A year on from first SARS case and much still unknown

FOSHAN, China, Nov 12 (AFP) - A year ago the deputy head of a local village came to this southern Chinese city looking for a doctor who could treat a raging fever, a worsening cough and increasing breathing difficulties.

Pang Zuoyou was the world's first known SARS case.

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On November 16 the middle-aged man headed to the Foshan Number One People's Hospital where doctors treated him for pneumonia and released him after he recovered. He remains in good health today.

At the time, medical workers had no idea that Pang was infected with Severe Acute Respiratory Syndrome. It would be months before the villager from Zhangcha township near Foshan would be retrospectively diagnosed as the world's first documented SARS patient.

Four workers at the hospital were infected by him, but doctors are still baffled at how members of his family escaped the deadly disease and remain concerned the virus could spread to people who do not show symptoms but are nevertheless infectious.

"Within two weeks of the Foshan case, other outbreaks occurred in Heyuan city which is pretty far away from Foshan," Feng Shaoming, an official with the Guangdong provincial health bureau, told AFP.

"By January and February seven cities in Guangdong had recorded cases of this new type of atypical pneumonia."

There were no clear-cut links between the early first cases of a disease that spread globally from Guangdong in March to infect nearly 8,500 people in over 30 countries, killing more the 800.

China was the worst hit, with almost 350 fatalities from over 5,300 infections.

After creeping over the border into neighboring Hong Kong, where some 300 people died, the virus spread by plane around the world as the World Health Organization (WHO) set alarm bells ringing about a new deadly disease that had the potential to be as fatal as the black plague or HIV/AIDS.

"With SARS we were lucky," said Dr. Julie Hall, a contagious diseases expert with the WHO in Beijing who was sent to the Chinese capital to monitor the SARS situation.

"We were lucky in terms of the virus itself, which didn't spread quickly and was not an air-borne disease. We were also lucky that we were on high alert and the global response was very good."

If SARS were an air-borne disease, instead of being spread in droplets of water emitted by talking, coughing or sneezing, then the disease would have been much harder to control and would have spread much faster, Hall said.

Thanks to the global alert, many underdeveloped countries with poor health facilities were spared SARS and in places around the world where infections did emerge the tip-off helped ensure that it did not spread widely.

Still, a great deal is left unknown about the mystery disease.

"We can't say 100 percent that there was no link between the earlier cases, but there is no evidence that these people interacted with each other," Feng, the Guangdong health official said.

"So there is a possibility that the disease emerged in different places at the same time and was not isolated to one person who went on to infect other people."

This scenario could mean that the SARS virus is still out there, possibly among animals, and could be seasonal in nature and ready to reemerge at anytime, he said.

Although it has not been completely proven, overwhelming evidence appears to support the theory that SARS jumped from an animal to the human population, WHO's Hall said.

"We are calling for more research in animal populations, how did it jump the species barrier?, where is the highest risk?, is it in eating animals?, probably not, in butchering them?, probably yes," Hall said.

More than one third of the early SARS cases, with dates of onset before February 2003, were in people who kill and sell animals, or those who prepare and serve food.

After February 1, more than 30 percent of SARS patients were healthcare workers.

Slightly different strains of the coronavirus, the virus that causes SARS, have been identified in a series of wild animals that are culinary delicacies in southern China, a recent WHO report said.

These include the masked palm civet (or civet cat), the racoon dog, the Chinese ferret badger, cynomolgus macaques, fruit bats, snakes and wild pigs.

With still no SARS vaccine available and many unknown factors surrounding the disease, those places that experienced outbreaks are already preparing for its reemergence, especially in China.

At the Foshan's Number One People's Hospital an isolated fever clinic has been set up to ensure that potential SARS patients displaying the tell-tale fever cannot spread it further.

"We hope SARS doesn't come back, but we can't guarantee that it won't. But one thing we can guarantee is that we will be ready and we won't let it spread like it did before," Feng said.

sai/mp/pch

Health-SARS-China-Guangdong