patient safety & quality
By Kathy Warye
2019-n-CoV: Lessons Learned from the
SARS Outbreak
In
February 2003, Severe Acute Respiratory Syndrome
(SARS), a unique respiratory illness erupted in China.
SARS was caused by a coronavirus never before seen in
humans. An unusual mutation in the virus enabled ease of
transmission. Air travel propelled the spread of SARS rapidly
throughout Asia and to 29 other countries including Canada
and the U.S. In total, 8,096 people developed SARS and
774 of them died. SARS also wreaked more damage to the
global economy than the September 11th terrorist attacks
in the U.S. Over a six-month period, SARS cost the world
economy approximately $40 billion. Then it disappeared.
Since the initial outbreak there have been no reported cases
anywhere in the world.
On Dec. 31, 2019, the Chinese health authority notified
the World Health Organization (WHO) of a “pneumonia”
of unknown cause in the Wuhan, Hubei province with
an epidemiological link to a cluster of people who had
frequented the Huanan Seafood Wholesale Market where
there was sale of live animals.
Health authorities in Hong Kong, Macau, and Taiwan
stepped up border surveillance and concern that a novel
and serious threat to public health had emerged.
By the third week of January, more than 830 cases had
been confirmed worldwide and an additional 8,420 people
reported to be under observation. The 2019-nCoV appears
to be clinically milder than SARS in terms of severity, case
fatality rate and transmissibility. 1
While the current situation presents a serious threat to
public health, much has changed since the SARS outbreak
in 2003. What’s different between 2003 and 2020?
• Most significant has been the response of the Chinese
government to the 2019 n-CoV. China initially denied the
SARS outbreak, then downplayed the magnitude of the
threat delaying response and handicapping the ability of
the global health community to implement appropriate
measures. It took months for the true implications of SARS
to be exposed. In contrast to 17 years ago, with the current
outbreak the Chinese health authority promptly notified
the WHO of a cluster of infections of concern and took
comprehensive public health measures including closure of
the markets implicated in the outbreak, intensive surveillance
and prohibition on travel from affected geographies.
• The advent of and use of rapid genetic sequencing also
represents a significant advantage. Chinese microbiologists
were immediately able to rule out SARS-CoV, MERS-CoV,
avian influenza and other respiratory viruses. Most impor-
tantly they were able to quickly isolate 2019-nCoV from
a patient and perform gene sequencing. On Jan. 12, the
Chinese health authority transmitted the genetic sequence of
www.healthcarehygienemagazine.com • february 2020
Coronavirus image courtesy of NIAID
the 2019-nCoV to the WHO. Because of this, public health
laboratories around the world have been able to produce
rapid diagnostic PCR tests to detect 2019-nCoV infection.
• More robust and connected surveillance globally,
supported by communications protocols established during
the SARS outbreaks has enabled early response by health
authorities and infectious disease experts around the world.
• In the U.S., the coordination between the Department of
Homeland (DOH) security and the Centers for Disease Control
and Prevention (CDC) since notification of the outbreak is
also unprecedented. DOH set up surveillance of arrivals at
key U.S. airports and took the additional step of rerouting
planes originating from Wuhan through these airports.
The routing and surveillance is enabling early detection of
individuals potentially infected with n-CoV.
While the eventual trajectory and impact of 2019 n-CoV
cannot be known at this time, the lessons learned from the
SARS outbreak were many and led to significant reforms in
China, new surveillance and response measures throughout
Asia and a more robust overall global infrastructure to protect
the public health from novel infectious disease outbreaks.
Kathy Warye is the founder and CEO of Infection
Prevention Partners where she provides strategic guidance
on the commercialization of solutions that detect, prevent
or manage infection.
Reference:
Hui DS, et al. The continuing 2019-nCoV epidemic threat of novel
coronaviruses to global health — The latest 2019 novel coronavirus outbreak in
Wuhan, China. International Journal of Infectious Diseases, Vol. 91, 264-266.
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