SARS outbreak 20 years ago: "The fourth phase of the epidemics"

20 years ago, a previously unknown lung disease emerged in southern China.

SARS outbreak 20 years ago: "The fourth phase of the epidemics"

20 years ago, a previously unknown lung disease emerged in southern China. Like Covid-19, it is triggered by a corona virus and is spreading around the world at breakneck speed. Her name: SARS. From the point of view of medical historian Jörg Vögele, it is the prelude to a new era.

The first patient fell ill on November 16, 2002. At least it is the first one that is known. He was 45 years old and lived with his wife and four children in the city of Foshan, south China's Guangdong Province. There he worked in the administration and as a village leader. Then he fell ill with a new type of lung disease that was later named SARS. He had not traveled before but had prepared foods including chicken, domestic cat and snake.

However, this first case did not come to light until much later. The Chinese government initially struggled to suppress coverage of the spreading unknown disease. Beijing only informed the WHO on February 10, 2003. At that time there were already more than 300 infections and five deaths in China.

And perhaps the disease would have remained a regional phenomenon had it not been for an incident in Hong Kong in February 2003. There, a professor from Guangdong Province checked into the Metropole Hotel. He wanted to attend his nephew's wedding. But he had been feeling ill for days. At the hotel, his condition worsened and he was taken to a hospital, where he died two weeks later. He was infected with the new SARS virus. Several other hotel guests became infected and carried the virus around the world.

It was the beginning of what was later described as a "mini-pandemic". SARS, also known as severe acute respiratory syndrome, affected more than 8,000 people worldwide. Of them, 774 died, about ten percent of all those infected. "In terms of lethality, this is of course much worse than Corona," says medical historian Jörg Vögele to "If SARS had been as contagious as Corona, then you would have had a real problem back then."

SARS, like Covid-19 later, is triggered by a corona virus. It is called Sars-CoV and is a close relative of Sars-CoV-2, but not a direct predecessor. Today it is assumed that the virus was transmitted to humans from civet cats of the larval roller type. Closely related viruses were discovered in animals sold at markets in Guangdong province. The building blocks for the virus were discovered 14 years later in bats in southern China, which are considered to be the original host.

But unlike Covid-19, the SARS pandemic ended after just a few months. On July 5, 2003, the WHO declared the global outbreak contained. "The virus was not as contagious as Corona," says Vögele. "And people were only contagious after they developed symptoms. That made control easier." Sick people could be quickly identified and isolated before they infect others. The insidious thing about Covid-19, on the other hand, is that people without symptoms also spread the virus.

Around 30 countries around the world were affected by the lightning pandemic of 2002/2003. There were also nine patients in Germany who all survived. There were no chains of infection in this country, all infected people had entered the country beforehand. At that time, a young German virologist named Christian Drosten made a name for himself because he identified the pathogen with colleagues and developed a quick test. During the corona pandemic from 2020, he will become one of the most important scientific voices in Germany.

So the SARS pandemic seems like a prelude to what was to follow almost two decades later. Both SARS, the MERS epidemic that emerged in 2012 and Covid-19 are triggered by corona viruses. "These corona viruses are a relatively new thing," says Vögele. "In the 19th century there was cholera and tuberculosis as chronic infectious diseases. In the 20th century it was the flu-like diseases and towards the end AIDS. And now the flu and corona-like diseases are coming."

The reasons for this: "You can only see this development in the context of increasing globalization," says Vögele. "If nature is overexploited, more and more forests are cleared, then there are more and more viruses that can spread from animals to humans." Humans themselves would open up "entirely new biotopes of viruses" through their activities. And with international air travel, new types of pathogens would be quickly distributed around the world. SARS already showed these "signs of pandemics in a global world" - countries like Canada and the USA, which were actually far away from the country of origin China, were affected relatively quickly.

With globalization, humanity is changing. If this change leads to altered disease patterns, this is referred to as an epidemiological transition. "There have been three phases so far," says Vögele. "The first is pre-industrial, the age of plague and famine. The second is the receding of plague and the increase in life expectancy during industrialization." The third phase is the 20th century era of man-made diseases, such as cardiovascular disease and cancer. "I would say we are now in a fourth phase of the epidemic. The return of infectious diseases."

But mankind is not at the mercy of this. And the comparatively mild SARS pandemic of 2002/2003 could also have been a kind of wake-up call. "At the time, the WHO had already recognized that this was a problem and in the following years the guidelines on how to deal with such pandemics were updated," says Vögele. There were also some countries in Asia that had prepared for the next pandemic after SARS, including Singapore and Taiwan. They were also the ones who responded most quickly with countermeasures after the outbreak of Covid-19. The first national pandemic plan was also formulated in Germany in 2005. The SARS outbreak also accelerated the establishment of the European Center for Disease Prevention and Control (ECDC).

In addition, the experience with SARS later helped with the extremely rapid development of a vaccine against Covid-19. Because after the outbreak of the SARS pandemic, work was also done on vaccines against the coronavirus at the time. However, none of these reached market maturity. That was also because SARS, after a brief flare-up in late 2003 and early 2004 - including infections following laboratory accidents in Beijing, Taiwan and Singapore - simply disappeared again. The disease has never been detected in humans since then.

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