How did the SARS outbreak end?

In the final months of 2002, a mysterious disease never-before seen began spreading in the province of Guangdong, China.

The symptoms were similar to that of the common flu – high fever, dry cough or a sore throat, and shortness of breath. 

From November 2002 to February 2003, more than 300 people in Guangdong were recorded to have an unknown pneumonia-like respiratory disease, 5 of whom died. 

SARS or severe acute respiratory syndrome is caused by a member of the coronavirus family, or the same family that causes the common cold.

According to Dr. Stanley Perlman, a microbiologist at the University of Iowa who studied coronaviruses, SARS virus went deep into people’s lungs, which made it spread slower unlike today’s COVID-19 virus.

Over 8 months after its discovery, 8,096 people contracted SARS

• Over the course of the next 8 months following its discovery, 8,096 people contracted the disease and 744 people died.
• The virus was spread first by a doctor who treated the pneumonia patients and then travelled to Hong Kong. People who were the first in their country to get infected, on the other hand, were found to have had travel history to Hong Kong.
• Scientists found on May 23, 2003 that the virus that caused SARS (SARS-cov), was found in civet cats that were sold in wildlife markets in Guangzhou. Civet cats were considered a delicacy in China, as were other wild animals.
• Experts believe the SARS-cov virus likely jumped from civet cats to humans. He also said that civet cats carried huge amounts of the virus in their stools and respiratory secretions but remain unaffected.

Measures to minimize the spread: Ban on Wildlife Hunting and Trade

To help curb the spread of severe acute respiratory syndrome, China imposed a ban on the hunting, transport, sale, and purchase of 54 types of wildlife animals, which includes civet cats.

SARS created panic mainly because not much was known about it. Scientists weren’t sure if SARS could be eliminated completely, and whether or not it will become a seasonal disease like the common flu.

The SARS outbreak was finally contained in July of 2003. Cases reported after the outbreak were found to be isolated and only in laboratory settings.

According to the Los Angeles Times, the worldwide strategy was simple: “If sick people can be stopped from infecting healthy people, the disease will eventually die off.”

SARS was eventually contained through international cooperation and traditional public health measures

Ultimately, SARS was contained through international cooperation and traditional public health measures.

The main challenge in containing the possibly fatal disease was to identify the cases with atypical presentation.

In February 2003 in Hong Kong, following the detection of an outbreak in a local hospital and before SARS was studied and discovered, the government already put up a surveillance system for ‘severe community acquired pneumonia’.

Eventually this system linked several SARS clusters in Hong Kong, Hanoi, Singapore, and Toronto. As the outbreak grew bigger, enhanced disease surveillance systems were practiced.

Real-time surveillance facilitated information flow and management

A real-time surveillance system between public hospitals and the Department of Health, another system was used to detect clusters of SARS cases and their relationships, while another system was used to consolidate SARS cases and their contacts.

These systems allowed for better information flow and management.

• Contact tracing with medical surveillance and quarantine was done on confirmed and suspected SARS cases.
• And on March 31, close contacts were required to report to one of four designated medical centers for daily check ups for 10 days following their contact with a SARS case.
• Temperature checks and chest x-rays were done on those who were with symptoms, and persons with positive chest x-rays were referred for hospital treatment.
• To prevent spread of SARS through international travel, all passengers were required to complete a health declaration form and temperature checks.
• Those who were found to be of close contact with a SARS patient were prohibited from leaving the country.

To prevent the spread in hospitals, Singapore centralized all SARS cases to a designated hospital, and a strict no visitor policy was implemented. Movement of hospital staff and patients were also limited. Fever clinics were established for triaging purposes. Special ambulances were designated to transport possible cases to the SARS-designated hospital.

Contact tracing helped prevent SARS from spreading further

Contact tracing was done to prevent community spread.

• Close contacts of those who were infected were quarantined in their homes and monitored daily.
• A large wholesale market was also ordered temporarily closed to limit the spread, and a mass education campaign was implemented to inform and raise awareness.
• Entry and exit screening were also done at all air, sea, and land points-of-entry, which resulted in zero importation and exportation of SARS cases.
• Scarborough General Hospital in Toronto temporarily closed down their emergency and intensive care services after having cared for the son of the woman who came from Hong Kong and died of SARS.
• The son sought medical care from the hospital, and shortly after, hospital staff fell ill. The hospital also refused new patients and transfers from other hospitals. People who entered the hospital after March 16, 2003 were asked to do a 10-day home quarantine.
• Under Ontario’s Health Protection and Promotion Act, public health officials were allowed to track infected people and issue orders to prevent them from engaging in activities that will spread the disease.
• Ontario also required all hospitals to create designated units to care for SARS patients, while Toronto activated “Code Orange” which meant selected hospitals should suspend non-essential services. Hospital visitors were limited, isolation units were made for SARS patients, and protective clothing was given to hospital staff.

After a few months of international cooperation and each country’s efforts to isolate and help cure infected patients, the SARS epidemic, also known as the first pandemic of the 21st century, came to an end.

Not a single case has been reported since late 2004, and the strain of SARS virus has not been reported to be found other than inside a laboratory.

The World Health Organization has said that the most reassuring thing about SARS was that it could be contained.

However, she also noted, that the sudden spread of SARS throughout the world just goes to show that there is potential for more serious diseases to cause an epidemic.