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The warnings

The history of SARS-CoV began in late 2002, when an unknown origin and unknown causal agent began spreading in cities of the Pearl River Delta of southeastern China, Guangzhou among others, together constituting one of the largest urban agglomerations on the planet. In January 2003, this pneumonia reached a Guangzhou hospital in the body of a portly seafood merchant suffering a respiratory crisis. In that hospital, and then at a respiratory facility to which he was transferred, the fishmonger coughed, gasped, spewed, and sputtered, especially during his intubation, infecting dozens of health care workers. He became known among Guangzhou medical staff as the Poison King. In retrospect, disease scientists applied a different label, calling him a super- spreader.

One infected physician, a nephrologist at the hospital, experienced flu- like symptoms but then, feeling better, took a three-hour bus ride to Hong Kong for his nephew's wedding. Staying in room 911 of the Metropole Hotel, a three-star place in the city's Kowloon district, the doctor became sick again, spreading the disease along the ninth-floor corridor. In the days that followed, other guests from the ninth floor flew home to Singapore and Toronto, taking the disease with them. Cases began to flare in those cities, also in Hanoi, especially among health care workers, which was an alarming indicator that the agent, whatever it was, transmitted well from human to human. On March 12, the WHO issued a global alert about this new, severe, respiratory disease. By March 15, the WHO was reporting 150 new cases worldwide and calling the thing SARS.

Two mysteries loomed, one urgent and one haunting: What was the cause? A new virus? If so, what kind? The first mystery was soon solved by a team led in part by Malik Peiris, a Sri Lankan doctor who had done a PhD in microbiology at Oxford before moving to the University of Hong Kong. Peiris and other members of the team specialized in influenza, and they first suspected that a flu virus might be the causative agent. One worrisome possibility was HSN1, an avian flu, troublesome in birds and often lethal on those rare occasions it gets into a person, but not known as infectious human to human. It had killed a thirty-three-year-old Hong Kong man just a month earlier, after he had picked it up, evidently from direct contact with some bird, possibly a chicken or a duck, during a New Year's visit to the mainland. If 115NI was the agent now circulating. if it had evolved into a form transmissible among humans, its case fatality rate could be terrible.

One route to identification of the SARS virus entailed culturing it growing it within some laboratory lineage of cells and seeing it destroy them but at first the culturing attempt got nowhere. The co-leader of this team with Peiris was K.Y. Yuen, the same fellow who, seventeen years later, would warn Hong Kong's government of the transmissibility of the new virus, the one causing COVID-19. "We were thinking of HSNI," Yuen said to a journalist at the time, and accordingly the team used virus-culturing techniques specific to that virus. "So we failed to culture the real SARS virus. It was a missed opportunity, and we have to be honest about it." They hadn't realized that they were looking for a novel virus, not a known one. The mistake cost weeks, crucial time in the early phase of an epidemic, but by mid-March they had corrected that. They found a virus in samples from two patients, sequenced a frag- ment of its genome from one sample, determined that the thing was a coronavirus, and with other techniques confirmed its presence in forty- five other patients, persuasive evidence that it was the agent of SARS. Although earlier tradition tended toward naming new viruses by geo- graphical association-Ebola was a river in Zaire, Marburg a city in Ger- many, Nipah a village in Malaysia, Hendra an Australian suburb-greater sensitivity about stigmatization prevailed. The pathogen became known as SARS-CoV.

This tidbit is from the book Breathless: The Scientific Race to Defeat a Deadly Virus by David Quammen

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