Stopping a Scourge
No one knows if SARS will strike again. But researchers' speedy work halting the epidemic makes a compelling case study of how to combat a deadly virus
- By David Brown
- Smithsonian magazine, September 2003, Subscribe
It was 11 minutes after noon on the third Friday in March, and Sherif Zaki was in a meeting at the Centers for Disease Control and Prevention (CDC) when he got a message on his pager. "I can’t believe it," the message said, "but it looks as though Tom’s group has isolated a coronavirus. The cells were ‘fried’ by the microwave, but I’m pretty certain (90 percent) that’s the result. Call me, I’m waiting on you to look before I pass on the info. Cynthia."
Zaki is chief of infectious disease pathology at the CDC. Pathology, the study of the nature and effects of disease, is not one of the heart-pounding specialties in medicine. It’s a field for brainy people who are happy to spend long periods of time at the microscope, scanning cellular landscapes for the unusual or telling feature. In their tolerance for high-risk monotony, they resemble air traffic controllers or lifeguards. As in those jobs, they are occasionally called on to move quickly. Zaki kept his counsel—the "Tom" of the message was sitting a few feet away—but messaged back: "I’ll be right down." He excused himself from the meeting.
Much of what can be said of pathologists also holds for electron microscopists. In 19 years at the CDC, Cynthia Goldsmith, author of the text message to Zaki, had looked at a lot of hostile territory and picked out a lot of bad actors at a magnification of 40,000x. She was among the first to take a picture of the Sin Nombre hantavirus responsible for cases of fatal pneumonia on a Navajo reservation in the Southwest in 1993. In 1999, she was first to identify the Nipah virus, which killed about a hundred pig farmers and slaughterhouse workers in Malaysia and Singapore. Both times, though, other lab tests had given her hints of what to look for. This was different. She was looking for the possible agent of severe acute respiratory syndrome (SARS), a contagious, sometimes fatal infection that had appeared on two continents half a planet apart. Nine days earlier, the World Health Organization (W.H.O.) had issued a "global alert" about the disease. She peered through the electron microscope at a virus originally taken from the throat of a SARS patient in Asia and grown in a flask of cells at the CDC. What she was seeing wasn’t what people said she should be seeing. Her heart raced as she and Zaki studied the images on a green phosphorescent screen.
Coronaviruses—the name comes from the spikelike formations on the virus surface that sometimes resemble a corona, or crown—were far down any list of candidates for the cause of SARS. Coronaviruses can cause colds (though not most colds, which are caused by rhinoviruses) and, in premature infants, pneumonia. But in general, coronaviruses are so unthreatening to human health that the 2,629-page Harrison’s Principles of Internal Medicine, the world’s best-selling English-language medical textbook, devotes a mere six paragraphs to them.
Yet Goldsmith was certain that she was indeed looking at a coronavirus. In 15 minutes, Zaki was convinced too. He and Goldsmith went down the hall, where Charles Humphrey, another electron microscopist, was looking at a virus sample from the same patient, Carlo Urbani. The first W.H.O. physician to investigate a SARS case, at the Vietnam French Hospital of Hanoi, Urbani would die eight days after the CDC researchers made their observation. Humphrey used a negative-stain technique—basically a form of backlighting—to outline the material. The virus sample was in poor condition, which made identification difficult. Nevertheless, Zaki, with studied neutrality, asked Humphrey what he thought he was seeing. As Zaki later explained, "Part of science is to do things in blinded fashion. I didn’t want to ask him a leading question. I was trying to avoid that at all costs."
Humphrey has been looking at infectious agents with electron microscopes since 1968. "It could be an influenza [virus] or a coronavirus," he told Zaki. "I was not quite ready to lean one way or the other," he said later. "It had characteristics of both." After Zaki and Goldsmith peered at Humphrey’s images, they took him to look at Goldsmith’s. By the middle of the afternoon, the trio was ready to share its conclusion with CDC colleagues: it was a coronavirus. Three days later, the CDC told the world.
In retrospect, it’s the excitement of the discovery that medical researchers remember. But at the time, they also felt apprehension. A new, often fatal disease was loose in several densely populated cities in China, and among the more frequent victims were medical workers.
The cause of the disease is a virus around 100 nanometers in diameter, or four-millionths of an inch. Genetically, the SARS virus (SARS-CoV) doesn’t closely resemble any of the dozen well-studied coronaviruses known to infect animals or people. It doesn’t even fall into one of the genus’s three broad genetic groups, forming instead a new branch on the family tree. Its origin is unknown—and so, in a sense, is its destination. Biologists haven’t yet charted the full range of human tissue it can inhabit or attack. And nobody knows whether it’s here to stay as a permanent disease that human flesh is heir to.
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