In November 2002, doctors in Guangdong Province, China, confronted a mysterious and deadly respiratory ailment among their patients. Over the next several months, severe acute respiratory syndrome (SARS) infected more than 8,000 people, killed 774, and threatened a worldwide pandemic. The crisis was averted only when cutting-edge science was combined with sophisticated communications strategies and close international cooperation.
- November 16
- Cases of a mysterious respiratory ailment started appearing in Guangdong Province, China.
- February 21
- Liu Jianlun—one of the first victims to unknowingly carry the SARS virus out of China—arrives in Hong Kong and infects other international guests at his hotel
- February 24
- The Global Public Health Intelligence Network gains evidence of hospital workers in the city of Guangzhou in Guangdong Province falling ill in alarming numbers.
- March 5
- Cases have been declared in Hong Kong, Vietnam, Singapore, and Toronto. The first Toronto case dies.
- March 13
- The WHO activates its Global Outbreak Alert and Response Network, setting in motion collaborative research efforts.
- March 15
- The WHO issues the first of a series of rare emergency travel alerts, and the disease is named SARS after its symptoms—sudden acute respiratory syndrome.
- March 17
- The WHO organizes and coordinates 11 laboratories in 9 countries.
- March 20
- The U.S. reports its first case.
- March 24
- CDC researchers, working with colleagues in Hong Kong, isolate a coronavirus in SARS patients and begin sequencing its genome and comparing it to other coronaviruses.
- April 16
- One month after collaborative scientific efforts are initiated, scientists announce the cause of SARS is an entirely new corona virus never before observed in humans or animals.
- April 20
- Chinese authorities announce cases are much higher than previously reported. Officials who provided misinformation are removed from office and China cooperates fully with international efforts.
- May 4
- Scientists report the virus can survive on plastic surfaces and in urine and feces, respectively for 48 hours, 24 hours, and 4 days. This information helps healthcare workers and policymakers take additional precautions.
- May 23
- Hong Kong and Guangdong Province are cleared by the WHO as safe for nonessential travel.
- July 5
- Toronto is the last area finally cleared by the WHO as safe for travel, and the outbreak is declared contained.
Putting Science into Action
A global pandemic was prevented when scientists and government leaders sprang into action.
The World Health Organization’s (WHO’s) network of 11 laboratories in nine countries around the world worked to combat the disease.
- The U.S. Centers for Disease Control and Prevention (CDC) deployed 84 staff members, including 52 epidemiologists, in 11 countries, either directly through the CDC’s own investigative efforts or as part of the WHO response.
- For all these scientists, solving an urgent, shared problem took precedence over national loyalties and professional rivalries. As a result, scientific understanding advanced more quickly, led to the early containment of the disease on July 31, 2003, and saved lives.
- Close collaboration between scientists, government officials, and health care workers in the field was paramount in mitigating the impact of SARS on the United States and around the world.
Understanding the Outbreak
- The SARS virus SCoV is zoonotic (i.e., originating in animals and traveling to humans). Scientists have traced SCoV’s evolutionary history to horseshoe bats but do not fully understood how SCoV got from bats to humans. The palm civet (pictured) was initially blamed. However, many civets were needlessly killed before scientists learned civets got the virus from humans. How SCoV got from bats to humans remains a mystery.
- A reemergence of SARS or a zoonotic pathogen like SCoV could cause the next great pandemic—an event on the scale of the 1918 flu outbreak that killed 40 million people worldwide.
- However, the multilateral government response to the 2003 SARS outbreak was historic because of the swift and effective collaboration among scientists. Once the international laboratories began to work together, they identified the mutant virus responsible for SARS within one month.
As a doctor who cares about people's lives and health, I have a responsibility to aid international and local efforts to prevent the spread of SARS. A failure to disclose accurate statistics about the illness will only lead to more deaths.
Science, Cooperation, and the Global Response
Transparency and a commitment to sharing the best available scientific information led to a better outcome.
- China’s initial refusal to share vital case data stalled containment efforts by Chinese doctors and control efforts by the international community, and led to a more severe outbreak. Hospitals in Hong Kong, Hanoi, and Toronto had no idea what they were dealing with when the first SARS victims arrived.
- By March 12, high rates of infection triggered the WHO to mobilize its Global Outbreak Alert and Response network, which in turn led the U.S. CDC to activate its emergency response center.
- In early April, China’s Dr. Jiang Yanyong felt compelled to tell the truth and risked personal repercussions by releasing a statement to the international press demonstrating the Chinese Minister of Health’s underreporting of SARS cases in Beijing. His risk helped make possible the sharing of information essential for scientists to collaborate, understand the pathogen, and provide reliable data to health officials and the public.
Evidence-based Decision Making
Clear and effective communication among scientists, policy makers, and the public helped avoid SARS deaths in the United States.
Scientists and government officials provided up-to-date, scientifically accurate information to the public without creating
unnecessary alarm. The CDC was clear about what it knew—and what it did not know—about the health crisis, and provided multiple avenues to bring the latest information to the public.
- CDC SARS websites received more than 17 million hits during the outbreak.
- The CDC answered 10,000 SARS calls from the media, issued 12 press releases, broadcast 21 live briefings and news conferences, and answered 35,000 phone inquiries from the general public.
- The CDC set up 30 conference calls to answer questions from health care providers, established a hotline for physicians through which CDC staff responded to more than 2,000 calls, and organized three satellite broadcasts directed toward clinicians that together were viewed an estimated 1.9 million times.
- CDC quarantine officers distributed 700,000 printed Health Alert fliers to passengers arriving in the United States on 11,840 flights from SARS-afflicted areas.