Beijing, China, experienced the largest outbreak of SARS in the world with a total of 2,521 reported probable cases. The outbreak began March 5, 2003, with the importation of several cases among travelers from other SARS-affected areas and soon accelerated as multiple SARS cases occurred in health care facilities, peaking in late April when more than 100 new patients with SARS were being hospitalized daily. During the first week of May, the number of new cases dropped steeply and then declined steadily during the next few weeks, with the onset of the last probable case on May 29, 2003. The onset of the last case occurred only 6 weeks after the peak of the outbreak.The researchers found that healthcare worker training in use of personal protective equipment and management of patients with SARS and establishing fever clinics and designated SARS wards in hospitals predated the steepest decline in cases. The national and municipal governments held 13 press conferences about SARS. The lessons learned from controlling this outbreak can hopefully serve to inform future responses to SARS, if it were to reemerge in Beijing or elsewhere.
James M. Hughes, M. D., Director of the National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta writes in The Journal of the American Medical Association (JAMA):
"The successful control of the 2003 SARS outbreak is a testament to the heroic, collaborative efforts of clinicians, laboratory scientists, and public health officials worldwide, all done in the absence of diagnostic tests, effective therapies, and a vaccine. The response also emphasized the importance as well as the effectiveness of stringent infection control precautions, including respiratory and hand hygiene; patient isolation; appropriate use of personal protective equipment; and implementation of quarantine strategies when faced with a new infectious agent. As the last decade and, especially, the last year have demonstrated, newly recognized pathogens will continue to emerge, requiring preparedness planning, a vigilant health system, a commitment to timely reporting of disease, and strong interdisciplinary partnerships to contain their spread. It is essential to continue to evaluate and learn from recent experiences. Applying the lessons learned from SARS will serve us well in responding to a recurrence and to future microbial threats."
Swine(pig) flu H1N1
Dr. Anne Schuchat, interim Deputy Director for CDC Science and Public Health, said that the American cases were found to be made up of genetic elements from four different flu viruses – North American swine influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe – an unusually mongrelised mix of genetic sequences. Infected Pigs acted as a potential "mixing vessel" in which reassortment can occur between flu viruses of several species.This new strain appears to be a result of reassortment of human influenza and swine influenza viruses, presumably due to superinfection in an individual human. Influenza viruses readily undergo reassortment because their genome is split between eight pieces of RNA.
Concern that the world could be on the brink of the first influenza pandemic in more than 40 years escalated Sunday as France, Hong Kong, New Zealand and Spain reported potential new cases in which people had been infected with swine flu and Canada confirmed several new cases. In the U.S., where 20 such infections have been confirmed, federal health officials declared a public-health emergency and are preparing to distribute to state and local agencies a quarter of the country's 50 million-dose stockpile of antiviral drugs. Meanwhile, in hard-hit Mexico, where more than 80 people have died from what is believed to be swine flu, the government closed all public schools and canceled hundreds of public events in Mexico City.
Impact on the present Global Recession:
WHO and individual countries are more likely to fall back on damage control, using antivirals and old-fashioned infection control - like closing schools, limiting public gatherings and even restricting travel - to slow the spread of the virus. But such efforts would likely inflict serious damage on an already faltering global economy.
The SARS outbreak, which disrupted travel, trade and the workplace in 2003, cost the Asia Pacific region an estimated $40 billion. It lasted six months and killed 775 of the 8,000 people it infected in 25 countries.
The World Bank estimated in 2008 that a flu pandemic could cost $3 trillion and result in a nearly 5 percent drop in world gross domestic product, damaging prospects of recovery in a world economy deep in financial crisis.
The greatest risk from a pandemic might not turn out to be from the swine flu virus itself - especially if it ends up being relatively mild - but what Michael Osterholm (a pandemic risk expert who runs the University of Minnesota's Center for Infectious Disease Research and Policy) calls "collateral damage" if governments respond to the emergency by instituting border controls and disrupting world trade. Not only would the global recession worsen - a 2008 World Bank report estimated that a severe pandemic could reduce the world's GDP by 4.8% - but we depend on international trade now for countless necessities, from generic medicines to surgical gloves. The just-in-time production systems embraced by companies like Wal-Mart - where inventories are kept as low as possible to cut waste and boost profit - mean that we don't have stockpiles of most things. Supply chains for food, medicines and even the coal that generates half our electricity are easily disruptable, with potentially catastrophic results.
Airline and other travel-related stocks suffered the sharpest losses recently.
The European Union health commissioner advised Europeans to avoid nonessential travel to Mexico and the United States.
Some pharmaceutical stocks, however, climbed. GlaxoSmithKline gained 7.6 percent, rising $2.22 to $31.56, and Gilead Sciences Inc. rose 3.8 percent, climbing $1.73 to $47.53. The two companies make flu treatments.
The 1918 Spanish flu pandemic began with a fairly mild wave of infections in the spring, but the virus returned a few months later in a far more virulent form. That can happen with the current swine flu as well for viruses re-emerge more virulent and dangerous. We should be well prepared as it can be a marathon, not a sprint.
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