2020 Coronavirus Pandemic is the result of ignoring “China’s 2002 SARS Epidemic.”

China’s 2002 SARS epidemic has 80 percentage resemblances with today’s Coronavirus pandemic. With the forecast of "WHO" that it may cause future pandemic, all countries should have taken it seriously and prepared for the possible solution.

Introduction:

Today the world is in such a situation where no solution is looking in near future. In such a position overnight all countries are only implementing preventive measures. Scientists are working day and night to study the properties of the novel coronavirus. But it is always said that we should learn from our mistakes and be ready for any worst situation. Future forecast from the remarks of a past scenario and preparedness is perpetually necessary for the survival of human civilization. In the year 2002, in Guangdong province of China SARS epidemic had broken out. It has 80 percentage resemblances with the today’s Coronavirus pandemic both in symptom and genetic wise. With the SARS outbreak in China and the forecast of “WHO” that it may cause “future pandemic”, all major countries should have taken it seriously and prepared for the possible solution. The 20 years of laxness have put the global population into a deadly stigma of Coronavirus pandemic that is questionable.

Let’s discuss what SARS is and how it is related to present Coronavirus Pandemic.

What is SARS?

Severe Acute Respiratory Syndrome (SARS) is a viral respiratory disease caused by the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV). Between November 2002 and July 2003, an outbreak of SARS in southern China caused an eventual 8,098 cases, resulting in 774 deaths reported in 29 countries (10% fatality rate with the majority of cases in mainland China and Hong Kong.)

How SARS is related to COVID-19?

Severe Acute Respiratory Syndrome Related Coronavirus (SARSr-CoV) is a species of Coronavirus which infects humans, bats and certain other mammal.

Note: Horseshoe bats appeared to be the natural reservoir of SARS-related coronaviruses.

Comparison of SARS-CoV and SARS-CoV-2:

(Source: European Review for Medical and Pharmacological Sciences )

Note: Case fatality Rate of Present Coronavirus Pandemic is still in research after its deadly global outburst.

Why Covid-19 Spread so easily than 2003 SARS?

At the first step of the infection, both SARS-CoV and SARS – CoV -2 bind to a protein on the surface of our cell, called ACE2 through their spike protein. However, SARS-CoV-2 has a specific structure that allows it to bind with higher affinity “at least 10 times more tightly than the corresponding spike protein of SARS-CoV.

There is also another important feature. Coronavirus spikes consist of two connected halves and when those halves are separated, the spike activates and only

then can the virus enter a host cell. In SARS- CoV, this separation of two connected halves happens with some difficulty. But in SARS-CoV-2, the bridge that connects the two halves can be easily cut by an enzyme called "furin", which is made by human cells and—crucially—is found across many tissues. “This is probably important for some of the really unusual things we see in this virus,” says Kristian Andersen of Scripps Research Translational Institute.

Now let’s discuss about the 2002 China’s SARS epidemic in detail:

SARS Outbreak in China:

In Mid November 2002, a form of atypical pneumonia called severe acute respiratory syndrome (SARS) began spreading rapidly around the world. The epicenter of the outbreak was Guangdong province, China, The earliest case of SARS is thought to have occurred in Foshan, a city southwest of Guangzhou in Guangdong province, in mid-November 2002. It was later also found in Heyuan and Zhongshan in Guangdong.

Political System of China Delayed in Responding SARS Epidemic:

This “strange disease” alerted Chinese health personnel as early as mid-December. The SARS epidemic was not simply a public health problem. Indeed, it caused the most severe socio-political crisis for the Chinese leadership.

On January 2, a team of health experts was sent to Heyuan and diagnosed the disease as an infection caused by a certain virus. A Chinese physician, who was in charge of treating a patient from Heyuan in a hospital in Guangzhou, quickly reported the disease to a local anti-epidemic station. On January 27, the report was sent to the provincial health bureau and, presumably, to the Ministry of Health in Beijing. The report was marked “top secret,” which meant that only top provincial health officials could open it.

[Note: According to the Implementing Regulations on the State Secrets Law regarding the handling of public health–related information, any occurrence of infectious diseases should be classified as a state secret before they are “announced by the Ministry of Health or organs authorized by the Ministry.” Until such time as the Ministry chose to make information about the disease public, any physician or journalist who reported on the disease would risk being persecuted for leaking state secrets.]

Further government reaction to the emerging disease, however, was delayed by the problems of information flow within the Chinese hierarchy. After the document was finally read, the provincial bureau distributed a bulletin to hospitals across the province. However, few health workers were alerted by the bulletin because most were on vacation for the Chinese New Year. In the meantime, the public was kept uninformed about the disease.

A virtual news blackout about SARS thus continued well into February. On February 8th, reports about a “deadly flu” began to be sent via short messages on mobile phones in Guangzhou. In the evening, words like bird flu and anthrax started to appear on some local Internet sites (South China Morning Post, 2003). On February 10, a circular appeared in the local media that acknowledged the presence of the disease and listed some preventive measures, including improving ventilation, using vinegar fumes to disinfect the air, and washing hands frequently. Responding to the advice, residents in Guangzhou and other cities cleared pharmacy shelves of antibiotics and flu medication. In some cities, even the vinegar was sold out. The panic spread quickly in Guangdong, and was felt even in other provinces.

On February 11, Guangdong health officials finally broke the silence by holding press conferences about the disease. The provincial health officials reported a total of 305 atypical pneumonia cases in the province. The officials also admitted that there were no effective drugs to treat the disease and that the outbreak was only tentatively contained (Nanfang zhoumu, 2003).

Yet in the meantime, the government played down the risk of the illness. Guangzhou city government on February 11 went so far as to announce the illness was “comprehensively” under effective control (Renmin wang, 2003b). As a result, while the panic was temporarily allayed, the public also lost vigilance about the disease. When some reports began to question the government’s handling of the outbreak, the provincial propaganda bureau again halted reporting on the disease on February 23. This news blackout continued during the run-up to the National People’s Congress in March, and government authorities shared little information with the World Health Organization until early April.

Official report to World Health Organization (WHO):

The first official report of an outbreak of atypical pneumonia in Guangdong Province, China was received by "WHO" on 11 February. In this report it has been mentioned that 305 persons were affected and caused 5 deaths. Around 30% of cases were reported to occur in health care workers. Confirmation that cases were consistent with the definition of SARS was made after permission was granted, on 2 April, for a WHO team to visit the province.

[It is believed that a WHO team that travelled to Beijing was not allowed to visit Guangdong province for several weeks. This resulted in international criticism, which seems to have led to a change in Government policy in early April.]

Global Spread

The SARS Coronavirus seemed to burst out of nowhere and demonstrated pandemic potential from February 2003 when it diffused globally via Hong Kong. World Health Organization (WHO) issued global alert on 12th March. Local transmission of SARS had been confirmed in Canada, Hong Kong Special Administrative Region of China (Hong Kong SAR), Singapore, Taiwan (China) and Hanoi in Viet Nam.

In a WHO press release on 15 March 2003, the new syndrome was named “SARS”. The acronym was easily confused with the abbreviation SAR by which Hong Kong was known. Since its “handover” from Britain in 1997, the territory had been a “Special Administrative Region” (or SAR) of the People’s Republic of China (PRC) – a quasi-autonomous region within the sovereignty of China. Hong Kong officials were wary of using the term SARS to describe the new disease. Instead, they continued calling it “atypical pneumonia.”

WHO issued the first emergency travel advisory on 15 March to airlines and travelers, providing case definitions for probable and suspected cases of SARS and advising airline crew of the need to report all such cases to airport and public health authorities. Additional guidance was issued on 27 March that recommended measures to reduce the risk of the global spread of SARS, including the exit screening of air passengers departing from areas reporting local transmission.

A cumulative total of 8422 probable cases, with 916 deaths, were reported from 29 countries during the outbreak up to 7 August 2003. Of this total, 5327 cases and 349 deaths are reported from mainland China.

In the United States, only eight persons were laboratory-confirmed as SARS cases. There were no SARS-related deaths in the United States. All of the eight persons with laboratory-confirmed SARS had traveled to areas where SARS-CoV transmission was occurring.

Note: On 16-17 May 2003, the World Health Organization held the first global meeting on the epidemiology of SARS in Geneva, Switzerland. The objectives of the meeting were to produce a "WHO consensus document on the current understanding of the epidemiology of SARS" as it informs public health practice and identify the gaps for the planning of additional epidemiological studies.

SARS Symptoms:

The illness usually begins with a high fever (measured temperature greater than 100.4°F [>38.0°C]). The fever is sometimes associated with chills or other symptoms, including headache, general feeling of discomfort and body aches. Some people also experience mild respiratory symptoms at the outset. Diarrhea is seen in approximately 10 percent to 20 percent of patients. After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that might be accompanied by or progress to a condition in which the oxygen levels in the blood are low (hypoxia). In 10 percent to 20 percent of cases, patients require mechanical ventilation. Most patients develop pneumonia.

SARS Spread:

The primary way that SARS appears to spread is by close person-to-person contact i.e. human-to-human transmission. SARS-CoV is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes. Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to 3 feet) through the air and deposited on the mucous membranes of the mouth, nose, or eyes of persons who are nearby. The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eye(s). In addition, it is possible that SARS-CoV might be spread more broadly through the air (airborne spread) or by other ways that are not now known.

Asymptotic SARS Transmission:

There was a paucity of information on the presence and epidemiological significance of asymptomatic infection. But National center for Biotechnology Information had conducted a thorough research on asymptomatic SARS-CoV infection among healthcare workers (HCWs) exposed to SARS patients in the first month of the nosocomial SARS outbreak at Tan Tock Seng Hospital in Singapore.

Note: A reverse transcription polymerase chain reaction (RT-PCR) is the laboratory test that can detect SARS-CoV in clinical specimens such as blood, stool, and nasal secretions. Serologic testing also can be performed to detect SARS-CoV antibodies produced after infection. Finally, viral culture has been used to detect SARS-CoV.

They found a substantial number of cases with asymptomatic SARS-CoV infection and subclinical (non pneumonic) SARS during the initial outbreak of SARS at Tan Tock Seng Hospital in Singapore. The incidence of asymptomatic cases among all exposed HCWs was 7.5%, and the proportion of asymptomatic cases out of all SARS-CoV–positive cases was 13% which contradict results from some previous studies, which reported an absence of asymptomatic SARS cases, but agree with results from other studies. The incidence rate of 7.5% was higher (although not significantly) than that of 3% and 2.3% reported in asymptomatic HCWs who cared for SARS patients in Hong Kong.

SARS Incubation Period:

The time between exposure to SARS-CoV and the onset of symptoms is called the incubation period. The incubation period for SARS is typically 2 to 7 days, although in some cases it may be as long as 10 days. In a very small proportion of cases, incubation periods of up to 14 days have been reported. Most countries reported a median incubation period of 4-5 days, and a mean of 4-6 days. The minimum reported incubation period of 1 day was reported from China (4 cases) and Singapore (3 cases) and the maximum of 14 days was reported by China.

Stability and Resistance of SARS-CoV:

Hospital environmental samples from a number of sites, including walls and the ventilation system, tested PCR positive in Canada. Virus loses infectivity after exposure to different commonly used disinfectants and fixatives.

Participants agreed there is need for additional guidance on environmental decontamination in the context of SARS, particularly for the effective cleaning of hospitals and residential buildings that is good enough to prevent the transmission of SARS-CoV and other common infections while remaining practical.

Virus is stable in faeces and urine at room temperature for at least 1-2 days. Virus is stable for up to 4 days in stool from patients with diarrhoea because of its higher pH compared to normal stool. Heat at 56°C rapidly kills approximately 10 000 units of SARS-CoV per 15 minutes.

SAR’s Case –Fatality Ratio (CFR):

Most SARS deaths occurred in the elderly people. In Canada, median age of SARS death was 75 years and 83% over 60 years. Diabetes and co-morbidities independently associated with mortality. In People republic of China, 17.6% CFR was shown in 60-69 age, 28% CFR in 70-79 age and 26.3% CFR in above 50 age people. Similarly in Hong Kong, 15% CFR was shown in 45-64 age and 52% case fatality ratio in people aged above 65. Males have a worse outcome than females in all age groups.

SARS & Health Care Workers:

The rapid spread of severe acute respiratory syndrome (SARS) in healthcare workers (HCW)—most notably in Toronto hospitals—during the global outbreak of SARS in 2002–2003.Singapore was also one of the countries most affected in the worldwide outbreak of SARS, with a total of 238 cases. 76% of infections were acquired in a healthcare facility. Researchers have found several key reasons for this development, such as the high-risk performances of medical operations on patients with SARS, inadequate use of protective equipment, psychological effects on the workers in response to the stress of dealing with the outbreak, and lack of information and training on treating SARS.

End of SARS:

The World Health Organization declared severe acute respiratory syndrome contained on 5 July 2003, however several SARS cases were reported until May 2004.

In April 2004, the Chinese Ministry of Health reported several new cases of possible SARS in Beijing and in Anhui Province, which is located in east-central China. As of April 26, the Ministry of Health had reported eight possible SARS cases: six in Bejing and two in Anhui Province. One of the patients in Anhui Province died. Nearly 1000 contacts of these patients with possible SARS were under medical observation, including 640 in Beijing and 353 in Anhui.

In May 2005, Jim Yardley of the New York Times wrote:

"Not a single case of the severe acute respiratory syndrome has been reported this year [2005] or in late 2004. It is the first winter without a case since the initial outbreak in late 2002. In addition, the epidemic strain of SARS that caused at least 774 deaths worldwide by June 2003 has not been seen outside of a laboratory since then."

Where SARS has gone?

However, the question that is periodically asked is: Where has SARS gone? Since 2004, SARS research has fallen-off dramatically. Some answered that public health measures were effective through case detection, isolation, quarantine and contact tracing which broke the chain of transmission. But SARS hasn’t gone since specimens still exist in research facilities. Potential security lapses keep alive the specter of the pathogen’s reemergence. After the WHO’s announcement that SARS had been contained, a number of outbreaks were linked to biosecurity breaches at research institutions in Asia. In September 2003, a researcher at the National University of Singapore contracted SARS through contaminated specimens. In December 2003, a researcher in Taiwan got infected through contaminated waste material. Poor security at the National Institute of Virology in Beijing led to a cluster of SARS infections in China in 2004. In a much publicized breach in 2014, the Institute Pasteur in Paris announced the disappearance of more than 2,000 vials containing fragments of the SARS virus.

SARS and Biosafety Research:

During the SARS epidemic between November 2002 and June 2003, a large number of specimens were collected from suspected and confirmed SARS human cases and sent to different national and international laboratories for a variety of pathological tests. WHO’s guidelines for the safe handling of those specimens during the outbreak period were described in WHO biosafety guidelines for handling of SARS specimens. WHO also issued post outbreak biosafety guidelines for handling of SARS-CoV specimen and Cultures. The guidelines take into account the absence of chains of human transmission, and highlight the importance of strict adherence to biosafety procedures and practices for laboratory work with SARS-CoV. WHO strongly recommended Biosafety Level 3 (BSL3) as the appropriate containment level for working with live SARS-CoV material.

Conclusion:

In the year 2003 with the SARS Outbreak in China, World Health Organization declared that SARS Coronavirus was having pandemic potential and a global threat. But at that time SARS-CoV was not so successful in its mission to harm wide range of human population because of its less diffusion capacity. After 2 decades, another strain of SARS Coronavirus has evolved with much higher affinity i.e. SARS-CoV-2, the causative agent of today’s Coronavirus Pandemic, which is massively ruining the human population. When a virus can emerge with such a potent planning to attack the human generation, we the human being how can ignorant to such a viral catastrophe. With so much of information on 2003 SARS-CoV i.e. it spreads by human to human transmission, attack mostly elderly people, HCW can also be infected, it can survive in plastic, metal and also airborne, proper information would have been shared about the predecessor. So that people can be aware of it and protect themselves before the occurrence of massive outburst. It may take time to study the features of the novel virus but sharing and cautioning people about the past occurrence always built an alert environment.

Lack of proper awareness always causes massive destruction. Wiser people always advise, "learn and alert from the past possibility because it may come in another form."

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