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SARS Timeline. Nov 16 ‘02 Feb 11 ‘03 Feb 28 March 11 March 12 March 19 March 27 April 5 April 9 April 14 April 17 April 28 First cases Hong Kong WHO Sequence

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SARS Timeline

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Sars timeline

SARS Timeline

Nov 16 ‘02Feb 11 ‘03Feb 28March 11March 12March 19March 27April 5April 9April 14April 17April 28

First cases Hong Kong WHO Sequence

retrospectively and Vietnam issues of suspected

Recognized, report out- travel agent, a

Guangdong, breaks in advisories coronavirus,

China hospital established

workers China

Acute coverup India

respiratory WHO admitted;

reported in issues SARS SARSGuangdong global made top

by China alert priority Vietnam

MOH contain-

Reported First ing virus

First in U.S. and SARS in (WHO)

SARS Europe Africa

case –


Case distribution of sars worldwide

Case Distribution of SARS Worldwide

ERSI, May 2003

Sars timeline

ERSI, May 2003

Sars timeline


18 HCW


Guangdong Province, China



11 close contacts






Hotel MHong Kong


Hong Kong SAR

95 HCW


I, L,M





>100 close contacts



United States



37 HCW


34 HCW

21 close contacts

37 close contacts

Effect of Travel and Missed Cases on the SARS Epidemic

Spread from Hotel M, Hong Kong

Sars hotspots as of may 28 2003

SARS Hotspots (as of May 28, 2003)

# Probable Cases# Deaths

China5322 321

Hong Kong1728 269

Taiwan 596 76

Singapore 206 31

Canada 148 26

United States 65 0

Vietnam 63 5

Philippines 12 2

Other Countries 62 4

Total8202 734

Sars timeline

Number of SARS Cases Reported over Time (China)

Symptoms of sars

Symptoms of SARS

  • Cough

  • High fever

  • Severe pneumonia

  • Difficult to distinguish from other respiratory diseases in early stages

Sars timeline

Incidence Difference across Different Age Groups (China)


CDC, 2003

Sars timeline

Fatality Rates of Different Age Groups

CDC, 2003

Sars timeline


Sars timeline

SARS DiagnosticsKey Messages

  • SARS diagnostic assays are sensitive and specific, but may not provide definitive diagnosis early in the illness

  • Changes in the quantity, type, and timing of specimens collected may improve detection of SARS-CoV infection

  • Rapid and accurate diagnosis of other respiratory pathogens associated with SARS-like illness may help rule out SARS-CoV infection and calm public fears

  • Interpretation of test results must take into consideration possibility of false positives and negatives; a clear strategy to minimize such possibilities and to confirm test results are essential

CDC, 2003

Sars timeline

Peiris: personal communication

Sars timeline

Prevention of SARS

Definitions of quarantine

Definitions of Quarantine

  • Isolation

    • Separation and restricted movement of illpersons with contagious disease

    • Often in a hospital setting

    • Primarily individual level, may be populations

  • Quarantine

    • Separation and restricted movement of wellpersons presumed exposed to contagion

    • Often at home, may be designated residential facility

    • Applied at the individual or community level

  • May be voluntary or mandatory

CDC, 2003

Modern quarantine

Modern Quarantine

A collective action for the common good predicated on aiding individuals infected or exposed to infectious agents while protecting others from the dangers of inadvertent exposure


Civil liberties

Meeting needs of individuals infected and exposed is paramount

CDC, 2003

Key issues to consider

Key Issues to Consider

  • Surveillance

  • Clinical evaluation

  • Infection control measures

  • Patient isolation

  • Engineering controls

  • Exposure evaluation

  • Staffing needs and personnel policies

  • Access controls

  • Supplies and equipment

  • Communication

CDC, 2003

Sars mysteries

SARS Mysteries

Origin of SARS – animal reservoirs?

Is coronavirus the etiologic agent?

  • Cases without antibody

  • Non-cases with antibody

Sars mysteries continued

SARS Mysteries (continued)

What proportion of exposed persons

develop clinical disease and death?

  • Proportion of exposed, infected and asymptomatic

    Are there asymptomatic carriers?

  • Reports of cases without known source of exposure

Sars mysteries continued1

SARS Mysteries (continued)

What causes “super shedders”?

  • Host characteristics; e.g., age

  • Agent characteristics – “virulent strain”

    Is pathology caused by the virus or the

    response to the virus?

  • AIDS patients appear to be resistant to SARS

Sars mysteries continued2

SARS Mysteries (continued)

Will SARS reappear in the fall?

  • SARS is transmitted through the respiratory route. These diseases, like influenza, tend to have a season cycle with resurgence in the late fall, winter and early spring

Will sars re emerge

Will SARS Re-emerge?

  • Potential sources of re-emergence

    • Animal reservoir

    • Humans with persistent infection

    • Unrecognized transmission in humans

    • Laboratory exposure

  • SARS most likely to recur outside U.S.

    • Well-established global surveillance is important to recognition of first case

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