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.

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 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.