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SARS Lessons Unlearned

Will SARS hit hard again this year or in the future? Experts go over what happened and what may be next.
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WebMD Feature

Will SARS come back? Experts agree only on this: It won't be the last worldwide killer epidemic.

A year ago, severe acute respiratory syndrome -- SARS -- was unknown. Like a winged dragon, it suddenly emerged from China, taking only a month to spread death from Asia to North America.

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And like a sleeping dragon, it's now nowhere to be found. Unless, of course, it wakes again. Will it? If anyone would know, that person would be Jeffrey Koplan, MD, MPH, former CDC director and longtime CDC disease detective, now vice president for academic health affairs at Emory University in Atlanta.

"Unknown," Koplan tells WebMD. "SARS can not come back; it can come back. Anyone who gives a firm statement of, 'This is what will happen with SARS,' I don't know where they are getting their information."

What is known, Koplan says, is that there's more than one sleeping dragon.

"The best-case scenario is we learn from SARS and prepare for what is going to be an inevitable return of this virus or something like it -- or something worse," Koplan says. "The worst case is we say, 'This isn't coming back,' or say, 'Other things are more urgent.' In that case, we are no better off than before. Right now, we are closer to nowhere."

This is the story of SARS -- so far. It's about what happened. It's about what we know and what we don't know. And it's about what, at our peril, we refuse to learn.

Unusual Pneumonia

The ancient city of Foshan sits in the Pearl River delta of southeast China. Foshan is home to some 320,000 people. It's an industrial city, but its exquisite silks and porcelains -- and its famous Cantonese cooking -- make it a popular tourist destination.

In November 2002, people in Foshan began coming down with an unusually severe pneumonia. By January 2003, this pneumonia had spread to the nearby -- and larger -- city of Guangzhou. But it wasn't until mid-February that the World Health Organization got its first official report of 305 cases and five deaths from an unidentified respiratory disease.

By then, SARS had taken flight -- literally. The worldwide epidemic began when a doctor who had been treating SARS patients flew to Hong Kong and checked in at the Metropol Hotel. In just a few days, he infected at least 17 other hotel guests. They carried the disease to Toronto, Vietnam, and Singapore.

Donald E. Low, MD, chief microbiologist at Mt. Sinai Hospital in Toronto, was in Hong Kong at that time. His hotel was down the street from the Metropol.

"I flew back the next day, and the SARS patient [who carried the disease to Canada] was on the same plane the next day," Low tells WebMD. "In that one day, SARS moved across the globe from Hong Kong to Toronto."

On March 12, 2003, the WHO issued a global SARS alert. Eventually, SARS spread to 26 countries on five continents. More than 8,000 people fell ill. There were 774 confirmed SARS deaths -- about a 10% case-fatality rate.

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