Timeline of the SARS outbreak

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2003 Probable cases of SARS - Worldwide

The following is a timeline of the 2002 to 2004 outbreak of severe acute respiratory syndrome (SARS).

November 2002[edit]

On 16 November 2002, an outbreak of severe acute respiratory syndrome (SARS) began in China's Guangdong province, bordering Hong Kong. A farmer in the Shunde district of Foshan County was likely the first case of infection. The People's Republic of China notified the World Health Organization (WHO) about this outbreak on 10 February 2003, reporting 305 cases including 105 health-care workers and five deaths.[1] Later it reported that the outbreak in Guangdong had peaked in mid-February 2003. However, this appears to have been false because subsequently 806 cases of infection and 34 deaths were reported.[2]

Early in the epidemic, the Chinese Government discouraged its press from reporting on SARS, delayed reporting to WHO, and initially did not provide information to Chinese outside Guangdong province, where the disease is believed to have originated.[3] Also, a WHO team that travelled to Beijing was not allowed to visit Guangdong province for several weeks.[4] This resulted in international criticism, which seems to have led to a change in Government policy in early April.

January 2003[edit]

The first super-spreader, Zhou Zuofen, a fishmonger, checked-in to the Sun Yat-sen Memorial Hospital in Guangzhou on January 31, where he infected 30 nurses and doctors. The virus soon spread to nearby hospitals.[5]

February 2003[edit]

Hong Kong[edit]

Ninth floor layout of the Hotel Metropole in Hong Kong, showing where a super-spreading event of the severe acute respiratory syndrome (SARS) occurred

In February 2003, Hong Kong's SARS index-patient was Dr. Liu Jianlun, who had come to attend a family wedding gathering; Dr. Liu was on the staff at Sun Yat-Sen Memorial Hospital in Guangdong and had treated SARS patients.[6]

On February 21, Dr. Liu and his wife checked into room 911 on the 9th floor of the Metropole Hotel. Despite feeling ill he visited with his family and they traveled around Hong Kong. By the morning of February 22, he knew he was very sick and walked to nearby Kwong Wah Hospital to seek treatment. He warned staff that he was very sick and to put him in isolation. He never recovered and died in the Intensive Care Unit on March 4.

Dr. Liu is believed to have been a SARS super-spreader: twenty-three other Metropole guests developed SARS, including seven from the ninth floor. Liu's brother-in-law, who sought treatment in late February, was hospitalized in Kwong Wah Hospital on March 1 and died on March 19. It is estimated that around 80% of the Hong Kong cases were due to Liu.[7]

Vietnam[edit]

The virus was carried to Hanoi, Vietnam by Chinese-American Johnny Chen, a resident of Shanghai who had roomed across the hall from Liu at the Metropole. He was admitted to the French Hospital of Hanoi on February 26, where he infected at least 38 members of the staff. Even though he was evacuated to Hong Kong, he died on March 13.[7]

Dr. Carlo Urbani, a WHO infectious disease specialist, was among the staff who examined Chen. Urbani observed that other hospital staff were already falling ill and realized that he was dealing with a new and dangerous disease. He himself became infected and died on March 29.[7]

Canada[edit]

On February 23, elderly lady Kwan Sui-Chu, another Metropole Hotel guest, returned to Toronto from Hong Kong. She died at home on March 5, after infecting her son Tse Chi Kwai, who subsequently spread the disease to Scarborough Grace Hospital and died on March 13.[8]

Taiwan[edit]

On February 25, a businessman who had traveled to Hong Kong and Guangdong Province returned home to Taipei, marking the beginning of the outbreak on Taiwan. Almost all of those infected were either medical staff or family members of persons who had fallen ill. It is believed[by whom?] that the affected medical staff were unaware of the risks and were not using respiratory precautions[clarification needed], a safety protocol intended to protect medical workers from highly contagious diseases.

March 2003[edit]

Singapore[edit]

On March 1, 26-year-old Esther Mok, another Metropole guest, was admitted to Tan Tock Seng Hospital after visiting Hong Kong, starting the outbreak in Singapore. Although she recovered, various family members did not.[9]

On March 4, a 27-year-old man, who had visited a guest on the Metropole's 9th floor 11 days earlier, was admitted to Hong Kong's Prince of Wales Hospital. At least 99 hospital workers (including 17 medical students) were infected while treating him.[10]

Thailand[edit]

On March 11, Dr. Carlo Urbani travelled to Bangkok, Thailand to attend a medical conference. He fell ill during the flight and told a friend waiting at Bangkok not to touch him, to call an ambulance and take him to a hospital. He was isolated in an Intensive Care Unit.

A similar outbreak of a mysterious respiratory infection was reported among Hong Kong healthcare workers.

On March 12, WHO issued a global alert about a new infectious disease of unknown origin in both Vietnam and Hong Kong.

On March 15, WHO issued a heightened global health alert about a mysterious pneumonia with a case definition of SARS after cases in Singapore and Canada were also identified. The alert included a rare emergency travel advisory to international travelers, healthcare professionals, and health authorities.

The Center for Disease Control (CDC) issued a travel advisory stating that persons considering travel to the affected areas in Asia (Hong Kong, Singapore, Vietnam, and China) should not go.

On March 17, an international network of 11 laboratories was established to determine the cause of SARS and develop potential treatments.

The CDC held its first briefing on SARS and said that 14 suspected SARS cases were being investigated in the US.

On March 20, WHO reported that several hospitals in Vietnam and Hong Kong were operating with half the usual staff because many workers stayed home out of fear of getting infected. WHO raised the concern that substandard care of the infected patients might contribute to the spread of the disease.

On March 25, Hong Kong authorities stated that nine tourists had contracted the disease from a mainland Chinese man who had boarded the same plane on 15 March, Air China Flight 112 to Beijing.[11] SARS started to hit Amoy Gardens Block E heavily.

The Singapore Government started to enforce compulsory quarantine of any infected person.

On March 27, Arthur K. C. Li, head of the Hong Kong Education and Manpower Bureau, announced cancellation of all classes in educational institutions. The Ministry of Education of Singapore announced that all primary schools, secondary schools, and junior colleges were to be shut until April 6, 2003. Polytechnics and universities were not affected.[12]

On March 29, Dr. Urbani died in Bangkok of a massive heart attack.

On March 30, Hong Kong authorities quarantined estate E of the Amoy Gardens housing estate due to a massive (200+ cases) outbreak in the building. The balcony was completely closed and guarded by the police. The residents of the building were later transferred to the quarantined Lei Yue Mun Holiday Camp and Lady MacLehose Holiday Village on April 1 because the building was deemed a health hazard.

Most of the cases were linked to apartments with a north-western orientation which shared the same sewage pipe. According to government officials, the virus was brought into the estate by an infected kidney patient (the type of kidney illness was not specified) after discharge from Prince of Wales Hospital, who visited his elder brother living on the seventh floor. Through excretion, the virus spread through drainage. One theory speculated that the virus was spread by airborne transmission, through dried up U-shaped P-traps in the drainage system which a maritime breeze blew into the estate's balconies and stairwell ventilation. It was confirmed that the virus spread via droplets, but this later outbreak made officials question the possibility that the virus could be spread through the air.

April 2003[edit]

On April 1, the U.S. government called back non-essential personnel in their consulate office in Hong Kong and Guangzhou. The US government also advised US citizens not to travel to the region.

On April 2, Chinese medical officials began reporting the status of the SARS outbreak. China's southern Guangdong province reported 361 new infections and 9 new deaths, increasing the total Mainland China figures previously reported at end-February. The virus was also detected in Beijing and Shanghai. The WHO also advised travellers to avoid Hong Kong and Guangdong during a press briefing.[13]

On April 3, a WHO team of international scientists landed in Guangzhou from Beijing to discuss with officials, but the team was yet to inspect any suspected origin or any medical facilities on the progress of infection control. Fifteen of the quarantined Amoy Gardens residents at Lei Yue Mun Holiday Camp were relocated to the Sai Kung Outdoor Recreation Centre after an overnight protest on washroom sharing. The first medical worker infected with SARS died in Hong Kong. The doctor's daughter and infected wife survived his illness, even though the wife was also among the quarantined medical workers under intensive care. Hong Kong school closures were extended by two weeks to April 21.

On April 4, the WHO team inspected the first infection case in Foshan County. The male infected four people. But, he did not infect his family. A 40-year-old woman became the first local case in Shanghai. A Chinese health specialist admitted at a press conference of not informing the public early enough about the outbreak. The PRC Health Minister also claimed that the disease has been under control in most parts of mainland China. He also released the names of seven drugs which he claimed to be effective in curing SARS. WHO officials said that the information provided by the PRC about the disease has been "very detailed".[citation needed] US government enforced compulsory quarantine of an infected person.

On April 5, the Singapore government announced that school closures would be extended. Junior colleges were to reopen on April 9, secondary schools would reopen on April 14 and primary schools and pre-schools would reopen on April 16.[14]

On April 6, a SARS case was found in Manila, a person who had returned from Hong Kong.

On April 8, SARS started to plague the Lower Ngau Tau Kok Estate near Amoy Gardens in Kowloon. Hong Kong health officials warned that SARS had spread so far domestically and abroad that it was here to stay. Nevertheless, WHO officials remained cautiously optimistic that the disease could still be contained.[15]

On April 9, James Earl Salisbury died of SARS at a hospital in Hong Kong. An American Mormon[16] and a teacher at Shenzhen Polytechnic,[17] he had been sick for approximately one month before his death,[18] but he was originally diagnosed with pneumonia.[19] His son Michael "Mickey" Salisbury was with him in China and also contracted the disease, but he survived it.[20] Salisbury's death led to more open admissions by the Chinese government about the spread of SARS.[21]

On April 10, Jim Hughes, the head of infectious disease at the CDC, confirming the warnings of Hong Kong health officials, claimed that he believed that SARS could no longer be eradicated in the Far East. However, he remained hopeful that it could be prevented from spreading widely in North America.[22]

On April 11, the World Health Organization issued a global health alert for SARS as it became clear the disease was being spread by global air travel.

On April 12, Marco Marra, director of the Michael Smith Genome Sciences Centre, which is part of the British Columbia Cancer Agency, announced that scientists at his centre had broken the genetic code of the virus suspected of causing the disease.[23] In Toronto, three more people died of SARS, bringing the Canadian death toll to 13.

On April 16, the WHO issued a press release stating that the coronavirus identified by a number of laboratories was the official cause of SARS. The virus was officially named the SARS virus.[24]

Doctors were surprised to discover the occurrence of at least two cases of SARS in Dinner, a village near Bangalore, India. Poor hygiene and a lack of adequate trash disposal seemed to have hastened the spread of the deadly disease.

On April 19, Premier of the People's Republic of China Wen Jiabao announced that there would be severe consequences for local officials who do not report SARS cases in a timely and accurate manner, signaling a major change in policy. (SARS had also been gaining prominence in the mainland Chinese media; by late April, it had jumped from virtual invisibility onto the front-page, with daily reports from all provinces on new cases and measures.)

On April 20, Beijing's mayor Meng Xuenong and the health minister of the PRC Zhang Wenkang were replaced respectively by Wang Qishan from Hainan and the former deputy health minister Gao Qiang. They were the first two high-rank officials in the PRC to be dismissed because of the fallout of the epidemic. In the news conference chaired by Gao Qiang several hours earlier, the PRC admitted that in Beijing there were more than 300 cases, as opposed to the previous figure of only 37. One day later the figure had increased to 407. Chinese officials also admitted to major underreporting of cases, which were attributed to bureaucratic ineptitude.

On April 22, schools, in Hong Kong, started to reopen in stages.

On April 23, Beijing announced that all primary and secondary schools would be closed for two weeks. A few days before, some colleges in Peking University had been closed because some students had been infected. The WHO issued travel advisories against Beijing, Toronto, and Shanxi Province.[25][26]

On April 25, Taipei city government closed Taipei Municipal Hospital Hoping branch, and quarantined its 930 staff and 240 patients for 2 weeks.[27] Later, people were relocated and the building sanitized.

On April 24, the Hong Kong Government announced an HK$11.8 billion relief package designed to assist Hong Kong's battered tourism, entertainment, retail, and catering sectors, consisting of a waiver of tourism- and transport-related license fees, and HK$1 billion allocated for tourism promotion overseas. The package also includes a salaries tax rebate and reduced rates.

On April 26, Wu Yi was named Zhang Wenkang's replacement as PRC health minister.

On April 26–27, Chinese authorities closed down theatres, discos, and other entertainment venues in Beijing as the death toll in Beijing continued to rise, threatening to become the worst-hit area of the country, eclipsing the Guangdong province. Authorities were bolstered by the fact that the infection rate seemed to have declined, with the Guangdong region only exporting three new infections over the weekend. The economic impact was becoming dramatic as shops, restaurants, markets, bars, universities, schools, and many other businesses had closed, while some government ministries and large state banks were working with minimal staff levels.

On April 28, WHO declared the outbreak in Vietnam to be over as no new cases were reported for 20 days.

On April 29, leaders of member countries of ASEAN and the PRC premier held an emergency summit in Bangkok, Thailand in order to address the SARS problem. Among the decisions made were the setting-up of a ministerial-level task force and uniform pre-departure health screening in airports.

On April 30, the World Health Organization lifted the SARS travel warning for Toronto. The decision was made because "it is satisfied with local measures to stop the spread of SARS". Canadian officials said they would step up screenings at airports.[28]

May 2003[edit]

On May 3, the 2003 FIFA Women's World Cup was abruptly moved to the United States due to the outbreak. China maintained its automatic qualification and later hosted the Women's World Cup 4 years later.

On May 4, the newly infected number of people in Hong Kong dropped to a single digit.

On May 19, the WHO Annual Meeting was held in Geneva. Hong Kong pushed for the Tourism Warning to be lifted.

On May 20, the WHO refused to lift the Tourism Warning for Hong Kong and Guangdong.

On May 23, after a recount of the number of SARS patients, the WHO lifted the Tourism Warning from Hong Kong and Guangdong.

On May 24, the number of newly infected patients reached zero for in Hong Kong, the first time since the outbreak in the territory in March.

On May 24, a new cluster of about 20 suspected patients was reported in Toronto.

By May 29, more than 7,000 people were instructed to quarantine themselves in Canada by authorities seeking to control the potential spread of the SARS outbreak.[29]

On May 31, Singapore was removed from WHO's list of 'Infected Areas'.

June 2003[edit]

On June 23, Hong Kong was removed from WHO's list of 'Affected Areas', while Toronto, Beijing, and Taiwan remained.

On June 27, the World Health Organization stated that the world population should be SARS-free within the next two to three weeks, but warned the disease could emerge in China next winter.[citation needed]

July 2003[edit]

On July 5, WHO declared the SARS outbreak contained and removed Taiwan from the list of affected areas. There had been no new cases for 20 days although around 200 people were still hospitalized with the disease.

September 2003[edit]

On Sep 8, Singapore announced that a post-doctoral worker in a SARS research lab in the National University of Singapore had contracted the disease while working on the West Nile virus but recovered shortly thereafter. It was suspected that the two viruses mixed while he was doing his research.

October/November 2003[edit]

The Hong Kong Harbour Fest was organized and held from 17 October to 11 November 2003 as part of an HK$1 billion program to revive the economy of Hong Kong after the SARS. It was a government underwritten event organized by InvestHK, under the auspices of the Economic Relaunch Working Group, in collaboration with the American Chamber of Commerce.

December 2003[edit]

On Dec 10, a researcher in a SARS lab in Taiwan was found infected with SARS after returning from Singapore attending a medical conference, 74 people in Singapore were quarantined but none of them was infected.

On Dec 27, China announced the first suspected case of SARS in six months in Guangdong in an individual who was not a SARS researcher.

January 2004[edit]

January 2: Shenzhen's bid for the 2009 Summer Universiade was cancelled, and announced a bid for the 2011 Summer Universiade by FISU.

January 5: China confirmed that the case reported in December was a case of wild source SARS. The Philippines announced a possible case in a person just returned from Hong Kong.

January 7: The Philippines announced that their possible SARS case was just pneumonia. In China, Asian palm civets were culled in markets (the civets were thought to be a reservoir for the disease).

January 10: A restaurant worker in Guangdong was confirmed as the second wild source SARS since the outbreak was contained. Guangzhou was also the site of the first case in December and was thought to be the origin of the virus in the original outbreak. Three Hong Kong television reporters who visited SARS-related sites in Guangzhou were declared free of the disease.

January 17: China announced a third case of SARS in Guangzhou. WHO officials urged more testing to bring the three recently announced cases into line with their standards; however they also announced SARS virus had been detected by a WHO team in civet cages at the restaurant where the second case worked and in civet cages in the market.

January 31: China announced the fourth case of SARS as a 40-year-old doctor from the southern city of Guangzhou, and gave his family name as Liu. He was discharged when the announcement was made.

April 2004[edit]

SARS broke out again in Beijing and in Anhui Province. On April 22, China announced that a 53-year-old woman had died on April 19, its first SARS death since June. One person died and nine were infected in the outbreak which was first reported on April 22.[30] The first 2 infected cases involved a postgraduate student and a researcher at the National Institute for Viral Disease Control and Prevention (abbrev.: Institute of Virology) of the Chinese Center for Disease Control and Prevention; an additional 7 cases were diagnosed, which were linked with close personal contact with the student, the lab or with a nurse who treated the student.[31].

May 2004[edit]

May 1: Two additional confirmed cases of SARS and three additional suspected cases were reported in Beijing, all related to a single research lab, the Diarrhea Virus Laboratory in the CDC's National Institute of Virology in Beijing.[32] "The cases had been linked to experiments using live and inactive SARS coronavirus in the CDC's virology and diarrhea institutes where interdisciplinary research on the SARS virus was conducted."[33] The total number of cases was six, with four in Beijing and two in Anhui Province.

May 2: China announced the three suspected cases as genuine cases of SARS, bringing the total cases in a recent outbreak to nine. 189 people were released from quarantine.

May 18: As no new infections had been reported in a three-week period, WHO announced China as free of further cases of SARS, but "but biosafety concerns remain".[34]

Subsequent status[edit]

Status of SARS as of May 15, 2005[edit]

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."[35]

See also[edit]

References[edit]

Citations[edit]

  1. ^ Severe Acute Respiratory Syndrome (SARS) – multi-country outbreak – Update 6. World Health Organization {www.who.int), accessed 22 January 2020
  2. ^ Cyranoski, D. (2003). "China joins investigation of mystery pneumonia". Nature. 422 (6931): 459. Bibcode:2003Natur.422..459C. doi:10.1038/422459b. PMID 12673214.
  3. ^ Rosenthal, E.; Altman, L. K. (March 27, 2003). "China Raises Tally of Cases and Deaths in Mystery Illness". The New York Times. Retrieved March 11, 2009.
  4. ^ "IDEESE Case: SARS". Retrieved 20 April 2015.
  5. ^ Peter McGrath (February 12, 2013). "Scientists wait for next mass killer to spill over from nature" (Zhou is erroneously named Zhou Zoufeng in the article). The Yorkshire Post. Retrieved January 26, 2020.
  6. ^ Abraham, Thomas (2004). Twenty-first Century Plague: The Story of SARS. archive.org. Retrieved 22 January 2020.
  7. ^ a b c Khan, Ali S. & Patrick, William. (2016). “The Next Pandemic.” New York: PublicAffairs.
  8. ^ Low, Donald (2004). Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary.
  9. ^ Yeoh, En-Lai (2003-04-09). "Singapore Woman Linked to 100 SARS Cases". Associated Press.
  10. ^ "Update: Outbreak of Severe Acute Respiratory Syndrome --- Worldwide, 2003". Retrieved 20 April 2015.
  11. ^ Koh, D.; Lim, M. K. (1 August 2003). "SARS and occupational health in the air". Occupational and Environmental Medicine. 60 (8): 539–540. doi:10.1136/oem.60.8.539. ISSN 1351-0711. PMC 1740596. PMID 12883012.
  12. ^ "Closure of schools: Joint Press Release by MOE and MOH". NAS. 26 March 2003. Retrieved 15 January 2020.
  13. ^ Severe Acute Respiratory Syndrome - Press briefing 1 April 2003 www.who.int, accessed 22 January 2020
  14. ^ "Phased Reopening of Schools". NAS. 5 April 2003. Retrieved 15 January 2020.
  15. ^ Keith Bradsher With Lawrence K. Altman: Asian Officials Say Mysterious Disease May Be Here to Stay 9 April 2003 www.nytimes.com, accessed 22 January 2020
  16. ^ "Church Member Dies of SARS", 11 April 2003, lds.org, accessed 22 January 2020
  17. ^ "Panic as China's SARS toll rises". www.theage.com.au. 12 April 2003. Retrieved 20 April 2015.
  18. ^ Doctor accuses China of covering up SARS outbreak
  19. ^ Reported on CBS's The Early Show Tatiana Morales: American Family Affected By SARS 11 April 2003, www.cbsnews.com, accessed 22 January 2020
  20. ^ "American SARS boy back home [SOUTHCN.COM]". www.newsgd.com. Retrieved 20 April 2015.
  21. ^ "CNN.com - Timeline: SARS outbreak - Apr. 24, 2003". edition.cnn.com. Retrieved 20 April 2015.
  22. ^ Sars illness 'not under control' 11 April 2003, bbc.co.uk, accessed 22 January 2020
  23. ^ Scientists claim SARS breakthrough 14 April 2003, Archived from www.abc.net.au, accessed 22 January 2020
  24. ^ Coronavirus never before seen in humans is the cause of SARS Unprecedented collaboration identifies new pathogen in record time Geneva, 16 April 2003, www.who.int, accessed 22 January 2020
  25. ^ [1] smilingsquad.com[dead link]
  26. ^ [2] 10 February 2020 smilingsquad.com, accessed 26 January 2020
  27. ^ Chang Yun-ping (2003-04-25). "SARS epidemic: Taipei City closes down hospital". Taipei Times. Retrieved 22 January 2020.
  28. ^ Toronto travel warning lifted 30 April 2003, news.bbc.co.uk, accessed 22 January 2020
  29. ^ Cohen, Tom (29 May 2003). "Canada Broadens Definition of SARS Cases". Kansas City Star. Associated Press. Archived from the original on 30 October 2004.
  30. ^ Zhang, Feng (2004-07-02). "Officials punished for SARS virus leak". China Daily (2004–07–02).
  31. ^ Stephenson, Joan (2 June 2004). "SARS in China". JAMA. 291 (21): 2534. doi:10.1001/jama.291.21.2534-d.
  32. ^ Liang, WN; et al. (2006). "Severe acute respiratory syndrome--retrospect and lessons of 2004 outbreak in China". Biomed Environ Sci. 19 (6): 445–51. PMID 17319269.
  33. ^ Zhang, Feng. "Officials punished for SARS virus leak". China Daily. Retrieved 14 February 2020.
  34. ^ WHO. "China's latest SARS outbreak has been contained, but biosafety concerns remain – Update 7". World Health Organization. Retrieved 14 February 2020.
  35. ^ Jim Yardley: After Its Epidemic Arrival, SARS Vanishes 15 May 2005 New York Times, accessed 22 January 2020

Sources[edit]