SARS: characteristics, transmission, and pandemic impact

Southeast Asia SARS outbreak of 2003: The anatomy of an epidemic.

Severe Acute Respiratory Syndrome or SARS is a viral respiratory illness that emerged as a serious global threat to health in March 2003. It first appeared in Southern China in November 2002. The illness was to spread to over a dozen countries in North America, South America, Europe, and Asia before it was contained. (Basic Information About SARS)

While the epidemic has been contained yet it raises a number of important issues that will be discussed in the paper. These include the question of the genesis and origins of the virus and the consequences, in both the short and long terms, of SARS as one of a number of previously unknown viral infections affecting world health. This paper will also look at the background, causes, symptoms and effects of the disease.

One of the central points that will form the fulcrum of this discussion is that SARS should not be seen as an isolated event. The SARS virus is one of many infectious diseases that now seem to be occurring with increasing prevalence in the modern world - the most recent being the Avian flu virus. In terms of sustainable solutions this will be an important aspect that will be addressed in this paper.

Background

In April of 2003 the World Health Organization (WHO) reported 3,947 probable severe acute respiratory syndrome (SARS) cases with 229 deaths worldwide. Most these case occurred in China, Hong Kong, Singapore, Vietnam, and Toronto, Canada. (Frequently Asked Questions About SARS)

While there was a general increase in the rate of the SARS cases, the rate of new cases was relatively slow. For example, there were only seven infectious at the beginning of the epidemic at the Hoping Hospital in Taipei, this grew to 264 cases and 34 deaths by mid-May, and 680 cases and 81 deaths by June 1. (ibid) SARS was a new phenomenon and resulted from a virus that had never been encountered in humans before. It was to result in worldwide panic before the infections finally halted. However, the wide ranging effects and implications of the epidemic are still being studied and debated today.

2.1. Causes

Essentially SARS is a type of viral pneumonia and is the result of infection by a coronavirus, called SARS-associated coronavirus (SARS-CoV). (Basic Information About SARS)

The initial outbreak of the disease is believed to have taken place in February 2003 in the Guangdong province of China. Approximately 300 people were infected and became ill, of which five died. Initially it was believed that Aparamyxovirus was responsible for the infection; however later the true cause was established to be a unique coronavirus with presented a number of different and unusual properties.

The causes or origins of the virus have been associated and linked to particular living conditions and the close handling of animal and related foodstuffs, "Many of these early cases were food handlers (persons who handle, kill, and sell food animals, or those who prepare and serve food.) (The cause of SARS) There is also evidence that natural infections with SARS-CoV occur in various species of animals indigenous to China and parts of south-east Asia. A joint study involving Hong Kong and China "detected several coronaviruses closely related genetically to the SARS coronavirus in two of the animal species tested (masked palm civet and raccoon dog). " (ibid) The study also found that the Chinese ferret badger elicited antibodies against the SARS-CoV. "These and other wild animals are traditionally considered delicacies and are sold for human consumption in markets throughout southern China." (The cause of SARS)

There is still ongoing research and conjecture about the actual origins of the SARS virus. An animal origin with human transmission is in all research studies generally accepted and recently independent scientific teams claim that the Chinese horseshoe bat is the reservoir of the virus in nature. (Altman L.K. 2005) Findings of this nature are important as a step in preventing future occurrences of SARS in that the chain of transmission may be broken if the originating source can be identified.

The cause of SARS has also been related to poor and unhygienic living conditions which fosters and possibly prepares the ground for the origin of the virus in association with livestock. This has important concomitant cause and effect factors that will be discussed in this paper. The World Health organization for example has stated that poor living environments and especially inadequate plumbing may also be a central factor in the initiation of this disease. "The findings also indicate that poorly designed or maintained plumbing could contribute to the spread of other diseases that are transmitted by highly infectious fecal droplets. " (Poor Plumbing a Likely Cause of SARS Spread)

The possibility has also been put forward in studies that the SARS outbreak in Hong king may have been facilitated by poor sewage and drainage systems. One of the most worrying aspects of the disease is that the exact origins and causative factors are not definitively known and this impact on the future solutions.

2.2. The symptoms and spread of SARS

The symptoms of SARS are generally flu-like with moderate to high fevers. Symptoms include the following characteristics of the disease:

dry cough, dyspnea (shortness of breath), headache, and hypoxaemia (low blood oxygen concentration)

Typical laboratory findings include lymphopaenia (reduced lymphocyte numbers) and mildly elevated aminotransferase levels (indicating liver damage).

Basic Information About SARS) notable symptomatic element is that approximately 10-20% of the infected individuals required mechanical ventilation. The mortality rate is between 6.8% for patients under the age of 60 and 55% for patients over 60 years old). (Jambresic S. 2005.) Death is often the result of progressive respiratory failure. Symptoms usually improve after the first week of infection but tend to worsen in the second week. This worsening is largely due to the deteriorating condition of the patents immune system.

The spread of the virus is through close person-to-person contact. Transmission through the spread of respiratory droplets through actions such as sneezing and coughing is common. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes. Furthermore, it is also suspect by medical experts that SARS can be spread through airborne infection. (ibid)

The Centers for Disease Control (CDC) reported that SARS appears to be spread by close person-to-person contact. Potential ways include touching the skin of other people or objects that are contaminated with infectious droplets and then touching the eyes, nose, or mouth. Or the virus can be transmitted when someone who is sick with SARS coughs or sneezes droplets into the air and someone else breathes them in. It's also possible that SARS can be spread more broadly through the air, or by other ways that are currently unknown.

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The estimated period for the survival of the virus in the environment can be several days but this factor is dependant on a number of factors. These factors may include "... The type of material or body fluid containing the virus and various environmental conditions such as temperature or humidity. " (Cause Of SARS)

The effects of SARS

One of the central questions that are raised in a holistic appraisal of SARS are the far- reaching implications of an epidemic of this nature. While the obvious impact of SARS on personal health is the dominant effect, the disease also has numerous social and economic effects, which in fact increases its overall negative effect.

One of the issues that have been raised in this regard is the economic cost of the disease as this has a concomitant effect on the ability of many countries to fight the disease. Economists point out that each victim of SARS in East Asia had an exponential and ripple effect on the economy of the region. However they also point out that the costs of the disease can be limited if quickly contained and properly managed. This emphasizes the fact that sustainable prevention and control measures are essential in dealing with infectious diseases like SARS.

During the period of its effect on Asia, SARS had a severe effect on production and activity in the region. One the main reason for this was the closure of factories and a reduction of tourism. Furthermore, "...consumer demand has was dealt a severe blow, as would be shoppers stayed home and wariness of an economic slowdown cause Asians to tighten their belts." (The Specter of SARS. p. 44) The Canadian economy was also severely weakened during this period and cased an estimated reduction of growth in the country by an average of 0.1% in April and May. (ibid)

The costs of the virus were extensive for China.

This tiny virus caused China huge economic losses, far costlier than either the Asian financial crisis in 1997 or the flood disaster in 1998. Some experts conclude that SARS resulted in direct economic losses of 400 billion RMB yuan (48 billion dollars). Several international conferences planned for China were postponed or changed venues

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SARS also had some positive effects in terms of media coverage. Studies claim that the outbreak in 2003 not only emphasized the importance of good media coverage in alerting the international community to epidemics but also "... raised standards of government preparedness and border control." (ibid) The importance of rapid communication and the role of the media became evident during the epidemic. This was also to show up the lack of media awareness in China. In this regard the epidemic highlighted the importance and value of the independent media in China, which was able to act in a way that alerted the international community to the epidemic.

In recent years, so-called "fringe media" publications have emerged in China. These fringe media are less controlled by government; these independent publications enjoy more autonomy than mainstream media and rely on the market for financial support. Therefore, their viewpoints are less influenced by the government propaganda machine. During the SARS crisis, some of these publications conducted in-depth investigations of the disease and its impact and delivered exclusive reports with unique angles. This gave them a golden opportunity to further establish their status as watchdogs.

The fact that China did not allow immediate free press access to the news of the disease resulted in accusations that the government had not acted responsibly or quickly enough in dealing with the outbreak. "...initial attempts to cover up the disease resulted in it spreading to Beijing and other provinces. Over time, a regional epidemic evolved into a national disaster."(ibid)

The SARS epidemic also revealed the way in which socio-economic conditions play an important role in the cause and perpetuation of epidemic diseases. From the socio-geographic perspective on the origins of the disease in Asia, it became evident that low or poor socio-economic conditions provide a breeding ground for diseases like SARS.

Finally, possibly the one result of the epidemic that is the cause for most concern is that is has led to a sense of uncertainly about the future. This aspect is emphasized by the fact that there is as yet no known and reliable cure for the SARS virus. Another concern that underlies much as the anxiety about the future of disease like SARS is the possibility of genetic recombination.

Ever since the SARS virus suddenly appeared in humans, scientists have been speculating about its origins and relationships to other, similar viruses. Using evolutionary analysis of protein sequences, the U-M researchers concluded that the SARS virus represents a different and previously little known lineage that has undergone some recombination, a process that can shuffle genes or gene regions among different viral lineages. This shuffling process provides genetic variation, which can help viruses survive and adapt in new hosts.

SARS Virus Can Change Quickly And Unpredictably)

Studies show that "The... recombination in the SARS-CoV lineages does indicate its potential for rapid, unpredictable evolutionary change, and this is a potentially important challenge for public health management and for drug and vaccine development." (ibid)

This aspect therefore increases the sense of anxiety about the disease and also adds to the need for comprehensive and more fully informed ways of dealing with a recurrence.

Prevention and solutions

Various measures were taken by the CDC at the time of the epidemic. These included closer cooperation with various authorities, a move which has set the tome for present day interventions and sustainable solutions.

CDC continues to work with other federal agencies, state and local health departments, and healthcare organizations to plan for rapid recognition and response if person-to-person transmission of SARS-CoV recurs. CDC has developed recommendations and guidelines to help public health and healthcare officials plan for and respond quickly to the reappearance of SARS in a healthcare facility or community.

Basic Information About SARS)

As mentioned, a central aspect that concerns this study is that the exact cause and origins of SARS is not known. This aspect raises a question mark when it comes to the issue of stainable solutions to the possibility of the reappearance of the virus. Some experts state that"... It is conceivable that an exact answer may never be determined." (China's Latest SARS Outbreak Contained, But Biosafety Concerns Remain)

This is a vital aspect in that control, prevention or management of future possible outbreaks is determined by the extent of knowledge that we have about the virus. The United Nations Food and Agricultural Organization (FAO) has warned that "The threat of future outbreaks of Severe Acute Respiratory Syndrome (SARS) remains real as long as its source is unknown" and has warned that more research on the disease is needed. (The cause of SARS) This presents various problematic concerns that have to be dealt to facilitate both prevention and sustainable solutions to future outbreaks.

The sustainability of solutions also has to take into account the rising incidences of viruses and infectious that has emerged since SARS - as these are possibly part of a pattern in the contemporary world. In other words, the issue of sustainability has to be cognizant of the total holistic picture and the context of SARS in the pattern of diseases and viral infections in the world to be effective.

The number infectious diseases continue to climb across the world. This has led to the realization that, our global community must do more to deal with the human, social and economic costs of infectious disease. Official development assistance, co-operative research and development programs and strategies to overcome market failures all can play a role in turning back the tide of infectious disease. But what we need most is a real international partnership, with OECD countries shouldering much of the responsibility for delivery of the most vital of the pillars of sustainability of good health for all.

Biotechnology and Sustainability)

The above sentiment is an indication of the most logical and practical way of dealing with the possible reemergence of SARS and the present viral infections, such as Avian flu.

Unfortunately the perception that new and dangerous forms are diseases are appearing in the modern world more often is largely true. This fact is partly the result of modern lifestyles and particularly the ubiquitous nature of modern travel, especially air travel, which had an enormous effect on the spread of diseases like SARS.

The above points all go to suggest that in terms of sustainable solutions the threat of disease like SARS must not be seen or dealt with in isolation. The following quotation emphasizes this point.

The emergence of SARS is by no means an isolated event. Since the 1970s, at least 30 new infectious diseases have emerged for which no effective treatment exists. One of the most destructive diseases the modern world currently faces was virtually unknown 20 years ago, but today the HIV / AIDS epidemic has infected more than 40 million people worldwide, killed 3 million in 2001 and continues to spread around the globe.

BIOTECHNOLOGY AND SUSTAINABILITY)

Diseases like SARS have a negative effect on the world economy, with subsequent effects on the social and health infrastructure of many countries, impeding their ability to deal with the disease. There is a growing sense in the word community that "... infectious diseases will need to be turned back...If the global community is serious about achieving sustainable development and growth in the world economy." (ibid)

To this end a number of public and private international partnerships have been established; such as the Medicines for Malaria Venture, the Global Alliance for TB Drug Development and the Global Alliance on Vaccines and Immunization. (ibid) Another example of the type of international cooperation that is needed is the establishment of the European Clinical Trials Platform, created by the European Commission in 2002. This platform supports common programs of research and clinical trials for various diseases.

Another area that has become particularly important in the area of sustainable prevention is the use of biotechnology, genomics and informatics. These tools and technologies offer "...a growing range of approaches to help prevent, monitor, detect, diagnose and treat infectious diseases. Appropriate policies are however necessary to ensure that the right tools reach the right people at the right time. (ibid)

The above emphasizes central point that is reiterated by many experts on SARS and other infectious diseases; namely that "...the battle... against infectious diseases...today is a challenge and a burden to be shared with all the global scientific community." (ibid) Scientific commentators state that the complexity of diseases like SARS, coupled with the easy spread of virus via air travel, has necessitated that an inclusive and wide- ranging strategy of sustainable prevention must be initiated in all countries.