What was the Origin of SARS in 2003?
Or — was SARS-CoV-2 natural, accidental, or intentional?
By Christopher Eddy, M.P.H., REHS, CP-FS
From 2003–2019, I lectured upon All-hazards readiness extensively as a public health official directly involved in the national response to 9/11, SARS, monkey pox, Ebola, West Nile virus, Zika, and the ever-present influenza threat. I have developed masters level coursework on disaster planning and emergency management, global health, One Health, and environmental health, while continuously teaching-coaching the future public health workforce. The lectures had a least common denominator: the next “Pathogen X,” the next new disease to menace the world. Although we knew from the beginning that the bat (ancient genetically and highly mobile) was key to the SARS origin, my early presentations followed the literature citing the Palm civet. Available live at “wet markets” internationally and considered a delicacy, the civet resembles a cross between a raccoon and a house cat. As the bat was increasingly tied to the most worrisome pathogens (Ebola, MERS, SARS, Nipah, Marburg), the civet became emblematic of a growing list of exotic creatures, such as the anteater-like pangolin, capable of bridging emerging and reemerging infectious disease to humans. The term to know is zoonosis.
Déjà vu — The now popular discussion of the novel coronavirus origin in 2019, no longer relegated to conspiracy theory, was specifically identified as the most likely source of our pandemic by former CDC Director Robert R. Redfield in a shocking interview by CNN in March 2021. US President Biden has demanded a full investigation of the Wuhan Institute of Virology (WIV). However, it is likely too little too late — it seems that we are back at Ground Zero, without Patient Zero, just like SARS all over again. The WHO already concluded its assessment in agreement with some of the world’s most highly regarded scientists that the laboratory incident scenario is “extremely unlikely.”
Natural, Accidental, or Intentional? Although the highly credible experts interviewed on 60 Minutes Australia following Dr. Redfield’s revelation discuss the possibility of natural and accidental pandemic origins, the concept of intentionality, just as important as the other two traditional descriptions of All-hazards readiness (natural, accidental, intentional — disaster) is normally excluded. Perhaps that is because rational people do not consider intentional attacks or acts of war. All-hazards readiness experts do exactly that. Therefore, if the point of origin of existential Pandemic COVID-19 was not naturally introduced by either direct or indirect contact of wet market animals and humans, from an All-hazards perspective, both accidental and intentional considerations should be made during future evaluations of pandemic origins. The proximity of the laboratory to a limitless supply of potential laboratory specimens, and major hubs of human transportation, should force us to follow primary objectives of disease investigation: find and analyze comparators, source determination, prevention strategy development. In this case, the elephant in a small room is SARS 2003. If we cannot know definitively what happened then, new investigations may be fruitless. See our future-thinking March 2020 paper on the complexities of transmission pathways for further consideration: An All-Hazards Approach to Pandemic COVID-19: Clarifying Pathogen Transmission Pathways Toward the Public Health Response.
Why the name and nature of the threat matters. I remember reading “SARS-COV-2” stamped across the cover page of a restricted but not classified military document, like a bolt of lightning. I wondered, is this a mistake? Is this novel coronavirus so like the source of the 2003 SARS global epidemic that it is classified nearly identically, SARS and SARS 2? Up to this point there was essentially no discussion in the news about SARS, only that we were dealing with a novel coronavirus that many people were confusing with influenza. However, we were already realizing that COVID-19 was much more infectious and more deadly than its SARS sibling. SARS-COV-2 was officialized by the International Committee on Taxonomy of Viruses and the logic published in the March edition [Vol. 5] of Nature Microbiology. But there were so many distractions through this point in time. For example, the US Department of Health and Human Services was absorbed in the Diamond Princess cruise ship US citizen repatriation mission: 1,000 people were extracted from the disease-stricken ship stranded in Yokohama Bay, Japan and repatriated, including 329 American citizens — some infected with COVID-19 only a few days before the first cases of COVID-19 were detected in the United States. The US President was intent to not lock down the nation stating that the heat of summer would destroy the novel coronavirus, while even the basic prevention strategies, masking and social distancing, were both contentious and poorly communicated. The result was a decreasing ability for the public to comprehend the magnitude of risk presented by the new SARS sibling.
Would the knowledge of the origin of the disaster change our response? In a normal sense, yes. If accidental from a laboratory source, the world would respond with an equally swift international response, while concurrently building consensus-based restrictive laws and protocol to prevent such experimentation until proven safe. Regardless, the zoonotic disease link pervades the natural, accidental, and intentional source possibilities. Advocating “One Health,” Environmental Health — Champions of One Health, our team found that the biosurveillance systems between environmental public health, veterinary, and medical practitioners necessary to prevent pandemics and acts of bioterrorism, was at best inadequate. Written in 2013, at the 10-year anniversary of SARS, the cautionary message warned of the next novel potentially pandemic pathogen. It was revealed in 2019. COVID-19.
We published critical analyses of the COVID-19 pandemic from an early point in the disaster. So early that we made last minute revisions with the journal editor to include the official proclamation of the pandemic by WHO. We considered potential disease transmission pathways, in lieu of perfect information, while under the public health emergency burden of responsibility to act now. We later published cautionary conclusions and recommendations regarding the implementation of crisis standards of care (this almost happened in Arizona while refrigerated morgue trucks were lining up at Texas hospitals), the inevitable rationing of life saving medical treatment in an overtaxed hospital system incapable of serving the community equitably. Crisis Standards of Care: On Justice and the Public Health Approach to the COVID-19 Pandemic. A practically implemented One Health perspective could establish adequate local up (the old saying in emergency management is that all disasters are local) surveillance systems regardless of the primary point of the outbreak: “One Health disease reporting concepts are essential to the early detection of, and expedient recovery from, pandemic disease events” (“Champions”).
Today (5.31.2021), all eyes should be upon increasing cases in Vietnam, Malaysia, South Korea, Taiwan, and Japan, all previously successful in controlling COVID-19. The disease and suffering presently occurring in India and Nepal should be guiding the conscience of global response efforts. New mutations/variants are harbingers of future threat severity uncertainty, the bane of All-hazards threat assessment, including the possibility for vaccine escape. Humanitarian interests aside, from a perspective of sheer pragmatism, everyone must understand and agree that the health of one nation is the health of all nations.