SARS: Gone But Not Forgotten?

Nature is full of surprises. Earthquakes, volcanoes, tsunamis, floods, plagues, hurricanes,

and vast forest fires are just some of the many sources of global surprise. What’s so surprising

about these chaotic events is that we are always surprised by them. That was the initial response

to the explosive emergence of a new virus in China in late 2002. That surprise quickly gave way

to a world-wide panic, which was subdued by a few cool heads in Switzerland and Canada, and

the fortuitous disappearance of the virus.

The new virus was given the seemingly redundant name, SARS, for Severe Acute

Respiratory Syndrome.

The SARS virus seems to have emerged in the “wet markets” of Guangdong, China.

These markets are part Noah’s Ark, part butcher shop, and the crowded co-mingling of people

and their soon-to-be-dinner animals probably created ideal opportunities for a virus to jump from

one species to another. A likely candidate for the source of the SARS virus is the civet cat, a

wild carnivore that looks like a cross between a raccoon and a lemur.

Whatever its original source, once the SARS virus made the leap to people it was able to

spread with astonishing speed, and alarming lethality. Infected travelers quickly carried the virus

to Hong Kong, Singapore and Vietnam, and ocean-spanning jetliners carried it to Canada and

Europe. According to the World Health Organization (WHO), the virus reached 5 countries in a

24-hour period and 30 others within 6 months.

On March 15, 2003, WHO issued a travel advisory to certain countries and cities, and

declared SARS a “worldwide health threat.” By the time the virus disappeared in July 2003
hundreds of people were dead and tens of billions of dollars had been lost from disrupted trade

and travel.

The SARS virus belongs to a family of viruses called the coronaviruses. Two different

coronaviruses cause colds and mild respiratory illnesses in people. Medical researchers were not

particularly interested in coronaviruses—they were boring—so what little we did know about

them came from veterinarians. A variety of coronaviruses cause respiratory and gastrointestinal

diseases in cattle, pigs, poultry and dogs. Some of these diseases (infectious bronchitis in

chickens and shipping fever pneumonia in cattle) cause serious economic losses in the U.S. but

are no threat to people.

SARS infections begin with high fevers, headaches and malaise. A dry cough and

pneumonia are common. The virus is spread by close person-to-person contact and has an

incubation period of 2-7 days. That’s plenty of time to catch it in Hong Kong, get on a plane,

and pass it to someone in Toronto. The overall case fatality rate is about 3%, though it is higher

among elderly patients. By the end of the SARS outbreak in 2003, 8,098 people worldwide had

become sick and 774 had died. In the U.S., eight people showed serological evidence of having

been infected, but did not get sick or die.

A recent editorial in the science journal, Nature, declared, “The world dodged a bullet in

2003” when SARS appeared. Will we need to dodge another shot from Mother Nature? Is there

any body armor to protect against these viral bullets?

No. No yet. But medical scientists are now interested in SARS and coronaviruses, and

are working on antiviral drugs and a SARS vaccine.

Maybe they’re working too quickly. Last year, scientists in three laboratories in

Singapore, Taiwan and China accidentally infected themselves and others while working with
SARS. That’s not reassuring news, but it does show the need for a vaccine to protect both

researchers and the public from the virus.

The Chinese, who lost 349 people to SARS, already are testing an inactivated vaccine in

a small group of people. The more cautious Canadians are testing one in ferrets instead of

people. It’s a good thing too, since the ferrets developed liver inflammation from the

experimental vaccine. In the U.S., a third experimental vaccine tested in mice appears to protect

against one SARS strain, but not others. Worse, the vaccine may exacerbate SARS infections by

increasing the ability of the virus to invade host cells.

Making safe, effective vaccines is part art, part science, and the science part is still fairly

weak. If anyone thought making a SARS vaccine for people would be easy they should have

asked the veterinary community whose own mediocre vaccines for cattle and chickens are only

good enough to get the animals to market alive.

If and when SARS reappears, we’ll have to depend, not on the protective immunity of a

high-tech vaccine, but on good public health surveillance, good medical care, and good luck.

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