Twenty-First Century Plague. The Story of SARS

The Focus section is a new regular feature that brings together reviews of books on related subjects to simulate debate and mark historiographic trends.SARS, like AIDS, is one of those elite acronymic words now seared into modern consciousness.Its shell-burst dissemination to dozens of countries in the first half of 2003, infecting over 8,000 persons and killing one-tenth of them, and its ominous pandemic potential, captured headlines for months.SARS also caused severe social and commercial disruption, forcing economic losses of approximately $30 billion.Like HIV, SARS (Severe Acute Respiratory Syndrome) typifies the sort of unexpected new epidemic disease that can 'emerge' in response to the rapidly changing scale and intensity of modern human economic activity, environmental encroachment, and physical mobility.This book, by an experienced Asian journalist, tells the story well.Thomas Abraham recounts, with impressive detail, the evolution of the short-lived pandemic and enriches the tale with insights into its political, cultural and commercial undercurrents.It chronicles the role of the World Health Organization (WHO), including its place in coordinating a remarkable (though inevitably competitive) international scientific collaboration to identify the virus responsible.The actual source of the SARS coronavirus remains uncertain.The evidence points to a zoonotic source, probably arising from animal husbandry or from live-animal trading in wet markets.As the author reminds us, most new infectious agents acquired by humans since agrarian settlement began have come from zoonotic sources via the occasional microbial mutant that successfully crosses the species barrier.SARS emerged from the world's backblocks.In November 2002 a middle-aged villager in Guangdong province, southern China, was admitted to hospital with a mysterious respiratory disease.By the end of the year, another 25 persons developed similar severe respiratory symptoms, including seventeen health-care workers exposed to just two of the cases.Early in 2003 information began to filter out about these, public anxiety rose, and the provincial centre for disease control in Guanghzou despatched investigators.Soon the disease reached adjoining Hong Kong, where both hospital 'super-spreading' and defective sewerage design in high-rise housing amplified the spread.By March the WHO was involved and coordinating surveillance activities and control policies.Cases began to be reported more widely, especially from Canada.Propelled by modern air travel, SARS extended to all continents and 31 countries.Meanwhile, the Chinese government remained secretive and insisted that the outbreak was limited in size, under control, and most likely due to 'atypical pneumonia'.The secretiveness was heightened by the politically exquisite timing of the outbreak, just before the central handover of power from Jiang Zemin to Hu Jintao.Party authorities wanted no rocking of the boat.Nevertheless, some courageous internal criticism (unthinkable several decades ago) and the manifest increase in the outbreak in Beijing during March -April finally forced the government to concede the magnitude of the problem; by now much greater than if open reporting had been followed earlier.This point was