SARS Outbreak in China

This article provides an overview of the Severe Acute Respiratory Syndrome (SARS) outbreak in China in 2002-2003. It discusses the impact of the outbreak on health, society, and the economy, as well as the risk factors and progression of the disease. The article also highlights the strengths and weaknesses of the epidemiological design used during the outbreak.

SARS OUTBREAK IN CHINA1
Severe Acute Respiratory Syndrome Outbreak in China
Name
Institution
Date
Course
Tutor
City/Sate

SARS OUTBREAK IN CHINA2
Introduction
Severe acute respiratory syndrome (SARS) is a life claiming epidemic that is more like
pneumonia and it was detected in China in the year 2002. The disease then quickly spread during
the winter to the southern parts of the country in 2003. It claimed lives of more than 600 people
and scared millions of others and it led to great negative economic impact to the Chinese. The
world health organization gave the name to the diseases after a Vietnam based Italian physician
informed the organization of the epidemic. The cause of the epidemic is a deadly virus known as
corona which kills at least 9% of those infected. The death tolls continued to rise with accusation
on the Chinese government failure to report the outbreak in the onset. The disease during the
winter and spring had spread to more than 30 countries an aspect that endangered more lives.
SARS Surveillance
The epidemic first appeared in the second last month of the year 2002 in a Chinese city in the
southern part known as Foshan near Guangzhou. By the first month of the following year there
was an alarming spread of the epidemic as some cases were reported from the neighboring cities
of Heyuan, Shunde and Zhongshan. In a short while, more than 300 cases were reported and the
death tolls had risen to 5 in the city of Guangdong (Song 2018p. 12). A notion was then spread
that the disease was from animals since the first reported death case was from a flesh seller who
had a business in Shunde. The reports continued to flock the media describing the origin of the
disease as the small animals used for food by the people of china. The animals that were
continuously on the headlines were snakes, frogs, chicken, cats, turtles and badgers which were
stacked in cages waiting for customers to buy them.

SARS OUTBREAK IN CHINA3
From November 2002 to July 2003, reports reached the world health organization that SARS had
spread to more than 25 countries. This meant that more people would continue to live under fear
of the outbreak an aspect that led dramatic cancellation of travel schedules by many individuals
more especially when one is supposed to travel to a country with the outbreak (Hu 2017 p. 20).
This led to negative economic impact as many business persons who had businesses in the
affected countries opted to step down and some sold their thrilling businesses at a loss to keep
off from the threat. More than 8,000 people were also reported to have contracted the virus an
aspect that led continued to expose more individuals to risk. An overwhelming over 780 people
succumbed to severe acute respiratory syndrome virus from 29 countries around the world.
China mainland itself reported more than 8000 cases and recorded more than 640 deaths during
the 6 months of the outbreak.
Clinicians and medical professionals took it to the centre stage to find out the ways in which
disease is transmitted but no laboratory test had detected transmission from one individual to the
other an aspect that continued to put governments and individuals in a wave of confusion since
no one knows when the reoccurrence of the pandemic. However they were unable to accurately
identify the means of transmission, large amounts of mouth droplets from an infected person
were said to be containing a corona virus that can spread to a length of 1.5 meters hence can
infect those within this space (Canchu 2017 p. 71). The incubation period of the disease ranges
from 4-6 days since most of the cases which were reported posed illness to an individual from
the 2nd day of infection to the 10th day. The disease was found out that it couldn’t be diagnosed
by use of signs and symptoms alone since it is more like other viral illnesses. The signs and
symptoms that mostly appeared in many of the patients include sore throat, dry cough, dyspnea,
breathing difficulties, headache and fever which are more the same as the symptoms of

SARS OUTBREAK IN CHINA4
pneumonia (Gouilh 2018 p. 90). The death rate is approximated at 9% and above but soars
higher to 50% in the cases of people who are aged 60 years and above.
Impacts of SARS
Health impact
People who contracted the disease have continued to have heath challenges. Mental illnesses
have been rampart particularly to those who had contracted the disease but managed to overcome
it. This is because isolation and quarantine was applied as a means to reduce the spread of the
epidemic. Most of the people then developed psychological challenges a higher level of
emotional stress and sadness hence negative impact on their mental health (Ohnishi, Hattori,
Kobayashi & Akaji 2019 p. 423). The disease was later declared contained in 2003 but families
that lost their loved ones have continually gone through traumatic experiences. This is because
most of them were not allowed to see their family members when they were hospitalized due to
fear of spreading.
Social impact
The higher levels of fear and tension which resulted from the setting in of the epidemic have left
the Chinese with a lasting negative social impact. Panic broke out as rumors circulated around
due to inability of the government to exactly tell what the cause of the disease was. The media
also instilled fear to the public through unrealistic reports. People begun looking for ways to
prevent SARS an aspect that led many of them to try different local herbs and others through
panic brought about purchase of antiviral drugs (Siu and man 2016 p. 769). People also started
putting on masks in a bid to prevent transmission through air an aspect that made people to force

SARS OUTBREAK IN CHINA5
others to put on masks. Criticism also rose as some individuals blamed the government of hiding
the truth about the pandemic an aspect that led to backlash of government officials and medical
practitioners.
Economic Impacts
The outbreak of the disease had great impact on the economy of the Chinese since industries
such as tourism almost stopped. This led to a significant decline of the number of people in
hotels and restaurants. Travelling was also reduced since people feared of the unknown state of
the other place thus people kept off (Xiao 2017 p. 9). Families also reduced their expenditure on
normal life requirements and started buying antiviral drugs to protect themselves. The rumors
that associated the epidemic to some foods also brought to its knees the retail industry of those
commodities. The country lost an estimated USD 10-20 billion and a drop of 1% in its GDP due
to less earning and more spending which turned out to be the order of the day in most Chinese
industries. People avoided social and crowded places so as to keep off from the disease an aspect
that led to dramatic loss in these industries.
Risk factors
Failure to wash hands
Due to touching several equipments, people who were directly exposed to the SARS patients
were advised to ensure they wash their hands. This is because patients may touch equipments
which when touched and used by those taking care of them, it will pose a threat to those caring
for the patients (Ting-Chun 2016 p. 7). It’s said that contact with fluids of an infected person will
definitely lead to transmission. People were also recommended to stop eating anyhow since this

SARS OUTBREAK IN CHINA6
may pose a threat due to high levels of unhygienic conditions facing in the environment. Total
avoidance of street foods was clearly made as it poses a greater threat of infection.
Close body contact with infected persons
Getting close to an infected person poses the greatest threat to infection this is because invading
personal space increases chances of getting into contact with the body and body fluids. People
involved in sexual activities such as deep kissing increased their exposure to the disease (Li,
Brewer, and Ley 2017 p. 83). This is because the virus can is transmitted through large amounts
of droplets from the mouth which is the case of deep kissing. Since the virus has a capability of
infecting those who are 1.5 meters away, they are more concentrated and strong when people are
in close contact. This aspect led to many people putting on masks in the streets of the Chinese
cities with an aim of reducing body contact. Isolation and quarantine then got the effect to limit
interaction between the uninfected and the infected persons. Though it led to stress and finally to
poor mental health amongst those who contracted the disease, it helped to minimize the cases of
spread from person to person. People were urged to keep off from places that have been declared
severe acute respiratory syndrome zones since they may get into contact with infected persons
who may increase the chances for them to get the illness (Yu 2019 p. 225). A case study of 60
nurses who were caring for the infected persons in Beijing shows that 51 of them contracted the
epidemic of which 6 of them died as a result. This shows that 85% of these nurses may have
failed to adhere to the restrictions hence they got the disease. 15% were accurate and they ended
up their duty safe 11% of those who contracted the infection died of the same.
SARS Progression

SARS OUTBREAK IN CHINA7
The first case of the epidemic is first noticed in Guangdong in the southern part of country in mid
November 2002. An alarm is raised in mid February the following year recording 305 cases and
5 deaths from the unknown acute respiratory infection. A physician from the said province who
had treated people with the epidemic checked into a hotel room in Hong Kong and infects more
than 10 other people (Reinke 2017 p. 11). A Vietnam based Italian doctor got alarmed from the
cases he was receiving and notified the world health organization of the possible outbreak. By
March a patient who exhibited the symptoms of the infection was admitted in Hanoi and 20
medical practitioners were infected. The world health organization then raised a global alarm of
severe acute respiratory syndrome outbreak. In the same month Singapore and Canada reported
the presence of the disease and it was traced to the areas said to be heavily infected and therefore
the intermediaries were travelers.
The efforts of WHO were futile since they reported that there were no traces of bacteria causing
the special pneumonia (Hansen 2011 p. 348). The numbers continued to increase especially in
places where people are crowded for example the Amoey Gardens where more than 15,000
people were residents. Screening was introduced in airports of the heavily infected areas with the
aim of trying to contain the infection. Besides being spread to other parts of the world, the
prevalence of SARS remained higher in the Chinese provinces (Yu 2019 p. 226). It quickly
spread from Foshan in Guangdong to the neighboring cities of Heyuan, Shunde and Zhongshan
and from these places it had further spread to other parts of the country like Beijing. The cases
continued to rise alarmingly with daily report of many people having contracted the illness.
Panic was also on the rise as rumors surfaced the nation and as the government had not fully
settled on the cause, health alerts were the only order of the day. By the time the disease was
declared contained in July 2003, more than 8,000 persons had contracted the illness resulting to a

SARS OUTBREAK IN CHINA8
death toll of more than 640 people in the Chinese provinces only (Wang 2014 p. 3). Several
other countries internationally reported cases of the disease and associated deaths which raised
the number to more than 780 known deaths that resulted from SARS.
Strengths and weaknesses of the epidemiology design used
In an art shell the strengths of the design used during the outbreak of SARS are numerous. The
origin of the disease was traced down to Foshan in Guangdong province in southern China where
its initial cases were reported. The spread to the other neighboring provinces and cities was noted
very early an aspect that led to early health alerts to try and contain the infection (Gralinski 2015
p.17). Of the sampled population the symptoms of the epidemic were identified as fever, sore
throat, dry cough, dyspnea, breathing difficulties, and headache. All this was in a bid to make
people to try and practice safety precautions since the accurate cause of the disease wasn’t
known. The swift report given to the world health organization led to bringing together the top
ten best clinics worldwide to try and find out the causative agent of the disease and ways to
contain it. The WHO then took an initiative to issue alerts of a possible outbreak of severe acute
respiratory syndrome globally (Füller 2016 p. 346). It then recommended that people should
avoid travelling to places that have been declared SARS zones. Screening in the airports and
ports was also advised in a bid to contain the contagious disease. Through continuous research
the disease was first pronounced contained in July 2003 and from that moment no deaths were
reported in association to SARS.
The epidemiological design had its own unique weaknesses and failure. First, the design did not
identify the cause of the epidemic which was claiming lives and quickly spreading across the
nation and across the world. Typically within days the infection was reported to have cross

SARS OUTBREAK IN CHINA9
boarders due to delay to identify the real cause of the disease and the way it is being transmitted
from one person to another (Hilgenfeld 2014 p. 4090). Though the symptoms were identified, the
preventive measures were not yet in place thus led to panic as people began buying some
antiviral drugs which through rumors had surfaced the southern part of china that it can prevent
the disease. The wave of panic extended and soared higher hence people begun wearing masks
everywhere including in the streets in a bid to keep off from the infection. The attached
misconceptions that the disease spreads faster in crowded places impacted some sectors e.g.
travelling and tourism, clubs and social places negatively as people began avoiding such places
due to increased levels of fear (Ng 2014 p. 8). People would not put up with any person who
exhibited any of the signs of the epidemic and it is reported that when people are travelling and it
happens that one coughs, people would alight in the next bus stop leaving behind the coughing
person alone. This led to mental torture especially to those who were infected because people
would not accept them due to fear.
Implications of the epidemiological research
The outbreak of the epidemic came to an end in the mid year 2003. The general public had a lot
of adjustments to make since the economy of the country had been seriously affected with a drop
of 1% in the Gross Domestic Product (GDP). Many of the industries lost billions of shillings in a
bid to stand the shaky ground of the ongoing epidemic (Xie 2011 p. 1102). Families that had lost
their members to the epidemic continued to go through traumatic experiences associated with the
sudden demise of some of which were the bread winners. This led to increased levels of poverty
due to much earnings were diverted to healthcare which had also been wavering at the moment.
Medics would discharge patients on accounts of common cold an aspect that increased the
prevalence of the disease. Cao (2016) denotes that social places and some industries were

SARS OUTBREAK IN CHINA10
completely brought down an aspect that led to people losing jobs to the same pandemic
(Watanabe 2010 p. 1131). The levels of stress and mental health problems continued to increase
due to the ongoing instability and failure of the government to provide lasting solutions to the
bereaved families who at the same time were avoided by other citizens and some of whom lost
their jobs.
Conclusion
Severe acute respiratory syndrome is a disease caused by coronary virus which broke out in
China in late 2002 to mid-year 2003. Started in Foshan and quickly spread across the southern
provinces of the country and later to other countries. The epidemic impacted the country’s
economy, social and health negatively with the primary ways of transmission being identified as
close contact with infected persons and failure to practice hygiene particularly hand washing.
The information was relied to the World Health Organization which took an active role to
conduct research on the disease in a bid to stop it from further spreading. They also issued
security alerts when its efforts became futile since the primary cause of the disease could not be
identified. The aftermath of the epidemic left the country with serious challenges which had
continued to haunt down the citizens and the economy of China.

SARS OUTBREAK IN CHINA11
References
Ar Gouilh, M. (2018) ‘SARS-CoV related Betacoronavirus and diverse Alphacoronavirus
members found in western old-world’, Virology, 517, pp. 88–97. doi:
10.1016/j.virol.2018.01.014.
Canchu Lin (2017) ‘Leader as Rhetor: An Analysis of China’s Anti-SARS Campaign’, China
Media Research, 13(2), pp. 67–74. Available at: http://search.ebscohost.com/login.aspx?
direct=true&db=ufh&AN=122884862&site=ehost-live (Accessed: 2 April 2019).
Cao, C. (2016) ‘Analysis of Spatiotemporal Characteristics of Pandemic SARS Spread in
Mainland China’, BioMed Research International, 2016, pp. 1–12. doi: 10.1155/2016/7247983.
Füller, H. (2016) ‘Pandemic cities: biopolitical effects of changing infection control in post-
SARS Hong Kong’, Geographical Journal, 182(4), pp. 342–352. doi: 10.1111/geoj.12179.
Gralinski, L. E. (2015) ‘Genome Wide Identification of SARS-CoV Susceptibility Loci Using
the Collaborative Cross’, PLoS Genetics, 11(10), pp. 1–21. doi: 10.1371/journal.pgen.1005504.
Hansen, K. F. (2011) ‘Approaching doomsday: how SARS was presented in the Norwegian
media’, Journal of Risk Research, 12(3/4), pp. 345–360. doi: 10.1080/13669870802661455.

SARS OUTBREAK IN CHINA12
Hilgenfeld, R. (2014) ‘From SARS to MERS: crystallographic studies on coronaviral proteases
enable antiviral drug design’, FEBS Journal, 281(18), pp. 4085–4096. doi: 10.1111/febs.12936.
Hu, B. (2017) ‘Discovery of a rich gene pool of bat SARS-related coronaviruses provides new
insights into the origin of SARS coronavirus’, PLoS Pathogens, 13(11), pp. 1–27. doi:
10.1371/journal.ppat.1006698.
Ng, O.-W. (2014) ‘Substitution at Aspartic Acid 1128 in the SARS Coronavirus Spike
Glycoprotein Mediates Escape from a S2 Domain-Targeting Neutralizing Monoclonal
Antibody’, PLoS ONE, 9(7), pp. 1–11. doi: 10.1371/journal.pone.0102415.
Ohnishi, K, Hattori, Y, Kobayashi, K & Akaji, K (2019), ‘Evaluation of a non-prime site
substituent and warheads combined with a decahydroisoquinolin scaffold as a SARS 3CL
protease inhibitor’, Bioorganic & Medicinal Chemistry, vol. 27, no. 2, pp. 425–435, viewed 2
April 2019, <http://search.ebscohost.com/login.aspx?
direct=true&db=aph&AN=134150868&site=ehost-live>.
Reinke, L. M. (2017) ‘Different residues in the SARS-CoV spike protein determine cleavage and
activation by the host cell protease TMPRSS2’, PLoS ONE, 12(6), pp. 1–15. doi:
10.1371/journal.pone.0179177.
Siu, J. Y. ‐ man (2016) ‘Coping with future epidemics: Tai chi practice as an overcoming
strategy used by survivors of severe acute respiratory syndrome ( SARS) in post- SARS Hong
Kong’, Health Expectations, 19(3), pp. 762–772. doi: 10.1111/hex.12270.

SARS OUTBREAK IN CHINA13
Song, W. (2018) ‘Cryo-EM structure of the SARS coronavirus spike glycoprotein in complex
with its host cell receptor ACE2’, PLoS Pathogens, 14(8), pp. 1–19. doi:
10.1371/journal.ppat.1007236.
Wang, K.-Y. (2014) ‘How Change of Public Transportation Usage Reveals Fear of the SARS
Virus in a City’, PLoS ONE, 9(3), pp. 1–10. doi: 10.1371/journal.pone.0089405.
Watanabe, T. (2010) ‘Development of a Dose-Response Model for SARS Coronavirus’, Risk
Analysis: An International Journal, 30(7), pp. 1129–1138. doi: 10.1111/j.1539-
6924.2010.01427.x.
Xiao, S. (2017) ‘Role of fomites in SARS transmission during the largest hospital outbreak in
Hong Kong’, PLoS ONE, 12(7), pp. 1–13. doi: 10.1371/journal.pone.0181558.
Xie, X.-F. (2011) ‘The “Typhoon Eye Effect”: determinants of distress during the SARS
epidemic’, Journal of Risk Research, 14(9), pp. 1091–1107. doi:
10.1080/13669877.2011.571790.
Yu, P. (2019) ‘Geographical structure of bat SARS-related coronaviruses’, Infection, Genetics &
Evolution, 69, pp. 224–229. doi: 10.1016/j.meegid.2019.02.001.
Yvonne Ting-Chun Yu (2016) ‘Surface vimentin is critical for the cell entry of SARS-CoV’,
Journal of Biomedical Science, 23, pp. 1–10. doi: 10.1186/s12929-016-0234-7.