A month into the 2003 global SARS scare, a plane coming from Tokyo landed at Mineta San Jose International Airport with a dire warning from the pilot: A few passengers had symptoms of the mysterious new respiratory illness.
The plane was surrounded by ambulances, fire engines and police cars after it landed. Five passengers with coughs and other respiratory symptoms were pulled aside and questioned; three were taken to the hospital for further screening. All of the passengers were handed public health cards telling them to monitor their health over the next couple of weeks in case they, too, developed symptoms.
No one on that plane had severe acute respiratory syndrome, though. And in fact, over the five-month run of the epidemic, only two people in California — a man and a woman in Santa Clara County — would be diagnosed with the disease that infected more than 8,000 worldwide.
But SARS then was a terrifying unknown. It was the first episode of the new century of a deadly virus unleashed on a vulnerable, unprepared global population. SARS ended up disappearing before it could become the international disaster scientists feared.
Now, with a new coronavirus spreading even faster than its SARS-causing sister virus, global health authorities are applying lessons learned from nearly 20 years ago, and reinforced over outbreaks like Ebola and H1N1 in the interim, to halt the new epidemic.
The U.S. public health response is both more aggressive and less chaotic this time than it was with SARS, infectious disease experts say. At airports, for example, federal authorities quickly introduced travel restrictions and screenings this year. And though several government-chartered planes full of passengers evacuated from China have been quarantined upon landing, so far there have been no emergency scrambles on the tarmac.
“I think for everybody, SARS was a humbling experience. It was a scramble back then,” said Dr. Tomás Aragón, health officer with the San Francisco Department of Public Health, who led the Center for Infectious Diseases and Emergency Readiness at UC Berkeley during SARS. “Now there’s a whole generation of people like myself with really deep experience in these things.”
New coronavirus versus previous epidemics: In just over a month, the new coronavirus has already infected more than 40,500 people — four times as many people as SARS did over five months in 2003, and more than 10 times as many people as were affected by MERS, another coronavirus illness. On Saturday, the outbreak hit an ominous benchmark: The death toll surpassed that of SARS for the first time. On Sunday, it rose to 910.
And the new virus does not appear to be letting up, with the case count climbing by thousands every day.
It appears to be less deadly than SARS and MERS, though. The mortality rate is about 10% for SARS and 30% for MERS. Roughly 2% of people with the new coronavirus are dying, at least so far — the rate keeps shifting as the number of new cases climbs each day.
That daily tally is a dramatic shift from the public health reporting in SARS. It took much longer for China to recognize SARS, which started in Guangdong province in Southern China. The first patients probably got sick in November 2002, but the outbreak went largely unchecked until February 2003, when a single infected person traveled to Hong Kong and stayed in a hotel where hundreds of others guests were exposed. The virus moved from there throughout the world.
There has been some criticism with the current outbreak that China still didn’t act fast enough. But the country’s response has been far more aggressive since the first few people were infected in late November or early December. China reported the outbreak to the global public health community at the end of December, and within a few weeks had shut off travel in and out of the province where things started.
Tracking the current outbreak — especially within the United States — has been aided by advances in technology. Months into the 2003 epidemic, scientists were using expensive and time-consuming antibody tests to confirm cases of SARS — results could take weeks, and many suspected cases outside the U.S. were never tested at all for lack of resources.
This time, scientists identified the specific virus involved less than two weeks after the first cases were reported, and the CDC began lab testing suspected cases a week after that. Last week, the CDC sent about 200 diagnostic kits to state health departments to do even more testing. As of Feb. 5, 337 people in the U.S. had been tested, but only 12 — including six in California — had come up positive for the new virus.
That kind of information can be both reassuring and alarming. Confidence is high among public health officials that new cases are being identified and isolated promptly. But it also means that there’s more awareness of how big an outbreak the world is facing.
“There was a lot of concern with SARS. More then than now,” said Dr. Lee Riley, an infectious disease expert at UC Berkeley. “Now we’re able to get updates and actual data much more rapidly. And it’s much easier to make the diagnosis of these types of infections, so there’s a little more comfort. It’s always the uncertainty that contributes to the fear.”
But he said he sees people overreacting now, too, especially on social media. “Part of this mass panic attack is being driven by these technologies that didn’t exist in the past,” Riley said.
Aside from the three coronavirus outbreaks, two other notable epidemics have hit the United States this century: H1N1 in 2009 and Ebola in 2014. The H1N1 “swine flu” epidemic swept across the country very quickly, infecting roughly 20 million people from April to October 2009, and killing up to 6,000.
On the other end of the spectrum, Ebola was an epidemic of West Africa, infecting nearly 30,000 people over two years and killing about 11,300. There were 11 cases in the United States, and two people died.
Of course, public health officials also note that the U.S. faces a major epidemic every year: influenza. Millions of Americans get the flu this time of year, and roughly 30,000 die from it. The main public health response comes down to flu shots and advising people wash their hands a lot and stay home if they’re sick.
Lessons from earlier public health responses: When SARS hit, the United States was still reeling from the Sept. 11 terrorist attacks, and much of the public health preparedness was designed around potential bioterrorism. The country had stockpiles of smallpox vaccines, for example, and much more security at airports, but those preparations weren’t geared specifically toward stopping a new infectious disease.
“Post-9/11, the pieces were in place,” Aragon said. “But SARS was a novel virus, so everybody had to learn in the moment what was happening.”
The Centers for Disease Control and Prevention introduced travel restrictions to and from affected parts of the world, but once people were in the United States it was up to local public health departments to determine how best to find new cases and monitor those at risk of illness. Strategies varied widely, and there were missteps.
A couple of months into SARS, UC Berkeley announced that it would not be accepting summer school students from China until the campus could identify safe, isolated housing for several hundred people if they became sick. A week later the university relaxed the restrictions after facing international criticism from public health officials and others.
No such announcements have come up this year, in part because many universities now have plans in place for isolating students if large numbers become sick. A handful of universities across the country have asked that students who were recently in China stay home from classes. But even a coronavirus case reported at Arizona State University didn’t prompt broad quarantines.
“With the uncertainty of these infections, the (UC Berkeley) campus made a decision that probably was not in retrospect the best decision” during the SARS scare, Riley said. “But you can always say this, in retrospect.”
It all starts at the airports: Ebola also provided some valuable lessons in disease response, in particular in terms of identifying people traveling to the United States from affected countries — sometimes by very circuitous routes — and connecting them with public health authorities.
The CDC had to figure out how to find these passengers, then rebook them on flights that would funnel them to specific airports for screening. From there, passengers would be isolated if symptomatic or told to look for symptoms and stay away from public spaces for a period of time.
That process has been replicated in the current coronavirus outbreak, with travelers coming from China now sent to one of 11 airports, including San Francisco International, where CDC screening clinics are already in place.
And it seems to be working: 10 of the 12 people so far diagnosed with the new illness knew to contact their doctor and the public health department when they developed symptoms after returning from China. The other two patients were spouses of people who had been infected.
“All of our efforts right now are based on two things: Active surveillance, which means putting the systems in place to identify a high percentage of cases. And then finding their contacts and making sure they don’t become new cases,” said Dr. Sara Cody, health officer in Santa Clara County, which has reported two coronavirus cases.
“You’re trying to do everything you can to prevent transmission from a case to someone else, and stop it right there at one,” she said. “Right now I think we can do that. Maybe that’s where this will all stop.”
San Francisco Chronicle Library Director Bill Van Niekerken contributed to this report.