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136-485: In 2005, following the 2002–2004 SARS outbreak , several changes were made to the previous revised IHRs originating from 1969. The 2005 IHR came into force in June 2007, with 196 binding countries that recognised that certain public health incidents, extending beyond disease, ought to be designated as a Public Health Emergency of International Concern (PHEIC), as they pose a significant global threat. Its first full application

272-462: A 45-day "health emergency" was declared in five regions of the country. On 25 May, six persons were placed in prison isolation after they were found travelling with the corpse of an individual who had died of the disease. On 1 June, it was reported that violent protests in a north Guinean town at the border with Guinea-Bissau had caused the Red Cross to withdraw its workers. In late June 2015,

408-883: A SARS research lab in the National University of Singapore had contracted the disease while working on the West Nile virus but recovered shortly thereafter. It was suspected that the two viruses mixed while he was doing his research. On 10 December, a researcher in a SARS lab in Taiwan was found infected with SARS after returning from Singapore attending a medical conference; 74 people in Singapore were quarantined but none of them were infected. Western African Ebola virus epidemic The 2013–2016 epidemic of Ebola virus disease , centered in West Africa ,

544-743: A WHO team of international scientists landed in Guangzhou from Beijing to discuss with officials, but the team was yet to inspect any suspected origin or any medical facilities on the progress of infection control. Fifteen of the quarantined Amoy Gardens residents at Lei Yue Mun Holiday Camp were relocated to the Sai Kung Outdoor Recreation Centre after an overnight protest on washroom sharing. The first medical worker infected with SARS died in Hong Kong. The doctor's daughter and infected wife survived his illness, although

680-560: A balance of experts from developed and developing countries, representation of a diversity of scientific opinion, approaches and practical experience in various parts of the world, and an appropriate interdisciplinary balance." Revisions to the International Health Regulations in 2005 were meant to lead to improved global health security and cooperation. However, the WHO's perceived delayed and inadequate response to

816-491: A case-fatality rate of 40%. As of 8 May 2016 , the World Health Organization (WHO) and respective governments reported a total of 28,646 suspected cases and 11,323 deaths (39.5%), though the WHO believes that this substantially understates the magnitude of the outbreak. On 8 August 2014, a Public Health Emergency of International Concern was declared and on 29 March 2016, the WHO terminated

952-583: A coronavirus in the same genus as the one that caused SARS, was discovered in Wuhan , Hubei , China. This strain causes COVID-19 , which spread to other areas of Asia, and then worldwide in early 2020, marking the start of the COVID-19 pandemic . On 16 November 2002, an outbreak of severe acute respiratory syndrome (SARS) began in China's Guangdong province, bordering Hong Kong. The first case of infection

1088-641: A family wedding gathering; Liu was on the staff at Sun Yat-Sen Memorial Hospital in Guangzhou and had treated SARS patients. On 21 February, Liu and his wife checked into room 911 on the ninth floor of the Metropole Hotel. Despite feeling ill he visited with his family and they traveled around Hong Kong. By the morning of 22 February, he knew he was very sick and walked to the Accident and Emergency Department of Kwong Wah Hospital to seek treatment. He

1224-586: A heightened global health alert about a mysterious pneumonia with a case definition of SARS after cases in Singapore and Canada were also identified. The alert included a rare emergency travel advisory to international travelers, healthcare professionals, and health authorities. The Centers for Disease Control (CDC) issued a travel advisory stating that persons considering travel to the affected areas in Asia (Hong Kong, Singapore, Vietnam, and China) should not go. On 17 March, an international network of 11 laboratories

1360-460: A major contributor to the slow response to Ebola. They found three major obstacles that contributed to poor compliance: The IHR requires countries to assess their disease surveillance and response capacities and to identify if they can adequately meet their requirements. The seven Ebola reports universally agree that the country's self-assessment capabilities are insufficient and that verification measures need to be improved upon. A significant problem

1496-451: A medical conference. He fell ill during the flight and told a friend waiting at Bangkok not to touch him, to call an ambulance and take him to a hospital. He was isolated in an intensive care unit. A similar outbreak of a mysterious respiratory infection was reported among Hong Kong healthcare workers. On 12 March, WHO issued a global alert about a new infectious disease of unknown origin in both Vietnam and Hong Kong. On 15 March, WHO issued

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1632-494: A minimum is critical to avoid further harm to countries experiencing outbreaks. Moreover, if governments assume that reporting will lead to inappropriate travel and trade restrictions, they may be hesitant to notify the international community about the outbreak. Potential solutions raised included the WHO and the UN more assertively "naming and shaming" countries and private companies that impose unjustified restrictions on WHO working with

1768-568: A month over the previous year; MSF reported that acceptance of Ebola education remained low and that further violence against their workers might force them to leave. Resistance to interventions by health officials among the Guinean population remained greater than in Sierra Leone and Liberia, per media reports, raising concerns over its impact on ongoing efforts to halt the epidemic; in mid-March, there were 95 new cases, and on 28 March, and

1904-559: A problem for Africa and the world, for years to come". On 17 December President Koroma of Sierra Leone launched "Operation Western Area Surge" and workers went door-to-door in the capital city looking for possible cases. The operation led to 403 new reports of cases between 14 and 17 December. According to the 21 January 2015 WHO Situation Report, the case incidence was rapidly decreasing in Sierra Leone. However, in February and March reports indicated another rise in

2040-561: A report released in August 2014, researchers tracked the spread of Ebola in Sierra Leone from the group first infected—13 women who had attended the funeral of the traditional healer, where they contracted the disease. This provided "the first time that the real evolution of the Ebola virus [could] be observed in humans." The research showed that the outbreak in Sierra Leone was sparked by at least two distinct lineages introduced from Guinea at about

2176-594: A resident of Shanghai who had roomed across the hall from Liu at the Metropole. He was admitted to the French Hospital of Hanoi on 26 February, where he infected at least 38 members of the staff. Even though he was evacuated to Hong Kong, he died on 13 March. Carlo Urbani , a World Health Organization (WHO) infectious disease specialist, was among the staff who examined Chen. Urbani observed that other hospital staff were already falling ill and realized that he

2312-664: A result of the medical evacuations. The US accepted four evacuees and three were flown to Germany. France, Italy, the Netherlands, Norway, Switzerland, and the United Kingdom received two patients (and five who were exposed). In August 2014, the WHO reported an outbreak of the Ebola virus in the Boende District, part of the northern Équateur province of the Democratic Republic of

2448-503: A timely and accurate manner, signaling a major change in policy. SARS had also been gaining prominence in the mainland Chinese media; by late April, it had jumped from virtual invisibility onto the front page, with daily reports from all provinces on new cases and measures. On 20 April, Beijing's mayor Meng Xuenong and the health minister of the PRC Zhang Wenkang were replaced respectively by Wang Qishan from Hainan and

2584-548: A total of 86 suspected cases, including 59 deaths, had been reported as of 24 March. By late May, the outbreak had spread to Conakry , Guinea's capital—a city of about two million people. On 28 May, the total number of reported cases had reached 281, with 186 deaths. In Liberia, the disease was reported in four counties by mid-April 2014 and cases in Liberia's capital Monrovia were reported in mid-June. The outbreak then spread to Sierra Leone and progressed rapidly. By 17 July,

2720-465: A waiver of tourism- and transport-related license fees, and HK$ 1 billion allocated for tourism promotion overseas. The package also includes a salaries tax rebate and reduced rates. On 26 April, Wu Yi was named Zhang Wenkang's replacement as PRC health minister. On 26–27 April, Chinese authorities locked down Beijing, closing down theatres, discos, and other entertainment venues in Beijing as

2856-482: Is believed to have been a SARS super-spreader: 23 other Metropole guests developed SARS, including seven from the ninth floor. Liu's brother-in-law, who sought treatment in late February, was hospitalized in Kwong Wah Hospital on 1 March and died on 19 March. It is estimated that around 80% of the Hong Kong cases were due to Liu. The virus was carried to Hanoi , Vietnam , by Chinese-American Johnny Chen,

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2992-521: Is defined in the IHR (2005) as, "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response". This definition implies a situation that is: Since 2007, the WHO Director-General has declared public health emergencies of international concern in response to

3128-774: Is the World Bank's Pandemic Emergency Financing Facility. This was created to provide rapid financing for the control of outbreaks and to protect countries from the devastating economic effects of outbreaks via an insurance program. A Joint External Evaluation ( JEE ) is "a voluntary, collaborative, multisectoral process to assess country capacities to prevent, detect and rapidly respond to public health risks whether occurring naturally or due to deliberate or accidental events". The JEE helps countries to identify critical gaps within their biosecurity systems in order to improve them and help prevent, detect and quickly respond to public health risks (whether natural, accidental or deliberate) in

3264-496: Is the apparent ability of the virus to "hide" in a recovered survivor's body for an extended period and then become active months or years later, either in the same individual or in a sexual partner. In December 2016, the WHO announced that a two-year trial of the rVSV-ZEBOV vaccine appeared to offer protection from the variant of EBOV responsible for the Western Africa outbreak. The vaccine is considered to be effective and

3400-427: Is the inadequate level of core capacities in some countries, and the question of how to build upon them has been frequently raised. The reports make several recommendations to encourage governments to increase investment in outbreak identification and response programs. These include technical help from external sources conditional on mobilizing domestic resources, external financing for low income countries, pressure from

3536-442: Is the only prophylactic that offers protection; hence, 300,000 doses have been stockpiled. rVSV-ZEBOV received regulatory approval in 2019. The 2013–2016 outbreak, caused by Ebola virus (EBOV), was the first anywhere in the world to reach epidemic proportions. Extreme poverty , dysfunctional healthcare systems, distrust of government after years of armed conflict, and the delay in responding for several months, all contributed to

3672-771: Is the responsibility of the DGWHO. They are selected from the IHR Experts Committee, and "when appropriate, other expert advisory panels of the Organization." Furthermore, the DGWHO "shall establish the number of members to be invited to a meeting, determine its date and duration, and convene the Committee." "The DGWHO shall select the members of the Review Committee on the basis of the principles of equitable geographical representation, gender balance,

3808-497: The Amoy Gardens housing estate due to a massive (200+ cases) outbreak in the building. The balcony was completely closed and guarded by the police. The residents of the building were later transferred to the quarantined Lei Yue Mun Holiday Camp and Lady MacLehose Holiday Village on 1 April because the building was deemed a health hazard. Most of the cases were linked to apartments with a north-western orientation which shared

3944-503: The CDC indicated that their main concern was Sierra Leone, where the epidemic had shown no signs of abating as cases continued to rise exponentially; by the second week of December, Sierra Leone had reported nearly 400 cases—more than three times the number reported by Guinea and Liberia combined. According to the CDC, "the risk we face now [is] that Ebola will simmer along, become native and be

4080-543: The Forécariah Prefecture by the WHO. On 6 November, a media report indicated Tana village to be the last known place with Ebola in the country, and on 11 November, WHO indicated that no Ebola cases were reported in Guinea; this was the first time since the epidemic began that no cases had been reported in any country. On 17 November, the last Ebola patient in Guinea had recovered, and was discharged from

4216-594: The IHR Emergency Committee (EC), one of which should be an expert nominated by the State within whose region the event arises. Rather than being a standing committee, the EC is created ad hoc . Until 2011, the names of IHR EC members were not publicly disclosed; in the wake of reforms now they are. These members are selected according to the disease in question and the nature of the event. Names are taken from

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4352-675: The IHR Experts Roster . The Director-General takes the EC's advice following their technical assessment of the crisis using legal criteria and a predetermined algorithm after a review of all available data on the event. Upon declaration of the PHEIC, the EC then makes recommendations on what actions the Director-General and Member States should take to address the crisis. The recommendations are temporary and require three-monthly reviews. The formation of an IHR Review Committee

4488-667: The United States and Spain . Isolated cases were recorded in Senegal , the United Kingdom and Italy . The number of cases peaked in October 2014 and then began to decline gradually, following the commitment of substantial international resources. It caused significant mortality, with a considerable case fatality rate . By the end of the epidemic, 28,616 people had been infected; of these, 11,310 had died, for

4624-711: The West African Ebola epidemic brought renewed international scrutiny to the International Health Regulations. By 2015, 127 of the 196 countries were unable to meet the eight core public health capacities and report public health events as outlined. Numerous published reports by high-level panels have assessed the International Health Regulations for inadequacies and proposed actions that can be taken to improve future responses to outbreaks. One publication reviewed seven of these major reports and identified areas of consensus on action. The seven reports noted inadequate compliance with WHO's International Health Regulations as

4760-627: The World Health Organization issued a global health alert for SARS as it became clear the disease was being spread by global air travel . On 12 April, Marco Marra , director of the Michael Smith Genome Sciences Centre, which is part of the British Columbia Cancer Agency , announced that scientists at his centre had broken the genetic code of the virus suspected of causing the disease. In Toronto, three more people died of SARS, bringing

4896-465: The 42 days, Liberia was declared free from the virus on 14 January 2016, effectively ending the outbreak that had started in neighbouring Guinea two years earlier. Liberia began a 90-day period of heightened surveillance, scheduled to conclude on 13 April 2016, but on 1 April, it was reported that a new Ebola fatality had occurred, and on 3 April, a second case was reported in Monrovia . On 4 April, it

5032-631: The Canadian death toll to 13. On 16 April, the WHO issued a press release stating that the coronavirus identified by a number of laboratories was the official cause of SARS. The virus was officially named the SARS virus . On 17 April, the first confirmed case of SARS from India was reported. On 19 April, Premier of the People's Republic of China Wen Jiabao announced that there would be severe consequences for local officials who did not report SARS cases in

5168-563: The Congo (DRC), where 13 people were reported to have died of Ebola-like symptoms. Genetic sequencing revealed that this outbreak was caused by the Zaire Ebola species, which is native to the DRC; there have been seven previous Ebola outbreaks in the country since 1976. The virology results and epidemiological findings indicated no connection to the epidemic in Western Africa. The WHO declared

5304-621: The Dakar laboratory, and the positive result launched an investigation, triggering urgent contact tracing. On 10 September, it was reported that the initial case had recovered. No further cases were reported, and on 17 October 2014, the WHO officially declared that the outbreak in Senegal had ended. The first case in Nigeria was a Liberian-American, who flew from Liberia to Nigeria's most populated city of Lagos on 20 July 2014. On 6 August 2014,

5440-605: The Disaster Emergency Committee, food shortages resulting from aggressive quarantines were making the situation worse, and on 4 November media reported that thousands had violated quarantine in search of food in the town of Kenema . With the number of cases continuing to increase, an MSF coordinator described the situation in Sierra Leone as "catastrophic", saying, "there are several villages and communities that have been basically wiped out ... Whole communities have disappeared but many of them are not in

5576-606: The IHR (1969) in relation to provisions on cholera. 1981: in view of the global eradication of smallpox, the Thirty-fourth World Health Assembly amended the IHR (1969) to exclude smallpox in the list of notifiable diseases subject to the IHR (1969). 1995 : during the Forty-Eighth World Health Assembly, the WHO and Member States agreed on the need to revise the IHR (1969). Several challenges were placed against

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5712-576: The Italian island of Sardinia . He was treated at Spallanzani Hospital , the national reference centre for Ebola patients. On 10 June, it was reported that he had recovered and was released from the hospital. On 5 August 2014, the Brothers Hospitallers of Saint John of God confirmed that Brother Miguel Pajares, who had been volunteering in Liberia, had become infected. He was evacuated to Spain and died on 12 August. On 21 September it

5848-817: The Meeting of the States Parties to the Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and Their Destruction in Geneva , the sanitary epidemiological reconnaissance was suggested as a well-tested means for enhancing the monitoring of infections and parasitic agents . The aim of this recommendation was to prevent and minimize

5984-624: The Ministry of Health by establishing Ebola treatment centres in the epicentre of the outbreak. On 31 March, the U.S. Centers for Disease Control and Prevention (CDC) sent a team to assist in the response. Thinking that the spread of the virus had been contained, MSF closed its treatment centres in May, leaving only a skeleton staff to handle the Macenta region. However, in late August, according to media reports, large numbers of new cases reappeared in

6120-544: The Nigerian health minister told reporters that one of the nurses who attended to the Liberian had died from the disease. Five newly confirmed cases were being treated at an isolation ward. On 22 September 2014, the Nigerian health ministry announced, "As of today, there is no case of Ebola in Nigeria." According to the WHO, 20 cases and 8 deaths were confirmed, including the imported case, who also died. Four of

6256-522: The Pasteur Clinic nurse who had died from the Ebola virus. On 12 December, the last case in treatment recovered and was discharged, "so there are no more people sick with Ebola in Mali", according to a Ministry of Health source. On 18 January 2015 the country was declared Ebola-free. On 29 December 2014, Pauline Cafferkey , a British aid worker who had just returned to Glasgow from Sierra Leone,

6392-552: The Public Health Emergency of International Concern status of the outbreak. Subsequent flare-ups occurred; the epidemic was finally declared over on 9 June 2016, 42 days after the last case tested negative on 28 April 2016 in Monrovia . The outbreak left about 17,000 survivors of the disease, many of whom report post-recovery symptoms termed post-Ebola syndrome , often severe enough to require medical care for months or even years. An additional cause for concern

6528-587: The SARS travel warning for Toronto. The decision was made because "it is satisfied with local measures to stop the spread of SARS". Canadian officials said they would step up screenings at airports. On 3 May, the 2003 FIFA Women's World Cup was abruptly moved to the United States due to the outbreak. China maintained its automatic qualification and later hosted the Women's World Cup four years later . On 4 May,

6664-691: The Singapore government announced that school closures would be extended. Junior colleges were to reopen on 9 April, secondary schools would reopen on 14 April and primary schools and pre-schools would reopen on 16 April. On 6 April, a SARS case was found in Manila , a person who had returned from Hong Kong. On 8 April, SARS was discovered in the Lower Ngau Tau Kok Estate near Amoy Gardens in Kowloon. Hong Kong health officials warned that SARS had spread so far domestically and abroad that it

6800-664: The Taipei City Government. The Control Yuan also launched an investigation into the hospital's closure. Taipei City Bureau of Health director Chiu Shu-ti resigned from Ma Ying-jeou 's mayoral administration on 25 May. On 27 May, the Taichung City Government , led by mayor Jason Hu , established a command center in central Taiwan to handle SARS. The Department of Health worked with several hospitals in Taiwan to expand medical facilities and treatment for SARS patients. On 31 May, Singapore

6936-404: The United Kingdom and the United States) also reported cases imported from Western Africa, with widespread and intense transmission. On 28 January 2015, the WHO reported that for the first time since the week ending 29 June 2014, there had been fewer than 100 new confirmed cases reported in a week in the three most-affected countries. The response to the epidemic then moved to a second phase, as

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7072-450: The United States after treating Ebola patients in Western Africa, tested positive for the virus. Spencer recovered and was released from hospital on 11 November. Many people who had become infected with Ebola were medically evacuated for treatment in isolation wards in Europe or the US. They were mostly health workers with one of the NGOs in Western Africa. Except for a single isolated case in Spain , no secondary infections occurred as

7208-463: The WHO reaffirmed that the cases in Liberia were the result of re-emergence of the virus in a previously infected person, and there was speculation that the boy may have been infected by an individual who became infectious once more due to pregnancy, which may have weakened her immune system. On 18 December, the WHO indicated that it still considered Ebola in Western Africa a public health emergency, though progress had been made. After having completed

7344-432: The WHO reported that "all known chains of transmission have been stopped in Western Africa", but cautioned that further small outbreaks of the disease could occur. The following day, Sierra Leone confirmed its first new case since September 2015. On 25 March 2014, the WHO reported an outbreak of Ebola virus disease in four southeastern districts of Guinea with a total of 86 suspected cases, including 59 deaths. MSF assisted

7480-444: The WHO reported that "weekly case incidence has stalled at between 20 and 27 cases since the end of May, whilst cases continue to arise from unknown sources of infection, and to be detected only after post-mortem testing of community deaths". On 29 July, a sharp decline in cases was reported; the number of cases eventually plateaued at one or two cases per week in early August. On 28 October, an additional three cases were reported in

7616-605: The World Trade Organization, International Civil Aviation Organization, and International Maritime Organization to develop standards and enforcement mechanisms for trade and travel restrictions. The third compliance issue relates to countries' obligation to rapidly report outbreaks. The reports recommend strengthening this obligation by WHO publicizing when countries delay reporting suspected outbreaks. In contrast, mechanisms ensuring that countries rapidly receive operational and financial support as soon as they do report were also recommended. A novel approach to encourage early notification

7752-402: The authors argued that "the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, [clarified] that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response." A Public Health Emergency of International Concern, or PHEIC ,

7888-467: The backdrop of the increased travel and trade characteristic of the 20th century. The revision of IHR (1969) came about because of its inherent limitations, most notably: In 2005, a values statement document entitled "The Principles Embodying the IHR" was published and said inter alia : On 15 June 2007, the IHR (2005) entered into force, and were binding as of June 2020 on 196 States Parties, including all 194 Member States (countries) of WHO. In 2010, at

8024-405: The child had not recently travelled or been exposed to someone with Ebola and the WHO stated that "we believe that this is probably again, somehow, someone who has come in contact with a virus that had been persisting in an individual, who had suffered the disease months ago." The infected boy died on 24 November, and on 3 December two remaining cases were released after recovering. On 16 December,

8160-412: The consequences of natural outbreaks of dangerous infectious diseases, as well as the threat of alleged use of biological weapons against BTWC States Parties. The conference also noted the significance of the sanitary epidemiological reconnaissance in assessing the sanitary-epidemiological situation, organizing and conducting preventive activities, indicating and identifying pathogenic biological agents in

8296-521: The country were placed under quarantine. With only 50 physicians in the entire country—one for every 70,000 citizens—Liberia was already in a healthcare crisis. In September, the CDC reported that some hospitals had been abandoned, while those still functioning lacked basic facilities and supplies. In October, the Liberian ambassador in Washington was reported as saying that he feared that his country may be "close to collapse"; by 24 October, all 15 counties had reported cases. By November 2014,

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8432-430: The dead were health workers who had cared for the index case. The WHO's representative in Nigeria officially declared the country Ebola-free on 20 October 2014, stating it was a "spectacular success story". Nigeria was the first African country to be declared Ebola-free. This was largely due to the early quarantine efforts of Dr. Ameyo Stella Adadevoh. On 23 October 2014, the first case of Ebola virus disease in Mali

8568-402: The death of a 16-year-old in a village in the Bombali District . It is suspected that she contracted the disease from the semen of an Ebola survivor who had been discharged in March 2015. On 7 November 2015 the country was declared Ebola-free. Sierra Leone had entered a 90-day period of enhanced surveillance that was scheduled to end on 5 February 2016, when, on 14 January, a new Ebola death

8704-622: The death toll in Beijing continued to rise, threatening to become the worst-hit area of the country, eclipsing the province of Guangdong . People who may have been exposed were ordered to stay home. Authorities were bolstered by the fact that the infection rate seemed to have declined, with Guangdong only exporting three new infections over the weekend. The economic impact was becoming dramatic as shops, restaurants, markets, bars, universities, schools, and many other businesses had closed, while some government ministries and large state banks were working with minimal staff levels. On 28 April, WHO declared

8840-565: The disease is believed to have originated. Also, a WHO team that travelled to Beijing was not allowed to visit Guangdong province for several weeks. This resulted in international criticism, which seems to have led to a change in government policy in early April. A fishmonger , named Zhou Zuofen, checked in to the Sun Yat-sen Memorial Hospital in Guangzhou on 31 January, where he infected 30 nurses and doctors. The virus soon spread to nearby hospitals. In February 2003, Liu Jianlun became Hong Kong's SARS index patient . He had come to attend

8976-469: The disease to other villages. These early cases were diagnosed as other conditions more common to the area and the disease had several months to spread before it became recognised as Ebola. On 25 March 2014, the WHO indicated that Guinea's Ministry of Health had reported an outbreak of Ebola virus disease in four southeastern districts and that suspected cases in the neighbouring countries of Liberia and Sierra Leone were being investigated. In Guinea,

9112-428: The disease was identified in a Yilan hospital on 15 March. Like the first case, the third case appeared in someone who had traveled to Guangdong and transited through Hong Kong before arriving in Taiwan. Shortly after the third case was diagnosed, officials from the Centers for Disease Control and Prevention in the United States traveled to Taiwan to study the disease. The fourth case, in another traveler to Guangdong,

9248-453: The drainage system which a maritime breeze blew into the estate's balconies and stairwell ventilation. It was confirmed that the virus spread via droplets, but this later outbreak made officials question the possibility that the virus could be spread through the air. On 1 April, the U.S. government called back non-essential personnel in their consulate office in Hong Kong and Guangzhou. The US government also advised US citizens not to travel to

9384-470: The environmental sites, conducting laboratory analysis of biological materials, suppressing hotbeds of infectious diseases, and providing advisory and practical assistance to local health authorities. In January 2018, a group of WHO bureaucrats published an article in the British Medical Journal on Global Health entitled "Strengthening global health security by embedding the International Health Regulations requirements into national health systems", in which

9520-411: The epidemic could be declared over. On 31 March 2015, one year after the first report of the outbreak, the total number of cases was over 25,000—with over 10,000 deaths. As the main epidemic was coming to an end in December 2015, the UN announced that 22,000 children had lost one or both parents to Ebola. On 14 January 2016, after all the previously infected countries had been declared Ebola-free,

9656-539: The extensive support of global partners, and the tireless and heroic work of local and international health teams." After three months with no new reports of cases, on 29 June Liberia reported that the body of a 17-year-old boy, who had been treated for malaria, tested positive for Ebola. The WHO said the boy had been in close contact with at least 200 people, who they were following up, and that "the case reportedly had no recent history of travel, contact with visitors from affected areas, or funeral attendance." A second case

9792-574: The failure to control the epidemic. Other factors, per media reports, included local burial customs of washing the body and the unprecedented spread of Ebola to densely populated cities. It is generally believed that a one or two-year-old boy, later identified as Emile Ouamouno , who died in December 2013 in the village of Méliandou in Guinea, was the index case . His mother, sister, and grandmother later became ill with similar symptoms and also died; people infected by these initial cases spread

9928-454: The father's funeral. All contacts were followed for 21 days, with no further spread of the disease reported. On 12 November 2014, Mali reported deaths from Ebola in an outbreak unconnected with the first case in Kayes. The first probable case was an imam who had fallen ill on 17 October in Guinea and was transferred to the Pasteur Clinic in Mali's capital city, Bamako , for treatment. He

10064-478: The first confirmed case of Ebola transmission outside of Africa. On 19 October, it was reported that Romero had recovered, and on 2 December the WHO declared Spain Ebola-free. On 30 September 2014, the CDC declared its first case of Ebola virus disease. Thomas Eric Duncan became infected in Liberia and travelled to Dallas , Texas, on 20 September. On 26 September, he fell ill and sought medical treatment, but

10200-583: The first of these series of early international sanitary conferences was convened in Paris in 1851. This was in the same year that telegraphic communications became established between London and Paris. 12 nations attended this conference, of which 11 were European states and three would sign the resulting convention. In the 19th century. there were 10 of these conferences. 1948: the World Health Organization Constitution

10336-581: The first time since the outbreak in the territory in March. On 24 May, a new cluster of about 20 suspected patients was reported in Toronto. By 29 May, more than 7,000 people were instructed to quarantine themselves in Canada by authorities seeking to control the potential spread of the SARS outbreak. In Taiwan, administrators and staff of Taipei Municipal Hospital's Hoping branch faced disciplinary action from

10472-470: The focus shifted from slowing transmission to ending the epidemic. On 8 April 2015, the WHO reported a total of only 30 confirmed cases, and the weekly update for 29 July reported only seven new cases. Cases continued to gradually dwindle and on 7 October 2015, all three of the most seriously affected countries, per media reports, recorded their first joint week without any new cases. However, sporadic new cases were still being recorded, frustrating hopes that

10608-584: The following: The IHR Experts Roster, which is regulated by Article 47 of the IHR, is tended by DGWHO , who "shall establish a roster composed of experts in all relevant fields of expertise... In addition, [s/he] shall appoint one member at the request of each State Party." In order to declare a PHEIC, the WHO Director-General is required to take into account factors which include the risk to human health and international spread as well as advice from an internationally made up committee of experts,

10744-1039: The former deputy health minister Gao Qiang . They were the first two high-rank officials in the PRC to be dismissed because of the fallout of the epidemic. In the news conference chaired by Gao Qiang several hours earlier, the PRC admitted that in Beijing there were more than 300 cases, as opposed to the previous figure of only 37. The figure had increased to 407 the following day. Chinese officials also admitted to major underreporting of cases, which were attributed to bureaucratic ineptitude. On 22 April, schools in Hong Kong started to reopen in stages. On 23 April, Beijing announced that all primary and secondary schools would be closed for two weeks. A few days before, some colleges in Peking University had been closed because some students had been infected. The WHO issued travel advisories against Beijing, Toronto, and Shanxi . After several cases of SARS were diagnosed in Taiwan throughout

10880-407: The funeral but died from the disease. On 29 April, WHO reported that Liberia had discharged the last patient. According to the WHO, tests indicated that the flare-up was likely due to contact with a prior Ebola survivor's infected body fluids. On 9 June, the flare-up was declared over, and the country Ebola-free. In March 2014, Senegal closed its southern border with Guinea, but on 29 August,

11016-560: The future. Developed as a result of the IHR Review Committee on Second Extensions for Establishing National Public Health Capacities and on IHR Implementation, WHO, in collaboration with partners and initiatives, developed the JEE process and published the first edition of the tool in 2016. A second edition was published in 2018. A JEE of Australia's capacity following the 2013–2016 Western African Ebola virus epidemic showed that

11152-498: The government later announced that 100 people had been quarantined. Investigations indicated that the deceased was a student from Lunsar who had gone to Kambia District on 28 December 2015 before returning symptomatic. She had also visited Bombali District to consult a herbalist and had later gone to a government hospital in Magburaka . The WHO indicated that there were 109 contacts and another three missing contacts, and that

11288-573: The government. On 30 April, the US shut down a special Ebola treatment unit in Liberia. The last known case of Ebola died on 27 March, and the country was officially declared Ebola-free on 9 May 2015. The WHO congratulated Liberia saying, "reaching this milestone is a testament to the strong leadership and coordination of Liberian President Ellen Johnson Sirleaf and the Liberian Government, the determination and vigilance of Liberian communities,

11424-399: The health minister announced the country's first case, who was being treated in a Dakar hospital. The patient was a native of Guinea who had travelled to Dakar, arriving on 20 August. On 28 August 2014, authorities in Guinea issued an alert that a person who had been in close contact with an Ebola-infected patient had escaped their surveillance system. The alert prompted testing for Ebola at

11560-447: The home where the cases took place. On 22 March, the media reported that medical authorities in Guinea had quarantined 816 suspected contacts of the prior cases; the same day, Liberia ordered its border with Guinea closed. On 29 March, it was reported that about 1,000 contacts had been identified, and on 30 March three more confirmed cases were reported. On 1 April, it was reported by the media, that possible contacts, which numbered in

11696-534: The hospital on 28 November. On 29 December 2015, the WHO declared Guinea Ebola-free. On 17 March 2016, the government of Guinea reported that two people had again tested positive for Ebola virus in Korokpara . On 19 March, it was also reported by the media that another individual had died due to the virus at the treatment centre in Nzerekore , consequently, the country's government quarantined an area around

11832-422: The hundreds, had been given an experimental vaccine using a ring vaccination approach. On 5 April 2016, it was reported via the media, that there had been nine new cases of Ebola since the virus resurfaced, out of which eight were fatal; on 1 June, after the stipulated waiting period, the WHO again declared Guinea Ebola-free. In September 2016, findings were published suggesting that the resurgence in Guinea

11968-609: The international community to increase investment, and considering outbreak preparedness as a factor in the International Monetary Fund's country economic assessments, which influence governments' budget priorities and access to capital markets. Another avenue under discussion is reform of Article 44 of the IHR, potentially through a new pandemic convention. The second issue frequently raised is ensuring that restrictions on trade and travel during outbreaks are justified. Because of increased attention and concern from

12104-433: The last Ebola patient was also released. On 4 February 2016 the last known case tested negative for a second consecutive time and Sierra Leone commenced another 42-day countdown towards being declared Ebola-free. On 17 March 2016 the WHO announced that the Sierra Leone flare-up was over and that no other chains of transmission were known to be active at that time. By 15 July the country had discontinued testing corpses for

12240-625: The month of April, including a cluster at Taipei Municipal Hospital's Hoping branch, the Taipei City Government closed that hospital and quarantined its 930 staff and 240 patients for two weeks. The decision to lock down the medical facility was protested by hospital staff. On 24 April, the Hong Kong Government announced an HK$ 11.8 billion relief package designed to assist Hong Kong's battered tourism, entertainment, retail, and catering sectors, consisting of

12376-479: The nation had very high level of capacity of response. Australia's National Action Plan for Health Security 2019-2023 was developed to help to implement the recommendations from the JEE. 2002%E2%80%932004 SARS outbreak The 2002–2004 outbreak of SARS , caused by severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-1), infected over 8,000 people from 30 countries and territories, and resulted in at least 774 deaths worldwide. The outbreak

12512-613: The newly infected number of people in Hong Kong dropped to single digits. On 19 May, the WHO Annual Meeting was held in Geneva. Hong Kong pushed for the Tourism Warning to be lifted. On 20 May, the WHO refused to lift the Tourism Warning for Hong Kong and Guangdong, but did so three days later after a recount of the number of SARS patients. On 24 May, the number of newly infected patients reached zero for in Hong Kong,

12648-407: The next two to three weeks, but warned the disease could emerge in China next winter. On 2 July, Canada was removed from the WHO's list of 'Infected Areas'. On 5 July, WHO declared the SARS outbreak contained and removed Taiwan from the list of affected areas. Taiwan's removal from the list signified the end of the outbreak. On 8 September, Singapore announced that a post-doctoral worker in

12784-540: The number of cases. The WHO weekly update for 29 July reported a total of only three new cases, the lowest in more than a year. On 17 August the country marked its first week with no new cases, and one week later the last patients were released. However, a new case emerged on 1 September, when a patient from Kambia District tested positive for the disease after her death; her case eventually resulted in three other infections among her contacts. On 14 September 2015 Sierra Leone's National Ebola Response Centre confirmed

12920-618: The outbreak in Guangdong had peaked in mid-February 2003. However, this appears to have been false because subsequently 806 cases of infection and 34 deaths were reported. Italian physician Carlo Urbani was the first to identify SARS as probably a new and dangerously contagious viral disease. Early in the epidemic, the Chinese government discouraged its press from reporting on SARS, delayed reporting to WHO, and initially did not provide information to Chinese outside Guangdong province, where

13056-650: The outbreak in Vietnam to be over as no new cases were reported for 20 days. On 29 April, leaders of member countries of ASEAN and the PRC premier held an emergency summit in Bangkok , Thailand to address the outbreak. Among the decisions made were the setting-up of a ministerial-level task force and uniform pre-departure health screening in airports. On 30 April, the World Health Organization lifted

13192-474: The outbreak over on 21 November 2014, after a total of 66 cases and 49 deaths. Of the four disease-causing viruses in the genus Ebolavirus , Ebola virus (or the Zaire Ebola virus) is dangerous and is the virus responsible for the epidemic in Western Africa. Since the discovery of the viruses in 1976, Ebola virus disease has been confined to areas in Middle Africa, where it is native. The epidemic

13328-426: The public and the media, many governments and private companies restricted trade and travel during the Ebola outbreak, though many of these measures were not necessary from a public health standpoint. These restrictions worsened financial repercussions and made the work of aid organizations sending support to affected regions more difficult. There was broad consensus across the reports that bringing such restrictions to

13464-432: The public early enough about the outbreak. The PRC Health Minister also claimed that the disease has been under control in most parts of mainland China. He also released the names of seven drugs which he claimed to be effective in curing SARS. WHO officials said that the information provided by the PRC about the disease has been "very detailed". US government enforced compulsory quarantine of an infected person. On 5 April,

13600-461: The rate of new infections in Liberia appeared to be declining and the state of emergency was lifted. The drop in cases was believed to be related to an integrated strategy combining isolation and treatment with community behaviour change, including safe burial practices, case finding and contact tracing . Roselyn Nugba-Ballah , leader of the Safe & Dignified Burial Practices Team during the crisis,

13736-431: The region. In February 2015, Guinea recorded a rise in cases; health authorities stated that this was related to the fact that they "were only now gaining access to faraway villages", where violence had previously prevented them from entering. On 14 February, violence erupted and an Ebola treatment centre near the centre of the country was destroyed. Guinean Red Cross teams said they had suffered an average of 10 attacks

13872-424: The region. On 2 April, Chinese medical officials began reporting the status of the SARS outbreak. China's southern Guangdong province reported 361 new infections and 9 new deaths, increasing the total Mainland China figures previously reported at end-February. The virus was also detected in Beijing and Shanghai. The WHO also advised travellers to avoid Hong Kong and Guangdong during a press briefing. On 3 April,

14008-461: The same area. On 14 July, a woman died of the disease in the county of Montserrado , bringing the total to 6. On 20 July, the last patients were discharged, and on 3 September 2015, Liberia was declared Ebola-free again. After two months of being Ebola-free, a new case was confirmed on 20 November 2015, when a 15-year-old boy was diagnosed with the virus and two family members subsequently tested positive. Health officials were concerned because

14144-448: The same sewage pipe. According to government officials, the virus was brought into the estate by an infected kidney patient (the type of kidney illness was not specified) after discharge from Prince of Wales Hospital , who visited his elder brother living on the seventh floor. Through excretion, the virus spread through drainage. One theory speculated that the virus was spread by airborne transmission , through dried up U-shaped P-traps in

14280-554: The same time. It is not clear whether the traditional healer was infected with both variants or if perhaps one of the women attending the funeral was independently infected. As the Sierra Leone epidemic progressed, one virus lineage disappeared from patient samples, while a third one appeared. In January 2015, the media stated researchers in Guinea had reported mutations in the virus samples that they were looking at. According to them, "We've now seen several cases that don't have any symptoms at all, asymptomatic cases. These people may be

14416-550: The source or route of transmission that caused the fatality was unknown. A second new case—a relative and caregiver of the aforementioned victim—had become symptomatic on 20 January while under observation at a quarantine centre. On 26 January WHO Director-General, Dr Margaret Chan officially confirmed that the outbreak was not yet over; that same day, it was also reported that Ebola restrictions had halted market activity in Kambia District amid protests. On 8 February

14552-404: The statistics." In mid-November, the WHO reported that, while there was some evidence that the number of cases was no longer rising in Guinea and Liberia, steep increases persisted in Sierra Leone. On 9 December 2014 news reports described the discovery of "a grim scene"—piles of bodies, overwhelmed medical personnel and exhausted burial teams—in the remote eastern Kono District . On 15 December

14688-574: The total number of suspected cases in the country stood at 442, surpassing those in Guinea and Liberia. By 20 July, additional cases of the disease had been reported by the media in the Bo District , while the first case in Freetown , Sierra Leone's capital, was reported in late July. As the epidemic progressed, a small outbreak occurred in Nigeria that resulted in 20 cases and another in Mali with seven cases. Four other countries (Senegal, Spain,

14824-501: The virus persisting in her brain. On 12 November, she was released from hospital after making a full recovery. However, on 23 February, Cafferkey was admitted for a third time, "under routine monitoring by the Infectious Diseases Unit ;... for further investigations". On 12 May 2015, it was reported that a nurse, who had been working in Sierra Leone, had been diagnosed with Ebola after returning home to

14960-405: The virus. In Liberia, the disease was reported in both Lofa and Nimba counties in late March 2014. On 27 July, President Ellen Johnson Sirleaf announced that Liberia would close its borders, with the exception of a few crossing points such as Roberts International Airport , where screening centres would be established. Schools and universities were closed, and the worst-affected areas in

15096-543: The wife was also among the quarantined medical workers under intensive care. Hong Kong school closures were extended by two weeks to 21 April. On 4 April, the WHO team inspected the first infection case in Foshan County. The person infected four people but did not infect his family. A 40-year-old woman became the first local case in Shanghai. A Chinese health specialist admitted at a press conference to not informing

15232-533: Was admitted to Tan Tock Seng Hospital after visiting Hong Kong, starting the outbreak in Singapore. Although she recovered, various family members did not. The first cases of atypical pneumonia in Taiwan were identified in a Guangdong-based businessman and his wife on 14 March and confirmed on 17 March. He had returned to Taiwan via Hong Kong on 23 February and reported a fever two days later. His wife became ill after caring for him, and both were admitted to National Taiwan University Hospital . Taiwan's third case of

15368-546: Was announced that Brother Manuel García Viejo, another Spanish citizen who was medical director at the St John of God Hospital Sierra Leone in Lunsar , had been evacuated to Spain from Sierra Leone after being infected with the virus. His death was announced on 25 September. In October 2014, a nursing assistant, Teresa Romero, who had cared for these patients became unwell and on 6 October tested positive for Ebola, making this

15504-547: Was awarded the Florence Nightingale Medal in 2017 for her work during the crisis. In January 2015, the MSF field coordinator reported that Liberia was down to only five confirmed cases. In March, after two weeks of not reporting any new cases, three new cases were confirmed. On 8 April, a new health minister was named to end Ebola in the country and on 26 April, MSF handed the Ebola treatment facility over to

15640-457: Was caused by an Ebola survivor who, after eight months of abstinence, had sexual relations with several partners, including the first victim in the new outbreak. The disease was also spread to Liberia. The first person reported infected in Sierra Leone, according to media reports, was a tribal healer who had been treating Ebola patients from across the nearby border with Guinea and who died on 26 May 2014; according to tribal tradition, her body

15776-410: Was confirmed in the city of Kayes —a two-year-old girl who had arrived from Guinea and died the next day. Her father had worked for the Red Cross in Guinea and also in a private health clinic; he had died earlier in the month, likely from an Ebola infection contracted in the private clinic. It was later established that several family members had also died of Ebola. The family had returned to Mali after

15912-436: Was confirmed on 1 July. After a third new case was confirmed on 2 July, and it was discovered that all three new cases had shared a meal of dog meat , researchers looked at the possibility that the meat may have been involved in the transfer of the virus. Testing of the dog's remains, however, was negative for the Ebola virus. By 9 July three more cases were discovered, bringing the total number of new cases to five, all from

16048-460: Was dealing with a new and dangerous disease. He himself became infected and died on 29 March. On 23 February, an elderly woman named Kwan Sui-Chu who had also been a Metropole Hotel guest, returned to Toronto , Canada, from Hong Kong. She died at home on 5 March, after infecting her son Tse Chi Kwai, who subsequently spread the disease to Scarborough Grace Hospital and died on 13 March. On 1 March, 26-year-old Esther Mok, another Metropole guest,

16184-420: Was diagnosed with Ebola. She was treated and released from hospital on 24 January 2015. On 8 October, she was readmitted for complications caused by the virus. On 14 October, her condition was listed as "critical" and 58 individuals were being monitored and 25 received an experimental vaccination, being close contacts. On 21 October, it was reported that she had been diagnosed with meningitis caused by

16320-859: Was established to determine the cause of SARS and develop potential treatments. On 25 March, Hong Kong authorities stated that nine tourists had contracted the disease from a mainland Chinese man who had boarded the same plane on 15 March, Air China Flight 112 to Beijing. On 27 March, Arthur K. C. Li , head of the Hong Kong Education and Manpower Bureau , announced cancellation of all classes in educational institutions. The Ministry of Education in Singapore announced that all primary schools, secondary schools, and junior colleges were to be shut until 6 April 2003. Polytechnics and universities were not affected. On 29 March, Urbani died in Bangkok. On 30 March, Hong Kong authorities quarantined estate E of

16456-666: Was first identified in Foshan , Guangdong , China , in November 2002. The World Health Organization (WHO) was notified of the outbreak in February 2003, and issued a global alert in March 2003. Initially, the cause of the outbreak was unknown, and some media outlets reported that an influenza virus was a potential culprit. The major part of the outbreak lasted about 8 months, and the World Health Organization declared SARS contained on 5 July 2003. However, several SARS cases were reported until May 2004. In late December 2019, SARS-CoV-2 ,

16592-643: Was founded. 1951: the WHO issued its first infectious disease prevention regulations, the International Sanitary Regulations (ISR 1951), which focussed on six quarantinable diseases; cholera , plague , relapsing fever , smallpox , typhoid and yellow fever . 1969: the ISR were revised and renamed the 'International Health Regulations'. 1973: the Twenty-Sixth World Health Assembly amended

16728-409: Was here to stay. Nevertheless, WHO officials remained cautiously optimistic that the disease could still be contained. On 9 April, James Earl Salisbury died of SARS at a hospital in Hong Kong. An American Mormon and a teacher at Shenzhen Polytechnic , he had been sick for approximately one month before his death, but he was originally diagnosed with pneumonia . His son Michael "Mickey" Salisbury

16864-580: Was identified in Chiayi on 18 March, after he sought treatment at a hospital the previous day. By 22 March, six cases in Taiwan had matched the World Health Organization definition of probable. On 4 March, a 27-year-old man, who had visited a guest on the Metropole's 9th floor 11 days earlier, was admitted to Hong Kong's Prince of Wales Hospital . At least 99 hospital workers (including 17 medical students) were infected while treating him. On 11 March, Carlo Urbani travelled to Bangkok , Thailand , to attend

17000-493: Was in response to the swine flu pandemic of 2009 . The original International Health Regulations (IHR) were adopted in 1969. However, its underpinnings can be traced to the mid-19th century, when measures to tackle the spread of plague, yellow fever, smallpox and particularly cholera across borders, with as little interference to global trade and commerce, were debated. To address the realisation that countries varied with regards to their sanitary regulations and quarantine measures,

17136-405: Was initially thought to be caused by a new species native to Guinea, rather than being imported from Middle to Western Africa. However, further studies have shown that the outbreak was likely caused by an Ebola virus lineage that spread from Middle Africa via an animal host within the last decade, with the first viral transfer to humans in Guinea. and with 341 genetic changes in the virion . In

17272-500: Was removed from WHO's list of 'Infected Areas'. On 10 June, the government of Ontario created the SARS Commission inquiry in order to "investigate the recent introduction and spread of SARS" in the province. On 23 June, Hong Kong was removed from WHO's list of 'Affected Areas', while Toronto, Beijing, and Taiwan remained. On 27 June, the World Health Organization stated that the world population should be SARS-free within

17408-486: Was reported in the Tonkolili District . Before this case, the WHO had advised that "we still anticipate more flare-ups and must be prepared for them. A massive effort is underway to ensure robust prevention, surveillance, and response capacity across all three countries by the end of March." On 16 January aid workers reported that a woman had died of the virus and that she may have exposed several individuals;

17544-421: Was reported that 84 individuals were under observation due to contact with the two confirmed Ebola cases. By 7 April, Liberia had confirmed three new cases since the virus resurfaced, and a total of 97 contacts, including 15 healthcare workers, were being monitored. The index case of the new flareup was reported to be the wife of a patient who died from Ebola in Guinea; she had travelled to Monrovia after

17680-446: Was sent home with antibiotics. He returned to the hospital by ambulance on 28 September and was placed in isolation and tested for Ebola. He died on 8 October. Two cases stemmed from Duncan, when two nurses that had treated him tested positive for the virus; they were declared Ebola-free on 24 and 22 October, respectively. A fourth case was identified on 23 October 2014, when Craig Spencer , an American physician who had returned to

17816-522: Was the most widespread outbreak of the disease in history . It caused major loss of life and socioeconomic disruption in the region, mainly in Guinea , Liberia and Sierra Leone . The first cases were recorded in Guinea in December 2013; the disease spread to neighbouring Liberia and Sierra Leone, with minor outbreaks occurring in Nigeria and Mali . Secondary infections of medical workers occurred in

17952-445: Was traced to Foshan . This first outbreak affected people in the food industry, such as farmers, market vendors, and chefs. The outbreak spread to healthcare workers after people sought medical treatment for the disease. The People's Republic of China notified the World Health Organization (WHO) about this outbreak on 11 February 2003, reporting 305 cases including 105 health-care workers and five deaths. Later it reported that

18088-555: Was treated by the triage nurse and doctor without protective measures even though a memorandum on surveillance of severe community-acquired pneumonia had been issued by the Hospital Authority of Hong Kong . After Liu's chest X-ray taken in Kwong Wah Hospital became available, staff became aware of the situation, wearing personal protective equipment and full isolation inside the ICU . He had not recovered and died on 4 March. Liu

18224-399: Was treated for kidney failure but was not tested for Ebola; he died on 27 October and his body returned to Guinea for burial. A nurse and a doctor who had treated the imam subsequently fell ill with Ebola and died. The next three cases were a man who had visited the imam while he was in hospital, his wife and his son. On 22 November, the final case related to the imam was reported—a friend of

18360-506: Was washed for burial, and this appears to have led to infections in women from neighbouring towns. On 11 June Sierra Leone shut its borders for trade with Guinea and Liberia and closed some schools in an attempt to slow the spread of the virus; on 30 July the government began to deploy troops to enforce quarantines. During the first week of November, reports told of a worsening situation due to intense transmission in Freetown. According to

18496-612: Was with him in China and also contracted the disease, but he survived it. Salisbury's death led to more open admissions by the Chinese government about the spread of SARS. On 10 April, Jim Hughes, the head of infectious disease at the CDC , confirming the warnings of Hong Kong health officials, claimed that he believed that SARS could no longer be eradicated in the Far East. However, he remained hopeful that it could be prevented from spreading widely in North America. On 11 April,

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