Riding bikes in Shanghai in the rain, these Chinese wear masks to avoid pollution and germs, 1986. Years later, such masks would become a ubiquitous sight during the outbreak of the SARS virus. PHOTO BY JOAN LEBOLD COHEN.

Severe Acute Respiratory Syndrome, or SARS, is a virus which caused a pandemic when it struck eastern Asia in 2002 and 2003, with large rates of infection recorded in the cities of Hong Kong and Guangzhou, the island of Taiwan, and other southeast Asian areas. The initial outbreak’s media coverage was not accurately reported to international authorities, the exposure of which prompted reform in international disease monitoring.

Severe Acute Respiratory Syndrome, or SARS, is caused by the SARS coronavirus, also known as SARS-CoV, which infects and replicates within the bloodstream. Symptoms of the virus include respiratory difficulties, fever, throat and mouth inflammation, occasionally myalgia (muscle pain), and lethargy. Most fatalities associated with the SARS outbreak were due to pneumonia and were largely confined to the very young and the elderly. The World Health Organization (WHO) estimated the final mortality rate at 9.6 percent.

Diagnosis in the early days of the outbreak was usually either the common cold or influenza, but increasing numbers of patients with similar symptoms and a history of contact with one another helped distinguish SARS as a new disease. The first WHO report identifying SARS by name was in March 2003, four months after the first case.

The source of SARS was originally thought to have been from masked palm civets, which are common in south and Southeast Asia, after SARS was found in the blood of civets found for sale in a Guangzhou market. As a consequence, thousands of civets were killed to prevent new outbreaks of the disease. In 2008, genetic studies at the State University of Ohio traced SARS back to several species of bats living in the area, but the connection between the bats and humans is not known.

Outbreak and Containment

The first case of SARS has been tracked back to the city of Guangzhou (Canton), in southern China, to a rural farm worker who became ill in November 2002. The disease began to spread in rural areas either from person-to-person contact, or from the original source. This outbreak was reported by the Chinese government as an outbreak of influenza to the WHO in the early days of February 2003. On 21 February, an unnamed doctor, who had been treating patients in the countryside, visited Hong Kong, where he transmitted the virus to other guests at his hotel; once his own symptoms manifested and he was hospitalized, the hospital staff were infected as well. It is estimated that between 70 percent and 85 percent of all SARS cases can be traced back to this one doctor. Outbreaks in Singapore, Thailand, and Taiwan, and Vietnam were reported in March, and the first non-Asian case of the disease emerged in Canada. The forty-five days from the middle of March to the end of April were the most active times of the epidemic in the south of China, as schools, public buildings, and residential areas were all shut down. By the end of April, the virus had been identified, and the quarantine was lifted in Vietnam. The United States withdrew its diplomatic staff from Guangzhou and Hong Kong facilities, but they quickly returned, when the WHO lifted its warning level due to a lack of new infections in April.

SARS didn’t arrive in northern China until early April 2003, which is remembered as a particularly disruptive time in Beijing. International media sources focused on images of Beijing’s efforts to control the outbreak, as the Peking University campus was shut down and residential area were sealed off. Many public areas, including subways and restaurants, were uncharacteristically empty.

Containment of the outbreak was accomplished primarily through public space restrictions and awareness campaigns. During the event, large public announcements warned against risk and encouraged sanitary behavior. Quarantines were enforced in large parts of several cities, and hospitals were given increased support from central authorities. By the end of April 2004, these measures were effective, and the rate of new cases of the disease reported fell.


SARS was the first international epidemic of the twenty-first century. It tested the international community’s ability to share information and to develop solutions for disease control in a time when ease of travel can quickly result in the spread of disease far from its initial occurrence. In the first months of the outbreak, the central Chinese government restricted information about the epidemic. Once the emergence of the disease became public knowledge, the central authorities increased media coverage, until by March and April, coverage of the outbreak was front-page news almost every day. Major international media attention to the outbreak was not given until a Westerner, James Earl Salisbury, died in the first week of April, having been sick for a month. There was a relatively intensive personnel shakeup as well, with the replacement of the mayor of Beijing and reorganization of the Ministry of Health.

After coverage of the spread of SARS began to spread to international media outlets, rapid international quarantine efforts began, and systems to prevent the spread of the virus were implemented. These were primarily through travel restrictions, warnings, sanitary efforts, and screenings at major travel hubs for persons with greater than average body temperatures. These screening stations are still in place today. Overall, the WHO reported 8,096 cases of SARS and 774 deaths.

The socioeconomic impact of SARS is debated. In all of the major cities affected, conferences and events were cancelled. In the United States and other western countries, business in Chinese restaurants declined during and in the months after SARS. The impact was still ft several years after, despite the fact that all major Chinatowns in North America did not report any cases of SARS. In Toronto, the hardest hit non-Asian city, a WHO travel warning led to a major decline in tourism, which recovered after celebrity concerts and other efforts by the Canadian government. After the two-to-three month period in 2003 when the SARS epidemic was at its height, the only cases have been at virology institutes in isolated contamination incidents in April and May 2004.

Further Reading

Abraham, T. (2007). Twenty-first century plague: The story of SARS. Baltimore: Johns Hopkins University Press.

World Health Organization. (2006). SARS: How a global epidemic was stopped. Manila, Philippines: WHO Regional Office for the Western Pacific.

World Health Organization. (2004). SARS: Epidemic and pandemic alert and response. Retrieved February 17, 2009, from http://www.who.int/csr/sars/en/

Source: The Editors. (2009). SARS. In Linsun Cheng, et al. (Eds.), Berkshire Encyclopedia of China, pp. 1922–1924. Great Barrington, MA: Berkshire Publishing.

SARS (Yánzhòng Jíxìng H?x? Z?nghézhèng ?????????)|Yánzhòng Jíxìng H?x? Z?nghézhèng ????????? (SARS)

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