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SARS or Severe Acute Respiratory Syndrome was a virus that began in the Guangdong Province in China in 2002 and spread to more than 35 countries before it was finished. At first, the medical community was completely taken off guard because this was a virus, the coronavirus (WHO, 2003b), that they had never seen before. A report from the WHO dated April 11, 2003 said that

"This appears to be the first severe and easily transmissible new disease to emerge in the 21st century. Though much about the disease remains poorly understood, including the exact identity of the causative virus, we do know that it has features that allow it to spread rapidly along international air travel routes."

The outbreak was sudden and the disease seemed tailor made for the present tide of global travel. Once SARS reached a major destination such as Hong King, as it did in the Spring of 2003, it quickly spread throughout the world,

The epidemiology of the outbreak determined that it had originated in China's Guangdong Province and that it had been first recorded in November of 2002 (WHO, 2003a). One of the main issues that healthcare workers had with the disease was that it seemed to be one that attacked young adults, mostly those in the same age range as the healthcare workers themselves. This was a warning flag for the workers who were exposed to SARS. Very few cases were reported in the most vulnerable populations that would normally be the ones afflicted with the influenza-like virus.

The epidemiology of the outbreak was further solidified as new cases began to arise in other Asian destinations and then in North America. Hong Kong had the second highest number of cases after Guangdong with 998 cases. The one positive sign, if it could be called that was the fact that death tolls from the disease remained relatively low as only 30 people died in Hong Kong. Viet Nam reported four deaths because the country had been forewarned of the outbreak and was able to implement health regulations that saved many of the people, and Singapore saw nine deaths of the 127 cases that they received (WHO, 2003a). Possibly the worst outbreak, from a fatality ratio standpoint, was in Toronto. Canada's outbreak was largely confined to a small region in Toronto because of the healthcare setting where it started. But, "the higher case-fatality ratio appears to be linked to the older age of the patients, who frequently have underlying chronic disease" (WHO, 2003a). The data that has been gathered also indicates that all of the infections were due to direct contact with an infected individual.

This data suggests that the primary age group that was affected by the outbreak was young and healthy when they contracted the disease, among other findings. Many of the people infected were somehow related to the healthcare industry and had come into direct contact with someone who already had the disease. The fatality rate was relatively high at approximately 10% (WHO, 2003a), as compared to that of influenza which is 0.3%. When older patients contracted the virus, they were much more likely to die from the exposure. This was related to the fact that they had secondary conditions which made them more vulnerable to the attack.

The virus began in China, but very quickly spread throughout the entire world. It is believed that infected individuals traveled from the relatively close Guangdong province to Hong Kong, possibly in search of better medical care (the inadequacies o the Chinese health system were exposed by this outbreak), and from there the virus traveled via airlines to other parts of the globe. The strength of the outbreak in different nations shows the spread pattern because deaths were much more common before there was an effective treatment found. China had the greatest number of cases, followed by Hong Kong and many of the other nations in the region. Surprisingly, Canada was one of the first nations outside of China and Hong Kong to have any significant population that contracted the disease. This seems to be because Canadian healthcare workers were some of the first to respond to the outbreak outside of Asia itself. Thus, when the outbreak occurred in Canada it was isolated to hospitals (Colizza, Barrat, Barthelemy, & Vespignani, 2007). Air travel was the culprit in all but the original and the Hong Kong outbreaks, and it is thought that the reason that nations such as the United States had such a high incidence of the virus is because there is a greater amount of business travel between the U.S. And China. The following map (WHO, 2003c) shows the areas of greatest concentration and how the virus likely spread throughout the globe.

This representation is now considered to be a potential model for how outbreaks will grow in the future (Colizza, et al., 2007).

The outbreak could affect any community because it is not known whether the agent has been completely eradicated or not (WHO, 2003a). There is also a danger that a stronger strain will manifest itself and be able to overwhelm the healthcare system already in place. The WHO and other agencies (such as the U.S. CDC) are working to make sure that such outbreaks are more easily detected and dealt with on a local level before they become pandemics.

Section B

The Centers for Disease Control in the United States works with other national and global healthcare organizations around the world to ensure that outbreaks of a scope of the SARS outbreak in 2003 do not occur. The CDC reports that since 2004 there have not been any verified reports of SARS infection in the world (CDC, 2005). The reporting procedure would most likely be specified by the specific institution, but it would have to include certain elements. The people affected would have to be placed in isolation and quarantined, and the hospital manager would have to be notified. There is a form to fill out on the CDC website regarding such an outbreak, and a hotline number that must be called in the event that any outbreak is suspected. Of course, the normal charting procedures would be followed. Whether local law enforcement or other official office would have to be notified to try and contain the people who may have been exposed would be up to the CDC after they have received the initial report.