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"Human judges can show mercy. But against the laws of nature,
there is no appeal." — Arthur C. Clarke


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SPREAD OF SEVERE ACUTE RESPIRATORY SYNDROME

BRIEF historical outline covering the spread of Severe Acute Respiratory Syndrome
(SARS) in 2003:
. . . . . . . . . .

narrative
the origin
Infection thought to originate in the Guangdong province of China, where 300 people fall ill, and five die during an outbreak in February, 2003.
new cases
US businessman returning from Shanghai in mid-March dies after receiving treatment in hospitals in Hanoi, Vietnam and Hong Kong.

Twenty hospital staff in Hanoi and 50 in Hong Kong fall ill. On March 12, the World Health Organization (WHO) issues a global alert. On March 15, WHO issues an emergency travel advisory.
illness spreads
SARS takes hold in Hong Kong, where by March 19th 123 people have fallen ill. Neighboring courntries of Singapore and Vietnam are badly hit.

Cases are also recorded in Taiwan and Canada, where three people die in the province of Ontario.

Air travelers spread the isolated cases to the US, UK, Germany, France, Italy, Romania, Thailand, Switzerland and Republic of Ireland.
april 2003:
new cases,
scientific progress
By April, the disease has infected nearly 6,000 people in 29 countries and killed over 380 people. Events below are presented in roughly chronological order:
  • Hong Kong: The city's healthcare system is overwhelmed, pushing the system to the brink of collapse, as the government braces for up to 3,000 people expected to become infected by the end of the month. Over 200 cases are reported in one block alone.

  • China: Government health officials report nearly 3,500 cases, including the first cases in Beijing and the remote northern region of Inner Mongolia and 167 fatalities from SARS. Hong Kong reports over 1,589 cases, and 157 deaths.

  • Australia: First case is reported. Health officials add SARS to its list of diseases requiring quarantine, ranking it as dangerous as cholera and smallpox.

  • China: Under international pressure and criticized for its slowness to acknowledge the disease and warn its neighbors, China allows members of the World Health Organization (WHO) to visit 'ground zero' & assess the progress of the disease in some areas.

  • Indonesia: Government declares the disease a national epidemic, and temporarily suspends sending its nationals to other Asian destinations.

  • United States: Healthcare officials add SARS to the list of communicable diseases, the first new disease to be added in two decades. President Bush issues an executive order allowing the forced quarantine of suspected SARS patients in the US. 166 suspected cases are reported in the US, but no deaths. In an attempt to contain the spread of the disease, US broadens its definition of who is at risk, widening the quartine field. US legislators push for an extra $150 million to strengthen worldwide surveillance networks to defend against future outbreaks.

  • Singapore: In an effort to contain the spread of SARS, government officials close Singapore primary schools. Singapore health officials call on government paramedics from the army & air force to help nurses screen incoming passengers at Changi International Airport. The government quarantines hundreds (as of April 14th, 608 are reported to be under home quarantine; by April 26, the number of quantined rises to nearly 2,800) and imposes a fine of S$10,000 (US$5,600) or six months in jail on those who break home quarantine. "Webcams" are mounted in homes of those quarantined; electronic wrist bands are used on those caught breaking house quarantine—bands alert authorities if they leave home. The Roman Catholic church suspends confessions in Singapore due to the spread of the SARS virus, saying priests will instead collectively forgive all churchgoers for their sins.

  • South Africa: First is reported.

  • Canada: Thousands of Canadians, many of them health care workers, are quarantined in their homes. In Ontario, health officials shut down 2 Toronto schools and send approx. 200 workers at a Toronto company into quarantine.

  • Malaysia: In an attempt to stop the spread of SARS, Malaysia bans all tourists from mainland China from entering the country, and imposes restrictions on visitors from other places badly hit by the illness. Malaysia's health minister decrees all visitors from other affected countries and cities must have a health certificate before entering. On April 12th, Malaysian health authorities 'temporarily' lift travel restrictions on Hong Kong, Vietnam and Canadian residents.

  • BREAKTHROUGH: On April 10th, scientists confirm the identification of the virus behind SARS as a new coronavirus, a relative of one of the many viruses that cause the common cold, and indicate they could finish work on an easy diagnostic test within 6 weeks.

  • BREAKTHROUGH: On April 13th, a Canadian lab, Genome Sciences Centre, says its breakthrough discovery of the genetic sequence behind the deadly SARS virus could help develop an effective vaccine.

  • China: After a near blackout on SARS coverage, China orchestrates a media blitz to convince its citizens to adopt healthier lifestyles in order to combat SARS spread. While there are signs the epidemic is being contained elsewhere in the world, WHO remains concerned about the ability of infected areas in China to recognize and control the illness, as new cases are reported. The southeastern province of Fujian reports its first cases. Infections in Beijing and northern Shanxi rise sharply and more cases are logged in Guangdong.

    Despite China's apparent new 'openness' regarding SARS, skepticism at its sudden transparency remains, as doctors continue to tell reporters of numerous officially unreported cases throughout the country. In Beijing, a military doctor criticizes the health minister for covering up SARS cases, saying there are at least 140 cases in military hospitals in the capital alone. A WHO team is still waiting to be allowed into them.

  • Singapore: Primary schools re-open April 14th after being closed for more than two weeks in a bid to halt the spread of SARS.

  • Hong Kong: While Hong Kong deaths & the number of new infections continue to rise, healthcare officials say the treatment used to treat SARS—a mix of anti-viral drugs and steroids—is seeing a good response in 80-90 percent of patients.

  • WHO statement: "If the SARS maintains its present pathogenicity and transmissibility, SARS could become the first severe new disease of the 21st century with global epidemic potential." —David Heymann, WHO executive director of communicable diseases

  • Indonesia, the Philippines, and Sweden: First cases of SARS are reported.

  • Canada: Health authorities in Toronto, Canada order an entire Catholic worship group𤿌 people in all, plus 100 people who may have worked with some of them—into home quarantine because of possible SARS infection.

  • China: After visiting a military hospital in Beijing, WHO says China has failed to report all its cases, asserting Beijing alone could have five times the official number. WHO calls for full disclosure from Chinese officials.

  • Hong Kong: Scientists say they may have detected a more virulent form of the virus in the densely populated city.

  • BREAKTHROUGH: Germany-based Artus Biotech developes a diagnostic test that drastically cuts the time needed to diagnose SARS to roughly 2 hours. Artus Biotech says its "real-time" test can detect the virus by looking for its genetic signature.

  • BREAKTHROUGH: The state-run Genome Institute of Singapore says it hopes to have a new test within a week which would take 3 hours and may be sensitive enough to detect the virus in its early stages before a person develops SARS symptoms such as high fever and a dry cough.

  • Singapore: In a further attempt to halt the spread of SARS, officials deploy a high-tech thermal-imaging thermometer that automatically checks the temperature of air travelers as they step off the plane. Walking through the sensor generates a heat-sensitive image; a burst of red dots on a computer screen indicates a fever. The system, built by government-backed Singapore Technologies, was originally designed for military use.

    On April 16, 200,000 primary school children in Singapore return to classes for the first time since a shutdown of the school system on March 27 to contain the virus.

  • Canada: The SARS outbreak forces Roman Catholics to change centuries-old Easter traditions: the practice of sipping sacramental wine from a communal cup is suspended; the traditional communion wafer is to be placed in churchgoers' hands, not on their tongues; confession will take place outside the confessional booth; churchgoers are to bow instead of shaking hands as a sign of peace during services; instead of kissing the crucifix, people are to bow or genuflect. In Ontario, the hardest hit province, health officials consider using electronic tracking devices to enforce quarantine orders. Approx. 10,000 people have gone into voluntary quarantine in Ontario since the outbreak began.

  • India: The first confirmed case of SARS is reported.

  • Economic Damage: As of mid-April, economists estimate the epidemic has already caused at least $30 billion in losses worldwide and will pose more of a threat to Asia's economic growth than the war on Iraq, through lower tourist earnings and reduced consumer spending.

  • WHO says of those patients recorded as infected about half have since recovered.

  • China: On April 18, Communist Party leadership, accused of half-hearted cooperation with the world on the SARS outbreak and masking its own numbers, orders an all-out, open war against the deadly virus. "There must be no delay and no deceit in reporting," state newspapers quote the committee as saying after a special meeting chaired by party boss Hu Jintao. It is expected that the number of suspected/confirmed cases will be significantly greater than what has officially been reported.

    Beijing universities cancel activities and some classes to prevent the spread of SARS.

  • United States: The US Centers for Disease Control and Prevention (CDC) changes the way it classifies patients with SARS, dropping the number of probable cases to 35 from 208. Instead of using a broader definition than other countries in a bid to catch anyone who might spread the disease, probable cases will now be defined as patients who have developed pneumonia, while suspect cases will consist of patients who have fever, cough and have recently traveled to affected parts of Asia or been in contact with a suspected SARS patient.

  • Hong Kong: Officials launched a 2-day mass cleanup effort across the territory. The government calls on every one of Hong Kong's seven million residents to take part in the clean-up, scrubbing and disinfecting housing blocks, streets, parks, public venues, shops and restaurants.

  • Singapore: Prime Minister Goh Chok Tong says city-state's outbreak could be the worst crisis it has ever faced. Health authorities close a leading wholesale vegetable market and quarantine all 2,500 employees after 3 people who work there contract the virus.

  • Vietnam: Health authority proposes closing the northern land border with China in an effort to prevent further SARS cases entering the country.

  • China/Hong Kong: China's state media, silenced for weeks as SARS spread through Beijing, open the floodgates after authorities report a huge spike in cases and the health minister and city's mayor are sacked for negligence. On April 18, state-controlled newspapers report Beijing has 482 infections, 25 deaths and 402 suspected cases of SARS—rather than the 37 cases and 4 deaths reported earlier.

    By April 22, the official Xinhua news agency, quoting Health Ministry data, reports the death toll in China—epicenter of the outbreak that has killed 236 people and infected nearly 4,300 in 25 countries—had risen by five to 97.

    Hong Kong also reports five more deaths for a total of 99, the highest in the world. The city reports 32 new cases, bringing its total to 1,434. Secondary school students in Hong Kong resume their studies after schools across the territory were closed for 3 weeks as part of efforts to contain the spread of SARS. Facemasks are made mandatory for all pupils and parents are asked to make daily temperature checks to monitor for signs of fever. Primary schools remain closed.

    Beijing suspends classes at 280 schools in the city's high-tech district, Haidian, after scared parents withdraw their children from the schools.

    China appeals for its citizens to cancel holidays and other travel plans as fears grow of travelers spreading the SARS virus to the country's poorer inland provinces, but the appeal is mostly ignored as thousands flee Beijing to other areas throughout China.

    On April 25, Ditan Hospital—with 500 beds and 643 staff—is sealed, the third hospital within the city to be sealed. Amid widespread panic in the city of Beijing, health authorities place 4,000 residents under house quarantine indefinitely.

  • WHO Alert: On April 23, WHO issues a warming against travel to Beijing, China's Shanxi province and Canada's business capital Toronto to try to halt the global spread of the deadly SARS virus. Hours after WHO's advisory, police in Beijing take positions around the 1,200-bed People's Hospital to stop people from going in or out. Toronto responds angrily to being added to WHO's list maintaining "it's safe to live in Toronto, it's safe to come to Toronto."

  • Taiwan: Health authorities quarantine over 1,100 doctors, nurses and patients in a hospital; Asian health chiefs meet on ways to standardize the way they tackle SARS and prepare the ground for a Bangkok SARS summit meeting between the 10 ASEAN members and China.

    On April 27 as the island reports its first death from the disease, Taiwanese health officials announce visitors from hot spots China, Hong Kong, Singapore and Canada will be barred from entering the country.

  • China: On April 27, in addition to schools, Beijing authorities order the temporary closure of public places such as cinemas and libraries and suspend the approval of marriages as part of stepped-up efforts to stem the spread of SARS. Health officials set aside a 98-acre area in the city suburbs for quarantine use. Highlighting deepening public fear as China fails to check the spread of the disease, residents of a town near Beijing riot after learning of a plan to set up a SARS quarantine center in an abandoned school. By April 30, nearly 10,000 people are quarantined in Beijing alone.

  • Vietnam: On April 28, Vietnam becomes the first SARS-infected country to be declared free of the virus.

  • WHO statement: On April 28, WHO's chief of communicable diseases, David Heymann says the spread of SARS has peaked in all countries known to have outbreaks, except China.

  • Singapore: As of April 29, Singapore, coping with the world's fourth-highest number of infections of SARS, goes two straight days without a new case, raising hope that tough government measures have contained the illness.

  • WHO announcement: On April 29, WHO lifts its warning against travel to Toronto, Canada's financial capital. On April 30, WHO adds Taiwan to its list of travel advisory countries, which includes mainland China, Hong Kong, and Singapore.
. . . . . . . . . .

Sources: BBC News (primary), Centers for Disease Control, CNN, ReliefWeb, Reuters, World Health Organization

Additional resources:
Hong Kong Department of Health
Singapore Ministry of Health
Health Canada

Major Disasters Worldwide: 2003
SARS Country Breakdown
SARS articles/resources
Genome Sciences Centre (Canadian)
GSC: SARS-associated Coronavirus (Canadian)





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