On Feb. 26, an American businessman in Hanoi, Vietnam was admitted to the hospital for treatment, and then transferred to Hong Kong, where he died. Thereafter, cases of atypical pneumonia combined with respiratory failure appeared in Hong Kong, Hanoi, Singapore and other areas.

In fact, as early as the end of November of 2002, there were already cases of atypical pneumonia in the Chinese province of Guangdong. The epidemic spread from there, and by the middle of March, a Taiwanese couple surnamed Chin who had not long before returned from mainland China were admitted to hospital with suspected cases of the mystery illness.

According to the World Health Organization (WHO), as of April 23 the virus had appeared in 22 countries or areas, with 3947 cases and 229 deaths being reported from around the world. As of that same date, in Taiwan there were 200 reports of potential cases, of which 29 were classified as "possible cases," 46 as "suspected cases," and 39 as unresolved, while 86 were excluded as SARS cases; 107 out of the 200 individuals involved were deemed out of danger and discharged from hospital.

On March 15, the WHO formally named the illness "serious acute respiratory syndrome" (SARS), and it declared a number of locations to have a high concentration of cases, including Guangdong, Hong Kong, Hanoi, Taiwan, Singapore, Toronto, and London.

What is SARS?

According to Taiwan's Department of Health, SARS symptoms include the following: a high fever (38°C or above), a dry cough, shortness of breath or difficulty breathing, and possibly the appearance on chest X-rays of an abnormality in the lungs. In addition, possible associated symptoms include headache, muscle stiffness, loss of appetite, fatigue, confusion, rashes, and diarrhea.

To find the SARS pathogen, on March 17, a multinational research project involving 11 cutting-edge laboratories in ten countries was announced. It is now known that the SARS pathogen is a new type of coronovirus. Experts note that the virus genome is entirely novel, and very possibly comes from animals.

There are divergent theories on how the virus spreads. Some experts say it spreads through droplets and others contend that it can be airborne, while bodily fluids and sexual activity are other suspected forms of infection. Experts from the Hong Kong Department of Health even suggest that persons who have been infected by SARS but have either recovered or not gotten ill in the first place might still be spreading the virus through expulsion of bodily waste, saliva, tears, or mucus, for a period of three to six months.

Meanwhile, Lee Lung-teng, deputy director-general of Taiwan's Department of Health (DOH) states that in Taiwan there have been verified cases of patients who have fully recovered but still test positive for the virus. It is not necessarily the case that the virus they carry is infectious, but if that proves to be true, it would be a serious problem.

It is clear that authorities are still groping to discover even the most basic knowledge about this disease. The WHO says that the SARS incubation period is three to five days. But there have been cases in Taiwan in which 10 days, or even more, have passed before illness has set in. When a large question mark hangs over even the incubation period, it is no surprise that people feel so apprehensive.

The market has responded to this sudden virus of uncertain origin and unknown cure with all kinds of prescriptions and formulas which are rumored to prevent SARS. Things like bee propolis, lingzhi fungus, isatis root, and multi-vitamins are all said to increase immunity. While some point out that there is no concrete medical evidence for such beliefs, people still think, "Anyway, they are good for you," and as a result there has been a run on health foods. In addition, another defining feature of the battle against SARS is the "masked population," and various kinds of protective masks have completely sold out from shops, despite the fact that experts are divided over the real effectiveness of masks against the virus. Overall, some advise that there is no need for excessive fear, others that it is better to err on the side of caution.

The Department of Health advises citizens that the most practical preventive measures involve old standbys: careful washing of hands, keeping surroundings clean and well ventilated, avoiding locations that are crowded or have poor ventilation, avoiding unnecessary trips to the doctor or hospital, eating a balanced diet, and getting appropriate amounts of rest and exercise.

In Taiwan a full mobilization has been declared against this virus. Because all the cases found in Taiwan have been among people who have just come back from Hong Kong or mainland China, EVA Air and China Airlines have both announced that they have stopped serving hot meals on flights to and from Hong Kong and Macao, so that people will not have to lower their masks in-flight. (They do provide boxed meals as compensation, but hope that people will wait until they deplane before eating them.)

On March 27, the DOH announced that it was listing SARS as a "type-4 infectious disease" as defined under the relevant statute. This means that hospitals cannot refuse to treat infected patients, doctors must immediately report suspected cases, and high-risk groups may be subjected to compulsory home quarantine.

To prevent SARS from being brought into the country, as of April 10 the DOH stipulated that all travelers entering the country would have their temperatures taken. Testing stations have been set up at CKS Airport in Taoyuan County and at Hsiaokang Airport in Kaohsiung. Anyone with a temperature over 38°C must be isolated as a first step, to be followed by further examination and treatment.

In response to the epidemic, the Executive Yuan has: (1) widely disseminated information related to preventing the spread of SARS; (2) called on citizens to minimize visits to affected areas (especially Hong Kong, China, and Vietnam); (3) stipulated measures in the five areas of prevention, reporting, follow-up, quarantine, and treatment in order to prevent the spread of the illness; (4) required that all visitors to Taiwan fill in reports stating whether they have been to affected areas within the past two weeks, or whether they have had symptoms such as fever or coughing; (5) suspended all official trips by civil servants to high-risk areas; (6) stepped up measures against illegal immigration from mainland China; (7) taken steps to isolate and treat known cases; (8) undertaken follow-up and isolation of "high risk groups," i.e. persons known to have been in close contact with infected individuals.

In fact, Taiwan is faring quite well in its battle against SARS in comparison with other SARS areas. So far, only one medical caregiver has been infected, the lowest of any affected country. And of the 70-plus "possible" and "suspected" cases there have been no deaths, and some people have already fully recovered and been released from hospital. Even the WHO, which still refuses to admit Taiwan even with observer status, has praised Taiwan's disease prevention work. Much of the credit, of course, goes to the medical personnel on the front lines.

Unfortunately, on April 22 seven suspected cases of SARS were discovered at Hoping Hospital. The hospital immediately stopped admitting patients, and on the 24th the hospital was sealed with no one allowed in or out. The medical community is worried that Taiwan's anti-SARS dike has sprung a leak. Chin Chuan-chun, a professor of epidemiology at National Taiwan University, says that there is a need for careful attention to preventive measures, and there is no room for complacency.

So far Taiwan is not only keeping its own house in order--so far there have been no fatalities, no community-wide infection, and no cases of individuals leaving Taiwan and infecting persons overseas--but the DOH has also dispatched personnel to Hong Kong to share information about prevention of the illness. In fact, the outbreak of SARS marks the first time that the two sides, working through NGOs, have worked together on disease prevention. In addition, Ho Mei-hsiang, a researcher at the Institute of Biomedical Sciences of the Academia Sinica, is currently in mainland China, in order to get a better understanding of the local epidemic situation there, and also to share Taiwan's experience with the PRC.

In terms of the economic fallout, the SARS crisis has already had a definite impact on Hong Kong and Singapore. In Taiwan, meanwhile, a number of international conferences have been canceled, and it is expected that SARS will continue to hurt a number of industries in affected areas, especially tourism, travel, and services.

The ROC Council for Economic Planning and Development points out in its assessment of SARS that if the epidemic continues, the disease could even cause a decline in GDP. Those industries likely to be most affected include travel services, restaurants, transportation, retail sales, cultural services, and recreation and leisure. Of these, the travel industry is being most affected, and business could fall by as much as 95% by worst case estimates if the situation does not improve. One indicator is that from April 1-14, the number of passengers traveling on the eight main routes served by airlines based in Taiwan fell by 23.7% compared to the same period last year.

Fortunately, the Ministry of Transportation has already approved a proposal to reduce various airport fees paid by airlines by half for a period of one year. Also, the national federation of the travel industry, facing a potential loss of 60,000 jobs, plans to march in the streets to draw attention to their plight and hopefully find a solution.

Besides the direct economic impact in Taiwan itself, foreign wire services point out that because mainland China concealed the SARS epidemic for so long and still does not have it fully under control, foreign investment in mainland China will decline, which in turn will indirectly affect Taiwan's economic performance. Concerns that the epidemic could have a negative impact on the entire economy and society mean that all the government's ministries, and not only the DOH, are girding for battle.

Besides hoping that the economic impact can be minimized, let us even more hope that all the people in areas affected by SARS can emerge victorious in this war pitting humans against microbes.

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Faced with a new and unknown virus, many people hope that a good defense will be the best offense. (photo by Hsueh Chi-kuang)