Southeast Asia SARS Outbreak of 2003: The

Southeast Asia SARS outbreak of 2003: The anatomy of an epidemic.

Severe Acute Respiratory Syndrome or SARS is a viral respiratory illness that emerged as a serious global threat to health in March 2003. It first appeared in Southern China in November 2002. The illness was to spread to over a dozen countries in North America, South America, Europe, and Asia before it was contained. (Basic Information About SARS)

While the epidemic has been contained yet it raises a number of important issues that will be discussed in the paper. These include the question of the genesis and origins of the virus and the consequences, in both the short and long terms, of SARS as one of a number of previously unknown viral infections affecting world health. This paper will also look at the background, causes, symptoms and effects of the disease.

One of the central points that will form the fulcrum of this discussion is that SARS should not be seen as an isolated event. The SARS virus is one of many infectious diseases that now seem to be occurring with increasing prevalence in the modern world - the most recent being the Avian flu virus. In terms of sustainable solutions this will be an important aspect that will be addressed in this paper.

Background

In April of 2003 the World Health Organization (WHO) reported 3,947 probable severe acute respiratory syndrome (SARS) cases with 229 deaths worldwide. Most these case occurred in China, Hong Kong, Singapore, Vietnam, and Toronto, Canada. (Frequently Asked Questions About SARS)

While there was a general increase in the rate of the SARS cases, the rate of new cases was relatively slow. For example, there were only seven infectious at the beginning of the epidemic at the Hoping Hospital in Taipei, this grew to 264 cases and 34 deaths by mid-May, and 680 cases and 81 deaths by June 1. (ibid) SARS was a new phenomenon and resulted from a virus that had never been encountered in humans before. It was to result in worldwide panic before the infections finally halted. However, the wide ranging effects and implications of the epidemic are still being studied and debated today.

2.1. Causes

Essentially SARS is a type of viral pneumonia and is the result of infection by a coronavirus, called SARS-associated coronavirus (SARS-CoV). (Basic Information About SARS)

The initial outbreak of the disease is believed to have taken place in February 2003 in the Guangdong province of China. Approximately 300 people were infected and became ill, of which five died. Initially it was believed that Aparamyxovirus was responsible for the infection; however later the true cause was established to be a unique coronavirus with presented a number of different and unusual properties.

The causes or origins of the virus have been associated and linked to particular living conditions and the close handling of animal and related foodstuffs, "Many of these early cases were food handlers (persons who handle, kill, and sell food animals, or those who prepare and serve food.) (The cause of SARS) There is also evidence that natural infections with SARS-CoV occur in various species of animals indigenous to China and parts of south-east Asia. A joint study involving Hong Kong and China "detected several coronaviruses closely related genetically to the SARS coronavirus in two of the animal species tested (masked palm civet and raccoon dog). " (ibid) The study also found that the Chinese ferret badger elicited antibodies against the SARS-CoV. "These and other wild animals are traditionally considered delicacies and are sold for human consumption in markets throughout southern China." (The cause of SARS)

There is still ongoing research and conjecture about the actual origins of the SARS virus. An animal origin with human transmission is in all research studies generally accepted and recently independent scientific teams claim that the Chinese horseshoe bat is the reservoir of the virus in nature. (Altman L.K. 2005) Findings of this nature are important as a step in preventing future occurrences of SARS in that the chain of transmission may be broken if the originating source can be identified.

The cause of SARS has also been related to poor and unhygienic living conditions which fosters and possibly prepares the ground for the origin of the virus in association with livestock. This has important concomitant cause and effect factors that will be discussed in this paper. The World Health organization for example has stated that poor living environments and especially inadequate plumbing may also be a central factor in the initiation of this disease. "The findings also indicate that poorly designed or maintained plumbing could contribute to the spread of other diseases that are transmitted by highly infectious fecal droplets. " (Poor Plumbing a Likely Cause of SARS Spread)

The possibility has also been put forward in studies that the SARS outbreak in Hong king may have been facilitated by poor sewage and drainage systems. One of the most worrying aspects of the disease is that the exact origins and causative factors are not definitively known and this impact on the future solutions.

2.2. The symptoms and spread of SARS

The symptoms of SARS are generally flu-like with moderate to high fevers. Symptoms include the following characteristics of the disease:

dry cough, dyspnea (shortness of breath), headache, and hypoxaemia (low blood oxygen concentration)

Typical laboratory findings include lymphopaenia (reduced lymphocyte numbers) and mildly elevated aminotransferase levels (indicating liver damage).

Basic Information About SARS) notable symptomatic element is that approximately 10-20% of the infected individuals required mechanical ventilation. The mortality rate is between 6.8% for patients under the age of 60 and 55% for patients over 60 years old). (Jambresic S. 2005.) Death is often the result of progressive respiratory failure. Symptoms usually improve after the first week of infection but tend to worsen in the second week. This worsening is largely due to the deteriorating condition of the patents immune system.

The spread of the virus is through close person-to-person contact. Transmission through the spread of respiratory droplets through actions such as sneezing and coughing is common. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes. Furthermore, it is also suspect by medical experts that SARS can be spread through airborne infection. (ibid)

The Centers for Disease Control (CDC) reported that SARS appears to be spread by close person-to-person contact. Potential ways include touching the skin of other people or objects that are contaminated with infectious droplets and then touching the eyes, nose, or mouth. Or the virus can be transmitted when someone who is sick with SARS coughs or sneezes droplets into the air and someone else breathes them in. It's also possible that SARS can be spread more broadly through the air, or by other ways that are currently unknown.

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The estimated period for the survival of the virus in the environment can be several days but this factor is dependant on a number of factors. These factors may include "... The type of material or body fluid containing the virus and various environmental conditions such as temperature or humidity. " (Cause Of SARS)

The effects of SARS

One of the central questions that are raised in a holistic appraisal of SARS are the far- reaching implications of an epidemic of this nature. While the obvious impact of SARS on personal health is the dominant effect, the disease also has numerous social and economic effects, which in fact increases its overall negative effect.

One of the issues that have been raised in this regard is the economic cost of the disease as this has a concomitant effect on the ability of many countries to fight the disease. Economists point out that each victim of SARS in East Asia had an exponential and ripple effect on the economy of the region. However they also point out that the costs of the disease can be limited if quickly contained and properly managed. This emphasizes the fact that sustainable prevention and control measures are essential in dealing with infectious diseases like SARS.

During the period of its effect on Asia, SARS had a severe effect on production and activity in the region. One the main reason for this was the closure of factories and a reduction of tourism. Furthermore, "...consumer demand has was dealt a severe blow, as would be shoppers stayed home and wariness of an economic slowdown cause Asians to tighten their belts." (The Specter of SARS. p. 44) The Canadian economy was also severely weakened during this period and cased an estimated reduction of growth in the country by an average of 0.1% in April and May. (ibid)

The costs of the virus were extensive for China.

This tiny virus caused China huge economic losses, far costlier than either the Asian financial crisis in 1997 or the flood disaster in 1998. Some experts conclude that SARS resulted in direct economic losses of 400 billion RMB yuan (48…