May 2, 2003
by Stuart Brown, Editor
FirstScience.com
SARS (Severe Acute Respiratory Syndrome) is the current de-rigeur 'killer virus'. It is only about six weeks from reports of the first cases to today. And yet it is the subject of untold column inches, and television programmes, with world maps in newspapers showing its insidious spread around the globe.
Until very recently, such well known third world health black-spots as Toronto in Canada, were on the World Health Organizations non-essential travel list (subsequently revoked). And even now, as much of the world seems to be recovering and getting SARS under control, other parts of the world like China and Hong Kong are struggling to contain it. It remains to be seen how SARS will play out. It is early days to discuss its long-term ramifications. What is clear however is that the threat from rogue viruses is a very real one. These evolutionary timebombs explode in our midst every so often, and are likely to become ever more prevalent in the face of burgeoning and mobile populations, and greater population densities.
As of the 30th April 2003 there are 5663 reported cases of SARS worldwide, with 372 deaths. Of these, 1589 cases are in Hong Kong, and 3460 in China. 316 of the dead are from these areas. (Full country breakdown here) This means that there are only 614 confirmed cases in countries outside of these two, and only 56 deaths. To further get these figures into perspective, consider that the World Health Organisation (WHO) estimated deaths from smoking to be 3.5 million a year in 1997, with an estimated 2000 people dieing in China each day from smoking related diseases. Allergic reactions to common medicines cause more deaths then SARS has so-far exhibited. Anaphylactic reactions to penicillin cause 400 deaths annually among Americans, and aspirin, although in many other ways a wonder drug, causes 500 deaths a year in the US in children under 6 through overdosing. So are we getting carried along with the SARS hype?
SARS is not the first 'killer virus', and will undoubtedly not be the last. History has a habit of knocking down those that ignore the lessons it teaches. In 1918 a strain of influenza hit the world like a thunderbolt. An estimated twenty five times more deadly than normal influenza, it was fatal in around 2.5% of cases and has been estimated to have killed anywhere between 20 and a 100 million people worldwide. To get that in perspective, somewhere around 28.5 million people are estimated to have been killed in the two world wars combined. Global population in 1918 was around the 1.8 billion mark, whereas now it is estimated at about 6.3 billion. The very real fear is that with a worldwide population that is over three times larger than the 1918 influenza outbreak, any virus that takes hold with anything like the same ferocity could potentially be catastrophic.
SARS currently has a death rate of about 6% of those who catch it succumbing to it; but in some areas, like Beijjing in China, the rate seems to be climbing up to 10%. There is also the problem of air travellers acting like latter day 'plague rats', and spreading the virus; and so the WHO is right to nip tragedy in the bud and stop SARS flowering out of control. In 1918 the death rate may have been much lower (2.5%), but those affected was much higher. More than 20% of the worlds population became ill. If these figures were repeated today more than 1.2 billion people would be ill; or in other words the approximate population of North America and Europe combined.
Ominously, the influenza of 1918 came in two waves. The first lasted a few months from February 1918 when the coastal town of San Sebastien in Spain started to come down with flu. People weren't dying at this stage, they experienced just a few days of illness, but nevertheless the rate of spread was unusually fast.
March 15th at Fort Riley in Kansas and an Army private reported flu symptoms, soon to be followed that day by a hundred similar cases. Suddenly cases were popping up everywhere. In San Quentin prison during April and May, 500 of 1,900 prisoners become ill. It spreads to France and the UK; where King George V catches what has become known as 'Spanish Flu'. A German general complains that it is affecting his countries battle plans due to sick men. And yet although the sufferers are ill it seems no different from any 'normal' flu. Fever, sore throats and headaches; yes. But not abnormal death rates. Certainly unusual and out of the ordinary in its rate of spread, but not catastrophic. Not by a long shot. That would come later.
Then, as quick as it had descended it seemed to dissappear. Just another passing fad in a world burdened with death through war. And yet the vision of death was destined to resurface in its second wave, and this time things would be different. It was still unusually contagious, but this time the cough and the high fever were accompanied with lung problems in about 80% of the cases. The lungs would either be weakened and attacked by bacteria, or else they would fill with fluid which would affect the capacity of the patient to breathe. The patients would also suffer from pneumonia. The death rate was now 25 times that of the earlier outbreak (2.5% as opposed to 0.1%), and the period to recover, even if you didn't die, was longer. By August much of Asia and Japan were affected, and troop movements as a result of the war were helping it to spread around the world. In late August it came to the United States via a group of sailors coming into Boston, and soon it was spreading like wildfire. First west into Massachusetts, and then into other Army camps. By September it was rampant. On the 28th of September 1918, 200,000 people gathered in Philadelphia for a rally, and within days 635 new cases were reported. In October 1918 alone 195,000 Americans would die from this new strain of influenza, and before it dissappeared in mid-1919 around 800,000 Americans would be dead.
The same story was repeated in countries around the world. It first appeared in Britain in Glasgow in May 1918, and during the next few months would go on to kill an estimated 228,000 people. In Germany over 400,000 people died in 1918, and a further 8 million were ill in Spain.. However, of all the countries India suffered most from the influenza pandemic with around 16 million deaths. That is almost twice the 8.5 million people that died globally in the First World War.
Then suddenly, in mid 1919 it dissappeared, never to show up again. It was then not until 1997, when the lungs of an eighteen-year-old soldier, Roscoe Vaughan, killed by the disease in September 1918, were used to obtain the genetic code of the disease. It was found that the disease started as a virus passed from birds to pigs. The pig immune system had forced the virus to mutate in order to survive, and it then infected humans. Again, this has alarming parallels to the SARS virus, which it is now believed might have originated with chickens in China.
As a result of the Influenza Pandemic in 1918, President Woodrow Wilson invested money into research into influenza and a vaccination program was begun. The Armistice Day celebrations of November 1918 were a public health disaster which helped to spread the flu amongst the enormous crowds. And we can see the 10 day quarantine measures that have been imposed in the wake of the SARS outbreak, and the attempts to stop public meetings and communal activities in affected areas as an approving nod to lessons learned from those times.
Whether the health authorities will be able to contain and control SARS remains to be seen. But that they should be given our full support to try everything in their power to stem the tide of the outbreak has the firm approval of history.
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