SARS outbreak 20 years ago: “Fourth phase of epidemics”

The SARS epidemic 20 years ago
“Fourth Phase of Epidemics”

By Kai Stoppel

20 years ago, a previously unknown lung disease appeared in southern China. Like Covid-19, it is triggered by a coronavirus and is spreading around the world at breakneck speed. Her name: SARS. From the perspective of medical historian Jörg Vögele, this is the prelude to a new era.

The first patient became ill on November 16, 2002. At least he is the first known. He was 45 years old and lived with his wife and four children in Foshan City, South China’s Guangdong Province. There he worked in administration and as a village leader. Then he contracted a new type of lung disease that was later named SARS. He had not traveled before but prepared meals including chicken, domestic cat and snake.

However, this first case did not come to light until much later. The Chinese government initially tried to suppress coverage of the spreading unknown disease. Beijing did not inform the WHO until February 10, 2003. At that time, there were already more than 300 infected and five deaths in China.

And perhaps the disease would have remained a regional phenomenon had it not been for the incident in Hong Kong in February 2003. There, a professor from Guangdong Province was staying at the Metropole Hotel. He wanted to attend his nephew’s wedding. But he felt sick for days. His condition worsened at the hotel and he was taken to hospital, where he died two weeks later. He was infected with the new SARS virus. Several other hotel guests became infected and spread the virus around the world.

It was the beginning of what was later described as a “mini-pandemic”. SARS, also known as severe acute respiratory syndrome, has affected more than 8,000 people worldwide. Of these, 774 died, about ten percent of all infected. “In terms of lethality, it is of course much worse than Corona,” medical historian Jörg Vögele tells “If SARS was as contagious as Corona, then you would have a real problem.

Leap from the animal kingdom

SARS, like later Covid-19, is triggered by a coronavirus. It is called Sars-CoV and is a close relative of Sars-CoV-2, but not a direct ancestor. Today, it is believed that the virus was transmitted to humans from larval roller civet cats. Closely related viruses were discovered in animals sold in markets in Guangdong province. The building blocks of the virus were discovered 14 years later in bats in southern China, which are believed to be the original host.

But unlike Covid-19, the SARS pandemic ended after a few months. On 5 July 2003, the WHO declared the global outbreak contained. “The virus was not as contagious as Corona,” says Vögele. “And people were contagious only after they developed symptoms. That made it easier to control.” Sick people could be quickly identified and isolated before they infected others. The insidious thing about Covid-19, on the other hand, is that the virus is spread even by people without symptoms.

Approximately 30 countries worldwide were affected by the 2002/2003 lightning pandemic. There were also nine patients in Germany, all of whom survived. There were no chains of infection in this country, all the infected got into the country in advance. At the time, a young German virologist, Christian Drosten, made a name for himself because he and his colleagues identified the pathogen and developed a rapid test. During the coronavirus pandemic from 2020, he will become one of the most important scientific voices in Germany.

Globalization brings new epidemics

Thus, the SARS pandemic appears as a prelude to what was to follow nearly two decades later. Both SARS, the MERS epidemic that emerged in 2012, and Covid-19 are caused by coronaviruses. “These coronaviruses are a relatively new thing,” says Vögele. “In the 19th century, cholera and tuberculosis were like chronic infectious diseases. In the 20th century, it was flu-like diseases and towards the end of AIDS. And now comes flu and corona-like diseases.”

Reasons: “You can only see this development in the context of increasing globalization,” says Vögele. “If nature is overused, more and more forests are cut down, then there are more and more viruses that can spread from animals to humans.” Humans themselves would open up “completely new virus habitats” through their activities. And thanks to international air travel, new types of pathogens would quickly spread around the world. SARS already showed these “signs of a pandemic in the global world” – countries like Canada and the US, which were actually far from the country of origin of China, were affected relatively quickly.

With globalization, humanity is changing. If this change leads to altered disease patterns, it is referred to as an epidemiological transition. “There have been three phases so far,” says Vögele. “The first is the pre-industrial era, the time of plague and famine. The second is the retreat of plague and the increase in life expectancy during industrialization.” The third phase is the age of man-made diseases in the 20th century, such as cardiovascular disease and cancer. “I would say we are now in the fourth phase of the epidemic. The return of infectious diseases.”

wake up call for the world

But humanity is not at its mercy. And the relatively mild SARS pandemic of 2002/2003 could also have been a kind of wake-up call. “At that time, the WHO already recognized that this was a problem, and in the following years guidelines were updated to deal with such pandemics,” Vögele says. There were also some countries in Asia that prepared for another post-SARS pandemic, including Singapore and Taiwan. They were also the ones who responded the fastest with countermeasures after the outbreak of Covid-19. In 2005, Germany’s first national pandemic plan was also formulated. The SARS outbreak also precipitated the establishment of the European Center for Disease Prevention and Control (ECDC).

Moreover, the experience with SARS later helped with the extremely rapid development of a vaccine against Covid-19. Because after the outbreak of the SARS pandemic, they were also working on vaccines against the coronavirus at that time. However, none of them have reached market maturity. It was also because SARS, after a brief flare-up in late 2003 and early 2004—including infections following laboratory accidents in Beijing, Taiwan, and Singapore—simply disappeared. Since then, the disease has never been detected in humans.

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