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VOICE ...Some have said it's a bigger threat than AIDS

VOICE ...That it could kill millions.

VOICE ...Others believe it is nothing to worry about at all.

VOICE ...SARS has caused panic.

VOICE ...Stock markets have collapsed.

VOICE ...Borders have been closed.

VOICE ...But was it all an overreaction?

VOICE ...This is the film that provides the answers... the real story of SARS,

VOICE ...seen from the inside by the people who are actually fighting the disease.

NARRATOR: When he visited a new patient at a clinic, in Hanoi Vietnam, Dr Carlo Urbani had no idea that he was also meeting the instrument of his own death. Urbani only knew that his patient, Johnny Cheng an American businessman was in a critical condition.

DR JULIE HALL: In the space of four days, he'd gone from being a fairly fit healthy man to somebody having incredible difficulty breathing, and really struggling.

NARRATOR: Cheng had a raging fever, a hacking cough and his lungs were filling up with fluid. He had all the symptoms of a deadly virus and no drugs seemed to work. Alarmed, Urbani contacted his bosses at the World Health Organisation

DR JULIE HALL: When he first called us he said, 'this is unusual, this is something quite different, I've not seen anything quiet like this before, we've got somebody very young getting sick very quickly what should I do?'

NARRATOR: Little did he know but the mystery disease was spreading through the hospital. Within three weeks, 60 of the staff were sick. Cheng, a nurse and another doctor were dead. Days later, Dr Urbani fell ill. He too would die of the lethal virus that he had been the first to identify, the virus that causes what we now know as SARS.

NARRATOR: A deadly contagious virus has long been one of the greatest fears stalking modern medicine.

VOICE ...Viruses can lead to diseases that race round the world at ferocious speed killing millions of people.

VOICE ...Diseases like lethal forms of flu, smallpox and AIDS.

VOICE ...It's all because viruses are the ultimate parasite.

DR ANDREW SIMOR: Viruses are really like the Trojan horse because they inject themselves into human cells and use human DNA in order to replicate and multiply and then spread to the next cell to the next cell to the next cell...

NARRATOR: When a virus enters your body it penetrates a cell. Then, it takes over the cell's own materials and uses these to reproduce. Once the cell is overloaded, the virus particles break out, attacking other cells throughout your body - spreading infection.

DR ANDREW SIMOR: I think of a virus as a microscope piece of trouble. They cause a whole wide range of human disease. They spread relatively easy from person to person and that just makes it that much more difficult to keep track of them to keep up to speed with them.

NARRATOR: For years scientists around the world have been on constant alert for any major killer outbreaks. SARS would turn out to be their first real challenge of the 21st century.

NARRATOR: As the calls from Dr. Urbani in Vietnam showed the disease had escaped and was on the loose. When the headquarters of the World Health Organisation received Urbani's warnings they swung into action. The WHO is the world's health watchdog. Its task is simple; to cut off any new disease and wipe it out, before it spreads.

DR MIKE RYAN: International transmission of any unknown disease is a worry. Once a new disease gets beyond a certain point it may be very difficult to control. Your best opportunity in controlling an unknown, or a new disease is to contain it at point source.

NARRATOR: In their time, the WHO has won battles against many lethal viruses - from Smallpox to Ebola. At this stage they knew very little about this new disease, except it had all the hallmarks of a deadly flu epidemic. So the WHO did what it had hoped never to do.

DR JULIE HALL: We have a document which is our war plan, our plan for fighting a new flu outbreak.

NARRATOR: The war plan had never been used before. It was reserved for only the worst situations.

DR JULIE HALL: I was sitting next to somebody who had actually been involved in writing it, and she thought we'd never have to use it.

NARRATOR: The war plan laid out a detailed series of tasks designed to identify, isolate and eradicate a major outbreak. But it also contained a warning... Should the disease escape, the result could be social and economic collapse, and millions dead. The stakes could not be higher.

DR JULIE HALL: I remember thinking gosh if this is the start of something, then a year from now the world would look quite different - ten percent or more of the world could be actually dead.

NARRATOR: The war plan's first instruction was to identify the mystery disease. This task was given to Dr Klaus Stohr, the WHO's flu specialist. So he set about getting samples from patients in Dr Urbani's hospital in Vietnam.

DR KLAUS STOHR: What we needed were samples samples from the lungs, samples from the nose, from the throat of those patients. But samples alone are not useful you have to get them, get them to a laboratory. NARRATOR: Soon the lab results started coming through. The good news was it wasn't the most contagious of all known viruses, a vicious strain of flu.

DR KLAUS STOHR: The lab results were negative for influenza which was completely surprising to all of us.

NARRATOR: But then came the bad news.

DR JULIE HALL: I remember sitting with Klaus and turning to him and saying, "if we knew what this was we would know by now wouldn't we?".

DR KLAUS STOHR: The lab results were all negative. They were negative for Haemorrhagic Fevers...

DR JULIE HALL: Ebola, Mar burgh, Hanta virus.

DR KLAUS STOHR: Lasso fever, onyong fever, you name it.

NARRATOR: And so it dawned on them... they had no idea what they were up against.

DR JULIE HALL: At that point I knew that we were dealing with something unknown, something new and that was an incredibly scary moment.

NARRATOR: Journalists looking for a story after the war in Iraq found no shortage of pundits prepared to say the WHO had lost control.

DIXON: They are struggling to contain the epidemic. We've gone from 1000 to 2000 to 3000 to 4000 cases in just the course of a month.

NARRATOR: Panic mounted. The worst scenario envisaged in the WHO War Plan, of meltdown and economic collapse, appeared to be coming true. And then unexpectedly, it all calmed down, for one simple reason. The WHO's tactics were actually starting to work. All over the world, countries co-ordinated their fight back against the disease.

DR JULIE HALL: It really is a good news, tingly, human story, just seeing the world which is often so fragmented pulling together to really try and fight this common cause.

NARRATOR: In Singapore, anyone entering or leaving the country was screened with thermal imaging equipment. Those appearing hot enough to be running a fever were sent for a medical examination. Members of parliament - including the prime minister - had their temperature taken as they arrived for work. Even children were taught how to use a thermometer to take daily readings.

TEACHER: Class I want you to take out your thermometer and let's get ready for our temperature checking. Put them in your mouth, close your mouth. Does anyone have a temperature of 37.6 degrees or higher?

NARRATOR: Vietnam - the poorest country with cases of SARS - was the first to be declared free of it.

MIKE RYAN: The lesson from Vietnam is that all countries can contain SARS if they apply the simple measures aggressively and consistently. Vietnam sends a message to the rest of the world that countries in development can contain SARS.

NARRATOR: In Hong Kong, there was drastic action. Several apartment blocks were emptied, with hundreds shipped off to quarantine. And even in Canada the disease has peaked. Hospitals started to reopen, but every doctor, nurse and visitor was screened on entry.

NARRATOR: Outside the hospitals, the epidemic was brought under control by mass quarantine.

DR ANDREW SIMOR: More than 10,000 individuals in the city of Toronto have been asked to go on voluntary quarantine.

NARRATOR: This level of vigilance will have to be maintained for weeks. These ambulance workers must take the strictest precautions.

AMBULANCE WORKER: That involves gown, mask, face shield and gloves.

NARRATOR: Canada has won a major battle against SARS but the war is not yet over

 

CORBIN: Three quarters of the cases of bird flu in people worldwide have occurred in Vietnam. Many of the victims have been brought to one hospital in the southern city of Ho Chi Minh. I went there to meet a British doctor who's lived and worked here for ten years. Jeremy Farrar has witnessed the devastation caused by the H5N1 bird flu virus. We have no natural defences against it and the body's immune reaction literally destroys the lungs. JEREMY FARRAR: So this is the chest X-ray of a normal patient. You can see the ribs here, and if you can see the black areas in between, this is where we breathe through, this is where we take in oxygen and breathe out carbon dioxide and we need this, of course, to live.

CORBIN: And then what happens in the patient with H5N1 virus?

FARRAR: So this is now a patient who was admitted in January with H5N1 and you can see that on admission to this hospital, already you can see the vast difference. The black areas of the right lung have now been completely destroyed by the virus, and so there's very little gas exchange, very little oxygen exchange going on in this lung. CORBIN: This bit.. the dark bit over here?

FARRAR: You can see this patient still had a little bit of lung that was working okay, and in fact this patient came into hospital breathing on their own, without any assistance from us. But you can see about two days later you can see there's an horrendous progression of the disease. So by now the whole of the lung tissue is destroyed, so both the right lung and the left lung now are completely damaged by the virus.

CORBIN: So essentially this patient is now.. the lungs have been destroyed. FARRAR: So there is essentially no lung there and the patient now is no longer able to breathe for themselves.

CORBIN: And what happened to that patient?

FARRAR: And this patient died about a day after this X-ray was taken.

CORBIN: All serious influenza viruses originate in birds. In Vietnam the poultry population has exploded in recent years, a cheap source of protein in this fast developing nation. People live cheek by jowl with their poultry. Cockfighting is just one way in which humans and their birds are brought into close contact. The greatest danger is when butchering birds infected with the flu virus. People can breathe in droplets of blood, saliva or faeces. It's thought eating infected poultry that's not properly cooked can be a way of catching the disease. Ducks in particular are reservoirs. They often carry it without showing any signs of ill health. This new virulent strain of bird flu has become endemic in flocks in Vietnam.

Winter is approaching and the flu season is about to start. At present Dr Farrar and the medical staff are caring for patients with malaria and dengue fever but they expect to soon see a new wave of bird flu cases. Dr JEREMY FARRAR Director, Clinical Research Unit Hospital for Tropical Diseases, Ho Chi Minh

I think we have to assume it's going to happen and in Hanoi and in Hiroshima city the various authorities and we in the clinical and research community are assuming it's going to happen and are trying to prepare for that. CORBIN: This lethal flu strain first jumped from bird to human in Honk Kong 8 years ago. It died down but then re-emerged in China. There have been 122 confirmed cases in Vietnam, Cambodia, Thailand and Indonesia in the past three years. They raised the spectre of 1918. The last great pandemic sparked by a virulent bird flu infected half the world's population during the First World War. It killed up to 50 million people in three distinct global waves of disease. Flue pandemics are natural phenomenon, there have been two lesser outbreaks last century. Professor John Oxford has researched the origins of the virus that caused the 1918 pandemic. He's exhumed bodies preserved in the

permafrost of Norway, to take samples of lung tissue to isolate the bird flu strain that began in an army camp in northern France. PROF. JOHN OXFORD : We think it broke out in the camp, and it started slowly, that's why we have to be so careful now, you know.. in the first months there were 50 cases. It had, in the near vicinity, geese, swans, ducks, chickens.

CORBIN: So those are soldiers.. what, buying geese to eat?

OXFORD: Yes, in the live goose market.. chicken market in the nearby village.

CORBIN: And of course geese have been carriers of this avian flu virus.

MAN: Yes.

CORBIN: Like the flu bird today, the 1918 strain took its heaviest toll on young healthy adults, not the elderly who had better immunity.

Professor JOHN OXFORD Virologist Queen Mary's School of Medicine, London

These samples were taken, it's a piece of lung from a victim from the 1918 pandemic. So we can come along all these years later, my colleagues in the United States, have reconstructed the virus totally from those genes.

CORBIN: And when you look at the genetic footprint of the 1918 virus in that, and you look at the virus today that we're so concerned about, do you see similarities? OXFORD: Unfortunately you do see similarities. I say unfortunately because it's again another warning. This H5N1 has a little too likeness, to my way of thinking, to the 1918 virus.

CORBIN: So far the H5N1 bird flu virus has only infected a person on 122 documented occasions, it hasn't spread beyond those people. Global pandemics occur when a flu virus finds a way to transmit easily from person to person. To do that the H5N1 virus either needs to change gradually, as happened in 1918, or to mix with a seasonal human flu virus inside a person. Either route could create a highly contagious and deadly strain.

Sir LIAM DONALDSON Chief Medical Officer Department of Health

It has been around for 5 or 6 years. We've had 60 deaths, probably a billion people have been exposed to it, so at the moment it's not showing any signs of mutating into a human strain, or mixing with a human flu virus, but it could happen in the short-term or it might be quite a long time before it happened, or even a third scenario it could be an entirely different bird flu strain that we don't yet know about. So all of those scenarios are possible.

CORBIN: An epidemiologist at Oxford University, Professor Angela McLean, has studied the pattern of infectious diseases and their effect on society. The longer between flu pandemics, the less immunity there is in the population. Professor McLean plans to send her children to the country, to try and protect them from the first wave of infection if a pandemic breaks out.

Professor ANGELA McLEAN Epidemiologist University of Oxford

The first wave of the epidemic is a bad one, and you'd expect it to be quite short. You expect it to last about 3 months and then things to go quiet again, for reasons that aren't entirely clear, and then for there to be other waves later. The pandemic could last for several years in different ways, but hopefully, as you get further into the pandemic, control will be much, much better. So yeah, I'm prepared to take three months out of my kids' education in order to protect them.

CORBIN: But isn't this all scare mongering? People are very afraid of this and it might not happen. It's been about to happen for some time with the warnings, but it might not happen at all.

McLEAN: I think it will happen, the question is when. It might not happen soon, that's right, but the problem is, if it does happen, it could be so bad. I hate scaremongering, I really do, but the fact is that very often with emerging infections, we've been in denial actually, and then things have turned out really bad.

CORBIN: Vietnam with 80 million people, and a huge reservoir of H5N1 in poultry is at risk of a serious outbreak. Each new case of bird flu in a person gives the virus a new opportunity to change into something able to pass easily from person to person, the pre-condition for a pandemic and what's been happening in this population in recent months raises the disturbing possibility that the virus is mutating. We visited Hanoi's Infectious Diseases Hospital where doctors saw 33 bird flu patients last year from across northern Vietnam.

DOCTOR: [giving tour of hospital] This area for isolation special. CORBIN: So far the medical staff haven't considered there's a high risk to them from nursing such patients. But now they worry, there are signs the virus is evolving.

Dr NGUYEN DUC HIEN Director, Institute of Tropical Diseases Bach Mai Hospital

The virus which causes this illness can change its form, and it's strain. Sometimes it makes the disease worse, sometimes less severe. We already sent our samples to some other countries to test, and the results show that the virus had changed at the end of last season's epidemic.

CORBIN: In the past year nearly three times as many Vietnamese have caught the bird flu virus as in the previous year, but more are surviving. But to the British doctor who has watched it spread here in the past two years, that is hardly reassuring.

Dr JEREMY FARRAR Director, Clinical Research Unit Hospital for Tropical Diseases, Ho Chi Minh

In this virus, so far, 50 or 60 percent of people who get the infection die, and of course that virus dies with that patient, and it's absolutely tragic for the patient and their family but in terms of spreading the virus to other people, it's actually very good news at a population level because that virus can't go on The worry would be if the virus started killing slightly fewer people, but infected more, then we have what we had in 1918 and then we have the chance for a global pandemic.

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