Twenty-First Century Plague: The Story of SARS

Abstract

Reviewed by: Twenty-First Century Plague: The Story of SARS Debra Rose Wilson, PhD, RN (bio) and William A. Wilson, BIS (bio) Twenty-First Century Plague: The Story of SARS, by Thomas Abraham. Baltimore, MD: Johns Hopkins University Press, 2007. 165 pp. Twenty-First Century Plague chronicles the 2002-2003 global outbreak of the SARS (Severe Acute Respiratory Syndrome) virus. It is tempting for many to overestimate the efficacy of modern medicine and technology in dealing with viral or bacteriological threats, especially in light of the successful eradication of diseases such as smallpox. The recent emergence of SARS and other viruses dispels this assumption. The study of emerging viruses is particularly significant in light of trade globalization and international travel. The author, Thomas Abraham, makes this point by comparing the five years it took for cholera to spread from India to North America in the age of steam travel, to the single day it would take for the same to happen in the modern era. The story of the SARS outbreak begins in the Guangdong province of mainland China, the site of the first reported case of the virus. The SARS virus spread rapidly, affected the young and healthy, and was not effectively contained by ordinary preventive measures. In one hospital, almost 100 hospital staff, patients, and relatives of patients were infected within two weeks. Fear, stress, and exhaustion of medical staff added further strain to the health care system. Although the Chinese government was tight-lipped and denied any serious problem, word-of-mouth communication led to local alarm and panic-buying of vinegar, herbal remedies, and antibiotics. The secrecy of government officials was a key component in the spreading of the disease. An apartment building in Hong Kong was the second major site of disease spread, resulting in over 200 cases in one week. A visiting professor who was hospitalized spread the infection to an entire respiratory medicine team. Once again, a key aggravating factor in the spread of the virus was the secrecy and misinformation from the mainland province. Medical resources were stressed, as approximately 25% of cases required intensive care. It should be noted that the epidemic died down when patients were hospitalized more quickly—an important point considering that in any future outbreaks the uninsured will likely delay seeking treatment until acutely ill. Vietnam, Singapore, and Toronto were other sites affected by outbreaks, thanks to the efficient transmission vector of international jet travel. The World Health Organization (WHO) had become involved by this point, and realized the importance of transparency and information dissemination to containing the disease. The WHO risked public panic and political backlash, bypassing the normal consultations with member governments to issue warnings about the outbreak directly. This was a wise strategy in [End Page 1410] light of the bureaucratic barriers already experienced in China. Collaboration between various administrations and laboratories was crucial to investigating, responding, and containing the outbreak on a global level. Had these organizations acted independently and competitively, knowledge of the threat and measures for fighting it would have taken much longer to establish. Even with such collaboration, there was the usual race to publish findings and grab the glory. The author of the book being reviewed concludes with a warning characterizing the SARS outbreak as a dress rehearsal for a major viral pandemic. The SARS virus infected about 8,000 people in the in the 2002-2003 outbreak, but another virus like the one that caused the 1918 influenza pandemic would infect millions. The author characterized the key lessons learned from the SARS outbreak as early transparent information sharing, global political cooperation, scientific collaboration, and government awareness of the need to work together to fight the threat. Abraham's writing style is characteristic of the science journalism genre, combining narrative with explanatory and historical material. The author does a good job in balancing the material to make a difficult subject engaging, without resorting to melodrama. The appendices are useful, especially the timeline, which provides a concise summary of important epidemiological events. The book is intended for a broad audience, and is neither overly technical nor oversimplified. The issues it covers are particularly relevant to the fields of public health...