SARS- Severe Acute Respiratory Syndrome

-its outbreak is a chilling reminder of humanity's frailty in the face of mother

nature.

There are around 5000 people infected worldwide and 300 deaths

SARS has spread at an alarming speed

Canada-front line of the fight against the disease
Toronto- badly hit

Command center in Canada- where medical officials, scientists, and politicians

strive to win against the battle of SARS epidemic -what do they do?
1. Track spread of new disease
2. Imposing quarantine
3. Monitoring global situation

Initial description of SARS

-not following any of the rules of infectious disease
-highly contagious

There is only 1 out 16 chance of dying by those who have SARS

Question: where will the disease go next?

=Beijing to Singapore
=Toronto to London

Origin: Roro, China (may have originated from animals)

Hong Kong- original epicenter of SARS explosion
-where the world was first alerted of the virus at the end of March
-city at the edge of the panic
~15,000 people- infected
~over 130 people- died
-locals fear the whole city is infected thus relied (hoped) that mask would
prevent any particles of the disease from entering them through their mouth
and nose

Rumors- caused unnecessary panic to locals

-led to social meltdown due to locals believing that SARS is not only spread
through coughing or sneezing but also of direct contact
=no one shakes hands
=business cards are no longer exchanged
=no usage of public phones
=shunned communal machines
=no touching of public hand rails

Bob Broadfoot- Economic Risk Consultant

-one of the people who believe that SARS led to social meltdown

February 21, 2003- Prof. Liu Jianlun (medical consultant) checked in to

Metropole Hotel, HongKong
Prof. Liu Jianlun- patient zero
-came from the Mainland South China province of Guangzhou
-visiting Hong Kong for a wedding
-ill with serious chest problem
-coughing and sneezing as he was checking in
-took lift to 9th floor of hotel where he encountered Chinese-American
business man named Johnny Cheng (also had a room in 9th floor)

February 23, 2003- admitted himself in Kwong Wah hospital

-initially, doctors thought the cause of chest pain was influenza
-when he laid dying, he confessed that he was containing a deadly disease
-more than 70% of health workers are becoming ill

Initial symptoms of SARS (similar to flu):

1. Shortness of breath
2. Coughing
3. High temperature
4. Full scale pneumonia (w/in a few days)
=struggled to get air into their lungs
=w/o oxygen treatment and robust immune system, there is a decrease of
survival chances
=patient's lungs is slowly filling up with water
=pushing oxygen through ventilator - last resort

After 1 month of Jianlu's death- the outbreak began (publicly) In just a few days,
200 SARS cases were reported from a single residential block (Amoy
Gardens)

Amoy Gardens- 33 stories high

- became definitive proof that SARS can spread by person-to-person contact
without them ever meeting and with an alarming speed
Anna Yuen- resident and witnessed the spread in Amoy Gardens
=1st day-4 cases
=2nd day-20 cases
=3rd day-30 cases
=4th day-40 cases

14 died With this, scientist believed that SARS can also be passed through
communal services like lift buttons and door handles Scientists were baffled
because:
-SARS virus moves vertically up the building Unclear transmission pattern-
Led to:
1. ) MASSIVE QUARANTINE OPERATION - isolated residents in an unused
holiday camp
2. ) FULL SCALE EMERGENCY - Hong Kong officials moved in to disinfect
the block

Prof. Malik Peiris- Hong Kong University

-led the fight against the outbreak
-early in March, he began examining tissues taken from patients who had
SARS
-employed lung biopsy and found out that SARS was literally eating out the
lungs
-----------------------------------------------------------------------------------------
Nov. 2002- in the hospital where patient zero worked, 5 patients died from a
mystery illness New patients- developed full scale pneumonia

Dec. 2002-January 2003- the outbreak began secretly Patient zero's patients
were peasants who worked closely with birds In South China provinces,
people always have close contact with birds (e.g chicken, duck)
-chickens and other live stocks were kept close to open sewers

Prof. Liu- secretly treats and researches for the new type of
disease/pneumonia

Prof. Liu's first patient- peasant farmer had visited a market near the town of
Foshan
=chicken sits on cages of dogs
=boiled and cooked with their feathers on
=humans had close contact with animals and the viruses they carry
Note! SARS is not the first killer bug epidemic that occurred in South China

Prof. Peter Curson- Macquarie University, Sydney

-said that South China has been an incubation period for diseases (e.g.
respiratory infection)

Prof. John Oxford- Queen Mary Med school, London

-expert on respiratory diseases such as influenza also points to South China
as the breeding ground for disease
-South China is the place where epidemic break out usually happen, because:
= huge proportion of population lives in the area
= humans live in fairly close association with livestock

Feb. 21, 2003- Prof. Liu prepare to fly to Hong Kong for the wedding
-had made an important breakthrough
=discovered that antibodies present in patients' bodies are not present in
normal and healthy people (appeared only in people fighting SARS)
=antibodies were new to humans thus must have come from animals

Prof. Liu- the superspreader of the epidemic

-initially had dry cough, then fever almost leading to SARS

Johnny Cheng- Chinese American business man began to develop SARS

-became patient 01 -became the next super spreader
-brought SARS virus to Vietnam
-developed fever in 5 days after meeting Liu
-admitted to hospital in the city Feb. 26
-went to Hong Kong airport to fly to Vietnam for business trip
-landed in Hanoi airport in Vietnam
Prof. Aileen Plant- World Head Org in Hanoi

Dr. Carlo Urbani- Italian dr. based in Hanoi

-treated Johnny Chen
-first one to describe the symptoms of SARS
-guided the world to the first description of SARS
-symptoms:
1. Fever
2. Headache
3. Body aches and pains
4. Dry cough
5. Respiratory distress syndrome
-died, along with 4 staffs and Johnny Chen, due to SARS but not before
infecting 63 others

Lungs of SARS patient- white full of fluid

Super-spreaders- name of people who have infected lots and lots of people

At the end of March- SARS began to spread in the city especially to other
guests who were ate the 9th floor of Metropole hotel

70 staffs of Prince of Wales hospital, Hong Kong were infected caused a panic
because if hospital staffs weren't safe then the hospital itself isn't safe

Prof. Peter Cameron- Prince of Wales hospital, Hong Kong

-precautionary measures are used by hospital staffs when going home to
families (e.g. sleeping in separate rooms) to avoid spreading the disease
further

Staffs from Prince of Wales hospital infected Pamela Youde hospital where
Kwok Chi Hung was a nursing assistant
Mar. 13- few colleagues showed signs of SARS

Due to detrimental effects, WHO in Geneva stepped in. Leading scientists

and laboratorists were mobilized in 10 countries around the world

It was a scientific challenge of global proportion, the problem was to find the
virus causing SARS and identify it. It was race against time.

In the Hongkong laboratory in the early April, scientist made a key

breakthrough, by utilizing some lung tissue of a patient having SARS. When
John Nicholis, a pathologist examined the tissue under electron microscope,
he discovered the exact type of virus causing SARS

He describe the virus have Fluid filled cavity in the center, with lots of small
viral particles on the surface of the cell.
When magnified a 100 thousand times, Nicholis was surprised to find that the
virus has spikes. The spike makes it a part of corona virus family. The normal
corona virus family causes common cold to humans, so finding these spike on
the virus is a major concern for causing severe respiratory problems.

In finding the virus, isolation takes place and finding its carrier animal/ agent
and creating a vaccine to public will be a major step. But the most urgent need
was how the SARS virus was spread

It was believed that Prof. Liu, had passed the disease by spraying droplets in
the air while coughing. When the 200 cases of SARS appeared almost
overnight in the blocks of Amoy Gardens, it emerged there might be other way
of catching the disease.

The residents where move and put in quarantine while the whole block was
disinfected. At first scientist, wondered it was caused by lift buttons. Once
Amoy Gardens have been disinfected, The residents return in a week of
isolation.

But Scientist did make an important discovery in Amoy Gardens, it was the
sewage pipe. Old and rusty and reappeared in a tiny kitchen of each flat,
these rusty pipes leaks and they knew that SARS virus can also be carried
in human sewage.

They discovered that the phenomenon at Amoy Gardens was caused by a

single super spreader. The carrier was a man with kidney failure, who have
been discharged from the SARS infected Price of Wails Hospital. He
visited his brother in Amoy Gardens and used the toilet.

The virus can be also shed in feces, and opens up a new potential route of
transmission and now it is a matter of time that SARS will move into North
America and Europe

Modern Air Travel has enable SARS to spread around the world with
frightening speed.

Before the outbreak in Hongkong, travelers would come in and out normal.
Another guest, who stayed in the infamous 9th floor, is Prof Liu and Johny
Cheng was Mrs. Chui Quang. She checked out in the Metropole Hotel and
headed for the airport to fly back home to Canada. She was another of the
super spreader. In one faithful trip, she was to take the deadly virus on the
other side of the world.

On Toronto airport, Feb 23rd 2003, she meet and embraced his son, as it
turned out, it was a deadly embrace. Her health rapidly deteriorated and died
10 days after arriving to Canada. Her son was admitted to Skybourg Grace
Hospital and died a week later.

Dr. Frank Plummer, works in National Microbiologgy Lab. Canada states that
SARS is transmitted by close personal contact. From a person who checked in
Metropole Hotel traveling back to Canada, infected her family, the health
wokers and spreading the deadly virus around the continent.

Before the health medical authorities realized what was going on the disease
was growing fast. Patient contaminated by SARS were transferred to other
Toronto Hospital including Mount Sinai Hospital

Dr. Don Low, said that they have to close health care unit in the emergency
dept. due to having cases of SARS in the ICU that was unrecognized. The
hospital was concerned about exposure and put any people in quarantine and
after 4 days admitted 5 health workers in the hospital with disease. That shows
how infectious the disease is.

One of those health care workers was Susan Sorrenti, one of the first nurses
who took care of SARS patient in Toronto and admitted the patient on a
Sunday evening and goes into quarantine method. Just after one week, Susan
started to develop symptoms. She was put in an isolation room in the hospital
and was devastated that her family was under quarantine and meant
pretending that her family was going to be okay.

The symptoms are you had initially a fever and then the fever developed into
chills and had a tempt. Of 39 degree Celsius, which is quite dangerous. This is
nasty virus that was ever known before for it has not ff. any rules of infection of
diseases.

To cope with this new world, the public health authority in Canada was
swanning into action, in which daily teleconference was held by experts around
Canada. One of these experts was Dr. Frank Plummer, and advised them in
quarantine protocol.

Dr. Paul Gully, the one who initiated to secure the traveler advisory and
started assisting the problem in terms of investigation.

Dr. Ron St. John immediately went to work of trying to collect data from the
epidemiology to the disease, of how spread is the disease, of how many
people have the disease.

It would take just only 2 days for a deadly disease to travel from South China to
Canada. From one small area in the Guanzhou province, SARS have spread
across the world and was now on a rampage.

The Canadian gov. has taken no chances in the message across about the
containment of SARS, so far their tough action has prevented it spreading
across the country. Daily press conference’s has keep the media and the
public abreast of safety guidelines, quarantine rules and how to protect
yourself against the deadly disease.

With over 20 deaths so far, Toronto is on the spotlight. The Canadian police
have the power to detain travelers from abroad and may believe carrying
SARS and to impose home quarantine on their own.
Controversially, on April 23rd, WHO advised that no one should travel to
Toronto for the nature of SARS is not fully understood. While the Canadians
are managing to contain this deadly killer, the rest of the world in wondering
where it would strike next.

In China where the SARS virus first surfaced, an epidemic is now raging out of
control, the number of cases have been kept in state official secret, known only
to top officials. Now a Chinese whistle blow, have alerted the world to hidden
disasters. A military doctor revealed that number of SARS cases in hospitals
was covered up and coincide with WHO fact finding visit to China.

SARS unsecrecy don’t go together, the Chinese govt. have been forced to
revealed that have 10 times more cases that previously admitted. With around
3000 cases and 1000 cases in Beijing alone, China stand revealed as the
worst hit country.

Prof. John Oxford said that it would have helped if Chinese authorities had
been more open about problems in the southern part of the country,
Surveillance early warning is a key to this thing.

Last 5 min talks about of how the deadly virus created panic and have greatly
impact everybody and how economic status was affected .