SARS Boils Over

The following is fiction, but it could become frighteningly true. This is a glimpse into Captain Dave's imagination regarding how SARS could enter the U.S. some time in the near future:

Mrs. Li could no longer gasp for breath – instead she sipped it in fast shallow breaths like a cat licking up milk one tiny drop at a time as she shuffled from the insignificant bathroom in her flat to the cot on which she slept. She slowly lowered herself onto graying sheets, slipping her slippers off, leaving them at the edge of the bed as she had done so many thousand times before that it was a much a habit as pushing her large glasses up over the small bump on her nose. She pulled the top sheet and the wool blanket up as she felt another shiver grip her frail body. She rested for a moment under the blanket's reassuring weight.

Tomorrow, she told herself. If she wasn't feeling any better tomorrow, she would go back to the herbalist and demand something stronger. Her head spun as she tried to remember how much money was left in the hiding place in her kitchen drawer. She wondered if she could afford to have a healer or perhaps a priest come to see her. She couldn't remember an illness like this since the fever her son had had when he was seven, a fever that none of the traditional remedies would cure. They had taken him in their oxcart from their village to the hospital almost 20 miles away. He had lived and grown into a fine young man, but she still hated hospitals with their cold tile floors and colder doctors.

She twisted slightly; rolling to the right seemed to ease her breathing a bit. Tomorrow, she would decide if she needed a healer or if she would approach her neighbor Mrs. Jeng and ask her to use her cell phone to call an ambulance. It would be embarrassing, but she had no ox cart here, and no husband any longer, either. She found intimidating the cold efficiency with which the San Francisco EMTs had strapped the fat American onto the stretcher and wheeled him out of the Dim Sum Palace when he had a heart attack, but perhaps a business-like approach was what was needed to cure these strange Western ills. But should could decide whether to go down that path tomorrow. Tonight, she thought as sleep carried her away, she would rest and hope that the tea would do its work.

Three days later the building's super, a cranky man named Ho, and two policemen discovered the shrunken body cocooned in the bed, clearly beyond saving. The police called the coroner instead of an ambulance. A detective was on his way as well, though no one suspected foul play. In a city of several million, elderly people were found dead in their beds every day, and there was a process to be followed.

Unfortunately, the process never took into account a mutated corona virus that caused severe acute respiratory syndrome, or SARS. In two weeks, there would be 97 cases in Chinatown. In three weeks, there would be more than 250 in Chinatown, plus another 80 scattered throughout the city, mostly in the hospitals, the police force and the fire and EMT department. It would be four weeks before Mrs. Li, who had died well before the outbreak, would be identified by epidemiologists as a super spreader both in life and after her death. An unassuming woman who made barely a ripple in the pond of life during her 58 years, she unknowingly started an epidemic that would eventually kill millions.

By the time they had identified the elderly Chinese restaurant worker as a super spreader, the disease had already put more than 1,500 people in San Francisco and the surrounding areas into hospitals and another 3,000 were only a day or two away from exhibiting symptoms. Perhaps 50,000 of their friends, family members, coworkers and complete strangers they had shared an elevator or grocery store line with were harboring the virus but had not yet become sick. Public health officials tried to track them down, but the numbers were too great. It got worse with every day that passed as every infected individual potentially infected dozens of people with this especially virile version of SARS. There were thousands of people quarantined, but the disease showed no sign of slowing. Already, significant outbreaks had cropped up in New York, Chicago, Seattle, Dallas and Denver as well as regional outbreaks in some smaller cities and towns across the country. Withing six weeks, SARS had been reported in most of the Pacific Rim, despite their increased vigilance and tougher quarantine programs, and in most of the population centers of Europe.

More than 200 of the first 1500 hospitalized in San Francisco died, but epidemiologists with the city's department of health predicted that the number would grow exponentially before summer arrived. Their dire predictions would prove to be true because the exponential growth of SARS meant future patients received less medical attention and fewer drugs. San Francisco quickly became overwhelmed and was the center of the pandemic that made the one in Hong Kong look like a walk in the park.

Mrs. Li would become infamous, but no one would ever find out for sure how she contracted the disease.

As she marched out of the office, she figured there was about a 10 percent chance the secretary would do as she suggested. She hoped the woman didn't have kids.

The first case of a child with SARS in the school was diagnosed 11 days later. School was canceled the following week. Of the 628 children originally enrolled, almost 450 were still in class at the time, a public health oversight that would prove to be costly. Although school was canceled, the damage had been done. More than 300 of the students contracted SARS and, as hospitals grew more crowded, more than a third of them died. It was later estimated that 80 percent of the surviving children in the public school lost at least one parent or a sibling in the epidemic, a higher concentration than the population at large.

Mrs. Dewit, the school secretary, did go into self imposed quarantine with her two children. Her husband, however, refused to cooperate and went to work every day until his office closed. He recovered from SARS after three weeks but complained for the rest of his life that he never felt the same again. Their daughter Chelsea, who at age 8 was a promising soccer player, died after fighting the fever for six grueling days. Mrs. Dewit never forgave her husband for bringing SARS into their home.