The New Global Threat. Severe Acute Respiratory Syndrome and Its Impacts. Tommy Koh, Aileen Plant, Eng Hin Lee. Singapore: World Scientific Publishing Company, 2004, pp. 356, $17.00 (PB) ISBN: 9812386688

In the annals of epidemiology 2003 will be remembered as the year that communicable disease surveillance came of age. The impetus for this right of passage was the emergence of Severe Acute Respiratory Syndrome (SARS) onto the world stage and its rapid spread to over 30 countries resulting in over 8000 cases. Due to fortuitous epidemiological characteristics and unprecedented international collaboration and leadership the outbreak was brought under control within months of its recognition. Koh, Plant, and Lee's book provides an excellent taster of the scientific, political, social, and economic consequences of an international outbreak that paid no respect to international boundaries and resulted in the deaths of over 700 individuals. This book condenses in a relatively small tome a wealth of information gained in a short period of time with specific reference to SARS as viewed in the major affected areas of China, Hong Kong SAR, Taiwan, and Toronto. The book's thrust is achieved by bringing together chapters written by individuals, representing teams that were in the thick of the epidemic. The first section and the editorial by Plant provide an insight into the vital role of the WHO in co-ordinating and leading the international response to SARS. It juxtaposes a number of concerns experienced by the WHO and how it set out to meet the challenges facing it. Many of the chapters provide a chronology of SARS as it appeared in various countries and makes inroads, albeit in a limited fashion, into how affected areas responded to the crisis as it unfolded and how they attempted to re-establish themselves as areas that were safe to visit and trade with after WHO travel advisories had been lifted. For the more practically minded Stanton and Yuen and Peiris recall the pressure placed upon teams of clinicians and virologists around the world to come up with the answers as to what the causative agent for SARS was and to devise a regime for treating affected individuals. Within weeks the former was a reality with discovery of SARS Coronavirus. The latter has to date proven to be a much more demanding challenge with no consistently effective treatment having been identified. On looking back many have argued as to why we were not prepared for SARS and why we had to rely on the basic principles of early detection and isolation. On infection control, Tambyah gives a very illuminating, though he stresses opinionated, insight into infection control polices in hospitals during SARS and highlights the confusing picture presented by the various guidelines for personal protective equipment (PPE) and quarantining in the event of identifying probable or suspect cases of SARS. In many areas SARS was considered to be the worst crisis in living memory. In Hong Kong SARS was considered the greatest challenge since the Second World War. However local commentators have reported that SARS has in fact helped the people of Hong Kong, locals and foreigners, to find a new collective identity irrespective of the government. Further chapters examine the impact of the outbreak as it occurred in affected areas. Within each of the sections a number of themes emerge as being of significance, in particular political, social, and individual responsibilities and the implication for society at national and international levels. For example in section II emphasis is placed on how, in China, a large and previously very restrictive country wrestled with SARS as it progressed and how this contributed to the shaping of a new government, sworn into office in the early days of the outbreak being recognized. This is echoed in chapters 5, 11, and 12, which suggests that the repercussions of SARS for the Asian countries go well beyond loss of life and economic loss and will have significant social consequences. Ho in, national government responses, analyses what he describes as ‘inept policies’ which for some created political legitimacy and in others led to resignations and enhancement of the crisis. In a similar vain Bishop describes the psychological impact of the SARS outbreak and the mechanisms of response in populations and individuals and the elements of discrimination and stigma engendered. Many lessons have been learned from SARS. Yuen and Peiris pick out three salient lessons as being of great importance: (i) intelligence gathering, especially from areas with poor surveillance infrastructures, (ii) risk assessments and monitoring at potential epidemic centres (healthcare facilities and wet markets), and (iii) effective communication to all sectors. Of all the lessons learned Chan sums it up in perhaps the most optimistic manner by suggesting for Severe Acute Respiratory Syndrome we should now consider Sustainable Action for the Rejuvenation of Society. For those who like a good informative read that can be taken on as bite size chunks I recommend this as a reliable account of what took place during the SARS outbreak of 2003 and more importantly what we need to prepare for in the future. For SARS, many factors played to our strengths. Next time, if unprepared, we may not be so lucky.

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