Severe acute respiratory syndrome (SARS): breath-taking progress (original) (raw)
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Journal of Medical Microbiology, 2003
Severe acute respiratory syndrome (SARS), now known to be caused by a coronavirus, probably originated in Guangdong province in southern China in late 2002. The first major outbreak occurred in Guangzhou, the capital of Guangdong, between January and March 2003. This study reviews the clinical presentation, laboratory findings and response to four different treatment protocols. Case notes and laboratory findings were analysed and outcome measures were collected prospectively. The SARS outbreak in Guangdong province and the outbreak in Guangzhou associated with hospitals in the city are described, documenting clinical and laboratory features in a cohort of 190 patients randomly allocated to four treatment regimens. Patients were infected by close contact in either family or health-care settings, particularly following procedures likely to generate aerosols of respiratory secretions (e.g. administration of nebulized drugs and bronchoscopy). The earliest symptom was a high fever followed, in most patients, by dyspnoea, cough and myalgia, with 24 % of patients complaining of diarrhoea. The most frequent chest X-ray changes were patchy consolidation with progression to bilateral bronchopneumonia over 5-10 days. Thirty-six cases developed adult respiratory distress syndrome (ARDS), of whom 11 died. There was no response to antibiotics. The best response (no deaths) was seen in the group of 60 patients receiving early highdose steroids and nasal CPAP (continuous airway positive pressure) ventilation; the other three treatment groups had significant mortality. Cross-infection to medical and nursing staff was completely prevented in one hospital by rigid adherence to barrier precautions during contact with infected patients. The use of rapid case identification and quarantine has controlled the outbreak in Guangzhou, in which more than 350 patients have been infected. Early administration of high-dose steroids and CPAP ventilation appears to offer the best supportive treatment with a reduced mortality compared with other treatment regimens.
Lessons from the Severe Acute Respiratory Syndrome Outbreak in Hong Kong
Emerging Infectious Diseases, 2003
Severe acute respiratory syndrome (SARS) is now a global public health threat with many medical, ethical, social, economic, political, and legal implications. The nonspecific signs and symptoms of this disease, coupled with a relatively long incubation period and the initial absence of a reliable diagnostic test, limited the understanding of the magnitude of the outbreak. This paper outlines our experience with public health issues that have arisen during this outbreak of SARS in Hong Kong. We confirmed that case detection, reporting, clear and timely dissemination of information, and strict infection control measures are essential in handling such an infectious disease outbreak. The need for an outbreak response unit is crucial to combat any future outbreak.
From SARS to 2019-Coronavirus (nCoV): U.S.-China Collaborations on Pandemic Response
RAND Corporation eBooks, 2020
hairman Bera, Ranking Member Yoho, and members of the subcommittee, thank you for inviting me to testify about U.S.-China collaboration on pandemic response, especially in light of the recent novel coronavirus outbreak. First, I will describe the 2002-2003 outbreak of severe acute respiratory syndrome (SARS) and the global response. Next, I will discuss U.S.-China collaboration from 2003-2012, followed by developments in the years prior to the current coronavirus outbreak. Lastly, I will analyze the characteristics of 2019-nCoV and China's early responses, and offer policy recommendations. 2002-2003: SARS Almost 17 years ago, a novel coronavirus was silently causing deadly pneumonia outbreaks-which later became known as SARS-in China. The index case of the SARS outbreak occurred in the city of Foshan in Guangdong Province, China, on November 16, 2002. Neither this case nor a few other cases in December attracted any notice from the public. A public health expert team from the province, which included a few representatives from the national Ministry of Health, went to one of the cities in Guangdong province in January 2003 to investigate. The team concluded that the atypical pneumonia diagnoses were probably caused by a virus. The team then suggested in a "top-secret" report that the provincial health bureau should establish a case-reporting system. This reasonable-although rather feeble-suggestion was expressed in a news bulletin for local health care professionals but fell on deaf ears during the Chinese New Year. The world did not find out for another two months that this was severe acute 1 The opinions and conclusions expressed in this testimony are the author's alone and should not be interpreted as representing those of the RAND Corporation or any of the sponsors of its research. 2 The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. C 2 respiratory syndrome (SARS), a viral pneumonia that would infect more than 8,000 people globally and lead to 774 deaths. At that time, China lacked a national center for disease control, which would have been responsible for maintaining a robust surveillance system for detecting emerging diseases. It also lacked a national case-reporting system. In addition, according to the Implementing Regulations of the Law of the People's Republic of China on Guarding State Secrets regarding the handling of public health-related information, any occurrence of infectious disease should be classified as a state secret before it is "announced by the Ministry of Health." 3 No physician or journalist can alert the public without breaking the law. With no information from government or media, the Chinese public was unaware of the outbreak until cell phone messages about a "deadly flu" started to circulate in early February 2003 in Guangzhou. A widespread panic caused residents to clear out antibiotics and flu medicines in pharmacies. Prompted by the public panic, the Guangdong health officials finally held a press conference on February 11 to announce the 305 atypical pneumonia cases in the province. China submitted the case report to the World Health Organization (WHO) as atypical pneumonia, probably caused by chlamydia or a virus around the same time. Afterward, information about the disease was reported on the news media, but the flow of information stopped on February 23. The news blackout from February 23 continued during the run-up to the National People's Congress in March, and the government shared little with the public until early April. 4 Meanwhile, a "super-spreading" chain of transmission emerged at the end of the January and lasted until March, causing international attention on the outbreak: A patient with pneumonia in Guangdong was transferred between three different hospitals, ultimately infecting 200 people, including a doctor from Zhongshan Hospital. The doctor traveled to Hong Kong and infected 12 people in a hotel, and these 12 people then carried the virus to Singapore, Vietnam, Canada, Ireland, and the United States. 5 By mid-March 2003, SARS clusters started to appear in Vietnam, Hong Kong, Singapore, and Canada. The WHO subsequently picked up the alerts from the Global Outbreak Alert and Response Network (GOARN) and issued a global alert about a new infectious disease of unknown origin. Between March 16 and March 21, the WHO started to suspect that the more than 300 cases from February-which China had labeled "atypical pneumonia" in its reportwere actually SARS cases. At China's request, the WHO sent a team to China on March 23. On March 27, the WHO team concluded that the "atypical pneumonia" cases were same as SARS, and China announced 792 cases and 31 deaths. 6 Under intense international pressure to mobilize against the pandemic threat, the Chinese government publicly acknowledged the SARS outbreak
The Lancet, 2003
Background An epidemic of severe acute respiratory syndrome (SARS) has been associated with an outbreak of atypical pneumonia originating in Guangdong Province, People's Republic of China. We aimed to identify the causative agent in the Guangdong outbreak and describe the emergence and spread of the disease within the province. Methods We analysed epidemiological information and collected serum and nasopharyngeal aspirates from patients with SARS in Guangdong in mid-February, 2003. We did virus isolation, serological tests, and molecular assays to identify the causative agent. Findings SARS had been circulating in other cities of Guangdong Province for about 2 months before causing a major outbreak in Guangzhou, the province's capital. A novel coronavirus, SARS coronavirus (CoV), was isolated from specimens from three patients with SARS. Viral antigens were also directly detected in nasopharyngeal aspirates from these patients. 48 of 55 (87%) patients had antibodies to SARS CoV in their convalescent sera. Genetic analysis showed that the SARS CoV isolates from Guangzhou shared the same origin with those in other countries, and had a phylogenetic pathway that matched the spread of SARS to the other parts of the world. Interpretation SARS CoV is the infectious agent responsible for the epidemic outbreak of SARS in Guangdong. The virus isolated from patients in Guangdong is the prototype of the SARS CoV in other regions and countries.
The SARS outbreak in a general hospital in Tianjin, China – the case of super-spreader
Epidemiology and Infection, 2006
objectives To describe clinical characteristics of severe acute respiratory syndrome (SARS) patients in a hospital in Tianjin, China, thereby comparing probable and suspected cases; to study risk factors associated with the death of cases; to describe the implementation of preventive interventions during the hospital outbreak.
A major outbreak of severe acute respiratory syndrome in Hong Kong
… England Journal of …, 2003
There has been an outbreak of the severe acute respiratory syndrome (SARS) worldwide. We report the clinical, laboratory, and radiologic features of 138 cases of suspected SARS during a hospital outbreak in Hong Kong. March 11 to 25, 2003, all patients with suspected SARS after exposure to an index patient or ward were admitted to the isolation wards of the Prince of Wales Hospital. Their demographic, clinical, laboratory, and radiologic characteristics were analyzed. Clinical end points included the need for intensive care and death. Univariate and multivariate analyses were performed.