My family and I are from the province of Guangdong in Southern China. Home to over 100 million people, Guangdong is a province rich with culture and heritage. When I think of Guangdong, I think of the diaolous in Kaiping City, Baiyun Mountain in Guangzhou and the streets that shaped the first couple years of my life. Although I haven’t been back many times since moving to America, I continue to learn about Guangdong from stories my parents tell me about their childhoods and now even in my virology class at Stanford University.
Those in public health know Guangdong as the location of the first SARS outbreak. SARS, severe acute respiratory syndrome, is a disease caused by a coronavirus called SARS-associated coronavirus (SARS-CoV). Individuals afflicted with this viral respiratory illness can experience high fever, headache, body aches, dry cough, and secondary bacterial and viral pneumonia. With a fatality rate of 15%, the SARS outbreak of 2003 resulted in the deaths of more than 700 people.
In November of 2002, an outbreak of SARS began in the Guangdong province. The months that followed saw upwards of over 800 cases of infection and over 30 deaths. During this epidemic, The People’s Republic of China (PRC) discouraged press reporting on SARS and lagged in reporting the situation to the World Health Organization (WHO). It wasn’t until February of 2003 when the first case of SARS was reported in Hong Kong.
The outbreak lasted about six months, spreading to over 2 dozen countries because stopping in July of 2003. Early in the outbreak, people were frightened, as the disease seemed to have appeared out of nowhere. There were even theories that the virus came from space. It wasn’t until later that researchers discovered and confirmed an animal reservoir for the virus.
The culprit? The masked palm civet cat.
The masked palm civet cat is a nocturnal weasel-like creature, more related to a raccoon than a cat. They can be found in Asia and Africa. In Guangdong, the civet cat is highly sought out by the wealthy Chinese. It is the main ingredient in a dish called “dragon-tiger-phoenix soup.” People in Guangdong are willing to pay large sums of money for this dish, as it is believed to have many health benefits. This soup, flavored with chrysanthemum, includes shreds of the animal. The Chinese widely believe that consuming civet cat can alleviate arthritis, increase the vigor of organs, and improve “poor” blood. Considered a delicacy, many Chinese were in disbelief that the civet cat was the cause of such a deadly disease.
According to scientists, almost three-quarters of the civet cats tested in southern China were seropositive for SARS-CoV. Almost half of traders in the exotic wild-game food markets that had civet cats were seropositive for the virus. The virus likely jumped into humans as people raised, traded, slaughtered, and cooked them. Although the virus did not seem to infect the civet cats in the same deadly manner it did humans, when it jumped hosts, its virulence evolved.
Viral zoonosis (the jumping of an animal virus into a human host) is difficult to control. What we can control is the rearing, slaughtering and selling of these animals that may put people at risk of infection. Tighter controls on civet cat trade were implemented in China (sale of civet cats is banned in Hong Kong) after the outbreak, but people still go to great lengths to eat it. The question at large remains how we can do so in a culturally sensitive way. The civet cat and dragon-tiger-phoenix soup have been part of Chinese culture for centuries. Despite the SARS epidemic, people to this day continue to participate in the civet cat trade. And although there is currently no known SARS transmission anywhere in the world, the stigma and legacy of the SARS outbreak remains in Asia.
The cultural impact on emerging infection is a topic often overlooked. Throughout history, emerging infection and zoonoses has been intricately intertwined. With changing behaviors and populations the big public health question remains. How do we educate people about animal reservoirs in a culturally sensitive way without stigmatizing the practices and beliefs of an entire culture?