What if...SARS had hit the West hard in 2002-3?:

The West is forced to take pandemics seriously from a preparedness perspective, as the East has done, and as a result Covid-19, aka SARS-CoV-2, proves far less deadly.

SARS-1, the epidemic / proto-pandemic that hit mainly the Far East, in 2002-3, was a massive shot across the world’s bows: a disease with high mortality (approximately 10%), that could have been much worse. But most of the world mostly didn’t hear the shot fired. While I, as a congenitally precautious person, was buying some good surgical masks, most people in the West (outside perhaps Canada, which suffered a small incidence from SARS) barely noticed it. This is because for complex reasons, including impressive containment strategies that were speedily developed in some of the Far Eastern countries most affected, SARS did not in the end run riot in the West.

Now, what if it had? How might history have been different?

It is fascinating to note that the countries most affected by SARS have suffered much lower mortality from Covid-19 than Western countries have. This is clearly partly because they had the ‘benefit’ of that warning shot. For example, Taiwan, one of the stand-out cases of learning from SARS, established the Taiwan Centre of Disease Control in its wake. (Taiwan, like New Zealand, is an especially interesting case for Brits to contemplate: an island that took advantage of being an island to do a strong job at preventing Covid as much as possible from entering into its territory in the first place, in stark contrast to the UK in early 2020.)

Habits of mask-wearing when ill or potentially-ill or potentially at risk of catching a disease were firmly ensconced in much of the East by SARS. All this helped prepare the ground for the astonishingly effective responses of South Korea, Taiwan etc to Covid-19.

Of course, it may well be that other factors were at play here too: crucially, cultural factors. My philosophical-cultural judgement is that fundamentally communitarian (vaguely ‘Confucian’) attitudes in the East contrast very favourably, where anti-disease precaution is concerned, with fundamentally ‘individualist’ (vaguely ‘liberal/libertarian’) attitudes in the West, which again and again in a multitude of ways have undermined having a truly effective Covid-response here.

But experiencing the warning shot of SARS more viscerally here could have altered even that aspect of the situation to some degree too.

So, this counter-factual history imagines a world in which SARS came to the West, and had a lasting effect on attitudes and policies. If we had suffered thousands of deaths from SARS, might some, most, possibly even nearly all, of the 15 million who have died from Covid have been saved? My view is that the answer is almost certainly: Yes.

Read on for how we might have had a much happier Covid-19 pandemic (or maybe not even a pandemic, merely a mostly contained epidemic), had history early in this millennium gone differently. What follows is a kind of best-case scenario alternative-history; even if something somewhat less optimal occurred, it could still have been so much better than the plague and fifteen-million excess-mortality we actually experienced…

By the time SARS hit Britain, a justified panic about this new killer disease had become a worldwide phenomenon. By autumn 2003, when the disease peaked, after two thousand deaths in Britain, the UK population was well-used to the regimen: of mask-wearing, working from home where possible, focussed, co-ordinated partial and complete local and regional lockdowns, rapid installation in key locales of safer ventilation-systems, and much more outdoor-living.

            In the wake of the worldwide SARS pandemic, there were of course…post-mortems, which lead to the unprecedented ‘Pandemics-Prevention Summit’ that was appended to climate CoP9 in Milan. The outcomes of this PPS included better funding for WHO and detailed contingency-planning for international co-ordination in the event of further such pandemics.

            It was this system that swung into action in January 2020, when Covid-19 burst onto the international scene. There was widespread and instant appetite at all levels of society for a precautionary response, to prevent a repeat or much worse of SARS. Not only did countries such as the UK and USA instantly initiate a souped-up version of the preparedness techniques that had been trialled under such desperate circumstances back in 2003, but a set of external (and in some cases internal) strict viral-border-controls were put swiftly in place. These began in January; worldwide air travel was effectively almost completely shut down by early February 2020; the sections of aviation that remained open utilised stringent quarantining etc methods.

            Furthermore, there was little concern that populations would resist such tough anti-pandemic measures; on the contrary, there was in fact a willing embrace of mass mask-wearing, made easy by plentiful supplies of ‘PPE’ having been stockpiled by most countries. (In most countries, from South Korea to Scotland, as a result of this strong, rapid civic engagement with a joined-up strategy of precaution, full national lockdowns were not required.)

            The first ‘wave’ of Covid-19 as a consequence killed ‘only’ several thousand people in Europe, and less in North America. This remained a heavy blow, but unexceptional compared to flus. The world-leading UK Centre of Disease Control was widely praised in particular for having kept the spread and harmfulness of Covid-19 almost as low on balance as had occurred under SARS, despite the greater infectiousness of Covid.

            In late 2020, a second wave started to be felt. Restrictions on travel, which had been relaxed were instantly tightened once again in co-ordinated fashions. Simultaneous stopping of cross-border travel, combined with co-ordinated partial lockdowns and South-Korean-style sub-lockdown full-spectrum response, rapidly put a lid on this second wave.

            By Spring 2021, with system-responses fine-tuned, and a vaccine for the vulnerable, the world had a pretty strong grip on Covid-19. While SARS had killed 20,000, mostly in Europe and the USA, Covid-19’s entire global death toll, estimated at 30,000, was broadly comparable.

Perhaps the biggest fascinating unknown of Covid-19 is: could there have been a version of the course of the disease which prevented most of the vicious variants from developing altogether? Principally, Delta. The counter-factual history I have sketched here imagines just this. Once Delta, let alone Omicron, came into being, there was very little chance of anything like a zero-Covid world, a world without endemic Covid, being attainable. But before Delta, with its much higher transmissibility (combined with worst prognosis for patients) burst onto the scene, perhaps Covid could have been contained - and that is what I have just imagined. A world in which, having learnt from SARS, there was an internationally-co-ordinated strategy to stop the virus from spreading, a strategy which, by creating many less reservoirs of infectivity, created many less chances for the virus to mutate, as in our world tragically it did, into the Delta variant (and beyond). A truly internationally co-ordinated strategy on Covid, with countries shutting borders and where necessary locking down simultaneously, would have been so much better than what we had: and, crucially, it would not have seen the massive fails to be precautious that characterised the UK, USA etc responses to Covid-19.

            I had the fascinating experience in April/May 2020, of meeting and talking with Michael Baker, a key player in New Zealand’s successful response to Covid-19. He relayed to us what had happened in New Zealand as the Covid pandemic broke. Initially, in January 2020, he and his colleagues in epidemiology and public health in New Zealand had expected to look to the leadership of much larger ‘Anglo’ countries for how to respond effectively to the threat of Covid-19. But in late January and early February, they realised…that there wasn’t going to be any such leadership. So, they swiftly switched to working with the East Asian countries instead. They looked to and learnt from Hong Kong, Taiwan, South Korea and so forth; and as a result, New Zealand experienced no net excess deaths from Covid-19.

            The counter-factual history above sketches how that could have been the course of events in the West too, if only we had learnt from SARS. For of course, it didn’t even have to take SARS actually coming to Europe etc. for us to have learnt from it…