Medical Examiner

Lessons From SARS

On How To!, Dr. Elisabeth Rosenthal, who reported on the 2003 SARS outbreak, says now is not the time to panic.

A little girl in pigtails wearing a surgical mask, with her arms wrapped around a luggage.
Photo illustration by Slate. Photo by Yuri Smityuk/TASS via Getty Images.

On this week’s episode of How To!, Charles Duhigg spoke with Elisabeth Rosenthal, a health journalist and physician, about the new coronavirus from China. Rosenthal reported on the 2003 SARS outbreak in China for the New York Times and is now editor in chief of Kaiser Health News. This transcript of their conversation has been condensed and edited for clarity.

Charles Duhigg: How does it start? What are the early warning signs that something’s going on?

Elisabeth Rosenthal: Well, in China, the early warning signs tend to be rumors, because there’s not a vibrant independent press. So you hear that there’s a new disease circulating, you hear that people are dying, and that’s what makes it scary. Then you have to kind of roll back and figure out, well, how is it spreading, and how lethal is it, really?

As a journalist, it’s really wild, because you’re trying to get around a country where quarantines are being imposed. We wanted to go to the hospital where SARS patients had been kept. So you do these trips, and you have to be careful.

So as a journalist and as a doctor, you have one perspective, but you were there with your kids and your husband, right? How old were your kids when you were there?

Well, at the time of SARS, they would have been 8 and 10. My kids were at the international school in Beijing, and I would say probably half to two-thirds of the kids’ families chose to leave, or the whole families left.

Leave the country altogether?

They left Beijing. There are various reasons why people make that choice. You worry that what’s going to happen is what we’re seeing now, that you won’t be able to get out if you wait too long, so better get out of dodge while we still can.

As a physician, I felt like [my kids] were in a pretty safe space that I could control. And one of the high-risk areas for transmitting disease is on airplanes or in airports. They’re very crowded, there’s recirculated air, and in fact, at our school, we had a mom get sick on a famous flight from Hong Kong to Beijing where 17 people, I believe, got infected from one person who had SARS. Those enclosed spaces can be very high-risk if you have a very sick person on board, which apparently was the case in that flight. But the more information comes out and the more you understand about the virus, the less scared you get.

But also, when there’s too much half-baked information, fear and panic spreads. As I watch the reporting on the coronavirus now that I’m not doing it, it bothers me a little bit that people keep calling it “the deadly coronavirus” because, by all indications, it’s not nearly as deadly as SARS. Do we say “the deadly influenza virus”? Yes, people can die from a whole lot of viruses, but we really have to keep things in perspective. I can tell you: A world where everyone walks around with masks and is paranoid about everyone else, as was the case when SARS was a full-blown problem in Beijing, is really not a fun world to live in.

Yeah. Remind me, how contagious and fatal was SARS?

SARS killed about 10 percent of people who were infected, so pretty high mortality rate. It killed young people as well as old people. That’s a little different than what we’re seeing with the coronavirus. Most of the people who’ve died in the coronavirus … have been old or had other conditions, which means they’re kind of weakened anyway.

We all see these photos from China of everyone wearing masks on the street. It’s really hard to get any infectious disease when you’re outdoors. It’s in these tight, enclosed spaces that you have to worry.

It’s interesting. Here in New York, I ride the subway system, and I’ve noticed I’ve seen more people with masks on. I feel terrible about this, but there’s almost this suspicious response, to think, Are they wearing a mask because they’re sick? Or are they suspicious of all the people around them and they’re worried that someone else is sick?

So I was on a plane really at the height of the SARS epidemic or outbreak, where it was mostly me and epidemiologists from the [Centers for Disease Control and Prevention], and we all started wearing our masks because we knew at that point planes were a high-risk environment. Then the beverage cart came, and we were like, “OK, masks off.” Now, I probably would have kept it on if the guy next to me or the woman next to me was coughing their brains out.

So what would you guys do every day, day to day, that was different? What were the protections you guys put in place?

What was really important was what happened at the school for my kids. They said, “Do not send your kid to school with any sickness at all,” and then they would do this hand-washing thing—they both probably can still sing the hand-washing song. So they would wash their hands many, many times a day at school, and that was really important.

What surprised me—and I’d known about good sanitation, all that, for years as a doctor—but during those months of SARS, no kid who stayed at that school got sick with anything. It was like a miracle. No stomach bugs, no sniffles, because everyone was really conscious of sanitary stuff.

So let me ask this for folks who are listening who aren’t in China. They’re reading in the paper every day about coronavirus. They’re trying to put the risk in perspective, and the hallways of hospitals are jampacked. They have 45 cranes to try and build a hospital in 10 days to take care of the sick. It’s hard to just say, “I’m going to trust that things are going to be OK.” How should listeners put this into context, and what should they do?

Can I do the “I’m a doctor” thing?

Yeah, please do. Please do.

I’m a doctor, and you should wash your hands and not panic, because you have to understand that a lot of the reactions at the center of an outbreak have nothing to do with us here, 3,000 to 6,000 miles away. Some of the interventions you see going on, in fact probably many of them, are just officials wanting to show that they’re doing something. You do what you can. I think for those of us in the U.S. right now, just remember the flu is your problem, not the coronavirus in Wuhan.

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