Dimalen, Bai Maddeha N.

BSMLS-2K
September 30, 2019

Where was the original epicenter of the SARS explosion?

The original epicenter of the SARS explosion was Hong Kong.

What was the initial impact when SARS first hit?

Due to the initial attack of SARS, people wear masks everyday, cannot shake hands so
there were not much business transactions. People also cannot use their phones and
cannot even dare to touch the hand rails.

What was the type of exposure?

SARS is an airborne disease so people would most likely to get virus form inhaling
droplets of the virus through coughs and sneezing.

What was the route of spread?

SARS spread from animals to humans then person to person. From the video, the
disease started from Professor Liu, he met business man Johnny Cheng who was also
infected by the disease after they met. The Doctor who treated Johnny Cheng also died.
Therefore, you can acquire the disease from inhaling droplets of coughs and sneezes of
a person carrying the virus.

What was the incubation period?

The Incubation period of the disease is from 2 to 7 days. From the documentary,
Professor Liu Jianlun triggered an epidemic after two days.

Who was considered as patient zero?

Professor Liu Jianlun was considered to be the patient zero because he triggered the
epidemic in Hong Kong.

Where did he come from?

Professor Liu came from the Guangdong Province of South China.

Where did patient zero likely acquire the virus?

Patient Zero likely acquired the virus from his province of South China.

How did he acquire it?

He acquired the disease through contact with his patients that are peasants working with
birds especially chicken and ducks. Chicken and ducks from the towns and cities of
South China were exposed to sewages.

What happened at Amoy Gardens?

There were reported 200 cases of SARS in Amoy Gardens when the outbreak came in
Hong Kong. The virus can spread from person to person and it moved vertically in the
building unlike most infectious disease which spread horizontally through corridors.

How did the officials deal with the situation at Amoy Gardens?
The Officials did a quarantining operation in which they evacuated the residents in a
holiday camp so they could clean up the block.
What is the difference between isolation and quarantine?
Isolation happens to a person when he/she is sick from a contagious disease. Here a
person lasts in the isolation room depending on how many days are you going to be
infected. Just like the first nurse who worked for the first patients during the outbreak,
she was isolated from her family. A quarantine evacuates people who are exposed to
the disease. At the same, they get vaccinations and the infected are. This lasts up when
people are confirmed to be uninfected of the disease.

When are they needed?

Isolation and Quarantine are needed when a person acquires a contagious disease
which are airborne diseases. These are also needed during times of outbreak to prevent
the further spread of the disease or to prevent the rising number of cases.

How is a “superspreader” defined?

A superspreader is defined as a man spreading the disease who is to infect hundreds of
people. According to the documentary, superspreaders are more contagious than the
ones having the disease.

How do the advances of the modern world play a role in the spread of disease?
Since the modern world is living dependently on technologies, its advances help in
solving problems quick. By the use of social media, people receive alerts and get
updates, and spread news so people get informed easily. Medical facilities are now
modernized through machines which implies a more efficient recovery and prevention of
diseases.

How is the SARS virus described? What instrument was used to identify it?
The SARS was described as animal Coronavirus. With the use of an Electron
Microscope, they examined a lung tissue infected with SARS. The lung tissue has virus
characterized with spikes which is also present in a coronavirus.

What are the signs and symptoms of SARS?

The signs and symptoms of SARS are the shortness of breath, coughing, high fever, and
later on a person develops Pneumonia making him/her hard to breathe.

What is the proposed etiology of SARS?

The proposed etiology for SARS is that it is a member of the Animal Coronavirus. So the
disease is caused by animals especially mammals and birds.

What can we learn about how the Canadians and Chinese deal with public health
concerns?
As what I have observed, the Canadians and Chinese deal with public health concerns
differently. We can learn from the Canadians that a fast response from officials is
important in order to eradicate the disease as soon as possible. They banned people
from traveling to their country especially Toronto. On the other hand, the Chinese kept
the disease from the people which slowed down the process of making solutions to the
disease. People were uninformed while the disease was spreading and they did not do
some safety measures because they did not know yet that they were already exposed.
From this, we should learn that whether a disease is contagious or not, through public
awareness, at least in some ways we could still prevent the disease with the help of
officials not only in the country but also with experts from another countries.
What is the SARS situation now in the Philippines?
The SARS situation in the Philippines in 2003 had 10 probable cases with two deaths.
During this time, patients were isolated and some were recovering in the hospital.
According to World Health Organization, authorities were confident about this problem
since contacts of the disease have been identified and isolated. They were no increased
transmission risk in the Philippines and they also did not prohibit travels to the
Philippines. Now, there are no cases or updates about the SARS disease in the country.
The last outbreak of the disease happened in 2003. However, disease may still
reemerge that is why authorities must continue in surveillance for public safety since
biological circumstances are inevitable.

Why is an early warning surveillance necessary?

An early warning surveillance is necessary for effective prevention of diseases or
outbreaks for the public health. This is very helpful in controlling disease as it interprets
the disease outbreak with a continuous and systematic collection and analysis of data.
With this, people are more knowledgeable of dealing with impending diseases such that
disease is an epidemic-prone disease which affects many people that leads to the rise of
such cases.

How does mutation play a role in the spread of disease?

Although some mutations may be beneficial for us, most of the time mutation also play a
role in the spread of disease. Mutation happens constantly. It is the start of our lives and
we also acquire these mutations during our lifetime. Some mutations may lead to
missing or malformed proteins which creates a disease. During replication, errors tend to
occur and passed on and the number of copies of mutations can pertain to the
occurrence of the disease. Two mutated copies will cause the disease while one
mutated copy can be resistant to the disease. One example for this phenomenon is the
Sickle cell Disease.

What is the prospect of emerging infectious diseases in the next few years?
In the next few years, emerging infectious diseases may be easily detected and
authorities will have better response. Although technologies help us today in dealing with
research, emerging infectious diseases are still the type of diseases which are not
previously recognized so the impact may still be unknown. These impacts may be fully
realized in the next few years. Another thing to consider is the emergence of multi-drug
resistant diseases as well as hazards brought by some vaccines. In the next few years,
we must look forward to the development of safe and effective vaccines in the 21st
century. Vaccines derived from microbial genome-based expression of candidate
antigens will be widely used. The evolution of the field of vaccinology has been driven by
the development of enabling technologies, such as detoxification methodologies, the use
of a variety of tissue culture systems to propagate microbes, and the new biotechnology
of the last quarter of the 20th century, particularly that of recombinant DNA.

Using the steps in epidemic outbreak investigation, create a table and identify
how each step was performed in the investigation of the SARS outbreak.

STEPS IN EPIDEMIC OUTBREAK APPLICATION DURING THE SARS

INVESTIGATION OUTBREAK
1. Establish Diagnosis Doctors tested a lung tissue under an
Electron Microscope in which they
 discovered that the characteristics of the
virus is similar to a coronavirus having
spikes. Therefore, the SARS is part of the
animal coronavirus family.

2. Establish case definition They established symptoms like

coughing, flu, and development of
pneumonia.

3. Determine if epidemic is occurring February 23, 2003

-One person was described as patient
zero admitted in Kwong Wah hospital.
(Patient died after 5 days)
-One patient admitted in Mount Sinai
Hospital, Toronto, Canada (died after 10
days)
-Another patient died a week after in
Toronto, Canada.
February 26, 2003 one person admitted
in Hanoi Hospital. (2 patients died).

The spread of disease in Hong Kong

started in March. 200 cases were
reported from Amoy Gardens.

4. Characterize epidemic (time, Epidemiologists described the disease

place, person) through the following information:
The epicenter of SARS is in Hong Kong.
The disease came from animals in
Guangdong Province. The type of
exposure for the disease is a single type
exposure. The incubation period is 2 to 7
days. The route of spread is respiratory
and everyone can be susceptible to the
disease.

5. Develop hypotheses (source, With the help of the findings of

patterns of spread, mode of epidemiologists and doctors from China
transmission) and Canada they knew that:
Source of Infection is from Animals
(especially birds which were exposed to
dirty sewages). Pattern of Spread are
inhalation of droplets, direct contact with
infected body fluids. Mode of
transmission of the disease is Person to
Person.
6. Test hypotheses Authorities between China and Hong
Kong communicated incorporating their
laboratory studies. From their tests they

7. Initiate control measure
8. Initiate specific follow-up
surveillance to evaluate control
measures
References:
https://academic.oup.com/cid/article/32/5/675/357623
have proved the symptoms and cause of
the disease.
Authorities did quarantine operations,
isolations, sanitations, and Diagnosis and
treatment. They also did Prophylaxis.
Authorities performed active surveillance
through biopsies and histological studies.