SARS By: Benjamin Weng, Darren

Ramcharan, Gurjot Goraya, Jagpreet Kaler, Pannya Bansal, Winnie Ma

Guiding Question To what extent did the SARS epidemic act as a

learning experience for future responses to global epidemics?

What is SARS?

• Stands for Severe Acute Respiratory Syndrome• It is a viral infection similar to

the flu virus and Pneumonia, but worsens within days

It needs a living host

Background information

• Very contagious50% of people who come in contact with a

patient gets infected with the virus

• Lethal for 15% of the patients

What is SARS? continued

What caused SARS?

• SARS is the result of being infected with the SARS coronavirus (SARS-CoV)

• It is believed to have transferred to a human host from an animal host (the Paguma larvata) in Guangdong, China around November 2002

What are Coronviruses?

• Subfamily of virus• Crown/halo appearance (corona) when viewed under microscope

What are Coronviruses?

•Common cause for mild to moderate upper respiratory illness for humans

•In animals it typically causes respiratory, gastrointestinal, liver or neurologic disease

SARS-CoV• Cannot be killed in heat• Never seen before, • Cannot be treated with normal medication

that would be used to treat pneumonia type diseases

“Traditional coronavirus causes sniffles. This has turned nasty”

Mike Leahy (virologist)

Origin of SARS-CoV• Unknown• Not related to the previously known subfamilies of

coronavirus• Not a genetic recombination of 2 known coronviruses

"Its unique sequence suggests that it has evolved independently from the other members of the family, in some animal host, for a long time”

- Malik Peiris (a virologist at the University of Hong Kong)

Symptoms Background Information

• High fever (greater than 38°C)• Dry cough • Shortness of breath or

breathing difficulties• There may also be changes in chest X-rays which indicate pneumonia • Other symptoms include headache, muscular stiffness, confusion, rash and diarrhea, loss of appetite, malaise (feeling of discomfort)

TreatmentsBackground Information

• A cure for SARS is yet to be found• Doctors may prescribe the following depending on

the severity of the infectionAntiviral agents such as oseltamivir or ribavirin Combination of steroids and antimicrobials may prescribe

the following depending on severity of the infection Only the symptoms can be treated, the actual virus is not

killed

• Scientist are researching effective treatment that would offer complete recovery

Preventative Measures

• Flu ShotsProtect from health effects caused by the flu

• Washing hands daily• Avoid traveling to

SARS infected countries• Contact your health

care provider for any concerns

For now … it is best to adopt essential preventive measures and report

symptoms as early as possible -Anonymous (e-Articles)

Places that were affected the most severely

Background Information

• Hong Kong, China• Toronto, Canada• Singapore• Hanoi, Vietnam

Source: World Health Organization Map Production: Public Health Mapping Team

As of May 15, 2003

In China

Source: Deadly Diseases and Epidemics by Joaquima Serradell

•SARS was first reported in China, however Public Health was slow to report to WHO; all governments were

•Electronic Warning System detected the flu, but the internet was in its beginning years, thus flawed

•They could only get limited information as there were no translation system

Trends During the Outbreak

•Healthcare systems in Asia were flawed, thus became decentralized and bureaucratic when responding to epidemics

Trends During the Outbreak

•Canada did not have the necessary research facilities, as funding was private for the public health research

The Spreading of SARSFactors:•With the ease of air travel, the virus was able to spread around the world in a short period of time•The virus has an incubation* period of 10 days

The carrier could therefore travel to different place and infect others without knowing it

•The symptoms of SARS are similar to those of the common flu

Doctors were unable to distinguish between the flu virus and the new SARS virus

Patients were wrongly given antibiotics in the beginning, which were ineffective

*”The time that elapses between infection and the appearance of symptoms of a disease”(Serradell 98)

The Spreading of SARSThe SARS virus spreads from person-to-person making

extermination impossible. This means that a cure must be found to control the disease.

•The virus is extremely contagious

• A person can infect another person by touching a common object such as a door knob or through aerial transfer.

• The SARS virus is able to survive several hours outside of the human body, increasing the probability of someone becoming infected through a common object

The Spreading of SARS

• When a person carrying the SARS virus coughs or sneezes, droplets containing the virus are released. These droplets can infect other people if they breath them in

• The Chinese authorities censored information about SARSPublic statements were made saying that the

spread of the virus had been brought under controlThe resulting lack of precaution by the public

helped the virus spread further

The Spread of SARS in China and Canada• Population density was one of the major differences between

the spread of SARS in China and Canada• SARS was more severe in China because of the population

density (population density of China was 134 while the population density of Canada was 3 people per square kilometer)

The Spread of SARS in China and Canada

The graphs shows the growth and affects of SARS in China and Canada in from April 2003 to June 2003. The numbers are based on total cases of SARS in each country indicated by the values on the Y- axis.

The patterns in both graph are very similar. Major differences include a drop in SARS cases at the end of May in Canada and the magnitude of the epidemic is greater in China based on numbers.

How spread of SARS could have been controlled

• The public was vulnerable to becoming infected because of ill-preparedness.

• Quarantining people infected with SARS would contain the virus in a small area where individuals could be treated for the virus. However, the virus had already been released into public areas and was able to spread before quarantining was in full effect.

Reaction of the Public• People were afraid to go out into public• People would not go to cinemas, take transit or go

to hotels in fear of contracting SARS• Since the elderly were more prone to death from

SARS there was more panic among the group• Of a telephone survey of

396 elderly people, “about 53% reported they were fearful of getting SARS, and 46% felt they had no control over the situation.”

Economic Impacts for Ontario

• Premier Premier Ernie Eves promised those who lost money when under

quarantine would

be compensated. (including those who were self-employed)• Toronto’s hospitals would be given $25 million after the SARS outbreak was over. A $10 million campaign promoting Toronto would be launched

Further Economical/Financial Implications

*Any index below 50 is seen as a shrinking economic condition

Hong KongWorst crisis for China since the 1998 Asian Financial Crisis

Severe downturn in Hong Kong’s economy for example; in May 2nd, 2003 the purchasing managers’ index fell from 48.4 to 38.1 from the previous month.*

The effect on Tour and Travel Industries saw a dramatic decrease in their profits, as flights were cancelled, and lower levels in number of tourist levels

Many people contained themselves within their house, drastically affecting the economy, Hong Kong had to campaign a “ We love HK” to get the economy going again

CanadaCountries put money into other countries to help them financially

Public places such as restaurants and cinemas experienced a severe downturn in their revenues (restaurants business was down 20 - 30 percent)

Cancellation for hotels in Toronto led to a 39 million dollars deficit during the moth of April 2003

Money was spent in creating flu shots however they did not cure the flu but only decreased the intensity of the symptoms

Canada’s Downturn in 2003

Major deficits could be seen in both the exporting and importing industries of Canada during the year of 2003.

Source: Statistics Canada

Hong Kong’s Downturn in 2003Hong Kong’s Invisible Trade

Hong Kong experienced a major drop in their trade during the year of 2003 due to the SARS outbreak.

Source: World Health Organization

Social Impacts• Decreased interaction within the society • Many were afraid to leave their house as they

may catch SARSThe subways were usually full in Beijing

before the SARS epidemicDuring the SARS epidemic, the subways

in Beijing were almost empty

Political Impacts

• Governments, especially China’s, rapidly changed policies in health. They made it more centralized and simpler.

• Increased government spending on healthcare and research

• Increased use of monitoring systems in transportation and public facilities

Ethical Implications

• Animal testing for SARS vaccine; we are regarding a human life as being worth more than that of an animal. Animals are being killed in an attempt to save our own.

• Quarantine; people who had the virus were isolated from society (without being asked) when the virus was identified.

SARS Epidemic and TodayEpidemics after the outbreak of SARS

Avian Influenza - 2004

Dengue Fever - 2004

Yellow Fever - 2004

Cholera - 2005

Marburg Haemorrhagic Fever - 2005

Rift Valley Fever - 2006

Pandemic H1N1 - 2009

Polio - 2010

Malaria

One of the most recent and major outbreak was the H1N1 Pandemic during the year of 2009.

SARS vs. H1N1 Pandemic

• In relation to SARS, the H1N1 Pandemic, or the Swine Flu was considered much less severe “Indeed, most doctors believe H1N1 is a significantly lesser threat to

the general public than SARS, and that H1N1 is more closely aligned to avian/bird flu in terms of its severity.” - CNW

“The latest A(H1N1) flu was a 'very manageable flu strain' compared to SARS." - Dr. Severin Schwan, CEO of Roche Group

• Despite the high number of reported cases for the H1N1, it was not considered severe, this is due to the fact that more precautions were taken.

From the experience during SARS, it allowed the world to be more prepared and careful. Many doctors had stated that H1N1 Flu was not as severe, but it may have become quite severe if the SARS Epidemic had not been a learning experience for the world. SARS allowed the world to see and understand the importance of communication with others and to react quickly before the situation gets out of hand.

A True Learning Experience

The world became united to find a cure for SARS and the World Health Organization helped to contain the SARS virus through open sharing of ideas. Governments learned to cooperate and act more swiftly when encountered with similar situations.

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