SARS pandemic 2002/2003

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SARS pandemic 2002/2003
Overview map of the countries affected by the SARS pandemic with confirmed deaths (black) or infections (red)
Overview map of the countries affected by the SARS pandemic with confirmed deaths (black) or infections (red)
Data
illness SARS
Pathogens SARS-CoV
origin South china
Beginning November 16, 2002
The End July 31, 2003
Affected countries 0025th
Confirmed Infected 8 096
Deaths 0 774

The SARS pandemic 2002/2003 is the first - equally worldwide - occurrence of the severe acute respiratory syndrome (SARS) caused by SARS-CoV , which began in November 2002. Starting in southern China, it spread across almost all continents within a few weeks and claimed 774 lives within six months. The World Health Organization (WHO) differentiated between countries in which local chains of infection existed, i.e. new infections occurred, and those in which the disease only occurred in travelers who had been infected in the countries of the first category. States with local chains of infection were the People's Republic of China, Hong Kong, Singapore, Canada, Vietnam, Taiwan, the United States and the United Kingdom.

As the first pandemic of the 21st century, it aroused new fears in the population and was widely covered by the media around the world. 45 people died outside of Asia and it is a warning example of the rapid spread of a disease in the networked, globalized world.

course

Outbreak in China

There is still no absolute certainty about the starting point of the SARS pandemic. However, the WHO assumes that it broke out on November 16, 2002. The first person to fall ill was a farmer from the city of Foshan in Guangdong Province , whose condition was classified by local doctors as "atypical pneumonia". Other sources report that the first three infected were chefs specializing in game . It is certain that a 33-year-old chef from Shenzhen traveled to his hometown of Heyuan at the end of November with symptoms of illness and was treated at the city hospital there at the beginning of December. During his inpatient stay, he infected eight clinic employees, including the ambulance driver. Despite intensive medical treatment, his condition worsened and it was soon apparent that he was suffering from a novel disease. He was transferred to a hospital in Guangzhou, and in January 2003 to the Zhongshan Memorial Hospital in the same city. There he infected 13 employees within a very short time. Among them was the 64-year-old senior doctor and lung specialist Liu Jianlun, who fell ill in mid-February.

The Chinese government, meanwhile, placed restrictions on the local press and censored reports of the disease. Information regarding the infections did not initially reach beyond Guangdong's borders. In addition, the necessary notification of the WHO was delayed and a first official report was postponed further and further. It was not until February 10, 2003 that China informed the WHO about the incidents and reported 305 infections and five deaths.

Spread of SARS on March 28, 2003 by the "Superspreader"

The "Superspreader"

On February 21, Liu Jianlun traveled from Guangzhou to Hong Kong for a wedding, although he had been ill for a few days . There he moved into room 911 on the ninth floor of the Metropole Hotel. Within 24 hours, he infected twelve hotel guests. He died on March 4th in Kwong Wah Hospital. Among the newly infected were three Singaporeans, two Canadians, the American businessman Johnny Chen on his way to Singapore and a 26-year-old local who was visiting a friend at the hotel. The international guests carried the virus as hosts beyond the Chinese borders to other countries and infected about 350 people directly or indirectly. The WHO calculated that more than 4000 SARS cases worldwide can be traced back to Liu Jianlun in the Metropole Hotel. For this reason, the building was given the name “ Superspreading ”, which was also used for Liu Jianlun himself in the media, especially in the tabloids .

Spread to pandemic

Within a few days, SARS spread into a pandemic. Many factors favored its spread, including the dense gathering of many people on public transport or at venues and the possibility that infected people would travel by air before the end of their incubation period and unwittingly carry the virus to other countries.

February and March

A businessman who was infected while on a business trip through Hong Kong and Guangdong traveled back to Taiwan on February 25 and is considered the starting point for the epidemic there - as are the returning Singaporeans in their state. On the same day, one of the two Canadians infected at the hotel, a 78-year-old diabetic, returned to Toronto . She died on March 5, before she could be hospitalized, and infected her 43-year-old son. He was taken to Grace Hospital in Scarborough Village, a northern suburb of Toronto, and died there on March 15th. Within a few days, Toronto became the region most severely affected by the pandemic outside of Asia. Johnny Chen from the Metropole Hotel in Hong Kong showed the first signs of illness on the onward flight to Singapore on February 26 , which is why the flight was diverted to Hanoi in Vietnam . Chen received treatment at the French Hospital of Hanoi, but infected many employees and was transferred back to Hong Kong, where he died in a hospital on March 14. Carlo Urbani , a WHO epidemiologist, was among those infected in Hanoi . Urbani immediately raised the alarm regarding the SARS outbreak. He was the first to recognize and classify the virus before succumbing to it himself on March 29.

The 26-year-old local, who was infected at the hotel, fell ill in late February and was treated as an outpatient at the Prince of Wales Hospital, the first hospital at the Chinese University of Hong Kong . His condition did not improve, so he was transferred to Ward 8A on March 4. This station subsequently developed into a focus of SARS as the patient infected numerous other patients, patient carriers, nurses, doctors and medical students. One of the infected patients was a 33-year-old man from Shenzhen who was hospitalized for dialysis . After his treatment, on March 14th and 19th, he visited his brother, who lived on the 7th floor in Block E, a 33-story building in the large housing estate Amoy Gardens . At a diarrheal disease suffering, he contaminated by the use of his brother's toilet, the sewers of the house. 321 residents of Amoy Gardens became infected, 41% of them in Block E of the residential complex. On March 30, the entire block was quarantined and the balconies closed under police supervision. A day later, all residents were transferred to hospitals. The Hong Kong Health Department stated that the cause of the large number of people affected was the high rate of concurrent diarrheal illnesses among residents as well as dried out siphons from floor drains in the bathroom, through which the virus spread when the exhaust fan was used, which generated negative pressure when the door was closed, could have spread. On March 12th, the WHO triggered a worldwide alarm regarding a new highly contagious disease of unknown origin in Vietnam and Hong Kong and raised the warning level on March 15th, after the first confirmed infections had also occurred in Canada and Singapore. At the same time, the Centers for Disease Control and Prevention issued a report that 14 Americans were infected. At the end of March, all public life in Hong Kong came to a standstill and the city was under a siege by officials, doctors, journalists and disease fighters.

The usually overcrowded Beijing Subway on May 11, 2003

April and May

While the SARS pandemic continued to spread, the US government issued a travel warning for Southeast Asia on April 1 and dismissed all non-essential employees from the embassies there. At a press conference on April 4, a Chinese health specialist publicly stated for the first time that he had not informed the population in good time about the initial cases of illness and the seriousness of the situation. The WHO made this clear on April 11th when it issued a global health alert after it had been officially confirmed that the disease had spread with the help of intercontinental flights. Since Vietnam had not recorded any new infections for more than 20 days, the WHO declared the SARS cluster there to be stopped on April 28 and lifted the travel warning for the Canadian metropolis of Toronto just two days later. The same happened to Hong Kong and the province of origin of SARS Guangdong on May 23, before Singapore was no longer considered an infected country as of May 31.

Finish

In the summer of 2003, the number of newly infected people worldwide fell steadily. On June 23, the WHO removed Hong Kong from the list of infected areas after long pressure from the authorities there - which now only included Toronto, Taiwan and Beijing. Four days later, the World Health Organization announced that it considered it possible to completely contain SARS within three weeks. This turned out to be a misconception, but from July 5, Taiwan was listed as an uninfected area again, even though more than 200 patients were still being treated there. In the following weeks there were only isolated cases of illnesses that could be recognized quickly each time, so that there were no further major outbreaks. China and the Philippines were affected by these last few infections . After a long wait and numerous tests, the WHO declared on May 19, 2004 that the pandemic had also been defeated in Beijing and had thus come to an end.

causes

The WHO sees the reasons for the rapid spread of the initial epidemic and subsequent pandemic in the very dense settlement of Guangzhou and the surrounding Pearl River Delta . Numerous wild animals and exotic animals are enjoyed as food in the region, which is why it is very popular with tourists with its numerous specialty restaurants. On animal farms, animal markets and in restaurants, the residents live, work and eat in close proximity to animals. The animals are kept in cages, sold and slaughtered in front of everyone. The counters where the raw meat and the slaughtered animals are sold are often only a few meters away from the workers' eating places. According to the WHO, these conditions - overpopulated and unsanitary - are a breeding ground for an infection to spread. It is now believed that SARS was transmitted from the larval roller .

Until the end of February 2003, it was mainly family members of the infected or medical staff in the hospitals who fell ill. It is believed that the employees, ignorant of the danger of the new disease, did not wear respiratory masks that would have prevented virus transmission through droplet infection . Since there was insufficient information about the treatment at that time, the doctors sometimes also used nebulizers and applied endotracheal intubations , which - instead of accelerating the healing process - greatly encouraged the spread of the virus.

Countermeasures

The measures against the pandemic were exhausted in preventive actions, such as numerous travel warnings or bans, forced quarantines and large-scale disinfection of entire city districts. Since no vaccine had yet been developed and it was initially unknown how the novel disease could be treated, most doctors administered antivirals .

In many of the Southeast Asian states affected, the health authorities have closed the various academic institutions. In Hong Kong, for example, all educational institutions were completely closed from March 27 to April 22, 2003, while in Singapore the universities were not affected by the measures at all and the junior colleges opened again on April 9 and the secondary schools on April 14 opened. In Beijing, on the other hand, on April 23, all primary and secondary schools were canceled for two weeks. On March 17, an international network of eleven leading laboratories was established to investigate the origin of the disease and develop potential treatments, and on April 26, 2003 the Beijing authorities closed all theaters, discos and other entertainment venues. In this way one wanted to exclude some possibilities of forming groups of people.

A major problem in coordinating countermeasures was the Taiwan conflict , which hampered a unified response by the WHO to the pandemic. The People's Republic of China, for example, ensured that Taiwan would not receive any direct advice from the organization, but was only kept informed via the WHO website. Taiwan stuck to its seat in the WHO, arguing that SARS shows the importance of integrating the state into the global health surveillance system. The People's Republic saw this as a politically motivated step towards Taiwanese independence. For this reason, under pressure from the People's Republic, Taiwan was unloaded by the WHO General Assembly and several SARS conferences. In retrospect, Taiwan argued that the direct communication deficit had prevented better responses to the disease in Taiwan and was therefore the cause of an unnecessarily high number of deaths. In fact, of the six countries with the most infections, Taiwan has by far the highest mortality rate. The People's Republic opposed the fact that video conferences with medical experts had taken place between the two sides.

Socio-economic impact

The considerable economic and socio-economic damage caused by the SARS pandemic in 2002/2003 was particularly evident in Asia. It mainly had an impact on consumer behavior and the tourism industry. The latter collapsed, so that in spring 2003 Singapore, Hong Kong, China and Malaysia had to accept a drop in tourist numbers of almost 70 percent. In the retail sector, sales fell by up to ten percent, as people only bought what was absolutely necessary. In this way, they wanted to avoid the risk of large crowds, for example in city centers or in shopping centers. Countless industrial companies cut their production in order to keep the risk of infection as low as possible with fewer staff.

China helped the affected economic sectors with tax breaks and other stabilization measures, and Hong Kong and Malaysia also decided on extensive aid packages. Hong Kong even fell into recession - as did Singapore. The city-state mainly supported the airlines from its companies and devalued its national currency, the Singapore dollar . The fear of the disease also led to the postponement of several major sporting events. On March 30, 2003 , the International Ice Hockey Federation canceled the staging of the women's ice hockey world championship , which was due to begin on April 3 in Beijing . The FIFA responded and moved the contracts awarded to China Football World Women's Championship in 2003 in an emergency procedure on 3 May in the United States. The Hong Kong authorities declared on 24 April 2003 the adoption of an aid package amounting to 11.8 billion Hong Kong dollars in support of urban tourism, retail trade and catering industry. In addition to numerous tax breaks, this measure also provided for the provision of 1 billion Hong Kong dollars for marketing campaigns overseas in order to make Hong Kong more attractive again and to give it a better image after it had been in the media with negative headlines for weeks. Overall, the economic damage amounted by the pandemic in Asia to approximately 18 billion US dollars .

A national study by the Harvard School of Public Health of Harvard University showed that in mid-April had heard in 2003, 93 percent of US citizens of SARS and the abbreviation was a term them. In the USA in particular, the uncertainty and lack of knowledge about the disease resulted in a generalized stigmatization of all Asians. According to the Harvard survey, 14 percent of Americans avoided doing business or other relationships with Asia. Especially in the Chinatowns of the big cities, this led to a drop in sales and the absence of the usual tourist flows. For a few weeks the districts resembled ghettos , which hardly any non-Asians dared to go to. The American comedian Margaret Cho with South Korean roots named such reservations towards Asia, which were highlighted by the pandemic, based on the abbreviation for the disease "severe Asian racism syndrome" ("severe Asian racism syndrome").

In Canada, too, the impact of the pandemic was enormous. Most of the conferences and trade fairs in the metropolis of Toronto have been canceled and the last remaining major conference, the American Library Association Convention in summer 2003, was the largest participant in the Library of Congress . On April 22, 2003, CBC / Radio-Canada reported that the occupancy in Toronto's hotels was only half of its normal value. A tightening of the travel warning by the WHO the following day and a request to postpone non-essential trips to Canada led Toronto city officials to forecast a major economic decline. Experts at the Bank of Canada even said the travel warning could cause drastic and long-term damage to the entire Canadian economy.

consequences

The establishment of a center for disease prevention, which was decided on May 6, 2003 at a hastily convened meeting of EU health ministers, is seen as a decisive consequence of the pandemic for Europe . Almost a year later, the newly founded center, the European Center for Disease Control (ECDC) , was presented in Stockholm .

In the People's Republic of China, personnel consequences were drawn as a result of the numerous infections and deaths. On April 20, 2003, Chinese Minister of Health Zhang Wenkang and Mayor of Beijing Meng Xuenong were removed from their posts due to increasing criticism of their handling of the danger posed by SARS and poor public relations work. Zhang was replaced by Wu Yi . This is a peculiarity in that civil servants or other high-ranking state employees in China are seldom fired for administrative errors.

Affected States

The following list of the WHO dated April 21, 2004 indicates all those states and areas in which infections with SARS occurred in the course of the pandemic. In addition to the number of illnesses, it differentiates between deaths and recoveries and the resulting mortality rate .

Likely SARS cases with illness between November 1, 2002 and July 31, 2003 according to WHO
country cases dead Recovered Mortality rate in%
AustraliaAustralia Australia 6th 0 6th 0
GermanyGermany Germany 9 0 9 0
FranceFrance France 7th 1 6th 14th
IndiaIndia India 3 0 3 0
IndonesiaIndonesia Indonesia 2 0 2 0
ItalyItaly Italy 4th 0 4th 0
CanadaCanada Canada 251 43 208 17th
KuwaitKuwait Kuwait 1 0 1 0
MalaysiaMalaysia Malaysia 5 2 3 40
MongoliaMongolia Mongolia 9 0 9 0
New ZealandNew Zealand New Zealand 1 0 1 0
PhilippinesPhilippines Philippines 14th 2 12 14th
TaiwanRepublic of China (Taiwan) Republic of China (Taiwan) 346 37 309 11
RomaniaRomania Romania 1 0 1 0
RussiaRussia Russia 1 0 1 0
SwedenSweden Sweden 5 0 5 0
SwitzerlandSwitzerland Switzerland 1 0 1 0
SingaporeSingapore Singapore 238 33 205 14th
SpainSpain Spain 1 0 1 0
South AfricaSouth Africa South Africa 1 1 0 100
ThailandThailand Thailand 9 2 7th 22nd
United StatesUnited States United States 27 0 27 0
United KingdomUnited Kingdom United Kingdom 4th 0 4th 0
VietnamVietnam Vietnam 63 5 58 8th
China People's RepublicPeople's Republic of China People's Republic of China  (total)
without special administrative areas Macau Hong Kong
MacauMacau 
Hong KongHong Kong 
7083  (total)
5327
1
1755
648  (total)
349
0
299
6406  (sat.)
4949
1
1456
(total)
7
0
17
total 8096 774 7322 9.6

See also

literature

  • Christian Drosten : SARS. World tour of a new virus. In: Biology in Our Time. Volume 33, No. 4, 2003, pp. 212-213. ISSN  0045-205X .
  • Evelyn Lu Yen Roloff: The SARS Crisis in Hong Kong. On the government of security in the global city. Transcript Verlag, Bielefeld 2007, ISBN 978-3-89942-612-0 .

Individual evidence

  1. ^ Kristian G. Andersen, Andrew Rambaut, W. Ian Lipkin, Edward C. Holmes, Robert F. Garry: The proximal origin of SARS-CoV-2 . In: Nature Medicine . tape 26 , no. 4 , 2020, p. 450–452 , doi : 10.1038 / s41591-020-0820-9 (English, nature.com [accessed April 28, 2020]).
  2. a b c d Summary of probable SARS cases with onset of illness from November 1, 2002 to July 31, 2003. WHO , April 21, 2004, accessed on December 11, 2017 (English).
  3. Martin Enserink: SARS: Chronology of the Epidemic. In: Science . Volume 339, No. 6125, 2013, pp. 1266-1271, doi: 10.1126 / science.339.6125.1266 .
  4. ^ Raymond SM Wong, David S. Hui: Index Patient and SARS Outbreak in Hong Kong . In: Emerging Infectious Diseases . tape 10 , no. 2 , February 2004, p. 339–341 , doi : 10.3201 / eid1002.030645 , PMID 15030708 , PMC 3322929 (free full text) - (English).
  5. a b c d e Outbreak of Severe Acute Respiratory Syndrome (SARS) at Amoy Gardens, Kowloon Bay, Hong Kong - Main Findings of the Investigation. (PDF; 31.2 kB) In: info.gov.hk. Department of Health, April 17, 2003, accessed January 28, 2020 .
  6. Lee Shiu Hung: The SARS epidemic in Hong Kong: what lessons have we learned? In: Journal of the Royal Society of Medicine . tape 96 , no. 8 , August 2003, p. 374–378 , doi : 10.1258 / jrsm.96.8.374 , PMID 12893851 , PMC 539564 (free full text) - (English, with a sketch of the sewage system).