EVEN as the first reports trickled in of a mysterious, flu-like disease killing people in China, alarm bells started ringing. Was SARS the start of the 鈥渂ig one鈥� 鈥� the flu pandemic that is expected to surface sometime soon in Asia, a rival for the 1918 outbreak that killed at least 20 million people?
In the end, there was no global catastrophe. Caused by a coronavirus, severe acute respiratory syndrome affected a reported 8098 people, killing 774 of them. But though that hardly compares to the hundreds of thousands of deaths flu causes each year, the social effects of the SARS epidemic have been astonishing. Over the past year I鈥檝e watched in awe as the disease has triggered panic, shaken up political systems and paralysed the Asian economy.
It started back in November 2002, with unsettling rumours of a mystery respiratory illness in China鈥檚 Guangdong province. That China might cover up a major disease outbreak and put the world at risk had always worried the experts, and initially that is exactly what happened. But after three months in denial the Chinese government cracked. On 11 February this year, it reported an outbreak of 鈥渦nexplained pneumonia鈥� to the World Health Organization, although that was too late to prevent the spread of the disease to 29 countries, including Vietnam, Singapore and Canada. Then in April the government sacked its health minister, Zhang Wenkang.
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The move signalled a new era of Chinese cooperation in the fight against infectious diseases. But the openness went only so far, as I soon learned when my attempts to get to the bottom of reports that people in China had been arrested for spreading 鈥淪ARS-related rumours鈥� by email ended in frustration.
Reporting on SARS also meant copping criticism for scaremongering: the loss of life is tragic, went the argument, but in the grand scheme of things the numbers were too low to warrant the coverage and concern. In response I鈥檇 make three points: one, it is only with hindsight we know SARS wasn鈥檛 the 鈥渂ig one鈥�; two, it had to be taken seriously from the start precisely to prevent a catastrophic pandemic; three, SARS could yet explode.
No one knows for sure why the epidemic fizzled out, but many experts expect SARS to resurface at some point. Once again, those historic flu pandemics come to mind. The first flu season of 1918 was bad but not catastrophic. Then things went quiet for six months or so as the virus appeared to mutate, before returning with a vengeance and going on to cause the worst human epidemic on record.
Thanks to a huge biomedical effort, we鈥檝e got a head start on SARS. And as a journalist living in Melbourne, Australia, far from the European and American research powerhouses, it was refreshing to see scientists in Singapore and Hong Kong steal the limelight for a change. Within weeks, Asian researchers had identified the infectious agent and its animal carriers, developed blood tests, worked out how the virus spread, and found new ways to treat patients. Less than a month after the virus was identified, its genome had been sequenced by several teams worldwide. Sequences of over 30 isolates are now available and are helping researchers track how the disease spread around the world.
Candidate vaccines based on killed virus are already being tested in the lab. Meanwhile drug researchers are focusing on betainterferon, which may interfere with the replication of the virus, and glycyrrhizin, a component of liquorice roots, which also has an effect on HIV.
Even so, if the disease reappears in the next few months, we won鈥檛 be ready. Again we鈥檒l have to rely on primitive quarantine measures to contain it. Even if the virus lies dormant for a few years before reemerging we could still be in trouble. With no great economic incentive for drug companies to invest in SARS research, the danger is that the work into drugs and vaccines will stagnate. Those alarm bells are still ringing.