SARS Outbreak and Identification


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OpenStax Microbiology

On November 16, 2002, the first case of a SARS outbreak was reported in Guangdong Province, China. The patient exhibited influenza-like symptoms such as fever, cough, myalgia, sore throat, and shortness of breath. As the number of cases grew, the Chinese government was reluctant to openly communicate information about the epidemic with the World Health Organization (WHO) and the international community. The slow reaction of Chinese public health officials to this new disease contributed to the spread of the epidemic within and later outside China. In April 2003, the Chinese government finally responded with a huge public health effort involving quarantines, medical checkpoints, and massive cleaning projects. Over 18,000 people were quarantined in Beijing alone. Large funding initiatives were created to improve health-care facilities, and dedicated outbreak teams were created to coordinate the response. By August 16, 2003, the last SARS patients were released from a hospital in Beijing nine months after the first case was reported in China.

In the meantime, SARS spread to other countries on its way to becoming a global pandemic. Though the infectious agent had yet to be identified, it was thought to be an influenza virus. The disease was named SARS, an acronym for severe acute respiratory syndrome, until the etiologic agent could be identified. Travel restrictions to Southeast Asia were enforced by many countries. By the end of the outbreak, there were 8,098 cases and 774 deaths worldwide. China and Hong Kong were hit hardest by the epidemic, but Taiwan, Singapore, and Toronto, Canada, also saw significant numbers of cases.

Fortunately, timely public health responses in many countries effectively suppressed the outbreak and led to its eventual containment. For example, the disease was introduced to Canada in February 2003 by an infected traveler from Hong Kong, who died shortly after being hospitalized. By the end of March, hospital isolation and home quarantine procedures were in place in the Toronto area, stringent anti-infection protocols were introduced in hospitals, and the media were actively reporting on the disease. Public health officials tracked down contacts of infected individuals and quarantined them. A total of 25,000 individuals were quarantined in the city. Thanks to the vigorous response of the Canadian public health community, SARS was brought under control in Toronto by June, a mere four months after it was introduced.

In 2003, WHO established a collaborative effort to identify the causative agent of SARS, which has now been identified as a coronavirus that was associated with horseshoe bats. The genome of the SARS virus was sequenced and published by researchers at the CDC and in Canada in May 2003, and in the same month researchers in the Netherlands confirmed the etiology of the disease by fulfilling Koch’s postulates for the SARS coronavirus. The last known case of SARS worldwide was reported in 2004.

This map shows the spread of SARS as of March 28, 2003. Ireland had 1 case, Canada had 29 cases, the United States had 1 case, Hong Kong had 195 cases, Singapore had 71 cases, and Vietnam has 58 cases.
This map shows the spread of SARS as of March 28, 2003. (credit: modification of work by Central Intelligence Agency)


Parker, N., Schneegurt, M., Thi Tu, A.-H., Forster, B. M., & Lister, P. (n.d.). Microbiology. Houston, Texas: OpenStax. Access for free at: