Tim Brookes says he "knew nothing" about severe acute respiratory syndrome, a.k.a. SARS, when he was first approached to write about it. "I couldn't even spell it," says the Champlain College professor and Essex author of books on asthma, hospice care and hitchhiking across America. "I'd heard in the background that this was going on. I knew that the epicenter had been in South China and Hong Kong; I remembered that something had happened in Toronto, but I was really almost entirely ignorant."
Then a cricket-playing friend who works for the American Public Health Association asked if Brookes could document the illness that killed 774 people worldwide. "They were looking for a writer who could handle the research and the comprehension of the subject matter," says Brookes, "but also who could write in a conversational, approachable way."
And so in mid-December 2003, five months after SARS had been contained, Brookes started researching his new book, Behind the Mask: How the World Survived SARS, the First Epidemic of the Twenty-First Century. He spoke with hundreds of doctors, nurses, patients, victims' families and health-care officials. "I've never had such widespread cooperation and openness in anything I've ever written," he observes. "Every-where I went, people couldn't wait to tell their stories." He shared some of his own with Seven Days.
SEVEN DAYS: What was it like traveling back to areas that had been infected by SARS?
TIM BROOKES: At one point I spent nearly two weeks in Hong Kong. I stayed in the Hotel Metropole, which was really the point of dissemination of the whole virus... the number of the room where the index [first] patient stayed was room 911. Apparently when that number first became known at the CDC, there were immediately alarm bells going off; did this mean there was bioterrorism involved? It's still not clear how Liu Jianlun transmitted the virus to other people, but the current theory is that they found viral fragments in the carpet outside his room so he may have vomited onto the carpet, and possibly air movement or the vacuum cleaner would have distributed the virus. At first there was this tremendous fear of elevators, that he had touched the No. 9 button. Even today in Hong Kong people are very concerned about the elevator as a "vector" for disease spread.
The SARS outbreak taught people an enormous amount about infectious disease. For example, Toronto has a number of private and public ambulances, which is very common. But all of a sudden you need to be able to track where every patient is and has been and which ambulance they've been in. There's no such tracking informatics available. It's a major eye opener about the inability of a privatized health system to deal with a public-health emergency.
SD: The United States had only eight confirmed cases. How did we avoid a serious SARS crisis?
TB: The Canadians really got very unlucky because a patient who came home from Hong Kong essentially stayed at home and infected several other family members before anybody was seen in a hospital. And that just didn't happen in the U.S. So part of it was ... dumb luck; the head of the CDC will absolutely admit that. And part of it had to do with the capriciousness of the virus. In one incident, a woman waited in an emergency room for 45 minutes and infected 16 people. Then there was somebody who was really highly infective who sat on a plane between two other people and didn't infect them.
SD: How would you compare SARS to other global epidemics such as AIDS?
TB: Every epidemic is different. SARS wasn't as infectious as, say, flu is. AIDS is, in a curious way, the opposite of SARS in that, with SARS, you don't typically infect other people until you are very sick. With AIDS, you can be infecting people for years before you have any symptoms at all. Consequently, SARS broke out in the hospitals, because [patients were] already showing symptoms of being ill before they started infecting other people. The downside of that is that the first wave of people to go down -- in droves -- were health-care workers. What that meant is that everywhere SARS broke out, the health-care system was on the verge of collapse.
SD: Were you afraid of picking up any lingering strain when you were researching?
TB: When I was in Hong Kong, they were still on alert. They take public health extremely seriously, and SARS had kind of morphed in and out of public concern about avian flu. Consequently I had this probably entirely irrational and self-deluding belief that I was actually in the best place in the world. Staying in the Hotel Metropole, I thought, 'This is the cleanest hotel in Hong Kong.' The one place where I felt uneasy was at the live animal market in China. It is such a wild place; the air is just full of the smell of animal waste -- or, as I was starting to think of it, viral fragments -- that it was impossible to believe that anybody could be in that market for more than 15 minutes and not come down with something. Hygiene was still several generations away.
SD: Is avian flu the greatest concern in Asia now? Should it be a larger concern globally?
TB: It's not widely known, but avian influenza is in the U.S. now, and it has been for at least months and probably more than a year. Avian flu has been identified by [the World Health Organization] as the single most likely candidate for a global pandemic. What the WHO is really worried about is that the virus will further mutate -- viruses mutate all the time, anyway -- and that it will become a virus that moves more easily from animals to humans and humans to humans. Then you've got real problems.
SD: What was the biggest factor in containing SARS?
TB: There was no accurate diagnosis, no treatment, no cure, and so it had to be treated by doing one's best to treat [patients] and at the same time looking after the health-care workers. For any new emerging infectious disease, in the end it's going to be these old-fashioned public-health methods [versus technology] that make the difference. ... Some of those are actions of people employed in public health, but many of those are actually actions by the public: how you behave, how you behave toward others, what happens if you think you have symptoms. That in the end is going to make all the difference.
Time to dust off the wedding gowns, tuxedos and even that old bridesmaid dress. On February 12, Sugarbush hosts the Jimmie Heuga Race for the Roses, in which competitors wearing nuptial garb will get a two-second advantage over the rest of the pack. Those with cold feet, take heart: the most lovey-dovey couple wins a night at the Pitcher Inn. Speaking of horizontal bonding, Touchstone Healing Arts offers a couples' massage workshop on February 14. More than just double your pleasure, touch-for-two helps boost levels of oxytocin, a hormone that helps create intimacy; massage also increases circulation, flexibility and immune function.