Severe acute respiratory syndrome

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Severe acute respiratory syndrome
Coronaviruses 004 lores.jpg
SARS coronavirus (SARS-CoV) is causative of the syndrome.
Specialty Infectious disease

Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the SARS coronavirus (SARS-CoV). Between November 2002 and July 2003, an outbreak of SARS in southern China caused an eventual 8,098 cases, resulting in 774 deaths reported in 37 countries, [1] with the majority of cases in China and Hong Kong [2] (9.6% fatality rate) according to the World Health Organization (WHO). [2] No cases of SARS have been reported worldwide since 2004. [3] In late 2017, Chinese scientists traced the virus through the intermediary of civets to cave-dwelling horseshoe bats in Yunnan province. [4]

Respiratory disease disease of the respiratory system

Respiratory disease, or lung disease, is a medical term that encompasses pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, and the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, acute asthma and lung cancer.

World Health Organization Specialized agency of the United Nations

The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations.

Horseshoe bat family of mammals

Horseshoe bats make up the bat family Rhinolophidae. In addition to the single living genus, Rhinolophus, one extinct genus, Palaeonycteris, has been recognized. The closely related Hipposideridae are sometimes included within the horseshoe bats as a subfamily, Hipposiderinae. Both families are classified in the suborder Yinpterochiroptera or Pteropodiformes and were previously included in Microchiroptera.


Signs and symptoms

Initial symptoms are flu-like and may include fever, muscle pain, lethargy symptoms, cough, sore throat, and other nonspecific symptoms. The only symptom common to all patients appears to be a fever above 38 °C (100 °F). SARS may eventually lead to shortness of breath and pneumonia; either direct viral pneumonia or secondary bacterial pneumonia.[ citation needed ]

Influenza-like illness

Influenza-like illness (ILI), also known as flu-like syndrome/symptoms, is a medical diagnosis of possible influenza or other illness causing a set of common symptoms.

Myalgia, or muscle pain, is a symptom that presents with a large array of diseases. While the most common cause is the overuse of a muscle or group of muscles, acute myalgia may also be due to viral infections, especially in the absence of a traumatic history. Longer-term myalgias may be indicative of a metabolic myopathy, some nutritional deficiencies, or chronic fatigue syndrome.

Lethargy is a state of tiredness, weariness, fatigue, or lack of energy. It can be accompanied by depression, decreased motivation, or apathy. Lethargy can be a normal response to inadequate sleep, overexertion, overworking, stress, lack of exercise, improper nutrition, boredom, or a symptom of an illness or a disorder. It may also be a side-effect of medication or caused by an interaction between medications or medication(s) and alcohol. When part of a normal response, lethargy often resolves with rest, adequate sleep, decreased stress, physical exercise and good nutrition. Lethargy's symptoms can last days or even months.

The average incubation period for SARS is 4–6 days, although rarely it could be as short as 1 day or as long as 14 days. [5]

Incubation period time between an infection and the onset of disease symptoms

Incubation period is the time elapsed between exposure to a pathogenic organism, a chemical, or radiation, and when symptoms and signs are first apparent. In a typical infectious disease, incubation period signifies the period taken by the multiplying organism to reach a threshold necessary to produce symptoms in the host.


The primary route of transmission for SARS is contact of the mucous membranes with respiratory droplets or fomites. Whilst diarrhoea is common in people with SARS, the fecal-oral route does not appear to be a common mode of transmission. [5] The basic reproduction number of SARS, R0, ranges from 2 to 4 depending on different analyses. Control measures introduced in April 2003 reduced this down to 0.4. [5]

In medicine, public health, and biology, transmission is the passing of a pathogen causing communicable disease from an infected host individual or group to a particular individual or group, regardless of whether the other individual was previously infected.

Fomite non living object capable of carrying infectious agent

A fomes or fomite is any inanimate object, that when contaminated with or exposed to infectious agents, such as pathogenic bacteria, viruses or fungi, can transfer disease to a new host.

Fecal–oral route Disease transmission via pathogens from fecal particles

The fecal–oral route describes a particular route of transmission of a disease wherein pathogens in fecal particles pass from one person to the mouth of another person. Main causes of fecal–oral disease transmission include lack of adequate sanitation, and poor hygiene practices. If soil or water bodies are polluted with fecal material, humans can be infected with waterborne diseases or soil-transmitted diseases. Fecal contamination of food is another form of fecal-oral transmission. Washing hands properly after changing a baby's diaper or after performing anal hygiene can prevent foodborne illness from spreading.


A chest X-ray showing increased opacity in both lungs, indicative of pneumonia, in a patient with SARS SARS xray.jpg
A chest X-ray showing increased opacity in both lungs, indicative of pneumonia, in a patient with SARS

SARS may be suspected in a patient who has:

  1. Contact (sexual or casual) with someone with a diagnosis of SARS within the last 10 days or
  2. Travel to any of the regions identified by the World Health Organization (WHO) as areas with recent local transmission of SARS (affected regions as of 10 May 2003 were parts of China, Hong Kong, Singapore and the town of Geraldton, Ontario, Canada).

For a case to be considered probable, a chest X-ray must be positive for atypical pneumonia or respiratory distress syndrome.

Atypical pneumonia, also known as walking pneumonia, is the type of pneumonia not caused by one of the pathogens most commonly associated with the disease. Its clinical presentation contrasts to that of "typical" pneumonia. A variety of microorganisms can cause it. When it develops independently from another disease, it is called primary atypical pneumonia (PAP).

The WHO has added the category of "laboratory confirmed SARS" for patients who would otherwise be considered "probable" but who have not yet had a positive chest X-ray changes, but have tested positive for SARS based on one of the approved tests (ELISA, immunofluorescence or PCR). [6]

The appearance of SARS in chest X-rays is not always uniform but generally appears as an abnormality with patchy infiltrates. [7]


There is no vaccine for SARS. Isolation and quarantine remain the most effective means to prevent the spread of SARS. Other preventative measures include:

Many public health interventions were made to try to control the spread of the disease, which is mainly spread through respiratory droplets in the air. These interventions included earlier detection of the disease; isolation of people who are infected; droplet and contact precautions; and the use of personal protective equipment (PPE), including masks and isolation gowns. [9] A screening process was also put in place at airports to monitor air travel to and from affected countries. [10] Although no cases have been identified since 2004, the CDC is still working to make federal and local rapid response guidelines and recommendations in the event of a reappearance of the virus. [11]

SARS is most infectious in severely ill patients, which usually occurs during the second week of illness. This delayed infectious period meant that quarantine was highly effective; people who were isolated before day five of their illness rarely transmitted the disease to others. [5]


Award to the staff of the Hopital Francais de Hanoi for their dedication during the SARS crisis Acte de courage et de devouement.jpg
Award to the staff of the Hôpital Français de Hanoï for their dedication during the SARS crisis

Antibiotics are ineffective, as SARS is a viral disease. Treatment of SARS is mainly supportive with antipyretics, supplemental oxygen and mechanical ventilation as needed. Antiviral medications are used as well as high doses of steroids to reduce swelling in the lungs.

People with SARS must be isolated, preferably in negative pressure rooms, with complete barrier nursing precautions taken for any necessary contact with these patients, to limit the chances of medical personnel getting infected with SARS.

Some of the more serious damage caused by SARS may be due to the body's own immune system reacting in what is known as cytokine storm. [12]

As of 2017, there is no cure or protective vaccine for SARS that has been shown to be both safe and effective in humans. [13] The identification and development of novel vaccines and medicines to treat SARS is a priority for governments and public health agencies around the world. MassBiologics, a non-profit organization engaged in the discovery, development and manufacturing of biologic therapies, is cooperating with researchers at NIH and the CDC in developing a monoclonal antibody therapy that demonstrated efficacy in animal models. [14] [15] [16]


Several consequent reports from China on some recovered SARS patients showed severe long-time sequelae. The most typical diseases include, among other things, pulmonary fibrosis, osteoporosis, and femoral necrosis, which have led to the complete loss of working ability or even self-care ability of these cases. As a result of quarantine procedures, some of the post-SARS patients have been documented suffering from posttraumatic stress disorder (PTSD) and major depressive disorder. [17] [18]


SARS was a relatively rare disease; at the end of the epidemic in June 2003, the incidence was 8422 cases with a case-fatality rate of 11%. [9]

The case-fatality ratio ranges from 0% to 50% depending on the age group of the patient. [5] Patients under 24 were least likely to die; those 65 and older were most likely to die. [19]


Probable cases of SARS by country and region, 1 November 2002 – 31 July 2003.
Country or RegionCasesDeathsSARS cases dead due to other causesFatality (%)
China, People's Republic of *5,328349196.6
Hong Kong1,755299517
Taiwan **346373611
United States27000
Republic of Ireland1000
Russian Federation1000
South Korea4000
(*) Figures for the People's Republic of China exclude Hong Kong and Macau, which are reported separately by the WHO.
(**) Since 11 July 2003, 325 Taiwanese cases have been 'discarded'. Laboratory information was insufficient or incomplete for 135 discarded cases; 101 of these patients died.
Source:World Health Organization. [20]

Outbreak in South China

The viral outbreak can be genetically traced to a colony of cave-dwelling horseshoe bats in China's Yunnan province. [21]

The SARS epidemic appears to have started in Guangdong Province, China in November 2002 where the first case was reported that same month. The patient, a farmer from Shunde, Foshan, Guangdong, was treated in the First People's Hospital of Foshan. The patient died soon after, and no definite diagnosis was made on his cause of death. Despite taking some action to control it, Chinese government officials did not inform the World Health Organization of the outbreak until February 2003. This lack of openness caused delays in efforts to control the epidemic, resulting in criticism of the People's Republic of China from the international community. China has since officially apologized for early slowness in dealing with the SARS epidemic. [22]

The outbreak first appeared on 27 November 2002, when Canada's Global Public Health Intelligence Network (GPHIN), an electronic warning system that is part of the World Health Organization's Global Outbreak Alert and Response Network (GOARN), picked up reports of a "flu outbreak" in China through Internet media monitoring and analysis and sent them to the WHO. While GPHIN's capability had recently been upgraded to enable Arabic, Chinese, English, French, Russian, and Spanish translation, the system was limited to English or French in presenting this information. Thus, while the first reports of an unusual outbreak were in Chinese, an English report was not generated until 21 January 2003. [23] [24] The first super-spreader, Zhou Zoufeng was admitted to the Sun Yat-sen Memorial Hospital in Guangzhou on January 31, which soon spread the disease to nearby hospitals. [25]

Subsequent to this, the WHO requested information from Chinese authorities on 5 and 11 December. Despite the successes of the network in previous outbreak of diseases, it did not receive intelligence until the media reports from China several months after the outbreak of SARS. Along with the second alert, WHO released the name, definition, as well as an activation of a coordinated global outbreak response network that brought sensitive attention and containment procedures. [26] By the time the WHO took action, over 500 deaths and an additional 2,000 cases had already occurred worldwide. [24]

In early April, after Jiang Yanyong pushed to report the danger to China, [27] [28] there appeared to be a change in official policy when SARS began to receive a much greater prominence in the official media. Some have directly attributed this to the death of American James Earl Salisbury. [29] It was around this same time that Jiang Yanyong made accusations regarding the undercounting of cases in Beijing military hospitals. [27] [28] After intense pressure, Chinese officials allowed international officials to investigate the situation there. This revealed problems plaguing the aging mainland Chinese healthcare system, including increasing decentralization, red tape, and inadequate communication.

Many healthcare workers in the affected nations risked and lost their lives by treating patients and trying to contain the infection before ways to prevent infection were known. [30]

Spread to other countries and regions

Areas of the World Affected by SARS in 2002-2003 Sars Cases and Deaths.pdf
Areas of the World Affected by SARS in 2002–2003

The epidemic reached the public spotlight in February 2003, when an American businessman traveling from China, Johnny Chen, became afflicted with pneumonia-like symptoms while on a flight to Singapore. The plane stopped in Hanoi, Vietnam, where the victim died in Hanoi French Hospital. Several of the medical staff who treated him soon developed the same disease despite basic hospital procedures. Italian doctor Carlo Urbani identified the threat and communicated it to WHO and the Vietnamese government; he later succumbed to the disease. [31]

The severity of the symptoms and the infection among hospital staff alarmed global health authorities, who were fearful of another emergent pneumonia epidemic. On 12 March 2003, the WHO issued a global alert, followed by a health alert by the United States Centers for Disease Control and Prevention (CDC). Local transmission of SARS took place in Toronto, Ottawa, San Francisco, Ulaanbaatar, Manila, Singapore, Taiwan, Hanoi and Hong Kong whereas within China it spread to Guangdong, Jilin, Hebei, Hubei, Shaanxi, Jiangsu, Shanxi, Tianjin, and Inner Mongolia.[ citation needed ]

Hong Kong

9th floor layout of the Hotel Metropole in Hong Kong, showing where a super-spreading event of severe acute respiratory syndrome (SARS) occurred Hotel Metropole 9th floor layout SARS 2003.jpg
9th floor layout of the Hotel Metropole in Hong Kong, showing where a super-spreading event of severe acute respiratory syndrome (SARS) occurred

The disease spread in Hong Kong from Liu Jianlun, a Guangdong doctor who was treating patients at Sun Yat-Sen Memorial Hospital. [32] He arrived in February and stayed on the ninth floor of the Metropole Hotel in Kowloon, infecting 16 of the hotel visitors. Those visitors traveled to Canada, Singapore, Taiwan (Republic of China), and Vietnam, spreading SARS to those locations. [33]

Another larger cluster of cases in Hong Kong centred on the Amoy Gardens housing estate. Its spread is suspected to have been facilitated by defects in its drainage system. Concerned citizens in Hong Kong worried that information was not reaching people quickly enough and created a website called, which eventually forced the Hong Kong government to provide information related to SARS in a timely manner. [34] The first cohort of affected people were discharged from hospital on 29 March 2003. [35]


The first case of SARS in Toronto, Canada was identified on February 23, 2003. [36] Beginning with an elderly woman, Kwan Sui-Chu, returning from a trip to Hong Kong, the virus killed her on March 5 and eventually infected 257 individuals in the province of Ontario. The trajectory of this outbreak is typically divided into two phases, the first centring around her son Tse Chi Kwai, who infected other patients at the Scarborough Grace Hospital and died on March 13. The second major wave of cases was clustered around accidental exposure among patients, visitors, and staff within the North York General Hospital. The WHO officially removed Toronto from its list of infected areas by the end of June, 2003. [37]

The official response by the Ontario provincial government and Canadian federal government has been widely criticized in the years following the outbreak. Brian Schwartz, vice-chair of Ontario's SARS Scientific Advisory Committee, described public health officials’ preparedness and emergency response at the time of the outbreak as “very, very basic and minimal at best”. [38] Critics of the response often cite poorly outlined and enforced protocol for protecting healthcare workers and identifying infected patients as a major contributing factor to the continued spread of the virus. The atmosphere of fear and uncertainty surrounding the outbreak resulted in staffing issues in area hospitals when healthcare workers elected to resign rather than risk exposure to SARS.[ citation needed ]

Identification of virus

The CDC and Canada's National Microbiology Laboratory identified the SARS genome in April 2003. [39] [40] Scientists at Erasmus University in Rotterdam, the Netherlands demonstrated that the SARS coronavirus fulfilled Koch's postulates thereby confirming it as the causative agent. In the experiments, macaques infected with the virus developed the same symptoms as human SARS victims. [41]

In late May 2003, studies were conducted using samples of wild animals sold as food in the local market in Guangdong, China. The results found that the SARS coronavirus could be isolated from masked palm civets (Paguma sp.), even if the animals did not show clinical signs of the virus. The preliminary conclusion was the SARS virus crossed the xenographic barrier from asian palm civet to humans, and more than 10,000 masked palm civets were killed in Guangdong Province. The virus was also later found in raccoon dogs (Nyctereuteus sp.), ferret badgers (Melogale spp.), and domestic cats. In 2005, two studies identified a number of SARS-like coronaviruses in Chinese bats. [42] [43]

Phylogenetic analysis of these viruses indicated a high probability that SARS coronavirus originated in bats and spread to humans either directly or through animals held in Chinese markets. The bats did not show any visible signs of disease, but are the likely natural reservoirs of SARS-like coronaviruses. In late 2006, scientists from the Chinese Centre for Disease Control and Prevention of Hong Kong University and the Guangzhou Centre for Disease Control and Prevention established a genetic link between the SARS coronavirus appearing in civets and humans, bearing out claims that the disease had jumped across species. [44]

In December 2017, "after years of searching across China, where the disease first emerged, researchers reported ... that they had found a remote cave in Yunnan province, which is home to horseshoe bats that carry a strain of a particular virus known as a coronavirus. This strain has all the genetic building blocks of the type that triggered the global outbreak of SARS in 2002." The research was "published in the journal Public Library of Science Pathogens" and "was led by Shi Zheng-Li and Cui Jie of the Wuhan Institute of Virology, China... In their paper, the Chinese team warn that another deadly outbreak of SARS could emerge at any time. As they point out, the cave where they discovered their strain is only a kilometre from the nearest village." [4]


The World Health Organization declared severe acute respiratory syndrome contained on 9 July 2003. In the following years, four SARS cases were reported in China between December 2003 and January 2004. There were also three separate laboratory accidents that resulted in infection. In one of these cases, an ill lab worker spread the virus to several other people. [45] [46] Study of live SARS specimens requires a BSL-3 facility; some studies of inactivated SARS specimens can be done at BSL-2 facilities. [47]

Society and culture

Community response

Fear of contracting the virus from consuming infected wild animals resulted in public bans and reduced business for meat markets throughout southern China and Hong Kong. [48] In China, Cantonese foodways, which often incorporate a wide range of meat sources, were frequently indicted as an important contributing factor to the origins of the SARS outbreak.[ citation needed ]

Toronto's Asian minority population faced increased discrimination over the course of the city's outbreak. Local advocacy groups reported Asians being passed over by real-estate agents and taxi drivers and shunned on public transportation. [49] In Boston and New York City, rumors and April Fools pranks gone awry resulted in an atmosphere of fear and substantial economic loss in the cities’ Chinatowns.[ citation needed ]

See also

Related Research Articles

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Timeline of the SARS outbreak pandemic

The following is a timeline of the 2002–04 outbreak of severe acute respiratory syndrome (SARS).

<i>Severe acute respiratory syndrome-related coronavirus</i> species of virus

The Severe acute respiratory syndrome-related coronavirus, sometimes shortened to SARS-CoV, is the virus that causes severe acute respiratory syndrome (SARS). On April 16, 2003, following the outbreak of SARS in Asia and secondary cases elsewhere in the world, the World Health Organization (WHO) issued a press release stating that the coronavirus identified by a number of laboratories was the official cause of SARS. Samples of the virus are being held in laboratories in New York City, San Francisco, Manila, Hong Kong, and Toronto.

The SARS conspiracy theory began to emerge during the severe acute respiratory syndrome (SARS) outbreak in China in the spring of 2003, when Sergei Kolesnikov, a Russian scientist and a member of the Russian Academy of Medical Sciences, first publicized his claim that the SARS coronavirus is a synthesis of measles and mumps. According to Kolesnikov, this combination cannot be formed in the natural world and thus the SARS virus must have been produced under laboratory conditions. Another Russian scientist, Nikolai Filatov, head of Moscow's epidemiological services, had earlier commented that the SARS virus was probably man-made. However, independent labs concluded these claims to be premature since the SARS virus is a coronavirus, whereas measles and mumps are paramyxoviruses. The primary differences between a coronavirus and a parmyxovirus are in their structures and method of infection, thus making it implausible for a coronavirus to have been created from two paramyxoviruses.

<i>Coronaviridae</i> family of virus

Coronaviridae is a family of enveloped, positive-sense, single-stranded RNA viruses. The viral genome is 26–32 kb in length. The particles are typically decorated with large (~20 nm), club- or petal-shaped surface projections, which in electron micrographs of spherical particles create an image reminiscent of the solar corona. Members of this family are thus referred to as coronaviruses.

Human coronavirus NL63 or HCoV-NL63 is a species of Alphacoronavirus that was identified in late 2004 in a seven-month-old child with bronchiolitis in the Netherlands. Infection with the virus has been confirmed worldwide, and has an association with many common symptoms and diseases. Associated diseases include mild to moderate upper respiratory tract infections, severe lower respiratory tract infection, croup and bronchiolitis. The virus is found primarily in young children, the elderly, and immunocompromised patients with acute respiratory illness. It also has a seasonal association in temperate climates. A study performed in Amsterdam estimated the presence of HCoV-NL63 in approximately 4.7% of common respiratory illnesses. Further studies confirmed that the virus is not an emerging virus, but rather one that continually circulates the human population.

Yuen Kwok-yung (袁國勇), GBS, JP is a Hong Kong microbiologist, physician and surgeon. He is a Fellow of the Royal College of Physicians, Surgeons and Pathologists. After years of clinical and laboratory training, he established the infectious disease service and rapid molecular diagnosis for cytomegalovirus and tuberculosis at the Queen Mary Hospital, the teaching hospital of the University of Hong Kong. His major research interest is on microbial hunting and novel microbes in emerging infectious diseases.

Joseph Sriyal Malik Peiris (裴偉士), ( ඡීරිස්), ( பீறிஸ்), FRS, Légion d'Honneur, was born on 10 November 1949, in Sri Lanka. He is referred to in scientific publications and media reports as JSM Peiris, JS Peiris, Joseph Peiris and, most commonly, as Malik Peiris. His close family and friends prefer to use the middle name Sriyal. He is a distinguished old boy of St. Anthony's College Kandy and later studied medicine at the University of Ceylon, Peradeniya, Sri Lanka. This was followed by post graduate study at the Sir William Dunn School of Pathology, University of Oxford, UK, leading to the award of the DPhil degree. After further work in the UK and Sri Lanka, he founded the clinical diagnostic and public health virology laboratory at Queen Mary Hospital, which is part of the University of Hong Kong, in 1995. Malik Peiris and his team of scientists and doctors were strategically placed to face the challenges of the Avian influenza virus outbreak, the Severe Acute Respiratory Syndrome (SARS) coronavirus outbreak, and the Middle Eastern Respiratory Syndrome (MERS) coronavirus outbreak. Original research carried out by the Hong Kong laboratories have made major contributions to the knowledge of the causative viruses of these diseases, and the understanding, diagnosis, treatment and prevention of the diseases that these viruses cause. During the years 2003-2004, Malik Peiris was credited with authoring the highest number of high impact publications in the scientific world. He and his co-workers have published more than 600 scientific papers in a research career spanning more than 35 years and are credited with 32 scientific patents relating to diagnosis of viral infections. He currently holds the Tam Wah-Ching Professorship, Division of Public Health Laboratory Sciences, University of Hong Kong, where he continues to lead ground breaking research with a particular interest in newly emerging virus diseases at the animal-human interface.

W. Ian Lipkin is the John Snow Professor of Epidemiology at the Mailman School of Public Health at Columbia University and Professor of Neurology and Pathology at the College of Physicians and Surgeons at Columbia University. Lipkin is also Director of the Center for Infection and Immunity, an academic laboratory for microbe hunting in acute and chronic diseases.

<i>Middle East respiratory syndrome-related coronavirus</i> Human virus

Middle East respiratory syndrome-related coronavirus (MERS-CoV), or EMC/2012 (HCoV-EMC/2012), is a novel positive-sense, single-stranded RNA virus of the genus Betacoronavirus.

Middle East respiratory syndrome viral respiratory infection

Middle East respiratory syndrome (MERS), also known as camel flu, is a viral respiratory infection caused by the MERS-coronavirus (MERS-CoV). Symptoms may range from mild to severe. They include fever, cough, diarrhea, and shortness of breath. Disease is typically more severe in those with other health problems. Mortality is about one-third of diagnosed cases.

Bat SARS-like coronavirus WIV1, also sometimes called SARS-like coronavirus WIV1, is a newly identified CoV isolated from Chinese rufous horseshoe bats. The discovery confirms that bats are the natural reservoir of the SARS virus. Phylogenetic analysis shows the possibility of direct transmission of SARS from bats to humans without the intermediary Chinese civets, as previously believed. It is a single-stranded, enveloped, positive-sense RNA betacoronavirus.

MERS coronavirus EMC/2012, or MERS coronavirus Erasmus Medical Center/2012 is the name of a strain of coronavirus isolated from the sputum of the first person to become infected with what was later named Middle East respiratory syndrome-related coronavirus, or MERS-CoV.

A bat-borne virus is any virus whose primary reservoir is any species of bat. The viruses species include coronaviruses, hantaviruses, lyssaviruses, rabies virus, nipah virus, lassa virus, Henipavirus, Ebola virus and Marburg virus. Bat-borne viruses are among the most important of the emerging viruses.

2012 Middle East respiratory syndrome coronavirus outbreak

Since 2012, an outbreak of Middle East respiratory syndrome coronavirus has affected several countries, primarily in its namesake, the Middle East. The virus, which causes Middle East respiratory syndrome (MERS), is a newly emerged betacoronavirus that was first identified in a patient from Saudi Arabia in April 2012.

The Severe acute respiratory syndrome (SARS) Network refers to the system by which the SARS virus managed to have initial seedings in many different geographical locations, with intense but tightly circumscribed activity, without breaking out into an epidemic.

2002–2003 SARS outbreak among healthcare workers

The rapid spread of Severe acute respiratory syndrome (SARS) in healthcare workers (HCW)—most notably in Toronto hospitals—during the global outbreak of SARS in 2002-2003 contributed to dozens of identified cases, some of them fatal. Researchers have found several key reasons for this development, such as the high-risk performances of medical operations on patients with SARS, inadequate use of protective equipment, psychological effects on the workers in response to the stress of dealing with the outbreak, and lack of information and training on treating SARS. Lessons learned from this outbreak among healthcare workers have contributed to newly developed treatment and prevention efforts and new recommendations from groups such as the Centers for Disease Control and Prevention (CDC).

Swine acute diarrhea syndrome coronavirus (SADS-CoV) is a coronavirus related to Rhinolophus bat coronavirus HKU2. It is transmitted through the feces of horseshoe bats to pigs. Piglets less than 5 days old die with a probability of 90%. SADS-CoV was identified during the Severe acute respiratory syndrome outbreak caused by Severe acute respiratory syndrome-related coronavirus in Guangdong 2013 onwards, where it caused the death of more than 24,000 piglets on 4 farms. Current research says that it cannot infect humans. The fear remains that such a virus can mutate and then become dangerous for humans. Researches as well made clear, while bats carry zoonotic viruses, they are very important for a well balanced ecosystem. Some for example eat mosquitos which carry dangerous diseases like malaria, yellow fever, chikungunya, zika fever and others.

Air China Flight 112

Air China Flight 112 was a scheduled international passenger flight on 15 March 2003 that carried a 72-year-old man infected with severe acute respiratory syndrome (SARS). This man would later become the index passenger for the infection of another 20 passengers and two aircraft crew, resulting in the dissemination of SARS north to inner Mongolia and south to Thailand. The incident demonstrated how a single person could spread disease via air travel and was one of a number of superspreading events in the global spread of SARS in 2003. The speed of air travel and the multidirectional routes taken by affected passengers accelerated the spread of SARS with a consequential response from the World Health Organization (WHO), the aviation industry and the public.


  1. Smith, Richard D (2006). "Responding to global infectious disease outbreaks: Lessons from SARS on the role of risk perception, communication and management". Social Science & Medicine. 63 (12): 3113–23. doi:10.1016/j.socscimed.2006.08.004. PMID   16978751.
  2. 1 2 "Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003". World Health Organization (WHO). Retrieved 31 October 2008.
  3. "SARS (severe acute respiratory syndrome)". NHS Choices . United Kingdom: National Health Service. 3 October 2014. Retrieved 8 March 2016. Since 2004, there haven't been any known cases of SARS reported anywhere in the world.
  4. 1 2 McKie, Robin (10 December 2017). "Scientists trace 2002 Sars virus to colony of cave-dwelling bats in China". The Guardian. ISSN   0029-7712 . Retrieved 10 December 2017.
  5. 1 2 3 4 5 World Health Organization (2003). "Consensus document on the epidemiology of severe acute respiratory syndrome (SARS)". hdl:10665/70863.Cite journal requires |journal= (help)
  6. Chan, Paul K. S; To, Wing-Kin; Ng, King-Cheung; Lam, Rebecca K. Y; Ng, Tak-Keung; Chan, Rickjason C. W; Wu, Alan; Yu, Wai-Cho; Lee, Nelson; Hui, David S. C; Lai, Sik-To; Hon, Ellis K. L; Li, Chi-Kong; Sung, Joseph J. Y; Tam, John S (2004). "Laboratory Diagnosis of SARS". Emerging Infectious Diseases. 10 (5): 825–31. doi:10.3201/eid1005.030682. PMC   3323215 . PMID   15200815.
  7. Lu, P; Zhou, B; Chen, X; Yuan, M; Gong, X; Yang, G; Liu, J; Yuan, B; Zheng, G; Yang, G; Wang, H (2003). "Chest X-ray imaging of patients with SARS". Chinese Medical Journal. 116 (7): 972–5. PMID   12890364.
  8. "SARS: Prevention". 6 January 2011. Retrieved 14 July 2013.
  9. 1 2 Chan-Yeung, M; Xu, RH (November 2003). "SARS: epidemiology". Respirology (Carlton, Vic.). 8 Suppl: S9–14. doi:10.1046/j.1440-1843.2003.00518.x. PMID   15018127.
  10. "SARS (severe acute respiratory syndrome)". 19 October 2017. Retrieved 1 December 2017.
  11. "SARS" (PDF). Retrieved 1 December 2017.
  12. Perlman, Stanley; Dandekar, Ajai A (2005). "Immunopathogenesis of coronavirus infections: Implications for SARS". Nature Reviews Immunology. 5 (12): 917–27. doi:10.1038/nri1732. PMID   16322745.
  13. Jiang, Shibo; Lu, Lu; Du, Lanying (2013). "Development of SARS vaccines and therapeutics is still needed". Future Virology. 8 (1): 1–2. doi:10.2217/fvl.12.126.
  14. Greenough, Thomas C; Babcock, Gregory J; Roberts, Anjeanette; Hernandez, Hector J; Thomas, Jr, William D; Coccia, Jennifer A; Graziano, Robert F; Srinivasan, Mohan; Lowy, Israel; Finberg, Robert W; Subbarao, Kanta; Vogel, Leatrice; Somasundaran, Mohan; Luzuriaga, Katherine; Sullivan, John L; Ambrosino, Donna M (2005). "Development and Characterization of a Severe Acute Respiratory Syndrome–Associated Coronavirus–Neutralizing Human Monoclonal Antibody That Provides Effective Immunoprophylaxis in Mice". The Journal of Infectious Diseases. 191 (4): 507–14. doi:10.1086/427242. PMID   15655773.
  15. Tripp, Ralph A; Haynes, Lia M; Moore, Deborah; Anderson, Barbara; Tamin, Azaibi; Harcourt, Brian H; Jones, Les P; Yilla, Mamadi; Babcock, Gregory J; Greenough, Thomas; Ambrosino, Donna M; Alvarez, Rene; Callaway, Justin; Cavitt, Sheana; Kamrud, Kurt; Alterson, Harold; Smith, Jonathan; Harcourt, Jennifer L; Miao, Congrong; Razdan, Raj; Comer, James A; Rollin, Pierre E; Ksiazek, Thomas G; Sanchez, Anthony; Rota, Paul A; Bellini, William J; Anderson, Larry J (2005). "Monoclonal antibodies to SARS-associated coronavirus (SARS-CoV): Identification of neutralizing and antibodies reactive to S, N, M and E viral proteins". Journal of Virological Methods. 128 (1–2): 21–8. doi:10.1016/j.jviromet.2005.03.021. PMID   15885812.
  16. Roberts, Anjeanette; Thomas, William D; Guarner, Jeannette; Lamirande, Elaine W; Babcock, Gregory J; Greenough, Thomas C; Vogel, Leatrice; Hayes, Norman; Sullivan, John L; Zaki, Sherif; Subbarao, Kanta; Ambrosino, Donna M (2006). "Therapy with a Severe Acute Respiratory Syndrome–Associated Coronavirus–Neutralizing Human Monoclonal Antibody Reduces Disease Severity and Viral Burden in Golden Syrian Hamsters". The Journal of Infectious Diseases. 193 (5): 685–92. doi:10.1086/500143. PMID   16453264.
  17. Hawryluck, Laura; Gold, Wayne L; Robinson, Susan; Pogorski, Stephen; Galea, Sandro; Styra, Rima (2004). "SARS Control and Psychological Effects of Quarantine, Toronto, Canada". Emerging Infectious Diseases. 10 (7): 1206–12. doi:10.3201/eid1007.030703. PMC   3323345 . PMID   15324539.
  18. Ma Jinyu (15 July 2009). "(Silence of the Post-SARS Patients)" (in Chinese). Southern People Weekly. Retrieved 3 August 2013.
  19. Monaghan, Karen J. (2004). SARS: DOWN BUT STILL A THREAT. National Academies Press (US).
  20. "Epidemic and Pandemic Alert and Response (EPR)". World Health Organization.
  21. McKie, Robin (10 December 2017), "Scientists trace 2002 Sars virus to colony of cave-dwelling bats in China", The Guardian
  22. "WHO targets SARS 'super spreaders'". CNN. 6 April 2003. Archived from the original on 7 March 2006. Retrieved 5 July 2006.
  23. Mawudeku, Abla; Blench, Michael (2005). "Global Public Health Intelligence Network" (PDF). Public Health Agency of Canada.
  24. 1 2 Rodier, G (10 February 2004). "Global Surveillance, National Surveillance, and SARS". Emerging Infectious Diseases. 10 (2): 173–5. doi:10.3201/eid1002.031038. PMC   3322938 . PMID   15040346.
  25. Abraham, Thomas (2004). Twenty-first Century Plague: The Story of SARS.
  26. Heymann, 2003[ full citation needed ]
  27. 1 2 Joseph Kahn (12 July 2007). "China bars U.S. trip for doctor who exposed SARS cover-up". The New York Times. Retrieved 3 August 2013.
  28. 1 2 "The 2004 Ramon Magsaysay Awardee for Public Service". Ramon Magsaysay Foundation. 31 August 2004. Retrieved 3 May 2013.
  29. "SARS death leads to China dispute". CNN. 10 April 2003. Archived from the original on 28 November 2007. Retrieved 3 April 2007.
  30. Sars: The people who risked their lives to stop the virus
  31. "WHO | Dr. Carlo Urbani of the World Health Organization dies of SARS". Retrieved 29 November 2017.
  32. "Inside the hospital where Patient Zero was infected". South China Morning Post. 27 March 2003. Retrieved 23 May 2018.
  33. "Sr. Irene Martineau". Oxford Medical School Gazette. Archived from the original on 10 October 2008. Retrieved 10 November 2008.Cite journal requires |journal= (help)
  34. "Hong Kong Residents Share SARS Information Online". Retrieved 11 May 2016.
  35. "Severe Acute Respiratory Syndrome (SARS) overview". News Medical Life Sciences. AZO network. 24 April 2004.
  36. "Update: Severe Acute Respiratory Syndrome --- Toronto, Canada, 2003". Retrieved 11 May 2016.
  37. Low, Donald (2004). Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary.
  38. "Is Canada ready for MERS? 3 lessons learned from SARS". Retrieved 11 May 2016.
  39. "Remembering SARS: A Deadly Puzzle and the Efforts to Solve It". Centers for Disease Control and Prevention. 11 April 2013. Retrieved 3 August 2013.
  40. "Coronavirus never before seen in humans is the cause of SARS". United Nations World Health Organization. 16 April 2006. Retrieved 5 July 2006.
  41. Fouchier, Ron A. M; Kuiken, Thijs; Schutten, Martin; Van Amerongen, Geert; Van Doornum, Gerard J. J; Van Den Hoogen, Bernadette G; Peiris, Malik; Lim, Wilina; Stöhr, Klaus; Osterhaus, Albert D. M. E (2003). "Aetiology: Koch's postulates fulfilled for SARS virus". Nature. 423 (6937): 240. Bibcode:2003Natur.423..240F. doi:10.1038/423240a. PMID   12748632.
  42. Li, W; Shi, Zhengli; Yu, Meng; Ren, Wuze; Smith, Craig; Epstein, Jonathan H; Wang, Hanzhong; Crameri, Gary; Hu, Zhihong; Zhang, Huajun; Zhang, Jianhong; McEachern, Jennifer; Field, Hume; Daszak, Peter; Eaton, Bryan T; Zhang, Shuyi; Wang, Lin-Fa (2005). "Bats Are Natural Reservoirs of SARS-Like Coronaviruses". Science. 310 (5748): 676–9. Bibcode:2005Sci...310..676L. doi:10.1126/science.1118391. PMID   16195424.
  43. Lau, S. K. P; Woo, P. C. Y; Li, K. S. M; Huang, Y; Tsoi, H.-W; Wong, B. H. L; Wong, S. S. Y; Leung, S.-Y; Chan, K.-H; Yuen, K.-Y (2005). "Severe acute respiratory syndrome coronavirus-like virus in Chinese horseshoe bats". Proceedings of the National Academy of Sciences. 102 (39): 14040–5. Bibcode:2005PNAS..10214040L. doi:10.1073/pnas.0506735102. PMC   1236580 . PMID   16169905.
  44. "Scientists prove SARS-civet cat link". China Daily. 23 November 2006.
  45. "SARS 2013: 10 Years Ago SARS Went Around the World, Where is It Now?". 11 March 2013.
  46. "WHO | SARS outbreak contained worldwide". Retrieved 16 October 2015.
  47. "SARS | Guidance | Lab Biosafety for Handling and Processing Specimens | CDC". Retrieved 11 September 2017.
  48. Zhan, MEI (2005). "Civet Cats, Fried Grasshoppers, and David Beckham's Pajamas: Unruly Bodies after SARS". American Anthropologist. 107 (1): 31–42. doi:10.1525/aa.2005.107.1.031. JSTOR   3567670.
  49. Schram, J (2003). "How popular perceptions of risk from SARS are fermenting discrimination". BMJ. 326 (7395): 939. doi:10.1136/bmj.326.7395.939. JSTOR   25454328. PMC   1125856 .

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External resources