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Posted on 04/25/2003 5:19:00 PM PDT by Prince Charles

April 26, 2003

Doctors say this isn't the big one -- at least not yet

By Anthony Brown

LIKE earthquakewatchers in California, doctors around the world have been waiting for the 'big one'. Diseases come and diseases go, but it is thought inevitable that one of them at one time will be so quick to spread, incurable and so lethal that even the full force of modern science could not stop millions of deaths.

The bubonic plague killed 25 million people in Europe in the 14th century, the Spanish flu in 1918 killed 70 million. Aids has killed 12 million so far, but it has taken many years to spread, and -- where there are sufficient resources -- it has proved easier to control than first feared.

As the Sars outbreak, the first new disease of the third millennium, has spread around the world at jumbo-jet speed, as the deaths have mounted day by day, doctors have watched nervously, asking many questions, but with just one at the top of their minds: "Is Sars the big one" Certainly, the panic is big. Just six weeks after the World Health Organisation brought the mysterious severe acute respiratory syndrome to the world's attention with an emergency alert, it has spread to about 30 countries and more than 4,000 people, and caused some 280 deaths.

Beijing has closed down all its schools and called off its May Day celebrations. Hospitals and whole housing blocks are under quarantine in Toronto and Hong Kong. The World Health Organisation has given warnings not to go to Toronto, Hong Kong or parts of China, airlines are screening passengers for signs of sickness and have cancelled hundreds of flights, and holidaymakers have cancelled tens of thousands of trips.

In much of the Far East, people wear masks and refuse to shake hands with strangers. Chinese restaurants worldwide have suffered a collapse in business, and in North America customers are shunning cinemas and supermarkets.

British schools have quarantined pupils in country houses and hospitals. GPs have been put on alert. As international travel has collapsed, the Organisation for Economic Co-operation and Development has given warning of global "financial turmoil".

The story began last November in the city of Foshan in the rural Guandong province of southern China, when a microscopic virus jumped from an animal -- possibly a chicken, perhaps a pig -- to a human and, instead of dying, it multiplied and spread. The first officially recorded case was a 40-year-old businessman. More cases occurred in the city with people running high temperatures, coughing and, occasionally, dying. The virus multiplies rapidly in the lungs, the body defends itself by pumping in immune-system fluid, forcing people to gasp for breath. One in twenty sufferers drown in their own body fluids.

By January, Guangzhou, the provincial capital of Guangdong, was awash with stories about the mysterious illness, which spread at frightening speed. The Chinese Government banned the media from reporting it because of fear of endangering "social stability".

Liu Jianlun, one of Guangzhou's top doctors, who had been treating Sars patients, went to a family wedding in Hong Kong, taking the 45-minute flight to the densely populated territory. He checked into the Metropole Hotel and entered the lobby lift coughing, unwittingly infecting 12 other people. He developed the pneumonia-like condition and, on his deathbed confessed what it was to doctors at the Kwong Wah Hospital. By March 4 he was dead, and 77 hospital staff were infected.

The guests at the Metropole Hotel, unaware of whom they had been sharing the lift with, carried on with their lives. Many turned out to be "super-spreaders", each capable of infecting a vast number of people.

One infected guest ended up in the Prince of Wales Hospital in Hong Kong, where he infected 70 staff and a kidney patient. A few days later, the kidney patient visited his brother at the Block E apartment building in Amoy Gardens in Hong Kong, infecting about 300 people. Hong Kong authorities quarantined the whole block, banning everyone from coming and going.

Another Metropole guest, Kwan Sui-Chu, 78, flew back to her family in Toronto, infecting her son and daughter-in-law, and dying on March 5. Since then, Canada has had 330 cases and 16 deaths.

Johnny Cheng, a Chinese-American businessman staying at the Metropole Hotel, flew to Hanoi in Vietnam, where he infected his staff and 22 nurses in the local hospital.

Carlo Urbani, an Italian doctor who was the infectious disease specialist for the World Heath Organisation in Hanoi, was called in to advise on Mr Cheng's condition, and became fascinated by the case. He identified the virus, and soon understood its threat.

He told Vietnamese health officials that they had to isolate patients and screen travellers, and alerted the World Health Organisation head office in Geneva. Realising that he, too, could be infected, he quarantined himself and his team inside the hospital. Dr Urbani, and four of his team, died. So did Mr Cheng.

Another guest at the Metropole Hotel was Esther Mok, a former flight attendant, aged 26. She was in Hong Kong on a shopping trip. She returned to Singapore and promptly became one of the disease's most extraordinary victims. As she lay sick, she was visited by members of her family and church, passing on the virus to scores of people. Although she recovered, many of those who visited her did not, including both her parents and her pastor. So far, nearly 200 people have been infected in Singapore, and 19 have died. "Esther Mok infected the whole lot of us," Lim Hng Kiang, the Health Minister, said.

Day by day, the disease has spread, the cases have multiplied and the deaths mounted. China was bullied by the World Health Organisation into admitting that it had 20 times as many cases in Beijing as its official figures suggested.

As panic gripped China, Hong Kong and Singapore, and as people fled the region, bringing the disease with them, more countries have become infected. Britain, Germany, Brazil, South Africa, India, Japan and Australia have all had cases.

So where will it go from here?

The rapid spread of the disease has alarmed not just the public, but doctors around the world. Experts have said that it could be a "new Aids", spreading though the air and rapidly causing millions of deaths.

Of particular concern is that it will take hold in teeming cities such as Calcutta, Bangkok and Shanghai, with millions of people living in close proximity and with poor sanitation and poor nutrition, and poor health facilities to help to contain the disease.

But there are signs of hope. An unprecedented international research effort has overcome doubts and reached a consensus that it is caused by the coronavirus, similar to the one that causes the common cold.

A test to tell whether people are infected has been developed, and measures to isolate cases rapidly implemented. There is no cure, but doctors have already worked out ways of improving the chance of survival.

Only in four countries has the disease been spread among the general public, and in all other countries it has been successfully contained. Five of the six cases in Britain became infected overseas, and only one passed it on, to one other person.

Many infectious diseases thrive in the warm, humid climate of South-East Asia but are far less of a threat in the colder, drier climate that prevails in Europe and North America, where people also tend to live further apart.

Most of those killed have been over 40; younger people, and otherwise healthy people, almost always survive.

The progress of the disease has had a powerful grip on the public imagination, but John Oxford, Professor of Virology at Queen Mary's School of Medicine, says that it is spreading far more slowly than flu, and the number of cases is actually relatively small.

"If it was influenza, it would be ripping around by now. But there isn?t a huge wave of infection. It is a bit of a plodder. This is not the big one," he said.

Professor Ian Jones, a virologist at the University of Reading, said: "It will be brought under control. We'll end up with a new human disease that flares up now and then."

The past two weeks have convinced most doctors that Sars is probably not the "the big one", but it is not going to disappear. More people will definitely die. A vaccine will probably be developed, and travellers to certain regions will be advised to be immunised before they go, just as they are now with typhoid and hepatitis.

But the outbreak is still at an early stage, and there is nothing so uncertain as the future. Professor Jones said: "One possibility is that it mutates to become a better transmitter; then you have a different scenario."

Then Sars could indeed prove to be "the big one".

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