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Lessons of SARS
Many features of the SARS epidemic and the public health response are worth recalling because they provide reminders of challenges posed by the emergence of a new disease that is transmissible from person to person. Some of these features include the initial lack of field investigative capacity, reference laboratory testing, and reporting transparency from southern China, which resulted in a 3-month delay in the reporting of the severe unexplained illness to WHO; the important role played by an alert clinician in Hanoi, Vietnam, in the initial recognition and response to the illness; the rapid spread of illness to >30 countries; and the effects on health care workers and family members, who were most at risk for person-to-person spread of the infection. Reviewing the events that occurred during the SARS epidemic is an opportunity to highlight the ultimate success of early patient isolation, contact tracing, quarantine, and infection control measures; the importance of rigorous attention to biosafety in laboratory settings; the effects of stigmatization of affected groups; the economic impact as a result of major disruptions in international travel and commerce; the identification of the mode and circumstances of cross-species transmission; and the role of "superspreaders" and superspreading events in the rapid dissemination of the illness.
In addition, during the epidemic, the leadership provided by WHO facilitated timely exchange of new information among clinicians, epidemiologists, and laboratory investigators around the world. These efforts included the formation of a global network of virology and pathology laboratories that used modern diagnostic methods, which contributed to the rapid identification, characterization, and sequencing of the agent and the timely dissemination of critical information and guidance through agency reports, expedited peer-reviewed publications, lay media, and the Internet. These experiences exemplify the characteristic features of the global SARS outbreak.
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