Since 2020, the news is inundated with information on the continuing SARS-COV-2, or COVID-19 outbreak. A similar occurrence occurred in early 2003 with the original SARS-COV outbreak.
As the acronym indicates, SARS-COV originated as a strain in the coronavirus family, which is also home to the common cold viruses. The initial transmission of this strain was a zoonotic spillover from the bat population of the Guangdong province in southeast China (1). From there, SARS spread to Beijing, which at the time, had a population of nearly 13.8 million people. From Beijing, it quickly spread internationally, resulting in 8096 cases and 782 fatalities (2).
The difficulty in tracking SARS was largely linked to its generic symptom profile nearly identical to the flu-fever, cough, chills, muscle aches, headache, and occasional diarrhea. The cause of SARS fatalities is it’s eventual progression to pneumonia (3).
The rapid spread of SARS internationally is accredited to superspreading: the transmission of a virus to at least eight contacts. Due to the initial lack of information on this deemed “atypical pneumonia” which spread through respiratory droplets that contaminated the air and surfaces, superspreading was most common amongst healthcare workers (4). One of the most notable being 64-year-old Dr. Liu Jianlun who, after checking into a Hong Kong Hotel for one night, infected seven people. Although he had less than eight contacts, one of the contacts was with a Canadian tourist who brought the virus with her back to Toronto where it infected 60 more people. Another three of his contacts brought the virus to Singapore, where it spread to more than 195 people. It’s estimated that nearly half of the world’s SARS cases could be traced back to Dr. Jianlun. Whilst it’s easy to simply blame poor public health initiatives and hospital safety protocols, healthcare workers wouldn’t have to contend with novel viruses without zoonotic spillovers (5).
SARS is largely believed to have spilled over from bats to humans in the Guangdong wet market. Wet markets are open-air markets which, in addition to selling domestic livestock, also sell wildlife. Although wet markets in larger cities are more hygienic, those of the smaller communities are known internationally for their unsanitary conditions. A recent analysis of 1725 game animals from wet markets across China found 71 mammalian viruses, including 18 potentially dangerous to humans (6). Wet markets aren’t unique to China as they’re also prominent in several other Asian, African, and Latin American countries(7).
And just like the bushmeat trade of Africa, much of the Chinese population depends on the more than $73 billion wildlife industry(8). Furthermore, wet markets are historically engrained in Chinese culture. Chinese wildlife trade began in the 1970s after tens of millions of Chinese citizens died of starvation under Mao Zedong’s communist rule(9). Additionally, many of the goods sold are used in traditional Chinese medicine.
However, the further danger is the Chinese government’s seeming disinterest in creating long-term policy changes. Due to the SARS outbreak, wet markets were banned between 2002-2004(10). After everything settled down, they reopened until the ban following the avian influenza outbreak in 2014(11). Wet markets were once again banned in 2020 for the COVID-19 outbreak(12). Zoonotic viruses don’t disappear from wild populations during these temporary bans. Once the bans are lifted, the danger of zoonotic spillovers return. Furthermore, these bans likely diminish the potential immunity of the countless venders and marketers frequently exposed to these viruses. The continuous cultural significance of wet markets and the government’s lacking initiative to properly handle this complex public health issue create a fantastic breeding-ground for future zoonotic spillovers and novel outbreaks.