Twenty-First Century Plague: The Story of SARS

  • Thomas Abraham
Johns Hopkins University Press: 2005. 176 pp. $24.95 0801881242 | ISBN: 0-801-88124-2

As a new and lethal disease caused by a previously unknown virus, severe acute respiratory syndrome (SARS) was the first species-jumping global epidemic this century, and will not be the last. This slim book puts SARS in context with an opening chapter on emerging infections, and ends with one that considers the looming threat of pandemic influenza.

Cover-up: Hong Kong was ill-prepared to face the threat of SARS following China's failure to release information about the disease. Credit: A. GIVON/AP

Twenty-First Century Plague is an accurate and intriguing account of the complexities of the SARS story, the interacting political responses and the underlying bioepidemiology, involving primarily China, Hong Kong and the World Health Organization (WHO). Written by Thomas Abraham, a journalist based in Hong Kong, the book focuses on the main players. We get a ringside seat to an accessible, well-referenced account of the science, the politics and the people involved.

The SARS story begins in China, and Abraham starts by illuminating the least-known aspect — what happened in Guangdong from November 2002 to March 2003. That was when the infection moved slowly from rural towns to the provincial capital before quickly spreading out from the province to the rest of China, Hong Kong and much of the world.

This is what we could not know when Chinese officials hid the facts despite incessant internal and external enquiries from the public, media, health agencies, governments and the WHO. At last, we learn how SARS first appeared and spread inside Guangdong, and how the local health system responded, with many examples of professional dedication, clinical excellence, intelligent investigation and selfless behaviour. Guangdong doctors produced excellent guidelines on diagnosis, treatment, hospital infection control and quarantine as early as 23 January 2003 — six weeks before the global emergency erupted. This information could have prevented thousands of infections but was not shared, even within China. Abraham gives us an excellent and dispassionate account of the cultural and political background to the cover-up, and the unfortunate consequences, both epidemiologically and politically, for China. There are lessons for everyone, as all governments could be tempted to cover up infection outbreaks, especially if the rest of the world cuts off social and economic contact. Transparency was the only solution for SARS, and eventually China paid a high price for its initial secrecy.

Subsequent chapters cover more familiar ground: the introduction of the disease to Hong Kong through an infected doctor visiting from Guangdong; explosive local transmission in several hospitals and a high-rise housing complex; and the spread to Singapore, Vietnam, Canada, Beijing and Taiwan. We also learn about the hunt for the virus and the crucial role of the WHO in inducing international collaboration and steering the global control efforts for this terrifying epidemic. We see the costs and benefits of our globalized world — at higher risk, but mobilizing faster and more smartly than ever before. This was the first ‘digital’ response to a lethal global epidemic: there were many examples of new digital tools, such as some excellent case-information and geographical contact-tracing systems devised in Hong Kong and a secure Internet-linked laboratory network mounted by the WHO.

Discovering and characterizing the causal virus and developing diagnostic tools transformed the global battle against SARS, and was done faster than for any previous infection. The tension created by simultaneous competition and collaboration among scientists chasing the virus, and the balance needed between excessive caution and reckless haste, are well described. This makes the virus hunt one of the most fascinating aspects of the SARS story. There were false leads and bad luck with initial culture attempts, but eventual success for several groups. Hong Kong University came out just ahead in the international race to identify the causative agent, and its findings were validated by others within a few hours. This satisfactory scientific outcome contrasts with that experienced by the hapless young Chinese scientists who seem to have discovered the virus several weeks earlier but could not reveal their findings because they would have contradicted incorrect statements made by their superiors — yet another price paid by China for its initial management of SARS.

The role played by the WHO is also an excellent story by itself. A small team based in Geneva, Manila, China and Vietnam collaborated to provide the global and regional leadership needed, and the results were excellent. We find out how difficult the task was — involving political skill, judgement and courage. It is clear that the WHO in 2003 had just the right people to meet the SARS challenge. Unfortunately, we cannot be assured that such resolve or skill will appear next time, and this is one of the more sobering lessons from SARS. If left chronically underfunded, as in the past, the WHO may not have the staff and vigilance needed next time a comparable challenge arises.

I commend this book to those with an interest in emerging infections, SARS and China.