ENCYCLOPEDIA OF Espionage, Intelligence, and Security Volume ...

Communicable Diseases, Isolation, and QuarantineThe first known case of SARS was traced to a November,2002, case in Guangdong province, China. By mid-February, 2003, Chinese health officials tracked more than300 cases, including five deaths in Guangdong provincefrom what was described at the time as an “acute respiratorysyndrome.”Many flu-causing virsues have previously originatedfrom Guangdong Province because of cultural and exoticcuisine practices that bring animals, animal parts, andhumans into close proximity. In such an environment,pathogens can more easily leap from animal hosts tohumans. The first cases of SARS showed high rates amongGuangdong food handlers and chefs.Chinese health officias initially remained silent aboutthe outbreak and no special precautions were taken tolimit travel or prevent the spread of the disease. The worldhealth community had no chance to institute testing,isolation, and quarantine measure that might have preventedthe subsequent global spread of the disease.On Feb. 21, Liu Jianlun, a 64-year-old Chinese physicianfrom Zhongshan hospital (later determined to haveunknowingly been a “super-spreader”—a highly contagiousinfected individual) traveled to Hong Kong despitethe fact that he had a fever to attend a family wedding.Epidemiologists subsequently determined that Jianlunpassed on the SARS virus to other guests at the MetropoleHotel where he stayed—including an American businessmanen route to Hanoi, three women from Singapore, twoCanadians, and a Hong Kong resident. Jianlun’s travel toHong Kong and the subsequent travel of those he infectedallowed SARS to spread from China to the infected traveler’simmediate destinations.Johnny Chen, the American businessman, grew ill inHanoi, Viet Nam, and was admitted to hospital. Cheninfected 20 health care workers at the hospital includingnoted Italian epidemiologist Carlo Urbani who cared forhim, and who worked at the Hanoi World Health Organization(WHO) office. Urbani first formally identified SARS asa unique disease on February 28, 2003. By early March, 22hospital workers in Hanoi were ill with SARS.Unaware of the emerging problems in China, theUrbani report drew increased attention among epidemiologiststhat in mid-March, Hong Kong health officials hadalso discovered an outbreak of an “acute respiratory syndrome”among health care workers. Unsuspecting hospitalworkers admitted the Hong Kong man infected byJianlun to a general ward at the Prince of Wales Hospitalbecause it was assumed he had a typical severe pneumonia—afairly routine admission. The first notice thatclinicians were dealing with an usual illness came—notfrom health notices from China of increasing illnesses anddeaths due to SARS—but from the observation that thathospital staff, and those subsequently determined to havebeen in close proximity to the infected persons, began toshow signs of illness. Eventually, 138 people, including 34nurses, 20 doctors, 16 medical students, and 15 otherhealth-care workers at the hospital contracted pneumonia.Encyclopedia of Espionage, Intelligence, and SecurityOne of the most intriguing aspects of the early HongKong cases was a cluster of more than 250 SARS casesthat occurred in high-rise apartment buildings—many housinghealth care workers—that provided evidence of a highrate of secondary transmission. Epidemiologists conductedextensive investigations to rule out the hypothesis that theillnesses were related to some form of local contamination(e.g., sewage, bacteria on the ventilation system, etc.).Rumors started that illness was due to cockroaches orrodents, but no scientific evidence supported the hypothesisthat the disease pathogen was carried by insects.Hong Kong authorities then decided that thosesufferingfrom the flu-like symptoms would be given theoption of self-isolation, with family members allowed toremain confined at home or in special camps. Compliancechecks were conducted by police.One of the Canadians infected in Hong Kong, KwanSui-Chu, returned to Toronto and died in a Toronto hospitalon March 5. As in Hong Kong, because there were noalerts from China about the SARS outbreak, Canadianofficials did suspect that Sui-Chu’s son and five healthworkers had been infected with a highly contagious virus.By mid April, Canada reported more than 130 SARS casesand 15 fatalities.Increasingly faced with reports that provided evidenceof global dissemination, on March 15, the WorldHealth Organization (WHO) took the unusual step of issuea travel warning that described SARS is a “worldwidehealth threat.” WHO officials announced that SARS confirmedand potential cases had been tracked from China toSingapore, Thailand, Vietnam, Indonesia, Philippines, andCanada. Although the exact cause of the “acute respiratorysyndrome” had not, at that time, been determined,the official issuance of the precautionary warning to travelersbound for South East Asia about the potential SARSrisk severed notice to public health officials about thepotential dangers of SARS.Within days of the WHO warning, SARS cases werereported in United Kingdom, Spain, Slovenia, Germany,and in the United States.WHO officials were initially encouraged that isolationprocedures and alerts were working to stem the spread ofSARS, because some countries reporting small numbersof cases experienced no further dissemination to hospitalstaff or others in contact with the SARS victims. However,in some countries, including Canada, where SARS casesoccurred before WHO alerts, SARS continued to spreadbeyond the bounds of isolated patients.WHO officials responded by recommending increasedscreening and quarantine measures that included mandatoryscreening of persons returning from visits to the mostseverely affected areas in China, Southeast Asia, andHong Kong.On March 29, Urbani, the scientist who first reported aSARS case, died of complications related to SARS.In early April, WHO took the controversial additionalstep of recommending against “non-essential travel to249