SARS: how a global epidemic was stopped

What times!

As we are trying to deal with the spread of Covid19, one often goes back to SARS. The virus broke out in China in Nov-2002 very similar to how Covid19 started as well and almost at the same time.

I came across this publication from WHO titled:  SARS: how a global epidemic was stopped. The entire publication is worth reading as it has contributions of several experts.

The last chapter by Brian Doberstyn points to some of the lessons:

  • Lesson 1: We were lucky this time
  • Lesson 2: Transparency is the best policy
  • Lesson 3: Public health is a serious business
  • Lesson 4: Human-rights issues must be attended to
  • Lesson 5: The media play a critical role in public health emergencies
  • Lesson 6: 21st century science played a relatively small role in controlling SARS; 19th-century techniques continued to prove their value (contact tracing, quarantine, and isolation)
  • Lesson 7: Partnerships worked, but the partners need to clarify and agree on their relative roles
  • Lesson 8: Modern modes of communication dramatically changed the way we work
  • Lesson 9: Clear travel guidance is needed
  • Lesson 10: Animal husbandry and marketing practices seriously affect human health
  • Lesson 11: Who should be on the front lines?
  • Lesson 12: With national disease surveillance systems in disrepair, informal avenues of reporting must be taken seriously
  • Lesson 13: Training and expertise in barrier nursing and hospital infection control are sadly deficient in the region

One could replace SARS with Covid19 in most part of the publication.

Lesson 1 in particular is worrying and also of hope:

The SARS virus could have become a constant threat to human health in the world we live in. It did not. Thanks to the intense and skilful efforts of the
governments of all affected areas, together with their regional and international partners, the virus was contained.

Certain characteristics of the SARS virus made containment possible. Infected individuals usually did not transmit the virus until several days after symptoms
began and were most infectious only by the tenth day or so of illness, when they develop severe symptoms. Therefore, effective isolation of patients was enough to control spread. If cases were infectious before symptoms appeared, or if asymptomatic cases transmitted the virus, the disease would have been much more difficult, perhaps even impossible, to control.

The chains of transmission could be broken at various points. The incubation period was relatively long (two to 10 days, with a median of five days), giving
more time for contacts to be traced and isolated before they fell ill and became infectious themselves. The incubation period also dictated how long contacts
had to be supervised. If the incubation period were longer, observation or quarantine would have been much more difficult to manage.

SARS being largely an urban disease, concentrated in relatively well-equipped hospitals, it was easier to detect cases and trace contacts, isolate patients, limit
infection, and therefore control the spread of the disease. Reporting was also more reliable.

We have obviously not learnt most of the lessons, particularly on animal husbandry. Shigeru Omi who encouraged others to contribute to the report int he introduction writes:

One way we can do that is to better understand why the SARS coronavirus and the avian influenza H5N1 virus crossed the species barrier from animals to
attack humans. What caused this strange migration? The explanation, in my view, lies in part in the way animals are raised for food in Asia, where increasing
prosperity has led to a greater demand for meat, and, in some cultures, a taste for the flesh of exotic animals.

In markets where wild animals are sold for the table, creatures that would never meet in their natural habitat are kept in proximity to one another, setting
the conditions for the emergence of new viruses. A similar threat lies in the way that chickens, ducks, and pigs are raised together, often in unhygienic conditions and usually with no barriers between them and humans. Such husbandry practices must change, or more viruses are likely to emerge from the animal world.

Exotic animals is a kind word for things like eating bats!

It was the first major disease which got amplified due to Passenger jets:

SARS was the first emerging disease of the age of globalization. I believe that, had it occurred in a time before mass international travel, it would probably
have remained a localized problem, with few consequences for global health. But the virus travelled around the world on passenger jets [see the account in
Chapter 15 of the consequences of one single flight between Hong Kong and Beijing], making it a true disease of the 21st century. To fight this 21st-century
disease, Member States applied 19th-century measures such as contact tracing, quarantine, and isolation. As old fashioned and labour intensive as they were,
these measures slowed the virus’s spread, and, in the end, contributed to its containment.

Of course this was true may be for jets. However, in the past flu travelled via ships.

Internet played a positive role:

But we also had a very modern ally: the Internet. Thousands of email messages flashed around the globe each day. Web pages not only kept the world informed daily, but also offered advice on scores of technical issues. At the same time, international laboratory experts set aside their traditional rivalries and grouped their expertise in a virtual network to decode the virus’s secrets. So successful was this unprecedented scientific cooperation that the causative agent, the coronavirus, was identified within weeks, whereas it might have taken months or possibly even years in the days before the Internet. 

Not sure what role internet has played this time. Mix of help and panic.

It is sad that humanity chooses to forget these big health crises and not learn.

Phew! Stay safe and quarantined..

 

One Response to “SARS: how a global epidemic was stopped”

  1. travel guide Says:

    Fastidious response in return of this matter with
    solid arguments and telling everything concerning that.

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