Daniel Lucey on Global Viral Outbreaks

On April 22, 2013, Daniel Lucey, Adjunct Professor of Microbiology and Immunology at ‎Georgetown University Medical Center and an expert on global virus outbreaks, delivered the ‎final CIRS Monthly Dialogue of the 2012-2013 academic year.  Titled “Global Travel and ‎Virus Outbreaks 2003-2013,” the talk focused on past global outbreaks of respiratory diseases ‎like SARS and H1N1, and a possible future one that has recently been discovered in the Middle ‎East. ‎

Giving some background into coronavirus epidemics, Lucey explained that the severe acute ‎respiratory syndrome (SARS) coronavirus first appeared in 2002 in Southeast China. He recalled ‎that “by the first half of 2003, the SARS coronavirus had spread to twenty-nine nations on five ‎continents,” largely through air travel. The virus initially spread through hospitals as infected ‎patients transmitted the disease to medical staff who in turn infected family members. The ‎contagion had a 10 percent fatality rate; out of the approximately 8,000 people who were ‎diagnosed, 800 people died. Due to the large percentage of fatalities, the Chinese government ‎received heavy criticism for their handling of the situation, but, according to Lucey, because this ‎was such a novel disease that spread at such a rapid pace, it could not have been predicted, nor ‎easily halted.

The World Health Organization (WHO) coined the term “super spreading event” to describe the ‎rapidity with which the virus was transmitted to multiple people in a short amount of time. A ‎decade after the outbreak of SARS, it is still unclear why one person, known as a “super ‎spreader,” can transmit the virus to more than ten people, while most others who are infected do ‎not transmit it to anyone else. “Of the 238 people with SARS in Singapore, basically, it could all ‎be traced back to five people – five so-called ‘super spreaders,’” Lucey maintained, citing a ‎publication from the WHO.‎

The SARS coronavirus was initially found to have infected bats, but was then transmitted to ‎intermediate hosts, such as the civet cat, which is known to be a culinary delicacy in some parts ‎of China, Vietnam, and Hong Kong. Through this close contact with animals, the virus infected ‎people, and then became contagious between humans. It is estimated that “two-thirds of all new ‎infectious diseases among humans over the last few decades have originated in animals,” he ‎argued. Once the virus mutated and could be transmitted through the air, it triggered an ‎international outbreak. ‎

In the Middle East, a novel coronavirus appeared in Jordan in 2012 and spread to medical staff ‎at a hospital and some of their family members in much the same pattern as the SARS and H1N1 ‎viruses were transmitted. It was first identified, however, in a patient in Saudi Arabia. The virus ‎was then also reported to have infected patients in Qatar and the UAE. Lucey maintained that ‎‎“by genetic sequencing, it is very similar to the coronaviruses that are known to exist in bats,” but ‎this connection remains unconfirmed. Lucey posed the question: “is the Middle East coronavirus ‎now, in 2013, like the SARS coronavirus in 2002 in terms of only causing sporadic infections and ‎only rarely causing person-to-person transmission?” ‎

In conclusion, Lucey argued that because “there is no antiviral drug treatment either then or ‎today, neither for the SARS coronavirus, nor the new virus discovered in the Middle East last ‎year,” it is important to be vigilant about preventing the spread of the disease. There are two main ‎lessons that can be learned from the 2002-2003 SARS coronavirus epidemic that can be adapted ‎to mitigate the 2012-2013 new coronavirus in the Middle East. The first is that “hospital ‎outbreaks are early warnings” that indicate the rise of a contagious virus, especially if medical ‎workers infect family members outside of the medical facility. The second is the international ‎spread of a virus due to air travel and contact of an infected person with others in different ‎countries. Lucey argued that “as new virus epidemics occur, they have to start somewhere, and ‎the sooner we can recognize them at the start, the more likely we can stop them, or at least ‎mitigate their serious effects – serious in terms of public health, and serious in terms of economic ‎impact.”‎

Daniel Lucey, MD, MPH, is a physician who completed his training in infectious diseases and ‎public health at Harvard University hospitals and School of Public Health. He worked at the ‎National Institutes of Health in the US Public Health Service as a Consultant Physician. During ‎the Severe Acute Respiratory (SARS) coronavirus outbreaks in 2003, he traveled to Asia and ‎worked in a “SARS hospital” in Canada to gain first-hand experience with this new viral disease. ‎Similarly, from 2004-2012 he traveled to Asia and Egypt to better understand bird flu viruses. ‎ 

Article by Suzi Mirgani, Manager and Editor for CIRS Publications.