Response to SARS-Like Virus an Improvement Over 2003 Outbreak
Health officials detected a SARS-like virus that started in the Middle East this month, but the global response is drastically different from what it was in 2003, when the world learned about the original SARS virus only after it had already taken hold of Hong Kong.
The World Health Organization announced Sunday that two cases of a SARS-like virus have been reported: a 49-year-old Qatari man in critical condition in a U.K. hospital and a 60-year-old Saudi woman who died earlier this year. They suffered from a 99.5 percent identical coronavirus that caused acute respiratory syndrome and renal failure. (Coronaviruses include a range of viruses from SARS to the common cold.)
"It took the outbreak in Hong Kong and subsequent spread to bring that to our attention," Dr. William Schaffner said of the 2003 SARS outbreak. Schaffner chairs preventative medicine at Vanderbilt University. "The surveillance for viruses that cause disease, particularly respiratory viruses, has improved enormously over the last 10 years worldwide. What happened here demonstrates that."
The man with the new SARS-like virus first showed symptoms on Sept. 3 and was admitted to an intensive care unit in Qatar on Sept. 7, according to a WHO statement. He was transferred to a hospital in the United Kingdom four days later, where the Health Protection Agency conducted lab testing to determine that he had a never-before-seen coronavirus similar to SARS. The U.K. informed WHO of the discovery on Sept. 22, and WHO made the announcement Sept. 23.
In short, the whole world found out about the new SARS-like virus less than three weeks after its second known victim first presented symptoms.
A decade ago, SARS infected 8,098 people from November 2002 through July 2003, killing 774 of them. It is believed that the virus began in Chinese horseshoe bats in 2002 before spreading to cats sold at animal markets for food, and spreading from there to humans. New cases tapered off and stopped around 2003, with the exception of eight new cases in China in 2004.
Schaffner said scientific and technological advances in the last ten years allowed health officials to shift from reaction to anticipation this time around. Not only are hospitals sending specimens of the viruses to labs earlier, he said, but technicians can do molecular testing that wasn't easily or cheaply available in 2003.
Ralph Baric, a professor at the University of North Carolina School of Public Health who has studied SARS for eight years, said it's important to realize that this SARS-like virus could actually be very different from the original, however, given that it's named for the symptoms (Severe Acute Respiratory Syndrome) rather than the virus's makeup.
"In this case, this has been caught earlier, and that is probably really good news, but again at this point it's just speculation and guessing," he said, adding that there have been many new coronaviruses over the last 30 years.
Baric said sporadic SARS cases - like the ones we're seeing now - probably first began in 2001, but it took until late 2002 or early 2003 for the disease to become a pandemic. The spread from China to Hong Kong was traced back to a doctor who was treating patients with SARS in China and traveled to Hong Kong for a family reunion, passing the virus to people on his hotel floor who then "seeded" other countries with SARS, Baric said.
A doctor named Carlo Urbani was treating patients in Vietnam in late February 2003 when he noticed patients experiencing a strange and severe respiratory disease. He became concerned and alerted WHO. Urbani died of SARS on March 29, 2003.
"SARS also told the entire world's communities you can't hide this," Schaffner said. "You have to identify these viruses and let the world public health community know about it."
In 2003, China was a much more "reclusive" place, and neighboring officials urged Chinese health officials not to keep the virus outbreak a secret, Schaffner said.
"When it comes to respiratory illness, you don't need a passport," he said. "We are all linked and we must let each other know when something is happening in our community because it could be in your community a day from now."
HPA officials have already learned that the new coronavirus has a seven-day incubation period, which has passed since the Qatari man was admitted to the hospital. So far, no health workers have shown signs of the virus, which was a key feature of the original SARS outbreak, meaning it's possible that this virus isn't as contagious. The current patient is still in respiratory isolation, and his hospital caregivers are required to wear respirators, gowns, gloves and goggles.
The WHO has not proposed any travel restrictions.