- After being criticized for a slow response to SARS, China is once again facing global scrutiny for its handling of the new coronavirus.
- By the time the global SARS outbreak was contained, the virus spread to over 8,000 people worldwide and killed almost 800.
- The new coronavirus, SARS-CoV-2, which causes the disease COVID-19, has already surpassed the 2003 SARS outbreak.
It’s been 17 years since a respiratory virus called severe acute respiratory syndrome (SARS) appeared in China.
Within months, SARS spread to more than two dozen countries in Europe, North America, South America, and Asia.
By the time the global outbreak was contained, the virus had spread to over 8,000 people worldwide and killed almost 800. At the time, the Chinese government was criticized for responding slowly to the outbreak and concealing the seriousness of the illness.
Now, a new respiratory illness has emerged in China. Like SARS, it’s caused by a coronavirus, this one known as SARS-CoV-2.
This new virus causes an illness known as COVID-19, with symptoms such as fever, cough, and shortness of breath. There’s currently no specific antiviral treatment or vaccine for it.
The outbreak of this illness has already surpassed SARS and is expected to continue to grow. As of Mar. 11, over 124,000 cases of COVID-19 have been reported worldwide, with over 4,500 deaths.
In the United States there have been more than 1,100 cases of COVID-19 with 30 deaths.
Issues over access to testing, though, have left some experts concerned about whether there are more cases than previously realized in the country.
Sequencing of the virus’ genome suggests that it may have been circulating undetected in the United States for 6 weeks.
In China, officials responded to the COVID-19 outbreak by quarantining millions of people in affected cities and restricting domestic and international travel.
In the United States, quarantining millions of people is much less likely to occur, but people who have been potentially exposed to the coronavirus are being asked to self-isolate for 14 days. During this time they can monitor themselves for symptoms.
China’s initial response to SARS was plagued by a “fatal period of hesitation regarding information sharing and action,” according to a 2004 report on its handling of the outbreak.
It took several months before the Chinese government started sharing information with the World Health Organization (WHO).
During that time, the Chinese public was kept largely in the dark about the new illness, which the 2004 report said “heightened anxieties, fear, and widespread speculation.”
Some experts say that this time around, Chinese officials were once again reluctant to share information during the early stages of the current outbreak, which hampered global recognition of the threat. For weeks, local officials in Wuhan — where the virus first appeared — downplayed the seriousness of the threat, reporting that people with the infection had contracted it through exposure to live animals at a market.
But as cases of human-to-human transmission started appearing, the seriousness of the outbreak became more clear.
Still, there are signs that Chinese officials tried to avoid repeating the mistakes of SARS.
“With the recent outbreak, I think the Chinese government has been much more willing to share information and be open. In fact, the head of WHO has been praising them for their willingness to share,” said Anne W. Rimoin, PhD, MPH, an epidemiologist and director of the UCLA Center for Global and Immigrant Health.
However, even with this greater transparency, some news outlets report that the Chinese government continues to censor unfavorable news about the outbreak, including on social media.
Dr. Arnold S. Monto, an epidemiologist in the University of Michigan’s School of Public Health agrees that China’s initial response was slow, but he said some of this is due to what happens when dealing with a large bureaucracy.
For example, some hospitals lacked testing kits for the virus. Also, case reports from local hospitals had to be reviewed by China’s central health commission before being made public.
One of the biggest changes since SARS is the advances in technology needed to understand the virus and develop diagnostic tests or treatments.
In January, Chinese scientists had already sequenced the virus, which first appeared in December. They also made that information available to scientists around the world. With SARS, it took scientists about 5 months to identify the virus after it began to spread.
“Having information quickly really helps public health officials start to contain it,” said Rimoin. “So the ability to rapidly identify viruses — and identify that you have a new virus — is an extraordinary and important new development.”
Genetic information about the virus is needed to help scientists develop diagnostic tests for the virus, as well as treatments and vaccines.
Several groups are already working on a vaccine. However, even with faster vaccine development compared to 17 years ago, it could still be 12 to 18 months before a vaccine is ready for widespread use in people.
Monto said that during SARS there was also no good diagnostic test until very late in the outbreak. Instead, doctors relied on symptoms to diagnose people.
“The case definition [with SARS] was basically a lower respiratory infection and a traveler from an infected area,” said Monto.
This approach is lot less clear than a diagnostic test. Monto said this case definition was also less useful inside China, where many people were coming from a SARS-affected area. A laboratory test for the new coronavirus is already available.
New genetic technologies will be a game changer for how China and other countries handle the new coronavirus, SARS-CoV-2.
But Rimoin said “even with all of these new technologies available, it’s going to come down to good disease surveillance, good case identification, and good contact tracing.”
Dr. Anthony S. Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, and his colleagues, said in a JAMA editorial earlier this year that it was these kinds of “classic public health measures” that brought the SARS epidemic to an end.
Chinese officials have already implemented many of these, including quarantining Wuhan and other cities. The current travel restrictions in China are much more drastic than they were during SARS.
Monto suspects that China is enacting wider travel restrictions than they did during SARS because they’re concerned about people with COVID-19 spreading the disease even if they don’t have symptoms.
There have been reports of people without symptoms passing the virus onto others, but it’s not clear how often that occurs. Still, these cases could make it harder to contain the spread of the virus.
“There were a lot of studies about travel restrictions during SARS,” said Monto, “and it’s very clear that just restricting the travel of people who are visibly sick from the infected areas didn’t work.”
Other countries are taking steps to slow the spread of cases that show up within their borders. The Trump administration recently expanded its coronavirus travel ban to include Iran, alongside China.
This bars any foreigner who has traveled in either of those countries in the last 14 days from entering the United States.
Several airports are also screening U.S. citizens and permanent residents coming from China or Iran for symptoms of COVID-19.
Some airports are asking passengers from Italy or South Korea, which have high numbers of cases, to isolate themselves at home for 14 days.
Although a coronavirus test has been available since last month, the United States has been slow to roll it out, which some critics say allowed the disease to spread in the country unchecked.
Commercial labs have recently started offering coronavirus testing, which should expand the number of people who can be tested.
Although the United States had 8 SARS cases in 2003, the real wake-up call for public health officials came in 2014 during the Ebola outbreak.
That year, a Liberian man with Ebola showed up at a Dallas emergency room with a high fever and abdominal pain. He was initially sent home with a diagnosis of a sinus infection before returning to the hospital. He died 2 weeks later. Two nurses who took care of him also contracted the virus.
The Ebola outbreak “tested [U.S.] hospitals’ ability to prepare and respond to emerging public health infectious disease outbreaks,” said Rita D’Aoust, PhD, associate dean for teaching and learning at Johns Hopkins School of Nursing.
After that, said D’Aoust, the U.S. Department of Health and Human Services developed guidelines for hospitals on how to prepare for other emerging infectious diseases.
“In addition, several federal, state, and local agencies have invested resources for training, coordinating, and conducting testing [related to infectious diseases],” she said.
There’s still a lot we don’t know about SARS-CoV-2, including how quickly it spreads and the severity of the illness caused by it.
But governments already touched by it are banking on strict public health measures along with new technologies to quickly contain the outbreak — the way they did during SARS.
“Nobody really predicted that SARS would not continue to be a problem,” said Monto. “But by public health measures — including isolation and proper precautions — it was possible to put the genie back in the bottle.”