SARS

1. SARS By: Benjamin Weng, Darren Ramcharan, Gurjot Goraya, Jagpreet Kaler, Pannya Bansal, Winnie Ma

2. Guiding Question To what extent did the SARS epidemic act as a learning experience for future responses to global epidemics?

3. What is SARS? Background information • Stands for Severe Acute Respiratory Syndrome • It is a viral infection similar to the flu virus and Pneumonia, but worsens within days • It needs a living host

4. What is SARS? continued • Very contagious • 50% of people who come in contact with a patient gets infected with the virus • Lethal for 15% of the patients

5. What caused SARS? • SARS is the result of being infected with the SARS coronavirus (SARS-CoV) • It is believed to have transferred to a human host from an animal host (the Paguma larvata) in Guangdong, China around November 2002

6. What are Coronviruses? • Subfamily of virus • Crown/halo appearance (corona) when viewed under microscope

7. What are Coronviruses? • Common cause for mild to moderate upper respiratory illness for humans • In animals it typically causes respiratory, gastrointestinal, liver or neurologic disease

8. SARS-CoV • Cannot be killed in heat • Never seen before, • Cannot be treated with normal medication that would be used to treat pneumonia type diseases “Traditional coronavirus causes sniffles. This has turned nasty” Mike Leahy (virologist)

9. Origin of SARS-CoV • Unknown • Not related to the previously known subfamilies of coronavirus • Not a genetic recombination of 2 known coronviruses "Its unique sequence suggests that it has evolved independently from the other members of the family, in some animal host, for a long time” - Malik Peiris (a virologist at the University of Hong Kong)

10. Symptoms Background Information • High fever (greater than 38°C) • Dry cough • Shortness of breath or breathing difficulties • There may also be changes in chest X-rays which indicate pneumonia • Other symptoms include headache, muscular stiffness, confusion, rash and diarrhea, loss of appetite, malaise (feeling of discomfort)

11. TreatmentsBackground Information • A cure for SARS is yet to be found • Doctors may prescribe the following depending on the severity of the infection • Antiviral agents such as oseltamivir or ribavirin • Combination of steroids and antimicrobials may prescribe the following depending on severity of the infection • Only the symptoms can be treated, the actual virus is not killed • Scientist are researching effective treatment that would offer complete recovery

12. Preventative Measures • Flu Shots • Protect from health effects caused by the flu • Washing hands daily • Avoid traveling to SARS infected countries • Contact your health care provider for any concerns

13. For now … it is best to adopt essential preventive measures and report symptoms as early as possible -Anonymous (e-Articles)

14. Places that were affected the most severelyBackground Information • Hong Kong, China • Toronto, Canada • Singapore • Hanoi, Vietnam

15. Source: World Health Organization Map Production: Public Health Mapping Team

16. As of May 15, 2003 In China Source: Deadly Diseases and Epidemics by Joaquima Serradell

17. Trends During the Outbreak • SARS was first reported in China, however Public Health was slow to report to WHO; all governments were • Electronic Warning System detected the flu, but the internet was in its beginning years, thus flawed • They could only get limited information as there were no translation system

18. Trends During the Outbreak • Healthcare systems in Asia were flawed, thus became decentralized and bureaucratic when responding to epidemics • Canada did not have the necessary research facilities, as funding was private for the public health research

19. The Spreading of SARS Factors: • With the ease of air travel, the virus was able to spread around the world in a short period of time • The virus has an incubation* period of 10 days • The carrier could therefore travel to different place and infect others without knowing it • The symptoms of SARS are similar to those of the common flu • Doctors were unable to distinguish between the flu virus and the new SARS virus • Patients were wrongly given antibiotics in the beginning, which were ineffective *”The time that elapses between infection and the appearance of symptoms of a disease”(Serradell 98)

20. The Spreading of SARS The SARS virus spreads from person-to-person making extermination impossible. This means that a cure must be found to control the disease. • The virus is extremely contagious • A person can infect another person by touching a common object such as a door knob or through aerial transfer. • The SARS virus is able to survive several hours outside of the human body, increasing the probability of someone becoming infected through a common object

21. The Spreading of SARS • When a person carrying the SARS virus coughs or sneezes, droplets containing the virus are released. These droplets can infect other people if they breath them in • The Chinese authorities censored information about SARS • Public statements were made saying that the spread of the virus had been brought under control • The resulting lack of precaution by the public helped the virus spread further

22. The Spread of SARS in China and Canada • Population density was one of the major differences between the spread of SARS in China and Canada • SARS was more severe in China because of the population density (population density of China was 134 while the population density of Canada was 3 people per square kilometer)

23. The Spread of SARS in China and Canada The graphs shows the growth and affects of SARS in China and Canada in from April 2003 to June 2003. The numbers are based on total cases of SARS in each country indicated by the values on the Y- axis. The patterns in both graph are very similar. Major differences include a drop in SARS cases at the end of May in Canada and the magnitude of the epidemic is greater in China based on numbers.

24. How spread of SARS could have been controlled • The public was vulnerable to becoming infected because of ill-preparedness. • Quarantining people infected with SARS would contain the virus in a small area where individuals could be treated for the virus. However, the virus had already been released into public areas and was able to spread before quarantining was in full effect.

26. Reaction of the Public • People were afraid to go out into public • People would not go to cinemas, take transit or go to hotels in fear of contracting SARS • Since the elderly were more prone to death from SARS there was more panic among the group • Of a telephone survey of 396 elderly people, “about 53% reported they were fearful of getting SARS, and 46% felt they had no control over the situation.”

27. Economic Impacts for Ontario • Premier Premier Ernie Eves promised those who lost money when under quarantine would • be compensated. (including those who were self-employed) • Toronto’s hospitals would be given $25 million after the SARS outbreak was over. A $10 million campaign promoting Toronto would be launched

28. Further Economical/Financial Implications *Any index below 50 is seen as a shrinking economic condition

29. Canada’s Downturn in 2003 Major deficits could be seen in both the exporting and importing industries of Canada during the year of 2003. Source: Statistics Canada

30. Hong Kong’s Downturn in 2003 Hong Kong’s Invisible Trade Hong Kong experienced a major drop in their trade during the year of 2003 due to the SARS outbreak. Source: World Health Organization

31. Social Impacts • Decreased interaction within the society • Many were afraid to leave their house as they may catch SARS During the SARS epidemic, the subways in Beijing were almost empty The subways were usually full in Beijing before the SARS epidemic

32. Political Impacts • Governments, especially China’s, rapidly changed policies in health. They made it more centralized and simpler. • Increased government spending on healthcare and research • Increased use of monitoring systems in transportation and public facilities

33. Ethical Implications • Animal testing for SARS vaccine; we are regarding a human life as being worth more than that of an animal. Animals are being killed in an attempt to save our own. • Quarantine; people who had the virus were isolated from society (without being asked) when the virus was identified.

34. SARS Epidemic and Today One of the most recent and major outbreak was the H1N1 Pandemic during the year of 2009.

35. SARS vs. H1N1 Pandemic • In relation to SARS, the H1N1 Pandemic, or the Swine Flu was considered much less severe • “Indeed, most doctors believe H1N1 is a significantly lesser threat to the general public than SARS, and that H1N1 is more closely aligned to avian/bird flu in terms of its severity.” - CNW • “The latest A(H1N1) flu was a 'very manageable flu strain' compared to SARS." - Dr. Severin Schwan, CEO of Roche Group • Despite the high number of reported cases for the H1N1, it was not considered severe, this is due to the fact that more precautions were taken.

36. A True Learning Experience From the experience during SARS, it allowed the world to be more prepared and careful. Many doctors had stated that H1N1 Flu was not as severe, but it may have become quite severe if the SARS Epidemic had not been a learning experience for the world. SARS allowed the world to see and understand the importance of communication with others and to react quickly before the situation gets out of hand. The world became united to find a cure for SARS and the World Health Organization helped to contain the SARS virus through open sharing of ideas. Governments learned to cooperate and act more swiftly when encountered with similar situations.

37. Bibliography • Affected Areas - Severe Acute Respiratory Syndrome (SARS) [home page on the Internet]. World Health Organization; 2003 Mar. 31. [Global Alert and Response (GAR); cited 2010 Dec. 21]. [about 9 lines]. Available from: http://www.who.int/csr/sars/areas/2003_03_31/en/. • Department of Health and Human Services (United States of America) Severe Acute Respiratory Syndrome. Infection Control in Healthcare, Home, and Community Settings. Department of Health and Human Services; 2004 Jan 8. 28 p. • GMA News. A(H1N1) flu ‘very manageable’ compared to SARS - Swiss pharmaceutical exec. 2009 May 22; Accessed  2011 Jan. 4. • Health Canada (Canada) [HC]. SARS. Health Canada; 2008 July 8; Available from: http://www.hc-sc.gc.ca/hc-ps/dc-ma/sars-sras-eng.php. Accessed 2010 Dec. 2.

38. Bibliography • Health Canada (Canada) [HC]. SEVERE ACUTE RESPIRATORY SYNDROME (SARS). It’s Your Health. 2004 Apr. 2 p. • International trade in culture services [home page on the Internet]. Statistics Canada; 2006 Mar. 28. [The Daily; cited 2010 Dec. 21]. 1 p. Available from: http://www.statcan.gc.ca/daily-quotidien/060328/dq060328b-eng.htm. • Joaquima J. SARS. Philadelphia (PA): Chelsea House Publishers; 2005. 111 p. • Leung P C, Ooi E E. SARS war: Combating the Disease. Singapore: World Scientific Publishing Co.; 2003. 150 p. • Lim L. SARS: Reports from University of Hong Kong describe recent advances in SARS. Virus Weekly 2008 Sept. 30. • Lovgren S. National Geographic News. 2003 Apr. 9; Available from: http://news.nationalgeographic.com/news/2003/04/0409_030409_sars.html. Accessed  2010 Dec. 23.

39. Bibliography • Mack T. M. SARS; Research results from Singapore, Canada and the United States update understanding of SARS. Virus Weekly 2007 Jan. 9; • McLean A R. SARS: a case study in emerging infections. New York City (NY): Oxford University Press; 2005. 133 p. • Murphy F. National Center for Biotechnology Information [homepage on the Internet]. 2009 Sept. 26. [cited 2010 Dec. 19]. Available from: http://www.ncbi.nlm.nih.gov/genomes/SARS/SARS.html. • Pacheco P. H1N1 flu virus not an extremely serious condition, most doctors say. 2009 May 29; Available from: http://www.newswire.ca/en/releases/archive/May2009/29/c8854.html. Accessed 2011 Jan. 5.

40. Bibliography • Painful side-effects. The Economist 2003 May 5; Available from: http://www.economist.com/node/1747241. Accessed  2010 Nov. 20. • Public Health Agency of Canada (Canada) Ethical Issues and Lessons from the SARS Outbreak. Learning from SARS. 2004 Nov 8. 1 p. Available from: Canada. • The Economic Impact of SARS [homepage on the Internet]. Toronto (On): CBC News; 2003 July 8. [cited 2010 Dec. 6]. Available from: http://www.cbc.ca/news/background/sars/economicimpact.html • The Economy in 2003 [home page on the Internet]. Hongkong: Hongkong Yearbook; 2003. [The Economy; cited 2010 Dec. 27]. [about 41 paragraphs]. Available from: http://www.yearbook.gov.hk/2003/english/chapter03/03_02.html.

41. Bibliography • Timeline 2010. World Health Organization; 2010. [cited 2011 Jan. 6]. [about 184 lines]. Available from: http://www.who.int/csr/don/archive/year/2010/en/index.html. • WHO guidelines for the global surveillance of severe acute respiratory syndrome (SARS) [home page on the Internet]. World Health Organization; 2004 Oct. [cited 2010 Dec. 12]. 38 p. Available from: http://www.who.int/csr/resources/publications/WHO_CDS_CSR_ARO_2004_1.pdf