SARS Lessons Not Learned
The first wave of the SARS epidemic was traced back to a fishseller from Guangzhou province ( 1000 km from Wuhan) in November 2002. When he fell ill, he infected over 100 health workers and began the worldwide spread of the SARS virus causing many casualties. The second victim was a chef from Heyuan who worked in a restaurant in Shenzhen. He prepared wild game meat. His family and seven healthcare workers who were in contact got infected. SARS virus was discovered in palm civets and raccoon dogs from wild-animal markets in the Guangdong Province of China. Eight thousand people were affected in SARS epidemics. During the outbreak in 2003, 8,096 cases (774 deaths) had occurred in over 30 countries on five continents.
In 2004, a waitress served palm civets meat at a restaurant in Guangzhou, China. Six palm civets were kept in cages at the same restaurant; all six were positive for SARS. The second wave of human infections occurred although it was contained quickly. In the following years, the antibodies to SARS were detected in 40% for asymptomatic animal handlers.
Thirteen years ago, in 2007, the science classified horseshoe bats as a primary host of the virus, civets as an intermediate host before the virus jumped to humans. Back then researchers highlighted the importance of wildlife handling in wet markets across China. These markets were named as a potential source and amplifier of novel viruses. Exotic wild animals such as civets and pangolins are still consumed by humans as of April 2020.
Imported exotic animals pose risk to humans
In 5 years — 1 trillion animals were imported into the United States
SARS pandemic taught worrying lessons that human to human transmission occurs by direct (mucosae with infectious respiratory droplets) or indirect contact ( likely contaminated surfaces and aerosols generated in toilets since feces, urine are found to contain a high virus load).
After contracting the SARS virus, one person could likely infect two to four people between day five and day 10 of the disease. Seasonal flu, for example, is highly transmissible in the first two days of the infection.
As many as third of SARS victims developed respiratory failure and needed IVL ( mechanical ventilation), and the overall mortality rate was around 15%.
For those who survived the outbreak, it took several months to recover from residual lung damage. After a year, a third of survivors still had a significant impairment of lung function. One unusual complication was noted in male survivors, orchitis — inflammation of the testicles. Health workers and survivors, including their families, were gravely hit by depression and posttraumatic stress disorder. Males were found to succumb to SARS more often than females.
During the acute SARS illness, the survivor’s immune system malfunctioned (switched from innate immunity to adaptive immunity). Some victims died after experiencing an apparent recovery. It was concluded that some individuals had fading antibodies level just before death, suggesting that the antibody response is likely to play an essential role in determining the final disease outcome. As of 2020, there is still no cure or protective vaccine for SARS.
The only method to distinguish SARS pneumonia from the community- or hospital-acquired pneumonia was a laboratory test. However, both viral culture and neutralizing antibodies testing required a biosafety level 3 laboratory, which was not available in most hospitals back in 2007.
The spread of SARS was deemed to be droplets or aerosol mediated. The SARS virus could be quickly inactivated by household bleach within 5 min. Without disinfection, the virus persisted for up to 7 days at room temperature in fecal and respiratory samples. Surface contamination was found to be longer on disposable synthetic gowns compared to cotton gowns. The virus was not detected on paper after it dried.
Animals were affected by human SARS diseases, as well. Many mammalian species are susceptible to SARS-CoV.
Animals are at risk of infection too
The initial, intermediate and final hosts of COVID-19 virus
The SARS was highly capable of jumping interspecies barriers and an excellent candidate as an emerging or re-emerging pathogen. No cases of SARS have been reported worldwide since 2004.
“The possibility of the re-emergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored”, American Society for Microbiology (ASM), 2007.
The lessons were never learned.