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lrogers{at}ajroffice.org
SARS made its debut in Guangdong province in southern China and quickly spread to adjacent Hong Kong. An epidemic ensued. From Hong Kong, those afflicted carried SARS to many parts of the world, which does not take long in these days of extended air travel associated with business and tourism.
In short order a large number of people became infected. By early May 2003, more than 6000 cases had been recorded. And as many as 6% of those affected have died. These events unleashed a media frenzy—a full-court, 24/7 news blitz, scaring the bejesus out of many people. They quit traveling to China; in fact, many quit traveling altogether. Americans even quit buying Chinese food, quit eating in Chinese restaurants, and stayed away from Chinatowns—all lest they become infected with SARS.
In response to the profusion of SARS cases, the World Health Organization (WHO) advised against travel to certain cities (e.g., Toronto), cities in which, the WHO insisted, SARS was epidemic. These declarations angered Canadian politicians, who countered by staging governmental meetings in Toronto to demonstrate that they had the situation under control and to pronounce, "It's safe to come to Toronto" [1].
In Beijing, the government, fearing negative economic consequences, initially suppressed information about SARS and officially denied the serious nature and true incidence of SARS. But a campaign initiated by a courageous 72-year-old retired Beijing surgeon and member of the Communist Party, Dr. Jiang Yanyong, unroofed the Chinese cover-up and exposed the significant incidence and severity of SARS in Beijing [2]. As a direct consequence, the Chinese government quickly backpedaled, sacked both its Minister of Health and the mayor of Beijing, and found it necessary to redress the government's approach to SARS in a more realistic and effective fashion.
Was it Confucius who said, "And the truth shall set you free"? OK, maybe Confucius didn't say it, but I'll bet Confucius would have agreed with it—for Confucius was a wise man.
It is always amusing to watch politicians scurry when there's heat on their griddle. When it comes to sticky issues, politicians are given to Brownian movement, given to "addressing" problems, not solving them.
Solving problems is frequently left to others. And when it has come to SARS, public health officials, health scientists, and the medical profession have marshaled their forces and come a long way in a short time. Through their collective efforts, SARS may now be contained. The infective agent (a heretofore unknown Coronavirus) has been identified, tests to identify the presence of this virus in humans are under development, and drugs to treat the infection are being sought.
As important as the preceding may be, a study of the epidemiology of SARS may prove to be of even greater fundamental importance. Epidemiologists studying SARS brought to light a fascinating chain of events that may account for the origin and transmission of certain viruses that affect humans. SARS is most likely a zoonosis, a disease transmitted from animals to humans. SARS is thought to be transmitted "from poultry to pigs to people" [1], a veritable zoonotic "axis of evil."
Large flocks of poultry (chickens and ducks) and large herds of pigs live in close proximity to each other and to people in densely populated areas of Guangdong. Ducks are said to have a weak immune system. It seems that viruses arise in or infect these ducks. These viruses are transmitted to pigs and then to pig farmers and thence from people to people in the world beyond. This mechanism may be the wellspring of past episodes of so-called Asian flu or Hong Kong flu and may even have been the source of the notorious, deadly worldwide influenza epidemic of 1918.
Now if the Chinese government will allow epidemiologists and other scientists to fully study this potential source of infective viruses, and if this theory of transmission can be confirmed, and then if measures are taken to eliminate or significantly reduce this source of human affliction (admittedly, a lot of ifs)—but if all this should come to pass, it would certainly be a major scientific triumph for the Chinese people and a tremendous contribution to public health worldwide.
Who says nothing good can come of SARS? There can be good and bad in everything, even SARS. Let's hope those in authority see the wisdom of initiating a full investigation of this potential source of viral diseases.
This month we are privileged to feature four articles on the timely subject of SARS. The first is the work of Dr. Nestor Müller and his colleagues [3] at Vancouver General Hospital, whereas the remaining three articles by Drs. Antonio et al. [4], Ho et al. [5], and King et al. [6] come from the Prince of Wales Hospital in Hong Kong. A case report on SARS, also from a group of researchers at Vancouver General Hospital, appeared in the May 2003 issue of the AJR [7]. Readers are certain to find these articles informative.
I take this opportunity to thank all these researchers for the urgency with which they provided descriptions of the imaging, nursing procedures, and infection control procedures required for radiologists to deal safely and effectively with patients with SARS. I also thank the reviewers for their rapid reviews that greatly expedited the publication of these important articles. And, last of all, my thanks to the AJR production staff in Leesburg, VA, for their readiness to reorder our publishing schedule to allow the fast-track publication of these five articles of such vital import to all radiologists and the patients we serve. Our readers will be most appreciative of these extraordinary efforts.
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