On April 1, the U.S. government called back non-essential personnel
in their consulate office in Hong Kong and Guangzhou. The US government
also advised US citizens not to travel to the region.
On April 2, Chinese medical officials began reporting the status of
the SARS outbreak. China's southern Guangdong province reported 361 new
infections and 9 new deaths, increasing the total Mainland China
figures previously reported at end-February. The virus was also
detected in Beijing and Shanghai. The WHO also advised travelers to
avoid Hong Kong and Guangdong during a press briefing.[1]
On April 3, a WHO team of international scientists landed in Guangzhou
from Beijing to discuss with officials, but the team was yet to inspect
any suspected origin or any medical facilities on progress of infection
control. Fifteen of the quarantined Amoy Gardens residents at Lei Yue Mun Holiday Camp were relocated to the Sai Kung Outdoor Recreation Centre
after an overnight protest on washroom sharing. The first medical
worker infected with SARS died in Hong Kong. The doctor was survived by a
daughter and his infected wife, who was also among the quarantined
medical workers under intensive care. Hong Kong school closures were
extended by two weeks to April 21.
On April 4, the WHO team inspected the first infection case in Foshan
County. The male infected four people. But, he did not infect his
family. A 40-year-old woman became the first local case in Shanghai. A
Chinese health specialist admitted at a press conference of not
informing the public early enough about the outbreak. The PRC Health
Minister also claimed that the disease has been under control in most
parts of mainland China. He also released the names of seven drugs which
he claimed to be effective in curing SARS. WHO officials said that the
information provided by the PRC about the disease has been "very
detailed". US government enforced compulsory quarantine of any infected
person.
On April 5, the Singapore
government announced that school closures will be extended. Junior
colleges will reopen on April 9, secondary schools will reopen on April
14 and primary schools and pre-schools will reopen on April 16.
On April 6, a SARS case was found in Manila, a person who had returned from Hong Kong.
On April 8, SARS starts to plague the Lower Ngau Tau Kok Estate
near Amoy Gardens in Kowloon. Hong Kong health officials warned that
SARS had spread so far domestically and abroad that it was here to stay.
Nevertheless, WHO officials remained cautiously optimistic that the
disease could still be contained.[2]
On April 9, James Earl Salisbury died of SARS at a hospital in Hong Kong. An American Mormon[11] and a teacher at Shenzhen Polytechnic,[12] he had been sick for approximately one month before his death,[13] but he was originally diagnosed with pneumonia.[14] His son Michael "Mickey" Salisbury was with him in China and also contracted the disease, but he survived it.[15] Salisbury's death led to more open admissions by the Chinese government about the spread of SARS.[16]
On April 10, Dr. Jim Hughes, the head of infectious disease at the CDC,
confirming the warnings of Hong Kong health officials, claimed that he
believed that SARS could no longer be eradicated in the Far East.
However, he remained hopeful that it could be prevented from spreading
widely in North America.[3]
On April 11, the World Health Organization issues a global health alert for SARS as it becomes clear the disease was being spread by global air travel.
On April 12, Dr. Marco Marra, director of the Michael Smith Genome
Sciences Centre, which is part of the British Columbia Cancer Agency,
announced that scientists at his center had broken the genetic code of
the virus suspected of causing the disease.[4] In Toronto, three more people die of SARS, bringing the Canadian death toll to 13.
On April 16, the WHO issued a press release stating that the
coronavirus identified by a number of laboratories was the official
cause of SARS. The virus was officially named the SARS virus.[5]
Doctors were surprised to discover the occurrence of at least two cases of SARS in Dinnur, a village near Bangalore, India. Poor hygiene and a lack of adequate trash disposal seemed to have hastened the spread of the deadly disease.
On April 19, Premier of the People's Republic of China Wen Jiabao
announced that there would be severe consequences for local officials
who do not report SARS cases in a timely and accurate manner, signalling
at a major change in policy. (SARS had also been gaining prominence in
the mainland Chinese media; by late April, it had jumped from virtual
invisibility onto the front-page, with daily reports from all provinces
on new cases and measures.)
On April 20, Beijing mayor Meng Xuenong and health minister of the PRC Zhang Wenkang were replaced respectively by Wang Qishan from Hainan and the former deputy health minister Gao Qiang.
They are the first two high rank officials in the PRC to be dismissed
because of the fallout of the epidemic. In the news conference chaired
by Gao Qiang several hours earlier, the PRC admitted that in Beijing
there are more than 300 cases, as opposed to the previous figure of only
37. One day later the figure has increased to 407. Chinese officials
also admitted to major underreporting of cases, which were attributed to
bureaucratic ineptitude.
On April 22, schools, in Hong Kong, start to reopen in stages.
On April 23, Beijing announced that all primary and secondary schools
will be closed for two weeks. A few days before, some colleges in
Peking University had been closed because some students had been
infected. The WHO issues travel advisories against Beijing, Toronto, and
Shanxi Province.[6]
On April 25, Taipei city government closed Taipei Municipal Hospital
Hoping branch, and quarantined its 930 staffs and 240 patients for 2
weeks.[17] Later, people were relocated and the building sanitized.
On April 24, the Hong Kong Government announced a HK$11.8 billion
relief package designed to assist Hong Kong's battered tourism,
entertainment, retail, and catering sectors, consisting of a waiver of
tourism- and transport-related licence fees, and HK$1 billion allocated
for tourism promotion overseas. The package also includes a salaries tax rebate, and reduced rates.
On April 26, Wu Yi was named Zhang Wenkang's replacement as PRC health minister.
On April 26–27, Chinese authorities closed down theaters, discos, and
other entertainment venues in Beijing as the death toll in Beijing
continued to rise, threatening to become the worst hit area of the
country, eclipsing the Guangdong
province. Authorities are bolstered by the fact that the infection rate
seems to have declined, with the Guangdong region only exporting three
new infections over the weekend. The economic impact is becoming
dramatic as shops, restaurants, markets, bars, universities, schools,
and many other businesses have closed, as well as some government
ministries and large state banks are working with minimal staff levels.
On April 28, WHO declared the outbreak in Vietnam to be over as no new cases were reported for 20 days.
On April 29, leaders of member countries of ASEAN and the PRC premier held an emergency summit in Bangkok, Thailand in order to address the SARS
problem. Among the decisions made were the setting-up of a
ministerial-level task force and uniform pre-departure health screening
in airports.
On April 30, the World Health Organization lifted the SARS travel
warning for Toronto. The decision was made because "it is satisfied with
local measures to stop the spread of SARS". Canadian officials say they
will step up screenings at airports [7].
Monday, March 27, 2017
March 2003
On March 4, a 27-year-old Hong Kong man who had visited a guest in Metropole (on the 9th floor) 11 days earlier was admitted to Prince of Wales Hospital. At least 99 hospital workers (including 17 medical students) were infected while treating him.[10]
On March 11, Carlo Urbani travelled to Bangkok to attend a medical conference. On the flight, he fell ill and upon arrival in Bangkok told an awaiting friend not to touch him and to call an ambulance to take him to a hospital. He was isolated in an intensive care unit.
A similar outbreak of a mysterious respiratory disease was reported among healthcare workers in Hong Kong.
On March 12, WHO issued a global alert about a new infectious disease of unknown origin in both Vietnam and Hong Kong.
On March 15, WHO issued a heightened global health alert about the mysterious pneumonia with a case definition of SARS as after cases in Singapore and Canada are also identified. The alert included a rare emergency travel advisory to international travelers, healthcare professionals and health authorities.
CDC issued a travel advisory stating that persons considering travel to the affected areas in Asia (Hong Kong, Singapore, Vietnam and China).
On March 17, an international network of 11 leading laboratories was established to determine the cause of SARS and develop potential treatments.
CDC held its first briefing on SARS and said the first 14 suspected SARS cases were being investigated in the U.S.
On March 20, WHO reported that several hospitals in Vietnam and Hong Kong were operating with half the usual staff, because many workers stayed home out of fear of getting infected. WHO raised the concern that substandard care of the infected patients may contribute to the spread of the disease.
On March 25, Hong Kong authorities said nine tourists came down with the disease when a mainland Chinese man boarded the same plane on a March 15 Air China flight to Beijing. SARS started to hit Amoy Gardens Block E heavily.
The Singapore Government enforced compulsory quarantine of any infected person.
On March 27, Arthur K. C. Li, the head of the Hong Kong Education and Manpower Bureau, announced class cancellation of all educational institutions. The Ministry of Education of Singapore announced that all primary schools, secondary schools and junior colleges were to be shut until April 6, 2003. Polytechnics and universities were not affected.
On March 29, Dr. Urbani died in Bangkok of a massive heart attack.
On March 30, Hong Kong authorities quarantined estate E of the Amoy Gardens Apartment due to a massive (200+ cases) outbreak in the building. The balcony was completely closed for all uses and guarded by the police. The residents of the building were later transferred to the quarantined Lei Yue Mun Holiday Camp and Lady MacLehose Holiday Village on April 1 because the building was deemed a health hazard. Most of the cases were tied to apartment units with a north-western orientation that shared the same sewage pipe. According to government officials, the virus was brought into the estate by an infected kidney patient (type of kidney illness was not specified) who after he was discharged from Prince of Wales Hospital, visited and thus infected his elder brother living in a flat on the seventh floor. Through excretion, the virus spread through drainage. One speculated theory that supported airborne transmission was that the virus was spread through dried up U-shaped P-traps in the drainage and was blown by a maritime breeze to the ventilation of the estate's balcony and stairwells. It was confirmed that the virus can spread via droplets, but this latest outbreak made the officials question the possibility of spreading through the air.
On March 11, Carlo Urbani travelled to Bangkok to attend a medical conference. On the flight, he fell ill and upon arrival in Bangkok told an awaiting friend not to touch him and to call an ambulance to take him to a hospital. He was isolated in an intensive care unit.
A similar outbreak of a mysterious respiratory disease was reported among healthcare workers in Hong Kong.
On March 12, WHO issued a global alert about a new infectious disease of unknown origin in both Vietnam and Hong Kong.
On March 15, WHO issued a heightened global health alert about the mysterious pneumonia with a case definition of SARS as after cases in Singapore and Canada are also identified. The alert included a rare emergency travel advisory to international travelers, healthcare professionals and health authorities.
CDC issued a travel advisory stating that persons considering travel to the affected areas in Asia (Hong Kong, Singapore, Vietnam and China).
On March 17, an international network of 11 leading laboratories was established to determine the cause of SARS and develop potential treatments.
CDC held its first briefing on SARS and said the first 14 suspected SARS cases were being investigated in the U.S.
On March 20, WHO reported that several hospitals in Vietnam and Hong Kong were operating with half the usual staff, because many workers stayed home out of fear of getting infected. WHO raised the concern that substandard care of the infected patients may contribute to the spread of the disease.
On March 25, Hong Kong authorities said nine tourists came down with the disease when a mainland Chinese man boarded the same plane on a March 15 Air China flight to Beijing. SARS started to hit Amoy Gardens Block E heavily.
The Singapore Government enforced compulsory quarantine of any infected person.
On March 27, Arthur K. C. Li, the head of the Hong Kong Education and Manpower Bureau, announced class cancellation of all educational institutions. The Ministry of Education of Singapore announced that all primary schools, secondary schools and junior colleges were to be shut until April 6, 2003. Polytechnics and universities were not affected.
On March 29, Dr. Urbani died in Bangkok of a massive heart attack.
On March 30, Hong Kong authorities quarantined estate E of the Amoy Gardens Apartment due to a massive (200+ cases) outbreak in the building. The balcony was completely closed for all uses and guarded by the police. The residents of the building were later transferred to the quarantined Lei Yue Mun Holiday Camp and Lady MacLehose Holiday Village on April 1 because the building was deemed a health hazard. Most of the cases were tied to apartment units with a north-western orientation that shared the same sewage pipe. According to government officials, the virus was brought into the estate by an infected kidney patient (type of kidney illness was not specified) who after he was discharged from Prince of Wales Hospital, visited and thus infected his elder brother living in a flat on the seventh floor. Through excretion, the virus spread through drainage. One speculated theory that supported airborne transmission was that the virus was spread through dried up U-shaped P-traps in the drainage and was blown by a maritime breeze to the ventilation of the estate's balcony and stairwells. It was confirmed that the virus can spread via droplets, but this latest outbreak made the officials question the possibility of spreading through the air.
November 2002
On November 16, 2002, an outbreak of what is believed to be severe acute respiratory syndrome (SARS), began in the Guangdong province of China, which borders on Hong Kong. The first case of infection was speculated to be a farmer in Foshan County. The People's Republic of China (PRC) notified the World Health Organization (WHO) about this outbreak on February 10, reporting 305 cases (including 105 health-care workers) and 5 deaths;[1]
it was later reported that the outbreak in Guangdong had peaked in
mid-February, but that appears to be false, as later 806 infections and
34 deaths were reported.[2]
Early in the epidemic, the PRC discouraged its press from reporting on SARS and lagged in reporting the situation to the World Health Organization, delaying the initial report. Initially, it did not provide information for Chinese provinces other than Guangdong, the province where the disease is believed to have originated.[3] For example, a WHO team that travelled to Beijing was not allowed to visit the Guangdong province for several weeks.[4] This resulted in international criticism which seemed to have caused a change in government policy in early April.
On February 21, Liu Jianlun,
a 64-year-old Chinese doctor who had treated cases in Guangdong arrived
in Hong Kong to attend a wedding. He checked into the Metropole Hotel
(the ninth floor – room 911).[5]
Although he had developed symptoms on February 15, he felt well enough
to travel, shop, and sight-see with his brother-in-law. On February 22,
he sought urgent care at the Kwong Wah Hospital and was admitted to the intensive care unit. He died on March 4.[6] About 80% of the Hong Kong cases have been traced back to this doctor.[citation needed]
On February 23,[7] a 47-year-old Chinese-American businessman (Johnny Chen, a Shanghai resident) who had stayed on the 9th floor of the Metropole Hotel (across the hall from the Chinese doctor)[8] travelled to Hanoi, Vietnam. After his arrival, he became ill and was admitted to The French Hospital of Hanoi on February 26. Seven days later, on ventilator support, he was medically evacuated to Hong Kong but by then seven hospital workers who had cared for him had already developed symptoms of SARS. He died on March 13.[9] At least 38 health-care workers in Hanoi were infected with SARS. WHO doctor Carlo Urbani, an infectious diseases specialist based in Hanoi who attended Mr Chen, noticed the outbreak among hospital workers there and first recognized SARS as a new disease. He initially suspected that it was avian influenza (bird flu).
On February 25, the 53-year-old brother-in-law of the Guangdong doctor went to the Kwong Wah Hospital. He was not admitted that day but his illness worsened. He was admitted on March 1, and died on March 19. The same day, a businessman who had travelled in Hong Kong and Guangdong Province returned home to Taipei, the beginning of the outbreak on the island of Taiwan. Also, another person who was at the Metropole returned to Singapore.
Almost all of those infected had been either medical staff or family members of people who had fallen ill. It is believed that, at the time of exposure, affected medical staff were not using respiratory precautions, a safety protocol intended to fully protect medical workers. The various cases around the world were directly or indirectly traceable to people who had recently visited Asia.
Early in the epidemic, the PRC discouraged its press from reporting on SARS and lagged in reporting the situation to the World Health Organization, delaying the initial report. Initially, it did not provide information for Chinese provinces other than Guangdong, the province where the disease is believed to have originated.[3] For example, a WHO team that travelled to Beijing was not allowed to visit the Guangdong province for several weeks.[4] This resulted in international criticism which seemed to have caused a change in government policy in early April.
February 2003
9th floor layout of the Hotel Metropole in Hong Kong, showing where
superspreading event of severe acute respiratory syndrome (SARS)
occurred
On February 23,[7] a 47-year-old Chinese-American businessman (Johnny Chen, a Shanghai resident) who had stayed on the 9th floor of the Metropole Hotel (across the hall from the Chinese doctor)[8] travelled to Hanoi, Vietnam. After his arrival, he became ill and was admitted to The French Hospital of Hanoi on February 26. Seven days later, on ventilator support, he was medically evacuated to Hong Kong but by then seven hospital workers who had cared for him had already developed symptoms of SARS. He died on March 13.[9] At least 38 health-care workers in Hanoi were infected with SARS. WHO doctor Carlo Urbani, an infectious diseases specialist based in Hanoi who attended Mr Chen, noticed the outbreak among hospital workers there and first recognized SARS as a new disease. He initially suspected that it was avian influenza (bird flu).
On February 25, the 53-year-old brother-in-law of the Guangdong doctor went to the Kwong Wah Hospital. He was not admitted that day but his illness worsened. He was admitted on March 1, and died on March 19. The same day, a businessman who had travelled in Hong Kong and Guangdong Province returned home to Taipei, the beginning of the outbreak on the island of Taiwan. Also, another person who was at the Metropole returned to Singapore.
Almost all of those infected had been either medical staff or family members of people who had fallen ill. It is believed that, at the time of exposure, affected medical staff were not using respiratory precautions, a safety protocol intended to fully protect medical workers. The various cases around the world were directly or indirectly traceable to people who had recently visited Asia.
Society and culture
Community response
Fear of contracting the virus from consuming infected wild animals resulted in public bans and reduced business for meat markets throughout southern China and Hong Kong.[37] In China, Cantonese foodways, which often incorporate a wide range of meat sources, were frequently indicted as an important contributing factor to the origins of the SARS outbreak.Toronto’s Asian minority population faced increased discrimination over the course of the city’s outbreak. Local advocacy groups reported Asians being passed over by real-estate agents and taxi drivers and shunned on public transportation.[38] In Boston and New York City, rumors and April Fools pranks gone awry resulted in an atmosphere of fear and substantial economic loss in the cities’ Chinatowns.
See also
- 2009 flu pandemic
- Bird flu
- MERS-CoV – Coronavirus discovered in June 2012 in Saudi Arabia
- Health crisis
- Jiang Yanyong
- Zhong Nanshan
- Carlo Urbani
- Public health in the People's Republic of China
- SARS conspiracy theory
- Super-spreader
- Progress of the SARS outbreak
- Bat-borne virus
Identification of virus
The CDC and Canada's National Microbiology Laboratory identified the SARS genome in April 2003.[29][30] Scientists at Erasmus University in Rotterdam, the Netherlands demonstrated that the SARS coronavirus fulfilled Koch's postulates thereby confirming it as the causative agent. In the experiments, macaques infected with the virus developed the same symptoms as human SARS victims.[31]
In late May 2003, studies were conducted using samples of wild animals sold as food in the local market in Guangdong, China. The results found that the SARS coronavirus could be isolated from masked palm civets (Paguma sp.), even if the animals did not show clinical signs of the virus. The preliminary conclusion was the SARS virus crossed the xenographic barrier from asian palm civet to humans, and more than 10,000 masked palm civets were killed in Guangdong Province. The virus was also later found in raccoon dogs (Nyctereuteus sp.), ferret badgers (Melogale spp.), and domestic cats. In 2005, two studies identified a number of SARS-like coronaviruses in Chinese bats.[32][33] Phylogenetic analysis of these viruses indicated a high probability that SARS coronavirus originated in bats and spread to humans either directly or through animals held in Chinese markets. The bats did not show any visible signs of disease, but are the likely natural reservoirs of SARS-like coronaviruses. In late 2006, scientists from the Chinese Centre for Disease Control and Prevention of Hong Kong University and the Guangzhou Centre for Disease Control and Prevention established a genetic link between the SARS coronavirus appearing in civets and humans, bearing out claims that the disease had jumped across species.[34]
In late May 2003, studies were conducted using samples of wild animals sold as food in the local market in Guangdong, China. The results found that the SARS coronavirus could be isolated from masked palm civets (Paguma sp.), even if the animals did not show clinical signs of the virus. The preliminary conclusion was the SARS virus crossed the xenographic barrier from asian palm civet to humans, and more than 10,000 masked palm civets were killed in Guangdong Province. The virus was also later found in raccoon dogs (Nyctereuteus sp.), ferret badgers (Melogale spp.), and domestic cats. In 2005, two studies identified a number of SARS-like coronaviruses in Chinese bats.[32][33] Phylogenetic analysis of these viruses indicated a high probability that SARS coronavirus originated in bats and spread to humans either directly or through animals held in Chinese markets. The bats did not show any visible signs of disease, but are the likely natural reservoirs of SARS-like coronaviruses. In late 2006, scientists from the Chinese Centre for Disease Control and Prevention of Hong Kong University and the Guangzhou Centre for Disease Control and Prevention established a genetic link between the SARS coronavirus appearing in civets and humans, bearing out claims that the disease had jumped across species.[34]
Containment
The World Health Organization declared severe acute respiratory syndrome contained on 9 July 2003. In the following years, four of SARS cases were reported in China between December 2003 and January 2004. There were also three separate laboratory accidents that resulted in infection. In one of these cases, an ill lab worker spread the virus to several other people.[35][36] The precise coronavirus that caused SARS is believed to be gone, or at least contained to BSL-4 laboratories for research.[citation needed]Spread to other countries and regions
The epidemic reached the public spotlight in February 2003, when an
American businessman traveling from China became afflicted with
pneumonia-like symptoms while on a flight to Singapore. The plane
stopped in Hanoi, Vietnam, where the victim died in The French Hospital of Hanoi.
Several of the medical staff who treated him soon developed the same
disease despite basic hospital procedures. Italian doctor Carlo Urbani identified the threat and communicated it to WHO and the Vietnamese government; he later succumbed to the disease.[23]
The severity of the symptoms and the infection among hospital staff alarmed global health authorities, who were fearful of another emergent pneumonia epidemic. On 12 March 2003, the WHO issued a global alert, followed by a health alert by the United States Centers for Disease Control and Prevention (CDC). Local transmission of SARS took place in Toronto, Ottawa, San Francisco, Ulaanbaatar, Manila, Singapore, Taiwan, Hanoi and Hong Kong whereas within China it spread to Guangdong, Jilin, Hebei, Hubei, Shaanxi, Jiangsu, Shanxi, Tianjin, and Inner Mongolia.
In Hong Kong, the first cohort of affected people were discharged from the hospital on 29 March 2003.[24]
The disease spread in Hong Kong from a mainland doctor who arrived in
February and stayed on the ninth floor of the Metropole Hotel in Kowloon,
infecting 16 of the hotel visitors. Those visitors traveled to Canada,
Singapore, Taiwan, and Vietnam, spreading SARS to those locations.[25]
Another larger cluster of cases in Hong Kong centred on the Amoy Gardens housing estate. Its spread is suspected to have been facilitated by defects in its drainage system. Concerned citizens in Hong Kong worried that information was not reaching people quickly enough and created a website called sosick.org, which eventually forced the Hong Kong government to provide information related to SARS in a timely manner.[26]
The Canadian State’s official response has been widely criticized in the years following the outbreak. Brian Schwartz, vice-chair of the Ontario's SARS Scientific Advisory Committee, described public health officials’ preparedness and emergency response at the time of the outbreak as “very, very basic and minimal at best”.[28] Critics of the response often cite poorly outlined and enforced protocol for protecting healthcare workers and identifying infected patients as a major contributing factor to the continued spread of the virus. The atmosphere of fear and uncertainty surrounding the outbreak resulted in staffing issues in area hospitals when healthcare workers elected to resign rather than risk exposure to SARS.
The severity of the symptoms and the infection among hospital staff alarmed global health authorities, who were fearful of another emergent pneumonia epidemic. On 12 March 2003, the WHO issued a global alert, followed by a health alert by the United States Centers for Disease Control and Prevention (CDC). Local transmission of SARS took place in Toronto, Ottawa, San Francisco, Ulaanbaatar, Manila, Singapore, Taiwan, Hanoi and Hong Kong whereas within China it spread to Guangdong, Jilin, Hebei, Hubei, Shaanxi, Jiangsu, Shanxi, Tianjin, and Inner Mongolia.
Hong Kong
9th floor layout of the Hotel Metropole in Hong Kong, showing where
superspreading event of severe acute respiratory syndrome (SARS)
occurred
Another larger cluster of cases in Hong Kong centred on the Amoy Gardens housing estate. Its spread is suspected to have been facilitated by defects in its drainage system. Concerned citizens in Hong Kong worried that information was not reaching people quickly enough and created a website called sosick.org, which eventually forced the Hong Kong government to provide information related to SARS in a timely manner.[26]
Toronto
The first case of SARS in Toronto, Canada was identified on February 23, 2003.[27] Beginning with a woman returning from a trip to Hong Kong, the virus eventually infected 257 individuals in the province of Ontario. The trajectory of this outbreak is typically divided into two phases, with the second major wave of cases clustered around accidental exposure among patients, visitors, and staff within a major Toronto hospital. The WHO officially removed Toronto from its list of infected areas by the end of June, 2003.The Canadian State’s official response has been widely criticized in the years following the outbreak. Brian Schwartz, vice-chair of the Ontario's SARS Scientific Advisory Committee, described public health officials’ preparedness and emergency response at the time of the outbreak as “very, very basic and minimal at best”.[28] Critics of the response often cite poorly outlined and enforced protocol for protecting healthcare workers and identifying infected patients as a major contributing factor to the continued spread of the virus. The atmosphere of fear and uncertainty surrounding the outbreak resulted in staffing issues in area hospitals when healthcare workers elected to resign rather than risk exposure to SARS.
Prognosis
Several consequent reports from China on some recovered SARS patients showed severe long-time sequelae exist. The most typical diseases include, among other things, pulmonary fibrosis, osteoporosis, and femoral necrosis,
which have led to the complete loss of working ability or even
self-care ability of these cases. As a result of quarantine procedures,
some of the post-SARS patients have been documented suffering from posttraumatic stress disorder (PTSD) and major depressive disorder.[12][13]
The outbreak first appeared on 27 November 2002, when Canada's Global Public Health Intelligence Network (GPHIN), an electronic warning system that is part of the World Health Organization's Global Outbreak Alert and Response Network (GOARN), picked up reports of a "flu outbreak" in China through Internet media monitoring and analysis and sent them to the WHO. While GPHIN's capability had recently been upgraded to enable Arabic, Chinese, English, French, Russian, and Spanish translation, the system was limited to English or French in presenting this information. Thus, while the first reports of an unusual outbreak were in Chinese, an English report was not generated until 21 January 2003.[17][17][18]
Subsequent to this, the WHO requested information from Chinese authorities on 5 and 11 December. Despite the successes of the network in previous outbreak of diseases, it didn't receive intelligence until the media reports from China several months after the outbreak of SARS. Along with the second alert, WHO released the name, definition, as well as an activation of a coordinated global outbreak response network that brought sensitive attention and containment procedures (Heymann, 2003). By the time the WHO took action, over 500 deaths and an additional 2,000 cases had already occurred worldwide.[18]
In early April, after Jiang Yanyong pushed to report the danger to China,[19][20] there appeared to be a change in official policy when SARS began to receive a much greater prominence in the official media. Some have directly attributed this to the death of American James Earl Salisbury.[21] It was around this same time that Jiang Yanyong made accusations regarding the undercounting of cases in Beijing military hospitals.[19][20] After intense pressure, Chinese officials allowed international officials to investigate the situation there. This revealed problems plaguing the aging mainland Chinese healthcare system, including increasing decentralization, red tape, and inadequate communication.
Many healthcare workers in the affected nations risked and lost their lives by treating patients and trying to contain the infection before ways to prevent infection were known.[22]
Epidemiology
SARS was a relatively rare disease, with 8,273 cases as of 2003.[14]History
| Probable cases of SARS by country, 1 November 2002 – 31 July 2003. | ||||
| Country or Region | Cases | Deaths | SARS cases dead due to other causes | Fatality (%) |
| Canada | 251 | 44 | 0 | 18 |
| China * | 5,328 | 349 | 19 | 6.6 |
| Hong Kong | 1,755 | 299 | 5 | 17 |
| Macau | 1 | 0 | 0 | 0 |
| Taiwan (Republic of China) ** | 346 | 37 | 36 | 11 |
| Singapore | 238 | 33 | 0 | 14 |
| Vietnam | 63 | 5 | 0 | 8 |
| United States | 27 | 0 | 0 | 0 |
| Philippines | 14 | 2 | 0 | 14 |
| Mongolia | 9 | 0 | 0 | 0 |
| Kuwait | 1 | 0 | 0 | 0 |
| Republic of Ireland | 1 | 0 | 0 | 0 |
| Romania | 1 | 0 | 0 | 0 |
| Russian Federation | 1 | 0 | 0 | 0 |
| Spain | 1 | 0 | 0 | 0 |
| Switzerland | 1 | 0 | 0 | 0 |
| South Korea | 4 | 0 | 0 | 0 |
| Total | 8273 | 775 | 60 | 9.6 |
| (*) Figures for the People's Republic of China exclude Hong Kong and Macau, which are reported separately by the WHO. | ||||
| (**) Since 11 July 2003, 325 Taiwanese cases have been 'discarded'. Laboratory information was insufficient or incomplete for 135 discarded cases; 101 of these patients died. | ||||
| Source:WHO.[15] | ||||
Outbreak in South China
Main article: Progress of the SARS outbreak
The SARS epidemic appears to have started in Guangdong Province, China in November 2002 where the first case was reported that same month. The patient, a farmer from Shunde, Foshan,
Guangdong, was treated in the First People's Hospital of Foshan. The
patient died soon after, and no definite diagnosis was made on his cause
of death. Despite taking some action to control it, Chinese government
officials did not inform the World Health Organization of the outbreak
until February 2003. This lack of openness caused delays in efforts to
control the epidemic, resulting in criticism of the People's Republic of
China from the international community. China has since officially
apologized for early slowness in dealing with the SARS epidemic.[16]The outbreak first appeared on 27 November 2002, when Canada's Global Public Health Intelligence Network (GPHIN), an electronic warning system that is part of the World Health Organization's Global Outbreak Alert and Response Network (GOARN), picked up reports of a "flu outbreak" in China through Internet media monitoring and analysis and sent them to the WHO. While GPHIN's capability had recently been upgraded to enable Arabic, Chinese, English, French, Russian, and Spanish translation, the system was limited to English or French in presenting this information. Thus, while the first reports of an unusual outbreak were in Chinese, an English report was not generated until 21 January 2003.[17][17][18]
Subsequent to this, the WHO requested information from Chinese authorities on 5 and 11 December. Despite the successes of the network in previous outbreak of diseases, it didn't receive intelligence until the media reports from China several months after the outbreak of SARS. Along with the second alert, WHO released the name, definition, as well as an activation of a coordinated global outbreak response network that brought sensitive attention and containment procedures (Heymann, 2003). By the time the WHO took action, over 500 deaths and an additional 2,000 cases had already occurred worldwide.[18]
In early April, after Jiang Yanyong pushed to report the danger to China,[19][20] there appeared to be a change in official policy when SARS began to receive a much greater prominence in the official media. Some have directly attributed this to the death of American James Earl Salisbury.[21] It was around this same time that Jiang Yanyong made accusations regarding the undercounting of cases in Beijing military hospitals.[19][20] After intense pressure, Chinese officials allowed international officials to investigate the situation there. This revealed problems plaguing the aging mainland Chinese healthcare system, including increasing decentralization, red tape, and inadequate communication.
Many healthcare workers in the affected nations risked and lost their lives by treating patients and trying to contain the infection before ways to prevent infection were known.[22]
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