SARS and SARS-CoV-1 • How was the epidemic stopped?

SARS, caused by the SARS-CoV-1 virus, spread around the world in 2002/2003. What is SARS? How does it differ from the current SARS-CoV-2 coronavirus? And how was SARS stopped?

SARS is the abbreviation for Severe Acute Respiratory Syndrome and is the name of a viral respiratory disease that was first observed in southern China in late 2002 and spread in the following months, first in Southeast Asia and then around the world. Mostly adults were affected. More than 8,000 illnesses and 774 deaths from the SARS virus have been counted. The hardest hit country outside of Asia was Canada with 251 confirmed cases of infection and 43 deaths. In Germany, nine (exclusively imported) cases were registered during the pandemic. Here all those affected survived SARS.

At a glance:

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SARS pandemic 2003/2004

When the epidemic broke out in early November 2002, the Chinese government put restrictions on the local press and censored reports on the novel virus. Only three months later, on February 10, 2003, did she inform the World Health Organization. At that time, there were 305 infections and five deaths from SARS, according to official figures. On March 13, 2003, the WHO spoke of a pandemic for the first time. However, the global chains of infection were quickly interrupted, so that the outbreak of the disease was declared contained on July 11, 2003. On May 19, 2004, the WHO announced the end of the pandemic. After that, only isolated cases of SARS were observed; there have been no more confirmed infections since the end of 2004. To this day, there is a legal obligation to report SARS in Germany and many other countries.

What is the cause of SARS?

Severe Acute Respiratory Syndrome is caused by a coronavirus that has been known as the SARS-associated coronavirus, SARS-CoV or SARS-CoV-1 for short, since it was identified in spring 2003. Coronaviruses usually cause mild to moderate upper respiratory diseases. The name Corona is derived from its crown-like structure.

SARS-CoV-1 infection and incubation period

The SARS virus was originally thought to have been transmitted from animals to humans and spreads from person to person – in most cases by means of droplet transmission. If an infected person sneezes or coughs, pathogens are thrown through the air and can be deposited on the facial mucous membranes (mouth, nose, eyes) of people in the vicinity, penetrating their organism and multiplying there. There is a high risk of infection when there is close contact (less than one to 1.5 meters) between infected and healthy people, for example during close face-to-face conversations. The direct exchange of respiratory secretions and body fluids is particularly critical (e.g. when kissing or through shared cutlery and dishes). It is also possible for the SARS virus to spread through hand contact with surfaces and objects contaminated with pathogens: according to studies, the SARS virus survives outside the human body for up to 24 hours. A transmission via infected aerosols – the finest virus-carrying suspended particles from the air we breathe – has also been proven.

According to the data available, people infected with SARS are particularly contagious in the second week of the disease.

On the other hand, the virus will be passed on before the actual disease breaks out: Anyone infected with SARS-CoV-1 but not (yet) showing any symptoms is therefore not or at least hardly contagious. This seems to be a major difference to the coronavirus SARS-CoV-2 (Covid-19), which first appeared in 2019, in which many infections apparently originate from unknowingly ill people who (yet) do not show any symptoms.

Both coronavirus variants seem to have the ability to change certain functions of the body’s own defense system, so that an immunological overreaction can set in and trigger massive inflammatory processes in the lungs. According to experts, this could explain the high percentage of severe disease courses.

The incubation time, i.e. the time between an infection and the appearance of the first symptoms, is around two to seven days for SARS-CoV-1, and in exceptional cases up to two weeks.

What are the symptoms of SARS?

At the beginning of the illness, a fever of over 38 degrees Celsius often occurs, which can be accompanied by chills, general malaise, and headache and body aches. Occasionally, respiratory problems can be observed even in the early stages; As a rule, however, it takes two to seven days for those affected to develop a dry, unproductive cough and deterioration in lung function, which is often associated with a drop in oxygen levels in the blood (hypoxia) and shortness of breath (dyspnea). During the SARS pandemic of 2002/2003, around ten to 20 percent of the sick had to be ventilated mechanically due to lung failure. Infected people often develop pneumonia. Diarrhea can also occur.

How is SARS diagnosed?

If SARS is suspected, the examiner asks the sick person as part of the anamnesis about symptoms, previous course of the disease and possible sources of infection. Your body temperature will then be measured and your lungs will be monitored with a stethoscope. An x-ray of the lungs can reveal tissue changes and fluid build-up caused by inflammation. A blood test will tell whether the number of platelets and white blood cells is decreased.

Like SARS-CoV-2, SARS-CoV-1 can be detected using molecular biological test methods in samples of blood, stool or bronchial secretions. In the SARS pandemic of 2003, the so-called reverse transcriptase polymerase chain reaction test (reverse transcription polymerase chain test, or RT-PCR test for short) was used in particular: the genetic material of the virus is extracted from blood or bronchial secretions are reproduced in the laboratory so that viruses can be detected even in extremely low concentrations. Such RT-PCR tests for SARS-CoV-1 have a high level of accuracy (specificity) or sensitivity (sensitivity) and were available from mid-April 2003. However, only people with typical SARS symptoms who can be shown to have had contact with a sick person were tested. Asymptomatic people at risk were later tested for antibodies (blood test) to see if they had gone through the disease.

Which therapies can help against SARS?

As with most viral diseases, there is no causal treatment for Severe Acute Respiratory Syndrome. There are currently no drugs that can render the virus harmless in the organism or eliminate it. During the SARS pandemic of 2002/2003, various active ingredients were tested, but they did not have any resounding success. Others were not considered because of undesirable side effects or did not have an adequate cost-benefit balance. In some cases, SARS sufferers were treated with antibiotics if bacterial superinfections were present. Therapy with anti-inflammatory drugs containing cortisone was also tried out.

Currently, the SARS virus can only be treated symptomatically: fever, headache and body aches are relieved by fever-lowering pain relievers such as ibuprofen. If those affected suffer from impaired lung function, shortness of breath or low oxygen saturation, they are supplied with oxygen via masks and connected to ventilators in critical cases. If severe diarrhea occurs, infusions help prevent fluid loss.

According to studies, so-called interferons – the body’s own tissue hormones that have an immune-stimulating and antiviral effect – could prove useful in SARS-CoV therapy in the future. Passive immunization is also being tested: In this process, antibodies against the virus are isolated from the blood serum of the sick person who has recovered, purified and then administered to an acutely affected person.

What is a typical SARS disease like?

The degree of illness as a result of an infection with SARS-CoV-1 can be extremely different. During the SARS pandemic of 2002/2003, a great number of severe, but also often mild or even asymptomatic courses were observed. However, every tenth confirmed infection with SARS-CoV-1 resulted in death. Statistical comparability with the corona situation since 2019 is difficult, since only symptomatic people were tested in 2003 and it can be assumed that this way many SARS infections went undetected.

After the first symptoms appear, the course of the disease in SARS is divided into two phases: in the first week, general flu-like symptoms typically appear, in the second week specific complaints such as cough, shortness of breath or shortness of breath appear.

According to the current state of knowledge, a survived SARS-CoV-1 infection can heal without consequences, but it can also leave long-term lung damage.

How was SARS stopped?

The fact that the SARS pandemic of 2002/2003 was declared over by the WHO after just a few months is due to various factors:

  • SARS-CoV-1 was apparently much less contagious than SARS-CoV-2. Among other things, it did not multiply in the throat, but only in the lungs. The greatest risk of infection came from those affected who had been showing symptoms for around ten days. Acutely ill people are naturally less mobile and accordingly carry the virus less frequently. In addition, potentially contagious people could be identified relatively quickly and reliably with the help of laboratory tests, so that control and quarantine measures had a major effect.

  • After the SARS infections in China became known in spring 2003, the World Health Organization (WHO) immediately raised the alarm and resolutely pushed ahead with the fight against the virus. Experts from virology, pulmonology, epidemiology and other medical disciplines exchanged research results internationally, so that extensive knowledge about the disease could be gathered quickly. The Internet and other new technologies have been helpful in exchanging information. Thanks to the preventive measures introduced quickly in many countries, the speed at which the virus spreads has been significantly reduced.

What preventive measures are effective against SARS?

A vaccine against SARS-CoV-1 was not developed. In 2005, however, a national pandemic plan for Germany (NPP) was drawn up in accordance with the guidelines of the WHO. It already contains the hygiene rules that have also been practiced in the latest corona pandemic since winter 2019/2020:

  • Maintain a physical distance from people outside your own household (at least one and a half meters)

  • Wash your hands frequently and thoroughly with soap and water (alternatively, use a suitable disinfectant)

  • do not touch your face with (possibly virus-contaminated) fingers

  • cover your nose and mouth with your elbow or a handkerchief when coughing or sneezing

  • Do not share cutlery and crockery with others

  • In closed rooms in which people from different households are – but also if the distance of at least 1.5 meters to others outside cannot be safely maintained – mouth and nose protection (ideally a medical or an FFP2 mask) wear

  • Ventilate rooms regularly

  • Restrict contacts

  • forego travel that is not absolutely necessary

Binding quarantine rules for sick or possibly infected people (contact persons) also help to keep SARS in check.

According to a report published by the Robert Koch Institute (RKI) in January 2004, it had to be expected that new cases of SARS would occur at any time.

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Source: Lifeline | Das Gesundheitsportal by www.lifeline.de.

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