was Stopped traces the answer back to 1995, when an outbreak of Ebola haemorrhagic fever in Democratic Republic of Congo showed how unprepared the world was to respond to emerging and epidemic-prone diseases. Lessons from that incident led WHO to create global intelligence and response networks that became instrumental when rumours of a “fatal flu” were detected in China in late 2002.

Manila-based WHO spokesperson for the Western Pacific Region Peter Cordingley told IRIN the unprecedented cooperation of experts from 11 laboratories in nine countries led to the early identification of the SARS-causing virus and the development of diagnostic tools.

At the same time, according to Cordingley, governments were cooperative, save for initial resistance from China. Government task forces were formed and any reports of new incidents went swiftly to WHO. In Vietnam, a 24-hour SARS reporting hotline was established. In Beijing, Hong Kong and Singapore, schools were closed. In Canada, Ontario declared a province-wide SARS emergency.

Old and new technologies

SARS initially seemed highly menacing: It was dispersed by aircraft and mimicked the symptoms of many diseases, but did not respond to usual treatments. To fight an unknown epidemic, Cordingley says, 19th century measures were used - contact tracing, quarantine, and infection control. The effectiveness of these measures in controlling the spread of SARS was eventually proven as scientists began to understand the disease and as infection rates slowed down. In fact, the WHO SARS book says: “None of the most modern technical tools had an important role to play in controlling SARS.”

But Cordingley adds that alongside these 19th century technologies, we did have a modern ally - the Internet. WHO’s intelligence network, for instance, scanned the internet for reports of suspicious events. Their global response network was linked through the Internet as well. WHO also issued guidelines on detecting and responding to SARS and travel advisories that were rapidly disseminated worldwide through the Internet and the media.

“SARS marked the first international outbreak in which information about a new disease was gathered and made public in real time, as the disease evolved,” says the WHO book.

WHO statistics show the impact of this information dissemination: Ninety percent of all SARS outbreaks and 79 percent of all deaths from the disease worldwide occurred in the period before the WHO global alerts began.

But the influx of information also perhaps contributed to more panic than was necessary, leading to massive economic losses. In WHO’s SARS book, Western Pacific Regional Director Shigeru Omu writes: “WHO was accused of overstating the problem, and, in retrospect, I suspect we probably did. Like everyone else, we were learning - and we didn’t always get things right the first time.”

SARS left improved public health systems

SARS may have been blown out of proportion, but, as WHO says, it awakened the global public health community from a kind of slumber. “SARS, for all the fear and suffering it caused, has left public health systems greatly improved,” wrote Omu. WHO officials said such improved public health systems, including the capacity to communicate quickly worldwide regarding outbreaks, have great benefits for tracking and contending with other epidemics in the future, such as avian influenza.

The world, however, was relatively lucky with SARS, Cordingley told IRIN, because the nature of the disease - with infected individuals not contagious until several days after symptoms began - made it easier to contain. If avian flu turns into a human epidemic, lessons from SARS may be useful only to a certain extent. “We would put in place exactly the same measures as we did with SARS, but the key is how infectious bird flu will be among humans,” said the WHO spokesperson.

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