Legacy of the SARS outbreak

Ten years ago, a highly infectious atypical pneumonia swept across China and the world. The disease, Severe Acute Respiratory Syndrome, or SARS, proved to be a turning point for China, as the pandemic exposed flaws in the country's public health emergency response system and the dire need for more information transparency.

Changes have been made as a result of SARS, which infected 5,327 people and killed 349 in China between November 2002 and August 2003. Regulations were passed concerning public health emergencies and information disclosure. There has been progress, especially as authorities are now paying more attention to public health issues, but a lot remains to be done, experts and observers say.

Zeng Guang, chief epidemiologist at the Chinese Center for Disease Control and Prevention, who fought front and center against SARS, said that things started to change in late April 2003 when authorities updated the actual number of cases and took a series of quarantine and prevention measures.

In late 2002, patients in South China's Guangdong Province showed symptoms such as fever, coughing and shortness of breath with some dying. In early 2003, SARS was already spreading from Guangdong to other parts of China. As people continued to travel, the disease went around the world.

A lack of experience in handling such pandemics led to the spread of the disease. Quarantine protocols weren't set. Some SARS patients stayed in hospitals that weren't equipped to treat patients with contagious diseases. Doctors and nurses didn't use proper protection when treating patients and many were infected in turn. One third of the 349 patients who died of SARS were medical workers.

Truth will out

Zeng was sent along with other experts to investigate the cases in Guangdong in February 2003. While visiting local hospitals, he noticed discrepancies between the number of cases and the numbers that were reported back to higher authorities, as many hospitals were afraid to report the real facts.

A similar fudging of the truth also happened in Beijing, where real numbers weren't available or made public.

SARS provided some valuable lessons in disease control, said Zeng. At the beginning of the outbreak, disease control wasn't a priority, and people were most concerned with treatment and rooting out the cause of the disease. After epidemiologists and disease control experts were consulted, patients were transferred to specialized wards or hospitals, and some hospitals, like the Peking University People's Hospital in Beijing, were quarantined to prevent further infection.

Different departments and medical systems also lacked communication and collaboration mechanisms. The military hospitals in Beijing for instance were not under the jurisdiction of the municipal government, but a lot of SARS patients in Beijing initially visited such hospitals for treatment. A lack of collaboration made it difficult for authorities to grasp the full picture of the disease.

In late April 2003, a joint command center was set up to direct disease control. A mechanism has also been established to ensure the collaboration of health, education, transportation and civil affairs departments.

In May 2003, the government passed a regulation on public health emergency responses. It set up a monitoring and report system for possible contagious disease outbreaks, unknown widespread diseases or major food poisoning cases. Emergency response offices were soon set up at local governments and health administrations.

"The most important improvement after SARS was increased awareness at every level of government and among the public," said Tong Zhaohui, a respiratory doctor at Chaoyang Hospital who worked on SARS cases for days on end during the outbreak.