Thread by @breakfast_dogs

How SARS exploded around the world: Mystery of the Hotel Metropole

Almost all SARS cases globally stemmed from a single super-spreader event which happened at Hong Kong's Hotel Metropole.

How it happened remains a mystery. Was this an act of bioterrorism?

The index case was Dr Liu Jianlun a doctor from the mainland who worked at Guangzhou's Sun Yat-Sen hospital. For weeks there had been rumors of an atypical pneumonia circulating in Guangdong. PRC authorities suppressed discussion of it claimed it was treatable with antibiotics.

A few days before arriving in HK, Liu had mild flu symptoms but felt well enough to travel. In HK he spent the day sightseeing with his sister and brother-in law. Liu and his wife checked into room 911 at Hotel Metropole at 5pm. The next morning he checked himself into hospital.

In the short time he was at the hotel, 19 other hotel guests were infected, all on the same floor. Four of these went on to seed outbreaks in Singapore, Toronto, Vietnam and elsewhere in Hong Kong, Three died, others had mild symptoms and infected no-one.

A WHO team of environmental health experts arrived in late April, following an earlier investigation by local authorities. They found traces of SARS RNA in the A/C air inlet by the lift lobby, and on the carpet and doorways adjacent to Liu's room. But not inside any of the rooms

A WHO report has a chapter "Solving the Metropole Hotel Mystery" but while it provides some important detail, it certainly doesn't solve it.

The WHO investigators realized the transmission must have been by aerosol. They speculated that Liu had vomited and perhaps staff cleaning vacuuming had aerosolized it.

But no staff reported or recalled having to clean up vomit, no staff became infected. The vacuum cleaner was also tested, but was negative.

This part of the investigation seems to have been quite thorough. But did they consider, say, a portable battery powered nebulizer placed by the doorway of room 911? I'm guessing not.

Though many reports note the irony of Liu's room number - 911 - it's generally seen as just coincidence.

Odd, because in 2003 terrorism was fresh in mind. It's also highly improbable, given the hotel had 487 rooms.

Bioterrorism struck the US one week after 9/11. Letters contaminated with anthrax were sent to politicians and media. Some e.g. these sent to NYPost and NBC, referred to 9/11.

Jihadists weren't seriously considered as suspects. They had no access to, or capacity to handle anthrax. The intent of the letters was to link the incidents to a terror network in the minds of the public.

The FBI focused attention on the scenario of a "lone wolf" US scientist.

The investigation into the anthrax attacks had an unsatisfying conclusion.
7 years later, FBI wanted to charge a Fort Detrick scientist, Bruce Ivins, but he apparently committed suicide. The case against him was largely circumstantial, a grand jury was not ready to indict him.

Perhaps the room number was intentional - the Metropole was meant to seem one of a series of terrorist acts, not an isolated incident?

But it went largely unnoticed, partly because the epidemiological significance was only recognized later, and by then the focus had changed.

At the time, the cause of SARS was unknown. Coronaviruses were known to cause common colds, not respiratory failure. When Liu's brother-in-law became sick, doctors took a lung biopsy. From this, scientists were eventually able to identify a novel coronavirus. AMMS already knew.

US biodefense efforts soon stepped up, recognizing the terrorism potential of SARS. But the Metropole was never investigated as possible terrorism. There was a LegCo enquiry and WHO work but there are gaps in the epidemiological data, witnesses not interviewed, questions unasked.

Even though SARS, MERS and SARS-CoV-2, are recognized bioweapon agents, and it is assumed that a sophisticated cover-up might be part of a planned release, bioterrorism is treated as a future threat, not current reality.

The scientific investigation was always focused on a zoonotic origin. Foreign groups were involved (e.g. CSIRO/EcoHealth) but they are zoonosis, not biowarfare, experts. And worse, they depended on WIV for sampling. Presumably this was the only arrangement acceptable to Beijing.

The role of HKU should also be questioned. Some HKU scientists worked closely with PRC authorities and military. HKU's microbiology department was declared a "State Key Lab", and received lavish funding to expand.

Yi Guan was recently senior author on a pangolin paper with AMMS.

Despite assertions, the Metropole mystery remains unsolved, and the natural origin of SARS is not settled. My research shows evidence provided by WIV/CSIRO is fraudulent.

Although SARS is well in the past, and the global impact wasn't huge, it set many precedents for SARS-CoV-2.