Ten years ago, a panicking world was in the throes of a virus.
The SARS epidemic had hit, and, for a while, there was no rhyme, no reason, no stopping it.
Now, 10 years later, another SARS-like virus has struck, and you very well may not have even heard about it.
What happened?
"The authorities here had promised the war against SARS was being won. But last night it was announced that a 57-year-old man has become the 30th Canadian to die from the virus."
To hear that report from 10 years ago is to realise the significance of another report just a few weeks ago.
"The Ministry of Health in Saudi Arabia has informed WHO of another confirmed case of infection with the novel coronavirus. The patient was hospitalised on the 29th of January 2013 and died on the 10th of February 2013."
In the first report lies the barely disguised panic of a virus running rampant, of a world running in fear from an epidemic with no apparent answer.
In the second is the straightforward, unflinching account of a new, related virus that is mysterious and, yes, deadly, but seemingly no threat to break out and come to your doo
Ten years on from the SARS epidemic that killed more than 700 people in seven countries, Perth clinical virologist David Smith says that is the legacy of SARS and what it taught us.
"I think the big lesson was international collaboration. We need to know what's happening in the global community, and we need to know as early as possible. We have powerful tools to identify new viruses, or new bacterial viruses, as they come through, and we need the collaboration to be able to investigate and identify those things. We need communication of those things early internationally so that other people are aware of what's happening and what they may do about it, particularly for countries like Australia. Often, these things are happening overseas, and we're trying to figure out what we're going to do if and when it comes to us."
In the case of the new SARS-like virus, the World Health Organisation, or WHO, quickly issued an international alert in September after the first known instance, of a Qatari man.
Almost half a year later, just 13 confirmed cases have unfolded as the WHO coordinates the medical response around the world
In the case of SARS, the virus originally broke out in southern China -- but the early communication, and, hence, early collaboration did not.
The Perth microbiologist who would lead the WHO mission into China to find out about SARS after it was exposed, Professor John Mackenzie, says that delay was deadly.
"I think it probably was critical. I think, if we'd known about what was happening earlier, we might have made those really important kind of jumps to (making sure) anyone coming from Guangdong would be under some degree of observation, certainly. Or, if there was anyone who arrived who looked ill, they could have been hospitalised immediately. So we had someone who was sick coming into the Hotel Metropole, and that gave rise to all the other outbreaks, basically."
The Hotel Metropole was in Hong Kong.
The someone was a doctor who had treated patients with atypical pneumonia in China's southern Guangdong province.
In retrospect, that virus was SARS, and the first patient had been a farmer from the province in November 2002.
The virus had spread quickly, but, for reasons that can only be conjecture, the China of 2003 did not spread the news -- to the outside world, or to the World Health Organisation.
Professor Mackenzie only alludes to the possible reasons indirectly when he talks with hope of the present.
"I'd like to think that countries would be much more willing to respond rapidly, but I also realise that countries don't always do what you want them to do when, uh, certain ingrown reasons, shall we say, that countries have, whether it be trade or tourism or whatever it might be ... They're not always as good as they should be."
WHO networks did pick up reports of a flu outbreak in China at the time, but the outbreak was an epidemic by the time the nature of the threat dawned on the outside world.
The doctor at the Metropole had already infected 16 other guests -- from Singapore, Taiwan, Vietnam and Canada.
But it was in Vietnam that the wake-up call came.
A United States businessman travelling from China to Singapore came down with the symptoms, was hospitalised during a stop in Hanoi and died at The French Hospital there.
Several members of the medical staff who treated him soon developed symptoms, and an Italian doctor, who also would die, warned the WHO and the Vietnamese government.
From there, the fight was on.
Professor Smith, with the University of Western Australia's School of Pathology and Laboratory Medicine, says SARS' low transmission rate helped save the day.
"When we talk about transmissible infections like that, we often talk about, on average, how many other people will get infected from one person. For SARS, that was never particularly high. So that, for every person who had SARS, on average, it was about 1.2 other people who would get infected. That means, on that figure, that it will spread, if slowly. But what was also clear with SARS is that, with the sort of standard quarantine measures -- isolating the people who had SARS, the use of masks, personal-hygiene measures -- you could reduce that to a less-than-1 risk. That means that, if you can put those controls in place, then it will burn out."
By comparison, pandemic influenza sometimes has a transmission rate of 2 to 3, so 1.2 was encouraging -- except for one detail.
It turned out the transmission of SARS came at a late stage, when more viruses are less dangerous, and medical workers came into the picture at a highly risky time.
In Canada, as the months passed, Ontario's Commissioner of Public Safety, Dr James Young, tried to explain to an impatient public why SARS had not yet been conquered.
"It's one of those viruses that, even when you gain control, it takes one ... one case to start it back up."
By the time SARS was controlled, largely through screening of airline passengers and quarantining of those infected, more than 8-thousand people had contracted it.
Of the 775 who died -- almost one in 10 cases -- about 650 were from China, with Canada, Taiwan and Singapore next in order.
In all, 37 countries and territories had SARS cases.
Australia had one, identified retrospectively, involving a German tourist travelling along the country's east coast.
Professor Smith says his case was only diagnosed when a mild illness during his stay in Australia was followed up as part of another case overseas.
"It was a good reminder that this virus could have got into Australia as well. It was luck that that case didn't have any secondary spread within Australia, but it was brought into the country, there was a potential for it to enter the country, we were lucky that it didn't. It, fortunately, was not that transmissible a virus, which made it more difficult for it to get a foothold within the community, and the person was not sick enough to go into hospital, where we were seeing spread within health-care settings. We got away with it, but we were lucky."
A decade later, the new SARS-like virus has been contained to Saudi Arabia, Jordan and Britain -- the Qatari man travelled from Saudi Arabia to Britain.
John Mackenzie says critical lessons have been learned, from the idea that most viruses like SARS come from wildlife to, especially, the need for early diagnosis and transparency.
"That (need for transparency) made WHO be much more proactive in finishing the International Health Regulations so there's a legal requirement on countries in the future to report any unknown disease of this nature. So there are those kinds of activities which really, I think, have made us much more aware today and much more able to respond today, quite rapidly, than we could back then."
Not that anyone is acting like the battle has been won.
Professor Mackenzie says the new virus has now put another key question in focus.
"I guess we still have questions about ... as we've seen just recently, with these new SARS-life virus cases in Saudi Arabia and Qatar and places, where people have been moving from the Middle East back to the UK or Germany or Holland, and they've gone there because of ill-health, because they feel sick. All these very sick people are upping (leaving) from their palatial residences in the Middle East and going off to England, or to other European cities, for treatment, and they're going in commercial aircraft. Look at all the people they're putting at risk. And the world at risk, for that matter. We need to be much more proactive, I think, in terms of having some way that we can prevent very sick people from travelling."
How to make that kind of move without being punitive?
David Smith, the clinical virologist, cites the same concern in that drive for greater transparency between nations.
How, he wonders, can a country be expected to report a virus that will scare away trade and tourists unless there is a means to repay that country, to counter that disincentive?
"And that was seen with avian influenza (bird flu), for example, where in parts of the world where it was in chicken flocks, if you had a flock with avian influenza, then the flock was destroyed. Now if you were a subsistence farmer who relies on the chickens to feed your own family and also to generate some income, that's a very big penalty for you."
