Twenty-First Century Plague: The Story of SARS

by Thomas Abraham

In the autumn of 2002 in southern China, a previously unknown virus jumped the species barrier from animal to man and sparked the first global epidemic of the new century. The disease sped along the air routes of a globalized world, spreading within months to thirty-one countries on every continent. Before it was reined in by a remarkable international scientific effort, the SARS virus demonstrated human society's vulnerability to disease. New infectious diseases like SARS have been emerging at an alarming rate over the past few decades. There is every indication the world will continue to face new viral diseases, some of them much more lethal and contagious than SARS. This book traces the emergence of SARS, in the process examining the global politics and economics of disease. It provides the first behind-the-scenes account of how the global battle against SARS was fought and the incredible research efforts that finally led to identification of the virus. Drawing on unprecedented access to scientists, doctors, and recovered patients, Thomas Abraham recounts the pressures and heartbreaks suffered by brave researchers who battled the clock to solve the SARS puzzle―even as colleagues and friends succumbed to the disease. "The caller at the other end of the phone was from the Manila office of the World Health Organization (WHO), and his message was alarming. Flying over the Atlantic Ocean on a Singapore Airlines flight was a critically ill man who had to be hospitalized in an isolation ward as soon as possible . . . There were over 300 passengers on the jet, which was bound for Singapore via Frankfurt, and unless the man was taken off the plane, they were all in danger." "On March 15, while David Heymann and his team were toiling away on their global travel alert in Geneva, a 72-year-old man boarded Air China flight 112 from Hong Kong to Beijing . . . Not only was he sick, he also happened to be a super-spreader of the disease. From his seat, 14E, he infected 21 other passengers and crew members."

Genres: Nonfiction, Science, Medicine

176 pages, Paperback

First published November 4, 2004

Reviews

[Russ · Rating 4 out of 5]

This book about the 2003 SARS outbreak is remarkably relevant to the COVID-19 pandemic. Everybody should read it.

The coronavirus family includes lesser viruses that cause about a quarter of common colds, and the more severe viruses that cause SARS, MERS, and COVID-19. The symptoms of COVID-19 are strikingly similar to SARS. After all, the virus that causes COVID is called SARS-CoV-2.

This book was published in 2004, fifteen years before COVID-19. But the themes are stunningly similar to the present. So much so that I would lapse into thinking it’s a book about the current contagion.

Guangdong is a province in southeastern China with jungles and rainforests, but it has a bustling capital city, Guangzhou (formerly known as Canton). Think of it like Louisiana and New Orleans.

Now to the content of the book itself… It was probably from an exotic meat market in Guangdong, with its confluence of birds, small mammals, and humans where the coronavirus that causes SARS mutated sufficiently to jump to humans, possibly from an intermediate host such as the palm civet cat (actually a viverrid, not a feline), and to begin spreading from human-to-human. However, none of this was known in early 2003.

The first patients—exhibiting dry cough, fever, and shadows on the lungs—were diagnosed with atypical pneumonia or even chlamydia. Those who suffered severe symptoms were hospitalized, and the disease quickly spread among paramedics, nurses and doctors in Guangzhou. The problem wasn’t really that little was known about the symptoms and treatment of the disease. The problem was that little was shared.

The authorities in Guangzhou quickly claimed the mystery disease was under control, and they suppressed the disclosure of information about it. Reporters who attempted to cover the disease were censored. Panic buying of medicine and supplies ensued as residents heard of the illness. Reporters tried to get around the medical censorship by covering the panic buying. Then the authorities censored those stories, and began prosecuting price gaugers. The reporters covered the price gauging stories until those were censored and the authorities told them not to report on any element, direct or indirect related to the outbreak.

High-level officials were part of the problem, declaring the disease as being under control while doctors and nurses were still fighting for their lives. Public statements went out: nothing to see here, mind your own business.

Zhong Nanshan, head of the Guangdong Institute for Respiratory Diseases, and a team from Beijing developed, investigated the earliest cases:

From the pattern of infection, researchers also concluded that the disease was spread through respiratory droplets.

The five-page report Zhong and his colleagues produced, known as the No 2 Report, described the basic clinical features of the disease and set out a range of treatment options that included both Chinese and Western medical techniques. It suggested treatment with corticosteroids and artificial respirators for critically ill patients, specified that patients should be quarantined and emphasized the importance of good ventilation and disinfection to prevent the disease spreading in hospitals.

The report was handed over to the provincial health authorities on January 23. By the end of the month, its main recommendations were distributed to major hospitals in Guangzhou. This document would have been an invaluable resource for the international community once SARS escaped into the wider world. But the Guangdong provincial authorities took no steps to share it with other countries struggling with the disease. (p. 34)

Consequently, little was known about the disease even by medical professionals. Unless they had a direct, personal relationship with a doctor at a hospital treating the disease, they didn’t know anything about it. So great was the ignorance that commerce and travel to Guangzhou continued unabated. A woman from Beijing traveled to Guangzhou became infected and returned to her doctor in Beijing. She told him something was going around in Guangzhou and he told her he’d never heard of it. And these are neighboring provinces in the same country!

Why the secrecy? Once a Chinese authority at a high level, such as a provincial or national leader, declared that it was pneumonia or that the situation was under control, it was culturally or politically unsafe for an underling official to state anything to the contrary.

The disease spread to Hong Kong, which has often been a gateway for infectious diseases to the world. (But because of that, they have some of the best scientists in the world.) Guests at Hong Kong’s Metropole Hotel carried SARS to cities as far as Toronto. Ultimately there would be about 8,000 cases and 800 deaths in the world, which isn’t many compared to COVID-19, but even that number of cases could have been dramatically reduced if information about the prevailing symptoms and treatment techniques had been shared sooner.

Ultimately it would be Hong Kong’s experts who identified the coronavirus responsible for SARS, though the CDC would also take credit for independent discovery at the same time. Labs in other countries were focused on red herrings like paramyxovirus. There’s a pretty good chapter toward the end of this book focusing on the World Health Organization’s role in facilitating real-time, international sharing of lab research to help identify the virus much more quickly than normal.

The conclusion warns about the probability of an influenza pandemic. The author, an Asia-based health beat reporter, makes a persuasive case, and a serious flu could still break out, but it turns out that paying closer attention to SARS itself would have helped mitigate COVID-19. Basically every error made during SARS was repeated during COVID-19.

[Gina · Rating 4 out of 5]

This book lays out how the original SARS outbreak began and then progressed, and I learned a lot of things about the virus that I never heard on the news both back then as well as now.

Reading this now, sixteen years later and in light of current events, is as fascinating as it is frustrating. We learned so much from the original SARS outbreak, and then how quickly we forgot it all, failed to fund new research, and failed to open our minds to the possibilities of pandemics caused by coronaviruses or, really, anything other than influenza.



Even at the end of this book, the final warning is about preparing for a new strain of future flu. That the SARS outbreak was a warning to the world to prepare for the next big flu pandemic. "The numbers of SARS cases in 2003 was a modest 8000 across the world. In the case of an influenza pandemic, the numbers would be in the millions." it warns. Well, as of the time I'm writing this, we've just hit over two million confirmed cases...of SARS-Cov-2. (The point about the flu stands as well, of course!)

I do recommend this book, though I was a little bothered near the beginning by the discussion of the gay community and drug using community being part of the spread of HIV ("Anonymous sex with multiple partners as often as possible became a fundamental element of gay liberation." etc) without really delving into part of the fault also lying with governments failing to act in any significant way to contain the spread of the virus BECAUSE of discrimination against those populations. It seems like an especially weird oversight since world organizations needing to act quickly and openly toward containing viruses is basically the theme of the whole book.

[Mary · Rating 5 out of 5]

This was a tough book to get going on. It was written about SARS before the hindsight of Covid and it was just really triggering because it sent me right back to December 2019 and made me relive all those memories. But the book itself is super interesting. I'd like to read a follow-up book now that we have the hindsight of Covid to explore what lessons we learned from SARS that were identified in this book that helped us with Covid. There are still a lot of unknowns for me from the start of Covid to where I don't have enough information to compare it to the SARS response. And maybe the fact that there are still a lot of unknowns tells me that we haven't learned the lessons we need to. Do we have better communications between doctors for example? Yes, because of social media. But have the respective governments done anything intentional and helpful to that end? Or are we just relying on social media for the initial phases of a new outbreak? I know we've tried to implement better surveillance in recent years, but did any of that actually help with Covid?

[Ron Urwongse · Rating 4 out of 5]

A journalist's account of how SARS emerged as a pandemic and brought the global health system to its knees.