This is SARS.

Before you read this, you need to understand that COVID19 is the name of the disease, SARS-CoV-2 is the coronavirus that is causing the disease, and that SARS-CoV-2 was named that way because it is a new strain of the same virus that caused SARS in 2003, which is called SARS-CoV. You should also understand that SARS stands for Severe Acute Respiratory Syndrome and has around a 9% case fatality rate (CFR).

Ok, now you can continue reading…

The common cold is caused by over 200 viruses, but we just call it a “cold”. There are many strains of flu viruses, but we just call it the “flu” which is short for influenza, or Italian for “influence”. When it comes to respiratory infections, we’ve been calling things by the disease, not the virus. So why aren’t we calling this SARS?

Now, there are two possible directions we can go here:

1. Perhaps we should stop calling colds “colds” and instead start getting more specific and referring to them as “rhinovirus disease” or “flu disease 2020”. This might especially be true for flus which have a huge variation in severity and mortality. I could buy this argument.
2. Maybe we should stop calling COVID19 “COVID” and instead refer to it as Severe Acute Respiratory Syndrome, or SARS. It is most definitely Severe for many people, even if if it doesn’t cause them to go to the hospital. It is Acute. And it is a Respiratory Syndrome, for sure. It may or may not be as severe as the original SARS disease.

The truth is that I don’t know which of these two camps I am in, but I think the world needs to consider #2 a little bit more.

When SARS-CoV-2 emerged, the media first called it “novel coronavirus” and then just “coronavirus” for short, which of course was a massive goof-up from a virology and terminology perspective and it took months to teach the world to start saying “SARS-CoV-2” and “COVID19” instead. In the early days, health officials repeatedly said that this was essentially like a “really bad cold” for 80% of the population, which may have been true but unfortunately lead to a sense of complacency and a tendency for young people to say things like “it’s just the flu, bro”.

As time went on, we’ve seen that this is so clearly not “just the flu”, as almost every country has in some form shut down or at least severely restricted the movement of its citizens and hospitals have become overwhelmed.

What’s interesting is that SARS-CoV-2 is so-named because it is a different strain of the SARS coronavirus and the disease it causes is almost identical, too, if not quite as bad. I challenge you to read the chapter of Viruses, Plagues, and History on SARS (an incredibly good book by the way). The book was published in 2018, quite awhile before COVID19 emerged, but the chapter may as well have been written about COVID. Everything that the author describes about SARS feels eerily familiar… as if he was writing this today about our present pandemic. Even the statistics about how many hospital patients have to be admitted to the ICU are the same.

The largest counter-argument to calling this disease SARS is that we currently think the fatality rate is much lower than the original SARS outbreak and that it would be overly dramatic or alarmist. But I raise two issues with that.

The first counterargument is that we don’t actually know that the fatality rate is less than the original SARS. We can’t really know for sure, 17 years later, that there weren’t a lot of undetected SARS cases and that the death rate wasn’t lower than we thought, and we can’t really know for sure that now the fatality rate for COVID19 isn’t the 10–11% that we saw with SARS. The numbers coming out of Italy, Spain, and France certainly aren’t reassuring, and as much as it is true that there are many undetected, untested COVID19 cases out there in the world, there are likely also many untested, uncounted COVID19 deaths. We simply don’t have enough data about either the numerator or the denominator to calculate an accurate CFR for COVID19. I deeply, sincerely hope that the fatality rate of COVID19 is lower than we all think — and I tend to think this is likely the case — but I think the same could be said about SARS, too, and that we absolutely need to err on the side of caution instead of simply allowing ourselves to believe the best-case scenario, as tempting as that is. It is important to remember that in 2003, there were “only” 8,000 known cases of SARS and that at the time that we had 8,000 cases of COVID19 in Wuhan, very little was known about either the virus or the disease — so how much did we really know about SARS, anyways? At the moment, from the data we have about SARS and the data we have about COVID19, as far as official closed cases go, they look like the same virus, the same disease, and the same CFR. Remember that the CFR for SARS started out at an estimated <4%, just like COVID, and was later revised upwards to as high as 15%.

What we name things has massive influence over how we think about it and react to it. I suspect that if the headlines in January had been “RNA of novel virus causing latest SARS epidemic successfully sequenced”, we would have seen much more precaution taken by both governments and the general population and we would have seen higher compliance with stay-at-home orders. Instead, we first got simply “coronavirus” and then “COVID19” along with a massive amount of discussion about how this is just like a severe version of the cold. Only now, after the world is shut down and our cities are filling up with refrigerator trucks full of bodies, are we finally giving this disease the level of seriousness that it deserved.

So.

I’m just a guy that reads a lot (like a lot lot). I’m no virologist, doctor, or epidemiologist. But, if you ask me, I think we should consider calling this what it is, which seems an awful lot like SARS.