Friday, January 9, 2009

Memories of SARS

It's been years since a novel coronavirus, Severe Acute Respiratory Syndrome, or SARS, set off worldwide panic upon its emergence. Despite living in the Toronto area, the North American epicentre of the infection (most of the casualties were incurred in Asia), I wasn't all that concerned about SARS. Yes, it was hitting a number of nearby populations; but in my suburban high school life, I had felt relatively insulated from the crisis.

Sure, I remember my Mom getting angry at my Dad, a family physician, for not wearing a mask at home after seeing patients during the day. I remember that communion at my church (a Chinese Community Church - a particularly risky population given the origins of the disease) switched to individually wrapped packets of bread and juice rather than from a communal plate. And who could forget the SARS Package - a tourism promotion to counteract the economic aftermath of the pandemic - including a theatre musical, baseball game, and dinner at a fancy restaurant, all for $100 CDN.

But even as recently as a few weeks ago, I felt like SARS hype was a relative overreaction (and to a certain extent it was). In fact, when my family visited an Italian friend, he told us a story about his visit to Italy during the SARS crisis. The plane passengers were stuck on board for something in the order of 3 days because the Italian workers refused to take their luggage off the plane. They knew the plane was from Toronto, and they were deathly afraid of SARS! I thought this treatment was preposterous, and certainly it was - the media had done more than its fair share to fan the flames of fear.

However, as I prepared for a SARS seminar in biochemistry this week, the true SARS scenario finally began to sink in - and it began to tug at my emotions. SARS started like this:

A man from Guangdong, China was patient zero. It is hypothesized that SARS has just recently made the evolutionary jump from an animal species to humans, as the genome is now known to have been relatively uniform across the world (it hadn't had time to mutate) and it was unlike any virus previously studied. He was visiting Hong Kong at the same time as an elderly Chinese couple from Canada.

The couple returned home to Toronto without incident, where they shared a home with two sons, a daughter-in-law, and a 5-month-old grandson. The wife soon became ill with pneumonia-like symptoms. She visited her family physician, who prescribed antibiotics for infection. Two days later, she was dead. It is suspected that the disease was contracted in a chance encounter with patient zero in a hotel elevator.

This time, the gravity of the situation really hit me - a disease so virulent that you can contract it by standing next to a stranger in an elevator while on vacation and then be dead in a week. It sent a shiver down my spine and I could feel a little itch at the back of my eye.

Subsequently, the wife's son contracted the disease. He presented to the hospital, was admitted, and died approximately two weeks later. the 43-year-old left behind his 24-year-old wife and 5-month-old baby boy. Another elderly patient was exposed lying next to the son in the emergency room, with a curtain drawn between the two of them. He also subsequently died. I was stunned - this patient had died just from sharing the same air as the son. It's not clear whether he even saw the person who infected him.

Infection then presented in the husband, the other son, the daughter-in-law and the family physician that had originally prescribed the wife the antibiotics. They all survived, treated with broad spectrum antibiotics and antivirals. But what really led to uncontrollable fear was the fact that nobody knew what was causing this disease. Widespread hospital quarantines were laid down as phenomenal efforts were put out to trace and contain the spread of disease.

At the same time, Carlo Urbani of the World Health Organization had quickly identified the spread of the disease to the hospital where he was working in Hanoi, Vietnam. He immediately quarantined the hospital and continued to work there, sending out samples of the virus for analysis and study. Thanks to his heroic efforts, the virus was contained in Hanoi. He himself eventually succumbed to the disease and died.

The way my professor tells the story, Urbani recognized the symptoms himself in the airport after leaving Hanoi. He tented himself inside his jacket and kept people away from himself until he could be safely removed from the premises.

I remember hearing this story during the actual pandemic, and while it was certainly moving and heroic, I felt fairly detached. Now I don't know if I've developed a new bleeding heart or whether my pending involvement of the medical field has helped me to better understand the reality of the situation, but I was really moved this time. I just imagined myself ten years down the road, working in a similar pandemic, afraid of infecting my loved ones. I pictured dying, quarantined and alone, unable to touch or hold my (future) wife or children throughout my final days. So noble, yet so terrifying.

Today we know that SARS was caused by a novel coronavirus that had previously never presented in humans before. 182 people died of the virus worldwide (although I imagine it's possible this is an underestimate do to China being less than responsible in care and less than forthcoming with statistics). It demonstrated a mortality rate of 4.9%, which is actually approximately the same as common pneumonia. Very few children died from the disease. The most at risk populations were the elderly (or those with underlying health conditions, such as heart problems) and health care professionals (many of whom contracted the disease from being on the front lines). Obviously, a more deadly virus could have crippled the health care system's ability to respond to the pandemic by taking out large swaths of the nation's health care capacity early on. In those over age 60, Hong Kong statistics point to a 43-55% mortality rate.

After all that storytelling, it's important to take in the sobering fact that SARS was not that deadly of a virus, and the media did work too hard to incite fear and panic. SARS spreads through droplets in the air, but then so do other diseases like influenza. It's mortality rate was on par with that of common pneumonia. The fear was largely associated with how little we knew about the disease when it arrived and how unprepared we were to contain it.

At the same time, hearing the story this time around has really helped me to appreciate the human sacrifice and emotional gravity of the situation. It was scary, it was horrible, and I get that now. Better late than never.

1 comment:

sandlot said...

SARS was great. Toronto tourism really upped their game and I ended up watching Mamma Mia, going to a Baseball game and eating at a swanky restaurant for a ridiculously cheap price.

I guess the downside is that people got sick and died of SARS.