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While the death toll of Coronavirus the last time a deadly Asian flu struck, a book was made …

Health Minister Matt Hancock declared the corona virus outbreak a “serious and imminent” threat to the British public this week.

More than 42,000 people have acquired the new species – now called COVID-19 – in Wuhan, a city of 11 million people in central China, and more than 1,000 people have died.

It is of course not the first highly contagious flu-like virus that starts in Asia and spreads rapidly, and it will not be the last.

In 2003, SARS (Severe Acute Respiratory Syndrome) – another coronavirus virus called the Angel of Death – killed nearly 1,000 people before it declined. The new virus appears to be more infectious than SARS, has caused more cases in a fraction of the time and is now exceeding the number of fatalities (although SARS had a mortality rate of nearly 10 percent compared to 2 percent for COVID-19).

But what have we learned from SARS, what is the role of the so-called super-spreaders, and how can we use that to stop this new species?

Here David Quammen, the author of an award-winning book on the SARS epidemic, draws on research from scientists around the world – and his own investigations – to show that a possible pandemic has arisen.

At the end of February 2003, SARS boarded a plane in Hong Kong and went to Toronto. The arrival in Canada was not announced, but within a few days it started to feel.

It killed the 78-year-old grandmother who had carried it to the country, killed her adult son a week later, and spread through the hospital where the son was treated.

It soon infected hundreds of other Toronto residents, 31 of whom eventually died.

Cathay Pacific crew wear masks at Chek Lap Kok airport in Hong Kong to protect against a murderous outbreak Severe Acute Respiratory Syndrome (SARS) in April 2003

Cathay Pacific crew wears masks at Chek Lap Kok airport in Hong Kong to protect against a murderous outbreak Severe Acute Respiratory Syndrome (SARS) in April 2003

One of the infected was a 46-year-old Filipino woman working in Ontario as a nursing assistant, who flew to the Philippines for Easter, fell ill the day after arrival (but remained active, visited shopping and relatives) – and started a new chain of infections on the island of Luzon.

So SARS had gone halfway around the world and back in six weeks.

Nobody could know for sure at that early stage whether the SARS agent was a virus, a bacterium or something else. In the meantime, it had also arrived in Singapore, Vietnam, Thailand, Taiwan and Beijing. Singapore became another epicenter.

It reached Beijing with at least two modes of transport, including China Airlines Flight 112, from Hong Kong on March 15. (The other route was by car when a sick woman from Shanxi province drove.)

Flight CA112 departed from Hong Kong that day with 120 people, including a feverish man with a cough getting worse. By the time it landed in Beijing, three hours later, 22 other passengers and two crew members had received contagious doses of germs from the coughing man.

A 90-year-old man is transported between hospitals during the March 2003 SARS outbreak in Hamburg, Germany

A 90-year-old man is transported between hospitals during the March 2003 SARS outbreak in Hamburg, Germany

A 90-year-old man is transported between hospitals during the March 2003 SARS outbreak in Hamburg, Germany

Of them, it spread to more than 70 hospitals in Beijing – yes, 70 – infecting nearly 400 employees, other patients, and visitors.

Two aspects of what made SARS so threatening were its infectivity and its fatality. Another ominous feature was that the new bug, whatever it was, seemed so good at driving on planes.

Hong Kong was only the gateway to its international distribution – but it was close to its origins.

The whole phenomenon had begun quietly, a few months earlier, in the southernmost province of mainland China, Guangdong, a place of flourishing trade and distinctive culinary practices.

On November 16, 2002, a 46-year-old man from a city came down 80 miles northwest of Hong Kong with fever and breathlessness. That he has triggered a series of other cases (his wife, an aunt, her husband and daughter) strongly suggests that SARS was what he had. He has been described as a ‘local government official’, but in retrospect, the only striking aspect of his profile is that he had helped prepare a few meals, the ingredients of which were chicken, domestic cat and snake.

Snake on the menu was not unusual in Guangdong. It is a province of unpleasant carnivores, where the list of animals that are considered delicious can be mistaken for the inventory of a pet store or zoo.

People wearing masks in the business district, Central, in Hong Kong, during the SARS outbreak in 2003

People wearing masks in the business district, Central, in Hong Kong, during the SARS outbreak in 2003

People wearing masks in the business district, Central, in Hong Kong, during the SARS outbreak in 2003

Three weeks later, in early December, a restaurant manager in Shenzhen, another major city in Guangdong, fell ill with similar symptoms.

Feeling sick, he commuted to a hospital in another city, Heyuan, where he infected at least six health professionals before being transferred to Guangzhou, about 130 miles to the southwest.

Not long after, other such diseases began to occur in Zhongshan, 60 miles south of Guangzhou. 28 cases were recognized there within a few weeks. Symptoms were headache, high fever, chills, body aches, severe and persistent cough, coughing up bloody mucus and progressive destruction of the lungs, which tended to stiffen and fill with fluid, causing oxygen deficiency that in some cases led to organ failure and death.

Thirteen of the patients were health professionals and at least one was another chef, whose bill included snakes, foxes, civets (small mammals, distantly related to mongoose) and rats.

Then a seafood wholesale company that Zhongshan had visited went to a hospital in Guangzhou and caused the chain of infections that would circle the world.

This seafood trader was Zhou Zuofeng. He became the first “super-spreader” of the SARS crisis.

A super spreader is a patient who, for some reason, directly infects many more people than the typical infected patient.

Chongqing, China, Asia - A female butcher stands in front of a butcher shop that sells poultry

Chongqing, China, Asia - A female butcher stands in front of a butcher shop that sells poultry

Chongqing, China, Asia – A female butcher stands in front of a butcher shop that sells poultry

Nobody seems to know where Zhou got his infection.

He ran a shop in a large fish market, close to other living markets, including those with domestic and wild birds and mammals. The infection persisted, caused cough and fever and drove him on January 30, 2003 to seek help in a hospital in Guangzhou. He infected at least 30 employees in two days.

Zhou himself would eventually become known as the “Poison King.” He survived the disease, although many people who got it from him – directly or indirectly through a long series of contacts – did not.

One of those secondary cases was physician Liu Jianlun, 64, professor of nephrology at the university hospital where Zhou was first treated. Professor Liu began to feel flu-like symptoms two weeks after his exposure to Zhou, and then seemed to get better – good enough, he thought, to push ahead with his cousin’s wedding attendance in Hong Kong.

He and his wife took the three-hour bus ride from Guangzhou on February 21, crossed the border, spent an evening with family, and then checked into a large hotel called the Metropole, favored by business people and tourists, in the Kowloon district. They were given room 911, opposite the elevators in the middle of a long corridor, a fact that became central to later epidemiological research.

Two fateful things happened that night in the Metropole. The professor’s condition deteriorated; and at some point he seems to have sneezed, coughed or (depending on which story you believe) vomited in the corridor on the ninth floor.

In any case, he threw a good dose of the pathogen that made him sick – enough to infect at least 16 other guests and a visitor to the hotel. Professor Liu thus became the second known super-spreader.

Among the hotel guests who shared floor nine was that 78-year-old grandmother from Canada. She had visited family and then spent a few nights at the Metropole hotel with her husband.

Her room was 904, across the corridor and a few steps lower than Professor Liu’s. Her stay only overlapped one night with his. Maybe they shared a lift in the lift. Maybe they were walking down the corridor. Maybe they have never seen each other. Nobody knows.

What is known is that the professor woke up the next day and felt too sick to go to a wedding. Instead, he checked to the nearest hospital. He would die on March 4.

One day after Professor Liu left the Metropole, the grandmother also left. Infected but not yet symptomatic, and feeling good, she boarded her flight to Toronto – with SARS worldwide.

Apart from a few after-shock cases at the start of 2004, SARS did not return to humans. . . so far. But now something very bad, the Wuhan corona virus, is spreading all over the world.

The scenario in 2003 could have been much worse. SARS was an outbreak, not a global pandemic. There were just over 8,000 cases, 774 died, not 7 million, as could have happened.

Several factors have contributed to limiting the extent of the outbreak, of which happiness was only one. Another was the speed and excellence of laboratory diagnostics – finding and identifying the virus – by scientists around the world. And another was the smooth efficiency with which cases were isolated, contacts were traced and quarantine measures were taken.

Another factor was inherent in the way SARS affects the body: symptoms usually occur before a person becomes highly contagious.

This sequence of events allowed many SARS cases to be recognized, hospitalized and isolated before they reach their peak of infectivity. With flu and many other diseases, the order is reversed, with days with high contagiousness before symptoms: the danger, then the warning.

That probably contributed to the scale of global misery and death during the 1918-1919 influenza [so-called Spanish flu] causing an estimated 50 million people to die: the bug traveled the sense of alarm ahead. And that was before globalization. Everything moves around the planet faster now, including viruses.

If the Next Big One comes, we can guess, it will probably meet the same perverse pattern, high infectivity prior to notable symptoms. That will help it move through cities and airports like an angel of death.

Will the current coronavirus become such an event, such a global plague, such an angel of death? Too fast to tell.

If so, we had to be ready for it yesterday. And if that’s not the case, the Next Big One will still come, and we have to prepare for it tomorrow.

Adapted from Spillover: Animal Infections And The Next Human Pandemic by David Quammen, published by Vintage for £ 12.99. © David Quammen 2012. Available at amazon.co.uk.

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