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]

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]