SARS – Severe Acute Respiratory Syndrome
Always an interesting worldwide event is the evolution of a
new disease and how scientists react to it. We see the world’s best
scientists, and a mixture of politics and money, getting behind a situation
which, at the time, is scary, but, in 10 years, will look simple.
It is scary because we do not know what the outcome might be,
and we test the very science on which our medical system is based. What if the
scientists get it wrong and, because of that, someone dies? We now think SARS
is a common cold-type virus that causes fever and swollen lungs, and kills
people because they can’t breath.
Since the discovery of acquired immune deficiency –
caused by a virus now known as HIV – there has been a mixture of fear and
excitement when new viruses emerge.
SARS started with the outbreak of a virus – probably from
pigs – in southern China in late-2002. Because of poor conditions in
China, some mystery surrounds the first few cases. The World Health
Organization originally saw SARS as a possible influenza outbreak.
The WHO specifically monitors the “flu” around the
world. Influenza killed millions of people in worldwide outbreaks around the
time of WWI and in the 1960s. Since then, another international disaster
killing millions of people has been expected.
Experts fear that, as it spreads around the world, the
influenza strain will mutate enough to kill people. The virus will look like
the flu but differ sufficiently for our immune system to be overwhelmed.
When SARS was first detected, the WHO thought it was a dreaded
flu pandemic. A similar scare came in 1997, when a chicken virus mutated in
Hong Kong and spread to humans. Only one or two people died, but all the
chickens in Hong Kong were destroyed for fear the virus would spread among
chickens and then to humans all over the world. The influenza virus can,
through international travel, infect others quickly.
When the WHO suspected an influenza pandemic, it was keen to
track down and stamp out the infection in China. But delays occurred and SARS
spread around the world.
Then, as the virus that caused SARS remained unidentified,
worldwide disagreement emerged over research into the virus and its type.
Eventually, experts agreed that it was a common-cold virus, which was different
from the influenza virus. By then, however, people had died.
Other options exist to control any disease like SARS. One
possibility is ring vaccinations. This is the plan for smallpox should it ever
become a problem in Australia. The idea is to identify the person with small
pox early enough to isolate him or her and then vaccinate all the contacts
around the “index case”.
The vaccine for small pox is good enough, and the cases are
easy to find. For SARS, however, there is no vaccine, and the cases are easy to
miss or mix up with other diseases.
SARS has also proved difficult to diagnose. It will have taken
almost 12 months by the time there is a sufficient test to diagnose SARS.
An amazing feature of SARS is that, while almost all sufferers
have a temperature, they do not have the usual signs of the flu or common cold.
In Hong Kong cases, 100 per cent had a fever, 50 per cent a cough, only 43% a
sore throat, and 39 per cent a runny nose.
The problem then is that the disease progresses before
treatment can be started. This is why it is so hard to stop the spread of the
disease: the fever is just about all there is to indicate the illness, which
can spread before there is a chance to catch the contacts.
Without strict control of contact-tracing, spread will occur.
The only way to stop it is with strict control of cases with possible SARS.
Only when all persons with fevers were isolated did it start to limit the
spread of SARS. Every person travelling from a SARS-affected area was isolated.
And, to make sure spread was interrupted, it was important to isolate people
for twice as long as any known case of SARS transmission.
Another challenge that SARS presents is how to treat the
virus. Debate existed in the scientific world about the best treatments, as
e-mails travelled across the globe to share experience.
Doctors and nurses died from the virus because they did not
wear proper protection and the masks (nebulizer) used to treat the patients
turned out to be a way to spread the virus quicker. Antiviral treatments took a
while to be shown to work, as everyone gradually tracked down the virus causing
the problem.
Now, a combination of specific antiviral medication and other
treatments are used to help the body cope. After many months, the best
treatment seems to have been established. Death rates are now around two per
cent with proper treatment, but those already unwell or older still face a
higher death risk – up to 17 per cent.
It takes time to get new diseases under control but, if care
is taken and people co-operate, even new diseases can be brought under control.
It is, at the outset, better to be over-cautious than lax about isolation and
safety. International co-operation is possible and seemed to work in the case
of SARS, despite differences of opinion.
SARS was not the predicted influenza pandemic, but perhaps it
was a good trial run to prepare for a worldwide outbreak that could kill
millions of people. Modern science does not offer guarantees when it comes to
saving lives, but it does a pretty good job and most people see it as well
placed to deal with an outbreak.
