2002–2004 SARS outbreak

Epidemic of severe acute respiratory syndrome originating in China September 2021 April 2020 2002–2004 SARS outbreak SARS map.svg Map of the infected countries of the epidemic of SARS between 1 Nov 2002 and 7 Aug 2003#2B2B2B Countries with confirmed deaths#FF2929 Countries with confirmed infections#B9B9B9 Countries without confirmed cases Sars Cases and Deaths.pdf Map of SARS cases and deaths around the world regarding the global population SARS SARS-CoV-1 Worldwidemostly in East Asia 16 Nov 2002 Early 2003 16 Nov 2002 – 19 May 2004 (2002 11 16 2004 05 19) Shunde, Guangdong, China 8,096 774 Around 30 countries The 2002–2004 outbreak of SARS, caused by severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-1), infected over 8,000 people from 30 countries and territories, and resulted in at least 774 deaths worldwide.https://www.businessinsider.com/deadly-sars-virus-history-2003-in-photos-2020-2 How SARS terrified the world in 2003, infecting more than 8,000 people and killing 774 Business Insider 20 February 2020 2 March 2020 https://web.archive.org/web/20200302170811/https://www.businessinsider.com/deadly-sars-virus-history-2003-in-photos-2020-2 2 March 2020 live The outbreak was first identified in Foshan, Guangdong, China, in November 2002.July–August 2003 A Chronicle on the SARS Epidemic https://www.tandfonline.com/doi/full/10.2753/CLG0009-4609360412 Chinese Law & Government en 36 4 12–15 10.2753/CLG0009-4609360412 219305114 0009-4609 12 June 2020 2 October 2020 https://web.archive.org/web/20201002175625/https://www.tandfonline.com/doi/abs/10.2753/CLG0009-4609360412 live subscription The World Health Organization (WHO) was notified of the outbreak in February 2003, and issued a global alert in March 2003. Initially, the cause of the outbreak was unknown, and some media outlets reported that an influenza virus was a potential culprit.https://news.bbc.co.uk/2/hi/health/2846243.stm Alert over Hong Kong 'super-flu' 13 March 2003 news.bbc.co.uk 25 October 2021 25 October 2021 https://web.archive.org/web/20211025185624/http://news.bbc.co.uk/2/hi/health/2846243.stm live The major part of the outbreak lasted about 8 months, and the World Health Organization declared SARS contained on 5 July 2003. However, several SARS cases were reported until May 2004. In late December 2019, SARS-CoV-2, a coronavirus in the same genus as the one that caused SARS, was discovered in Wuhan, Hubei, China. This strain causes COVID-19, which spread to other areas of Asia, and then worldwide in early 2020, marking the start of the COVID-19 pandemic.New coronavirus stable for hours on surfaces https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces National Institutes of Health (NIH) NIH.gov 4 May 2020 EN 17 March 2020 https://web.archive.org/web/20200323032520/https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces 23 March 2020 live Coronavirus Disease (COVID-19) Situation Reports: Data as reported by: 20 January 2020 https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4 www.who.int WHO 3 September 2020 en 29 January 2020 https://web.archive.org/web/20200129025723/https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4 live Outbreak by country and territory 400px|thumb|2003 probable cases of SARS worldwide + Probable cases of SARS by country and territory, 1 November 2002 – 31 July 2003Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003 21 April 2004 World Health Organization https://www.who.int/csr/sars/country/table2004_04_21/en/ 3 March 2020 https://web.archive.org/web/20200319162659/https://www.who.int/csr/sars/country/table2004_04_21/en/ 19 March 2020 live Country or region Cases Deaths Fatality (%)Mainland ChinaFigures for China exclude Hong Kong, Macau and Taiwan, which are reported separately by the WHO.5,3273496.6Hong Kong1,75529917.0TaiwanAfter 11 July 2003, 325 Taiwanese cases were 'discarded'. Laboratory information was insufficient or incomplete for 135 of the discarded cases; 101 of these patients died. https://www.cdc.gov.tw/Bulletin/Detail/epPvhTanl4S984qYmcaMXA?typeid=9 衛生署針對報載SARS死亡人數有極大差異乙事提出說明 DH's statement on significant differences in reported SARS deaths 台灣衛生福利部疾病管制署 (Disease Control Agency, Taiwan Ministry of Health and Welfare) zh-hant 3 March 2020 https://web.archive.org/web/20200320075731/https://www.cdc.gov.tw/Bulletin/Detail/epPvhTanl4S984qYmcaMXA?typeid=9 20 March 2020 live https://news.pts.org.tw/article/238707 十年前SARS流行 346人感染73死亡 25 April 2013 Ten years ago SARS epidemic 346 people infected 73 died Public Television Service zh-hant 3 March 2020 https://web.archive.org/web/20200219233224/https://news.pts.org.tw/article/238707 19 February 2020 live 34673 21.1Canada2514317.1Singapore2383313.9VietnamHồi ức 45 ngày kinh hoàng chống dịch SARS http://benhnhietdoi.vn/tin-tuc/chi-tiet/hoi-uc-45-ngay-kinh-hoang-chong-dich-sars/220 2023-04-03 benhnhietdoi.vn vi 3 April 2023 https://web.archive.org/web/20230403191214/http://benhnhietdoi.vn/tin-tuc/chi-tiet/hoi-uc-45-ngay-kinh-hoang-chong-dich-sars/220 live 6357.9United States2700Philippines14214.3Thailand9222.2Germany900Mongolia900France7114.3Australia600Malaysia5240.0Sweden500United Kingdom400Italy400India300South Korea 1997300Indonesia200South Africa11100.0Kuwait100Ireland100Macau100New Zealand100Romania100Russia100Spain100Switzerland100 Total excluding China2,76942515.4 Total (30 territories) 8,096 774 9.6 Timeline November 2002 On 16 November 2002,Dan Feng De Vlas Sake J. Fang Li-Qun Han Xiao-Na Zhao Wen-Juan Shen Sheng Yang Hong Jia Zhong-Wei Richardus Jan Hendrik Cao Wu-Chun The SARS epidemic in mainland China: bringing together all epidemiological data Tropical Medicine and International Health 27 October 2009 14 s1 4–13 10.1111/j.1365-3156.2008.02145.x 19508441 7169858 an outbreak of severe acute respiratory syndrome (SARS) began in China's Guangdong province, bordering Hong Kong. The first case of infection was traced to Foshan.Xu Rui-Heng He Jian-Feng Evans Meirion R. Peng Guo-Wen Field Hume E. Yu De-Wen Lee Chin-Kei Luo Hui-Min Lin Wei-Sheng Lin Peng Li Ling-Hui Liang Wen-Jia Lin Jin-Yan Schnur Alan Epidemiologic Clues to SARS Origin in China Emerging Infectious Diseases June 2004 10 6 1030–1037 3323155 10.3201/eid1006.030852 15207054Horstman Mark The facts about SARS https://www.abc.net.au/science/features/sars/outbreak.htm 25 May 2020 Australian Broadcasting Corporation 7 April 2003 https://web.archive.org/web/20191224122800/http://www.abc.net.au/science/features/sars/outbreak.htm 24 December 2019 live This first outbreak affected people in the food industry, such as farmers, market vendors, and chefs.Martin Nik SARS remembered – how a deadly respiratory virus hit Asian economies https://www.dw.com/en/sars-remembered-how-a-deadly-respiratory-virus-hit-asian-economies/a-52088462 25 May 2020 Deutsche Welle 22 January 2020 https://web.archive.org/web/20200612205736/https://www.dw.com/en/sars-remembered-how-a-deadly-respiratory-virus-hit-asian-economies/a-52088462 12 June 2020 live Rosenthal Elisabeth The SARS Epidemic: The Path; From China's Provinces, a Crafty Germ Breaks Out https://www.nytimes.com/2003/04/27/world/the-sars-epidemic-the-path-from-china-s-provinces-a-crafty-germ-breaks-out.html 25 May 2020 The New York Times 27 April 2003 https://web.archive.org/web/20200522172522/https://www.nytimes.com/2003/04/27/world/the-sars-epidemic-the-path-from-china-s-provinces-a-crafty-germ-breaks-out.html 22 May 2020 live The outbreak spread to healthcare workers after people sought medical treatment for the disease. The People's Republic of China notified the World Health Organization (WHO) about this outbreak on 11 February 2003, reporting 305 cases including 105 health-care workers and five deaths.Severe Acute Respiratory Syndrome (SARS) – multi-country outbreak – Update 6. https://web.archive.org/web/20090503063347/http://www.who.int/csr/don/2003_03_21/en/index.html 3 May 2009 World Health Organization (www.who.int). Retrieved 22 January 2020 Later, it reported that the outbreak in Guangdong had peaked in mid-February 2003. However, this appears to have been false because subsequently 806 cases of infection and 34 deaths were reported.Cyranoski D. 2003 China joins investigation of mystery pneumonia Nature 422 6931 459 10.1038/422459b 12673214 7094955 2003Natur.422..459C free Italian physician Carlo Urbani was the first to identify SARS as probably a new and dangerously contagious viral disease.http://www.timesonline.co.uk/tol/comment/obituaries/article1129034.ece London The Times Sam Coates Anushka Asthana Dr Carlo Urbani Health expert who identified the Sars outbreak as an epidemic, and was killed by the virus 14 December 2020 5 June 2011 https://web.archive.org/web/20110605002200/http://www.timesonline.co.uk/tol/comment/obituaries/article1129034.ece dead https://www.who.int/csr/sars/urbani/en/ https://web.archive.org/web/20030605150221/http://www.who.int/csr/sars/urbani/en/ dead 5 June 2003 29 March 2003 23 January 2020 WHO Dr. Carlo Urbani of the World Health Organization dies of SARS Early in the epidemic, the Chinese government discouraged its press from reporting on SARS, delayed reporting to WHO, and initially did not provide information to Chinese outside Guangdong province, where the disease is believed to have originated.https://www.nytimes.com/2003/03/27/world/china-raises-tally-of-cases-and-deaths-in-mystery-illness.html China Raises Tally of Cases and Deaths in Mystery Illness The New York Times 27 March 2003 11 March 2009 E. Rosenthal L. K. Altman https://web.archive.org/web/20090506004415/https://www.nytimes.com/2003/03/27/world/china-raises-tally-of-cases-and-deaths-in-mystery-illness.html 6 May 2009 Also, a WHO team that travelled to Beijing was not allowed to visit Guangdong province for several weeks.http://www.umass.edu/sts/ethics/online/cases/SARS/case.html IDEESE Case: SARS 20 April 2015 https://web.archive.org/web/20150427124829/http://www.umass.edu/sts/ethics/online/cases/SARS/case.html 27 April 2015 live This resulted in international criticism, which seems to have led to a change in government policy in early April.The SARS Epidemic https://www.umass.edu/sts/ethics/online/cases/SARS/case.html International Dimensions of Ethics Education in Science and Engineering Project University of Massachusetts Amherst 20 May 2020 https://web.archive.org/web/20200612230309/https://www.umass.edu/sts/ethics/online/cases/SARS/case.html 12 June 2020 live Ching Frank Sars Gives China a Lesson in Globalization https://yaleglobal.yale.edu/content/sars-gives-china-lesson-globalization YaleGlobal Yale University 20 May 2020 2 May 2003 https://web.archive.org/web/20200612203025/https://yaleglobal.yale.edu/content/sars-gives-china-lesson-globalization 12 June 2020 live January 2003 A fishmonger, named Zhou Zuofen, checked in to the Sun Yat-sen Memorial Hospital in Guangzhou on 31 January, where he infected 30 nurses and doctors. The virus soon spread to nearby hospitals.Scientists wait for next mass killer to spill over from nature Peter McGrath https://www.yorkshirepost.co.uk/news/analysis/scientists-wait-for-next-mass-killer-to-spill-over-from-nature-1-5399130 The Yorkshire Post 12 February 2013 26 January 2020 Zhou is erroneously named Zhou Zoufeng in the article https://web.archive.org/web/20200126133749/https://www.yorkshirepost.co.uk/news/analysis/scientists-wait-for-next-mass-killer-to-spill-over-from-nature-1-5399130 26 January 2020 live February 2003 Hong Kong thumbnail|Ninth floor layout of the Hotel Metropole in Hong Kong, showing where an outbreak of the severe acute respiratory syndrome (SARS) occurred In February 2003, Liu Jianlun became Hong Kong's SARS index patient. He and his wife had come to attend a wedding; Liu was on the staff at Sun Yat-Sen Memorial Hospital in Guangzhou and had treated SARS patients.Abraham Thomas Thomas Abraham 2004 Twenty-first Century Plague: The Story of SARS Johns Hopkins University Press https://archive.org/details/twentyfirstcentu00thom archive.org 9780801881244 registration 22 January 2020 https://web.archive.org/web/20200226203419/https://archive.org/details/twentyfirstcentu00thom 26 February 2020 live On 21 February, Liu and his wife checked into room 911 on the ninth floor of the Metropole Hotel. Despite feeling ill he and his family traveled around Hong Kong. By the morning of 22 February, he knew he was very ill and walked to the Accident and Emergency Department of Kwong Wah Hospital to seek treatment. He was treated by the triage nurse and doctor without protective measures even though a memorandum on surveillance of severe community-acquired pneumonia had been issued by the Hospital Authority of Hong Kong. After Liu's chest X-ray taken in Kwong Wah Hospital became available, staff became aware of the situation, wearing personal protective equipment and full isolation inside the ICU.https://www.legco.gov.hk/yr03-04/english/sc/sc_sars/reports/sars_rpt.htm Select Committee to inquire into the handling of the Severe Acute Respiratory Syndrome outbreak by the Government and the Hospital Authority www.legco.gov.hk 13 October 2021 19 April 2021 https://web.archive.org/web/20210419143128/https://www.legco.gov.hk/yr03-04/english/sc/sc_sars/reports/sars_rpt.htm live He did not recover and died on 4 March. Liu is believed to have been a SARS super-spreader: 23 other Metropole guests developed SARS, including seven from the ninth floor. Liu's brother-in-law, who sought treatment in late February, was hospitalized in Kwong Wah Hospital on 1 March and died on 19 March. It is estimated that around 80% of the Hong Kong cases were due to Liu.Khan, Ali S. & Patrick, William. (2016). "The Next Pandemic." New York: PublicAffairs. Vietnam The virus was carried to Hanoi, Vietnam, by Chinese-American Johnny Chen, a resident of Shanghai who had roomed across the hall from Liu at the Metropole. He was admitted to the French Hospital of Hanoi on 26 February, where he infected at least 38 members of the staff. Even though he was evacuated, he died on 13 March. Carlo Urbani, a World Health Organization (WHO) infectious disease specialist, was among the staff who examined Chen. Urbani observed that other hospital staff were already falling ill and realized that he was dealing with a new and dangerous disease. He himself became infected and died on 29 March. Canada 2002–2004 SARS outbreak among healthcare workers On 23 February, an elderly woman named Kwan Sui-Chu who had also been a Metropole Hotel guest, returned to Toronto, Canada, from Hong Kong. She died at home on 5 March, after infecting her son Tse Chi Kwai, who subsequently spread the disease to Scarborough Grace Hospital and died on 13 March.Low Donald Donald Low 2004 https://www.ncbi.nlm.nih.gov/books/NBK92467/ 63–71 Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary National Academies Press (US) 28 February 2020 https://web.archive.org/web/20200224085530/https://www.ncbi.nlm.nih.gov/books/NBK92467/ 24 February 2020 live March 2003 Singapore On 1 March, 26-year-old Esther Mok, another Metropole guest, was admitted to Tan Tock Seng Hospital after visiting Hong Kong, starting the outbreak in Singapore. Although she recovered, various family members did not.Yeoh En-Lai 9 April 2003 https://www.ph.ucla.edu/epi/bioter/singaporewomanSARS.html Singapore Woman Linked to 100 SARS Cases Associated Press 28 February 2020 https://web.archive.org/web/20130618210614/http://www.ph.ucla.edu/epi/bioter/singaporewomanSARS.html 18 June 2013 live Taiwan The first cases of atypical pneumonia in Taiwan were identified in a Guangdong-based businessman and his wife on 14 March and confirmed on 17 March. He had returned to Taiwan via Hong Kong on 23 February and reported a fever two days later. His wife became ill after caring for him, and both were admitted to National Taiwan University Hospital.Mystery bug strikes Taiwan couple https://taipeitimes.com/News/front/archives/2003/03/15/0000198082 19 April 2020 Taipei Times Central News Agency 15 March 2003 https://web.archive.org/web/20200516163856/https://taipeitimes.com/News/front/archives/2003/03/15/0000198082 16 May 2020 live Taiwan's third case of the disease was identified in a Yilan hospital on 15 March. Like the first case, the third case appeared in someone who had traveled to Guangdong and transited through Hong Kong before arriving in Taiwan.Chen Melody A third case of atypical pneumonia reported in Taiwan https://taipeitimes.com/News/front/archives/2003/03/16/0000198232 19 April 2020 Taipei Times 16 March 2003 https://web.archive.org/web/20200516160404/https://taipeitimes.com/News/front/archives/2003/03/16/0000198232 16 May 2020 live Shortly after the third case was diagnosed, officials from the Centers for Disease Control and Prevention in the United States traveled to Taiwan to study the disease.Chen Melody US specialists to study pneumonia cases https://taipeitimes.com/News/front/archives/2003/03/17/0000198360 19 April 2020 Taipei Times 17 March 2020 https://web.archive.org/web/20200516163330/https://taipeitimes.com/News/front/archives/2003/03/17/0000198360 16 May 2020 live Chen Melody Mystery illness highlights Taiwan's health isolation https://taipeitimes.com/News/front/archives/2003/03/18/0000198471 19 April 2020 Taipei Times 18 March 2003 https://web.archive.org/web/20200516141245/https://taipeitimes.com/News/front/archives/2003/03/18/0000198471 16 May 2020 live The fourth case, in another traveler to Guangdong, was identified in Chiayi on 18 March, after he sought treatment at a hospital the previous day.Chen Melody Ko Shu-ling Lin Mei-chun Fourth mystery pneumonia case confirmed in Chiayi https://taipeitimes.com/News/front/archives/2003/03/19/0000198748 19 April 2020 Taipei Times 19 March 2003 https://web.archive.org/web/20200516140705/https://taipeitimes.com/News/front/archives/2003/03/19/0000198748 16 May 2020 live By 22 March, six cases in Taiwan had matched the World Health Organization definition of probable.WHO pinpoints six 'probable' SARS cases in Taiwan https://taipeitimes.com/News/taiwan/archives/2003/03/23/0000199173 19 April 2020 Taipei Times 23 March 2003 https://web.archive.org/web/20200516142416/https://taipeitimes.com/News/taiwan/archives/2003/03/23/0000199173 16 May 2020 live Hong Kong Amoy Gardens#SARS outbreak On 4 March, a 27-year-old man, who had visited a guest on the Metropole's 9th floor 11 days earlier, was admitted to Hong Kong's Prince of Wales Hospital. At least 99 hospital workers (including 17 medical students) were infected while treating him.https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5212a1.htm Update: Outbreak of Severe Acute Respiratory Syndrome – Worldwide, 2003 20 April 2015 https://web.archive.org/web/20150427124814/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5212a1.htm 27 April 2015 live On 11 March, Carlo Urbani travelled to Bangkok, Thailand, to attend a medical conference. He fell ill during the flight and told a friend waiting in Bangkok not to touch him, to call an ambulance and take him to a hospital. He was isolated in an intensive care unit. A similar outbreak of a mysterious respiratory infection was reported among Hong Kong healthcare workers.2024-06-26 WHO Director-General's remarks at the Opening Ceremony of the Carlo Urbani Museum – 1 April 2023 https://www.who.int/director-general/speeches/detail/who-director-general-s-remarks-at-the-opening-ceremony-of-the-carlo-urbani-museum---1-april-2023 www.who.intFleck F. Carlo Urbani BMJ 326 7393 2003-04-12 0959-8138 10.1136/bmj.326.7393.825 825 On 12 March, WHO issued a global alert about a new infectious disease of unknown origin in both Vietnam and Hong Kong. On 15 March, WHO issued a heightened global health alert about a mysterious pneumonia with a case definition of SARS after cases in Singapore and Canada were also identified. The alert included a rare emergency travel advisory to international travelers, healthcare professionals, and health authorities. The Centers for Disease Control (CDC) issued a travel advisory stating that persons considering travel to the affected areas in Asia (Hong Kong, Singapore, Vietnam, and China) should not go.Mackenzie J.S. Drury P. Ellis A. Grein T. Leitmeyer K.C. Mardel S. Merianos A. Olowokure B. Roth C. Slattery R. Thomson G. Werker D. Ryan M. The WHO Response to SARS and Preparations for the Future National Academies Press (US) 2004 https://www.ncbi.nlm.nih.gov/books/NBK92476/ 2024-06-26CDC SARS Response Timeline CDC 2018-08-03 https://archive.cdc.gov/www_cdc_gov/about/history/sars/timeline.htm 2024-06-26Revision of the International Health Regulations Severe acute respiratory syndrome (SARS) https://apps.who.int/gb/ebwha/pdf_files/WHA56/ea5648.pdf World Health Organization 26 June 2024 17 May 2003 On 17 March, an international network of 11 laboratories was established to determine the cause of SARS and develop potential treatments.Shi Z. Wang L.-F. Genetics and Evolution of Infectious Diseases Evolution of SARS Coronavirus and the Relevance of Modern Molecular Epidemiology Elsevier 2017 978-0-12-799942-5 10.1016/b978-0-12-799942-5.00026-3 601–619 7150232 On 25 March, Hong Kong authorities stated that nine tourists had contracted the disease from a mainland Chinese man who had boarded the same plane on 15 March, Air China Flight 112 to Beijing.Koh D. Lim M. K. 1 August 2003 SARS and occupational health in the air Occupational and Environmental Medicine 60 8 539–540 10.1136/oem.60.8.539 1351-0711 12883012 1740596 On 27 March, Arthur K. C. Li, head of the Hong Kong Education and Manpower Bureau, announced cancellation of all classes in educational institutions. The Ministry of Education in Singapore announced that all primary schools, secondary schools, and junior colleges were to be shut until 6 April 2003. Polytechnics and universities were not affected.Closure of schools: Joint Press Release by MOE and MOH http://www.nas.gov.sg/archivesonline/data/pdfdoc/2003032606.htm NAS 15 January 2020 26 March 2003 https://web.archive.org/web/20200115053946/https://www.nas.gov.sg/archivesonline/data/pdfdoc/2003032606.htm 15 January 2020 live On 29 March, Urbani died in Bangkok. On 30 March, Hong Kong authorities quarantined estate E of the Amoy Gardens housing estate due to a massive (200+ cases) outbreak in the building. The balcony was completely closed and guarded by the police. The residents of the building were later transferred to the quarantined Lei Yue Mun Holiday Camp and Lady MacLehose Holiday Village zh 麥理浩夫人度假村 on 1 April because the building was deemed a health hazard.July 2020 Most of the cases were linked to apartments with a north-western orientation which shared the same sewage pipe. According to government officials, the virus was brought into the estate by an infected kidney patient (the type of kidney illness was not specified) after discharge from Prince of Wales Hospital, who visited his elder brother living on the seventh floor. Through excretion, the virus spread through drainage. One theory speculated that the virus was spread by airborne transmission, through dried up U-shaped P-traps in the drainage system which a maritime breeze blew into the estate's balconies and stairwell ventilation. It was confirmed that the virus spread via droplets, but this later outbreak made officials question the possibility that the virus could be spread through the air.Li Y, Huang X, Yu IT, Wong TW, Qian H Role of air distribution in SARS transmission during the largest nosocomial outbreak in Hong Kong Indoor Air April 2005 15 2 83–95 10.1111/j.1600-0668.2004.00317.x 15737151 2005InAir..15...83L 43348086 free April 2003 On 1 April, the U.S. government called back non-essential personnel in their consulate office in Hong Kong and Guangzhou. The US government also advised US citizens not to travel to the region.June 2021 On 2 April, Chinese medical officials began reporting the status of the SARS outbreak. China's southern Guangdong province reported 361 new infections and 9 new deaths, increasing the total Mainland China figures previously reported at end-February. The virus was also detected in Beijing and Shanghai. The WHO also advised travellers to avoid Hong Kong and Guangdong during a press briefing.Severe Acute Respiratory Syndrome – Press briefing https://web.archive.org/web/20030417131731/http://www.who.int/csr/sars/press2003_04_01/en/ 17 April 2003 1 April 2003 www.who.int. Retrieved 22 January 2020 On 3 April, a WHO team of international scientists landed in Guangzhou from Beijing to discuss with officials, but the team was yet to inspect any suspected origin or any medical facilities on the progress of infection control. Fifteen of the quarantined Amoy Gardens residents at Lei Yue Mun Holiday Camp were relocated to the Sai Kung Outdoor Recreation Centre after an overnight protest on washroom sharing. The first medical worker infected with SARS died in Hong Kong. The doctor's daughter and infected wife survived his illness, although the wife was also among the quarantined medical workers under intensive care. Hong Kong school closures were extended by two weeks to 21 April.June 2021 On 4 April, the WHO team inspected the first infection case in Foshan County. The person infected four people but did not infect his family. A 40-year-old woman became the first local case in Shanghai. A Chinese health specialist admitted at a press conference to not informing the public early enough about the outbreak. The PRC Health Minister also claimed that the disease has been under control in most parts of mainland China. He also released the names of seven drugs which he claimed to be effective in curing SARS. WHO officials said that the information provided by the PRC about the disease has been "very detailed".January 2020 US government enforced compulsory quarantine of an infected person.June 2021 On 5 April, the Singapore government announced that school closures would be extended. Junior colleges were to reopen on 9 April, secondary schools would reopen on 14 April and primary schools and pre-schools would reopen on 16 April.Phased Reopening of Schools http://www.nas.gov.sg/archivesonline/data/pdfdoc/2003040501.htm NAS 15 January 2020 5 April 2003 https://web.archive.org/web/20200115053936/https://www.nas.gov.sg/archivesonline/data/pdfdoc/2003040501.htm 15 January 2020 live On 6 April, a SARS case was found in Manila, a person who had returned from Hong Kong.June 2021 On 8 April, SARS was discovered in the Lower Ngau Tau Kok Estate near Amoy Gardens in Kowloon. Hong Kong health officials warned that SARS had spread so far domestically and abroad that it was here to stay. Nevertheless, WHO officials remained cautiously optimistic that the disease could still be contained.Keith Bradsher With Lawrence K. Altman: Asian Officials Say Mysterious Disease May Be Here to Stay 9 April 2003 The New York Times. Retrieved 22 January 2020 On 9 April, James Earl Salisbury died of SARS at a hospital in Hong Kong. An American Mormon"Church Member Dies of SARS", 11 April 2003, lds.org. Retrieved 22 January 2020 and a teacher at Shenzhen Polytechnic,http://www.theage.com.au/articles/2003/04/11/1049567875256.html Panic as China's SARS toll rises 12 April 2003 20 April 2015 The Age https://web.archive.org/web/20170602125510/http://www.theage.com.au/articles/2003/04/11/1049567875256.html 2 June 2017 live he had been sick for approximately one month before his death, but he was originally diagnosed with pneumonia.Reported on CBS's The Early Show Tatiana Morales: American Family Affected By SARS 11 April 2003, CBS News. Retrieved 22 January 2020 His son Michael "Mickey" Salisbury was with him in China and also contracted the disease, but he survived it.http://www.newsgd.com/english/news/bignews/200305060221.htm American SARS boy back home [SOUTHCN.COM] 20 April 2015 newsgd.com https://web.archive.org/web/20160303231029/http://www.newsgd.com/english/news/bignews/200305060221.htm 3 March 2016 live Salisbury's death led to more open admissions by the Chinese government about the spread of SARS.http://edition.cnn.com/2003/HEALTH/04/24/timeline.sars Timeline: SARS outbreak 24 April 2003 20 April 2015 CNN https://web.archive.org/web/20150427183702/http://edition.cnn.com/2003/HEALTH/04/24/timeline.sars/ 27 April 2015 dead On 10 April, Jim Hughes, the head of infectious disease at the CDC, confirming the warnings of Hong Kong health officials, claimed that he believed that SARS could no longer be eradicated in the Far East. However, he remained hopeful that it could be prevented from spreading widely in North America.Sars illness 'not under control' 11 April 2003, bbc.co.uk. Retrieved 22 January 2020 On 11 April, the World Health Organization issued a global health alert for SARS as it became clear the disease was being spread by global air travel.June 2021 On 12 April, Marco Marra, director of the Michael Smith Genome Sciences Centre, which is part of the British Columbia Cancer Agency, announced that scientists at his centre had broken the genetic code of the virus suspected of causing the disease.Scientists claim SARS breakthrough 14 April 2003, Archived from Australian Broadcasting Corporation. Retrieved 22 January 2020 In Toronto, three more people died of SARS, bringing the Canadian death toll to 13. On 16 April, the WHO issued a press release stating that the coronavirus identified by a number of laboratories was the official cause of SARS. The virus was officially named the SARS virus.Coronavirus never before seen in humans is the cause of SARS Unprecedented collaboration identifies new pathogen in record time https://web.archive.org/web/20040812124322/http://www.who.int/mediacentre/releases/2003/pr31/en/ 12 August 2004 Geneva, 16 April 2003, www.who.int. Retrieved 22 January 2020 On 17 April, the first confirmed case of SARS from India was reported.https://www.outlookindia.com/society/sars-in-india-news-219990 SARS in India 1 May 2003 Outlook India Sandeep Singh 7 June 2020 https://web.archive.org/web/20200612215517/https://www.outlookindia.com/website/story/sars-in-india/219990 12 June 2020 live Sars spreads to India https://www.theguardian.com/world/2003/apr/17/sars.india 9 June 2020 The Guardian 17 April 2003 https://web.archive.org/web/20200612144300/https://www.theguardian.com/world/2003/apr/17/sars.india 12 June 2020 live On 19 April, Premier of the People's Republic of China Wen Jiabao announced that there would be severe consequences for local officials who did not report SARS cases in a timely and accurate manner, signaling a major change in policy. SARS had also been gaining prominence in the mainland Chinese media; by late April, it had jumped from virtual invisibility onto the front page, with daily reports from all provinces on new cases and measures.June 2021 On 20 April, Beijing's mayor Meng Xuenong and the health minister of the PRC Zhang Wenkang were replaced respectively by Wang Qishan from Hainan and the former deputy health minister Gao Qiang. They were the first two high-rank officials in the PRC to be dismissed because of the fallout of the epidemic. In the news conference chaired by Gao Qiang several hours earlier, the PRC admitted that in Beijing there were more than 300 cases, as opposed to the previous figure of only 37. The figure had increased to 407 the following day. Chinese officials also admitted to major underreporting of cases, which were attributed to bureaucratic ineptitude.June 2021 On 22 April, schools in Hong Kong started to reopen in stages. On 23 April, Beijing announced that all primary and secondary schools would be closed for two weeks.Eckholm Erik 2003-04-23 The SARS Epidemic: Beijing; Chinese Capital Closes Schools for at Least Two Weeks en-US The New York Times https://www.nytimes.com/2003/04/23/world/the-sars-epidemic-beijing-chinese-capital-closes-schools-for-at-least-two-weeks.html live 2023-09-05 https://web.archive.org/web/20230905223622/https://www.nytimes.com/2003/04/23/world/the-sars-epidemic-beijing-chinese-capital-closes-schools-for-at-least-two-weeks.html 2023-09-05 0362-4331 A few days before, some colleges in Peking University had been closed because some students had been infected. The WHO issued travel advisories against Beijing, Toronto, and Shanxi.Why was Toronto included in the World Health Organization's SARS-related travel advisory? 2003 155962 Rodier G. R. Canadian Medical Association Journal 168 11 1434–1435 12771075 After several cases of SARS were diagnosed in Taiwan throughout the month of April,Chen Melody DOH says girl contracted SARS https://taipeitimes.com/News/front/archives/2003/04/16/0000202246 19 April 2020 Taipei Times 16 April 2003 https://web.archive.org/web/20200516142009/https://taipeitimes.com/News/front/archives/2003/04/16/0000202246 16 May 2020 live including a cluster at Taipei Municipal Hospital's Hoping branch,Chen Yun-ping Taipei health chief deflects blame bug https://taipeitimes.com/News/taiwan/archives/2003/04/28/0000203819 19 April 2020 Taipei Times 28 April 2003 https://web.archive.org/web/20200516140009/https://taipeitimes.com/News/taiwan/archives/2003/04/28/0000203819 16 May 2020 live Chen Melody New SARS cases linked to hospital https://taipeitimes.com/News/front/archives/2003/04/24/0000203252 19 April 2020 Taipei Times 24 April 2003 https://web.archive.org/web/20200516142421/https://taipeitimes.com/News/front/archives/2003/04/24/0000203252 16 May 2020 live the Taipei City Government closed that hospital and quarantined its 930 staff and 240 patients for two weeks.http://www.taipeitimes.com/News/taiwan/archives/2003/04/25/0000203407 SARS epidemic: Taipei City closes down hospital Taipei Times 25 April 2003 Chang Yun-ping 22 January 2020 https://web.archive.org/web/20200129161919/http://www.taipeitimes.com/News/taiwan/archives/2003/04/25/0000203407 29 January 2020 live The decision to lock down the medical facility was protested by hospital staff.Han Cheung Taiwan in Time: Remembering the SARS lockdown https://taipeitimes.com/News/feat/archives/2020/04/19/2003734881 19 April 2020 Taipei Times 18 April 2020 https://web.archive.org/web/20200422132030/https://www.taipeitimes.com/News/feat/archives/2020/04/19/2003734881 22 April 2020 live On 24 April, the Hong Kong Government announced an HK$11.8 billion relief package designed to assist Hong Kong's battered tourism, entertainment, retail, and catering sectors, consisting of a waiver of tourism- and transport-related license fees, and HK$1 billion allocated for tourism promotion overseas. The package also includes a salaries tax rebate and reduced rates.June 2021 On 26 April, Wu Yi was named Zhang Wenkang's replacement as PRC health minister. On 26–27 April, Chinese authorities locked down Beijing, closing down theatres, discos, and other entertainment venues in Beijing as the death toll in Beijing continued to rise, threatening to become the worst-hit area of the country, eclipsing the province of Guangdong. People who may have been exposed were ordered to stay home. Authorities were bolstered by the fact that the infection rate seemed to have declined, with Guangdong only exporting three new infections over the weekend. The economic impact was becoming dramatic as shops, restaurants, markets, bars, universities, schools, and many other businesses had closed, while some government ministries and large state banks were working with minimal staff levels.June 2021 On 28 April, WHO declared the outbreak in Vietnam to be over as no new cases were reported for 20 days. On 29 April, leaders of member countries of ASEAN and the PRC premier held an emergency summit in Bangkok, Thailand to address the outbreak. Among the decisions made were the setting-up of a ministerial-level task force and uniform pre-departure health screening in airports.June 2021 On 30 April, the World Health Organization lifted the SARS travel warning for Toronto. The decision was made because "it is satisfied with local measures to stop the spread of SARS". Canadian officials said they would step up screenings at airports.Toronto travel warning lifted 30 April 2003, news.bbc.co.uk. Retrieved 22 January 2020 May 2003 On 3 May, the 2003 FIFA Women's World Cup was abruptly moved to the United States due to the outbreak. China maintained its automatic qualification and later hosted the Women's World Cup four years later. On 4 May, the newly infected number of people in Hong Kong dropped to single digits. On 19 May, the WHO Annual Meeting was held in Geneva. Hong Kong pushed for the Tourism Warning to be lifted.June 2021 On 20 May, the WHO refused to lift the Tourism Warning for Hong Kong and Guangdong, but did so three days later after a recount of the number of SARS patients. On 24 May, the number of newly infected patients reached zero for in Hong Kong, the first time since the outbreak in the territory in March.June 2021 On 24 May, a new cluster of about 20 suspected patients was reported in Toronto. By 29 May, more than 7,000 people were instructed to quarantine themselves in Canada by authorities seeking to control the potential spread of the SARS outbreak.http://www.kansascity.com/mld/kansascity/news/breaking_news/5965221.htm Canada Broadens Definition of SARS Cases Cohen Tom Associated Press Kansas City Star 29 May 2003 https://web.archive.org/web/20041030134459/http://www.kansascity.com/mld/kansascity/news/breaking_news/5965221.htm 30 October 2004 In Taiwan, administrators and staff of Taipei Municipal Hospital's Hoping branch faced disciplinary action from the Taipei City Government.Chuang Jimmy Hoping investigation now focusing on top officials http://www.taipeitimes.com/News/taiwan/archives/2003/05/24/2003052423 20 April 2020 Taipei Times 24 May 2003 https://web.archive.org/web/20200516164102/http://www.taipeitimes.com/News/taiwan/archives/2003/05/24/2003052423 16 May 2020 live SARS doctors' ethics put to the test https://taipeitimes.com/News/taiwan/archives/2003/05/26/2003052693 19 April 2020 Taipei Times Reuters 26 May 2003 https://web.archive.org/web/20200516141959/https://taipeitimes.com/News/taiwan/archives/2003/05/26/2003052693 16 May 2020 live Wu Debby Hospital officials freed on bail https://taipeitimes.com/News/taiwan/archives/2003/05/27/2003052839 19 April 2020 Taipei Times 27 May 2003 https://web.archive.org/web/20200516142520/https://taipeitimes.com/News/taiwan/archives/2003/05/27/2003052839 16 May 2020 live Chuang Jimmy Fate of two Hoping Hospital officials still under review https://taipeitimes.com/News/taiwan/archives/2003/05/25/2003052564 19 April 2020 Taipei Times 25 May 2003 https://web.archive.org/web/20200516165801/https://taipeitimes.com/News/taiwan/archives/2003/05/25/2003052564 16 May 2020 live The Control Yuan also launched an investigation into the hospital's closure.Lu Fiona Control Yuan faults hospital closure https://taipeitimes.com/News/taiwan/archives/2003/05/28/2003052972 19 April 2020 Taipei Times 28 May 2003 https://web.archive.org/web/20200516140556/https://taipeitimes.com/News/taiwan/archives/2003/05/28/2003052972 16 May 2020 live Taipei City Bureau of Health director Chiu Shu-ti resigned from Ma Ying-jeou's mayoral administration on 25 May.Wu Debby Chen Melody City health director steps down https://taipeitimes.com/News/taiwan/archives/2003/05/26/2003052700 19 April 2020 Taipei Times 26 May 2003 https://web.archive.org/web/20200516162815/https://taipeitimes.com/News/taiwan/archives/2003/05/26/2003052700 16 May 2020 live Wu Debby City health chief comes under fire https://taipeitimes.com/News/taiwan/archives/2003/05/25/2003052550 19 April 2020 Taipei Times 25 May 2003 https://web.archive.org/web/20200516165806/https://taipeitimes.com/News/taiwan/archives/2003/05/25/2003052550 16 May 2020 live On 27 May, the Taichung City Government, led by mayor Jason Hu, established a command center in central Taiwan to handle SARS.Hsu Brian Central area unveils new SARS center https://taipeitimes.com/News/taiwan/archives/2003/05/28/2003052988 19 April 2020 Taipei Times 28 May 2003 https://web.archive.org/web/20200516150536/https://taipeitimes.com/News/taiwan/archives/2003/05/28/2003052988 16 May 2020 live The Department of Health worked with several hospitals in Taiwan to expand medical facilities and treatment for SARS patients.Ten regional hospitals install SARS-patient facilities https://taipeitimes.com/News/taiwan/archives/2003/05/26/2003052694 19 April 2020 Taipei Times Central News Agency 26 May 2003 https://web.archive.org/web/20200516160847/https://taipeitimes.com/News/taiwan/archives/2003/05/26/2003052694 16 May 2020 live On 31 May, Singapore was removed from WHO's list of 'Infected Areas'.June 2021 June 2003 On 10 June, the government of Ontario created the SARS Commission inquiry in order to "investigate the recent introduction and spread of SARS" in the province.Campbell Archie Gray SARS and Public Health in Ontario (Volume 4) 15 April 2004 Queen's Printer for Ontario Toronto 1-4249-2823-0 http://www.archives.gov.on.ca/en/e_records/sars/report/v4-pdf/Volume4.pdf 2 May 2020 https://web.archive.org/web/20181224172715/http://www.archives.gov.on.ca/en/e_records/sars/report/v4-pdf/Volume4.pdf 24 December 2018 dead On 23 June, Hong Kong was removed from WHO's list of 'Affected Areas', while Toronto, Beijing, and Taiwan remained. On 27 June, the World Health Organization stated that the world population should be SARS-free within the next two to three weeks, but warned the disease could re-emerge in China the following winter.WHO to say nation now free of SARS https://taipeitimes.com/News/front/archives/2003/07/05/2003058087 19 April 2020 Taipei Times 5 July 2003 https://web.archive.org/web/20200516141238/https://taipeitimes.com/News/front/archives/2003/07/05/2003058087 16 May 2020 live July 2003 On 2 July, Canada was removed from the WHO's list of 'Infected Areas'.June 2021 On 5 July, WHO declared the SARS outbreak contained and removed Taiwan from the list of affected areas.Country counting down to day WHO removes it from list https://taipeitimes.com/News/taiwan/archives/2003/07/03/2003057834 19 April 2020 Taipei Times 3 July 2003 https://web.archive.org/web/20200516151936/https://taipeitimes.com/News/taiwan/archives/2003/07/03/2003057834 16 May 2020 live Taiwan's removal from the list signified the end of the outbreak.WHO takes Taiwan off SARS list http://www.taipeitimes.com/News/front/archives/2003/07/06/2003058236 19 April 2020 Taipei Times 6 July 2003 https://web.archive.org/web/20200516142644/http://www.taipeitimes.com/News/front/archives/2003/07/06/2003058236 16 May 2020 live September 2003 On 8 September, Singapore announced that a post-doctoral worker in a SARS research lab in the National University of Singapore had contracted the disease while working on the West Nile virus but recovered shortly thereafter. It was suspected that the two viruses mixed while he was doing his research.June 2021 December 2003 On 10 December, a researcher in a SARS lab in Taiwan was found infected with SARS after returning from Singapore attending a medical conference;Su Joy Medical researcher contracts SARS https://www.taipeitimes.com/News/front/archives/2003/12/18/2003079998 19 April 2020 Taipei Times 18 December 2003 https://web.archive.org/web/20200516162546/https://www.taipeitimes.com/News/front/archives/2003/12/18/2003079998 16 May 2020 live 74 people in Singapore were quarantined but none of them were infected. On 27 December, China announced the first suspected case of SARS in six months in Guangdong in an individual who was not a SARS researcher.June 2021 January 2004 On 5 January, China confirmed that the case reported in December was a case of wild source SARS. The Philippines announced a possible case in a person just returned from Hong Kong. The patient was later determined to have had pneumonia and not SARS. In China, Asian palm civets were culled in markets (the civets were thought to be a reservoir for the disease).June 2021 On 10 January, a restaurant worker in Guangdong was confirmed as the second wild source SARS since the outbreak was contained. Guangzhou was also the site of the first case in December and was thought to be the origin of the virus in the original outbreak. Three Hong Kong television reporters who visited SARS-related sites in Guangzhou were declared free of the disease. On 17 January, China announced a third case of SARS in Guangzhou. WHO officials urged more testing to bring the three recently announced cases into line with their standards; however, they also announced SARS virus had been detected by a WHO team in civet cages at the restaurant where the second case worked and in civet cages in the market.June 2021 On 31 January, China announced the fourth case of SARS as a 40-year-old doctor from the southern city of Guangzhou, and gave his family name as Liu. He was discharged when the announcement was made.June 2021 April 2004 SARS broke out again in Beijing and in Anhui Province. On 22 April, China announced that a 53-year-old woman had died on 19 April, its first SARS death since June. One person died and nine were infected in the outbreak which was first reported on 22 April.Zhang Feng 2 July 2004 Officials punished for SARS virus leak China Daily https://www.chinadaily.com.cn/english/doc/2004-07/02/content_344755.htm live 14 February 2020 https://web.archive.org/web/20200219194740/http://www.chinadaily.com.cn/english/doc/2004-07/02/content_344755.htm 19 February 2020 The first 2 infected cases involved a postgraduate student and a researcher at the National Institute for Viral Disease Control and Prevention (abbrev.: Institute of Virology) of the Chinese Center for Disease Control and Prevention; an additional 7 cases were diagnosed, which were linked with close personal contact with the student, the lab or with a nurse who treated the student.Stephenson Joan SARS in China JAMA 2 June 2004 291 21 2534 10.1001/jama.291.21.2534-d May 2004 Two additional confirmed cases of SARS and three additional suspected cases were reported in Beijing on 1 May, all related to a single research lab, the Diarrhea Virus Laboratory in the CDC's National Institute of Virology in Beijing.Liang WN etal Severe acute respiratory syndrome – retrospect and lessons of 2004 outbreak in China. Biomed Environ Sci 19 6 445–51 17319269 2006 "The cases had been linked to experiments using live and inactive SARS coronavirus in the CDC's virology and diarrhea institutes where interdisciplinary research on the SARS virus was conducted." The total number of cases was six, with four in Beijing and two in Anhui.June 2021 On 2 May, China announced the three suspected cases as genuine cases of SARS, bringing the total cases in a recent outbreak to nine. 189 people were released from quarantine. On 18 May, after no new infections had been reported in a three-week period, WHO announced China as free of further cases of SARS, but stated that "biosafety concerns remain".WHO China's latest SARS outbreak has been contained, but biosafety concerns remain – Update 7 https://www.who.int/csr/don/2004_05_18a/en/ World Health Organization 18 May 2004 14 February 2020 https://web.archive.org/web/20200212205529/https://www.who.int/csr/don/2004_05_18a/en/ 12 February 2020 dead Subsequent status In May 2005, Jim Yardley of the New York Times wrote: "Not a single case of the severe acute respiratory syndrome has been reported this year [2005] or in late 2004. It is the first winter without a case since the initial outbreak in late 2002. In addition, the epidemic strain of SARS that caused at least 774 deaths worldwide by June 2003 has not been seen outside of a laboratory since then."Jim Yardley: After Its Epidemic Arrival, SARS Vanishes https://web.archive.org/web/20200128045809/https://www.nytimes.com/2005/05/15/health/after-its-epidemic-arrival-sars-vanishes.html 28 January 2020 15 May 2005 The New York Times. Retrieved 22 January 2020 Policy impact In China, the SARS epidemic resulted in substantial public criticism, prompted government statements that privatizing health care in rural China had been a failure, and brought rural reform to the top of the policy agenda.Heilmann Sebastian Red Swan: How Unorthodox Policy-Making Facilitated China's Rise 2018 The Chinese University of Hong Kong Press 978-962-996-827-4 10.2307/j.ctv2n7q6b j.ctv2n7q6b 158420253 Sebastian Heilmann104–105 Following the outbreak, China strengthened its reporting mechanisms for contagious diseases and reduced the reporting time from grassroots healthcare workers to the China Center for Disease Control and Prevention from 15 days to 4 hours.Zhang Angela Huyue High Wire: How China Regulates Big Tech and Governs Its Economy Oxford University Press 2024 978019768225867 See also Viruses Aerosol Air pollution Indoor air quality List of medical professionals who died during the SARS outbreak Severe acute respiratory syndrome–related coronavirus COVID-19 pandemic References Citations Sources CDC Morbidity and Mortality Weekly Report – SARS section SARS: An Open Scar https://web.archive.org/web/20051122010009/http://www.openscar.com/ 22 November 2005 SARS: Timeline of an Outbreak https://web.archive.org/web/20070426115411/http://www.webmd.com/news/20030411/sars-timeline-of-outbreak 26 April 2007 Further reading Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) (2004) Category:Severe acute respiratory syndrome Category:Disease outbreaks in China Category:Disease outbreaks in Hong Kong Category:Disease outbreaks in Taiwan Category:Disease outbreaks in Singapore Category:Disease outbreaks in Canada Category:2000s epidemics Category:2002 disease outbreaks Category:2003 disease outbreaks Category:2004 disease outbreaks Category:2002 disasters in China Category:2003 disasters in China Category:2004 disasters in China Category:2003 disasters in Canada Category:2003 in Hong Kong Category:2003 in Singapore Category:2003 in Toronto Category:2003 disasters in Singapore