SARS: lessons from a new disease and visitors, all linked to the same hotel floor. They carried the virus with them as they en- tered local hospitals or travelled on to Singapore, Toronto and viet Nam. An international outbreak that eventually spread to 30 countries had thus been seeded. Figure 5.1 maps th distribution of 8422 cases and 916 deaths that had occurred by 7 August 2003 Detection and response On 15 March 2003, when the second alert was made, the cause of Sars had not yet been identified Cases were concentrated in hospital workers and did not respond to medicines known to be effective against a number of different lung infections. Many patients were rap- idly progressing to severe pneumonia. The situation was alarming: no patients, including roung and previously healthy health workers, had recovered. Many of the patients were in a critical condition, several required mechanical ventilatory support, and two had died. The spread to major cities around the world meant that any city with an international airport was at potential risk of imported cases From the outset, WHO's objective was clear: to halt fur- ther international spread and interrupt human-to-human transmission through a global con tainment effort, and by so doing to minimize opportunities for the disease to establish endemicity(see Box 5.1) The global response to SARS was in reality the roll out of a way of detecting and responding to outbreaks that had been developed over the preceding seven years by WHO and its part ners, partly as a result of major weaknesses that came to light during the 1995 Ebola outbreak in the Democratic Republic of the Congo and during previous outbreaks of plague in India and cholera in Latin America. The SARS response depended on collaboration of the worlds top public health and laboratory experts, and took advantage of up-to-date communication technologies, including the Internet and video and telephone conferencing Figure 5.1 Probable cases of SARS worldwide, 7 August 2003 Russian Federation (1 USA (3) 水 China (5327 China, Hong Kong SAR (1755) Viet Nam( 63) Thailand⑨9) australia aFRica(1)SARS: lessons from a new disease 75 and visitors, all linked to the same hotel floor. They carried the virus with them as they en￾tered local hospitals or travelled on to Singapore, Toronto and Viet Nam. An international outbreak that eventually spread to 30 countries had thus been seeded. Figure 5.1 maps the distribution of 8422 cases and 916 deaths that had occurred by 7 August 2003. Detection and response On 15 March 2003, when the second alert was made, the cause of SARS had not yet been identified. Cases were concentrated in hospital workers and did not respond to medicines known to be effective against a number of different lung infections. Many patients were rap￾idly progressing to severe pneumonia. The situation was alarming: no patients, including young and previously healthy health workers, had recovered. Many of the patients were in a critical condition, several required mechanical ventilatory support, and two had died. The spread to major cities around the world meant that any city with an international airport was at potential risk of imported cases. From the outset, WHO’s objective was clear: to halt fur￾ther international spread and interrupt human-to-human transmission through a global con￾tainment effort, and by so doing to minimize opportunities for the disease to establish endemicity (see Box 5.1). The global response to SARS was in reality the roll out of a way of detecting and responding to outbreaks that had been developed over the preceding seven years by WHO and its part￾ners, partly as a result of major weaknesses that came to light during the 1995 Ebola outbreak in the Democratic Republic of the Congo and during previous outbreaks of plague in India and cholera in Latin America. The SARS response depended on collaboration of the world’s top public health and laboratory experts, and took advantage of up-to-date communication technologies, including the Internet and video and telephone conferencing. Outbreaks Imported cases Canada (251) USA (33) Colombia (1) Brazil (1) South Africa (1) India (3) Kuwait (1) Europe: 11 countries (33) Russian Federation (1) Mongolia (9) China (5327) Viet Nam (63) Singapore (238) New Zealand (1) China, Macao SAR (1) Taiwan, China (665) China, Hong Kong SAR (1755) Indonesia (2) Australia (6) Republic of Korea (3) Malaysia (5) Philippines (14) Thailand (9) Figure 5.1 Probable cases of SARS worldwide, 7 August 2003