Q&A with School of Medicine’s Mark Cameron: Lessons learned from SARS

Mark Cameron is no stranger to fast-moving, highly contagious respiratory viruses. Cameron, an associate professor in the university’s Department of Population and Quantitative Health Sciences in the School of Medicine, was a part of the rapid-response research team during the severe acute respiratory syndrome (SARS) outbreak in Toronto in 2003.

That was the world’s first glimpse of a deadly coronavirus epidemic in action.

Mark Cameron, an associate professor in the university’s Department of Population and Quantitative Health Sciences in the School of Medicine
Mark Cameron, associate professor in the university’s Department of Population and Quantitative Health Sciences in the School of Medicine

Cameron said there are lessons to be learned from that experience—nearly two decades later. For starters, under political pressure, Toronto lifted its emergency measures too early, causing a second wave to set in. Ohio can learn from what Toronto learned the hard way, he said.  

“We are working hard with a variety of academic and clinical collaborators across the city to relay our SARS experience and help mount a research response in parallel with any help we can provide in sampling and testing,” he said.

With some social-distancing involved, Cameron made time to talk with us to share his experiences in Canada, in an effort to help make sense of the current global pandemic.

What is your area of expertise?

My specialty area is immunology and systems biology. My interest lies in applying new technologies and bioinformatics to assess and analyze patient-immune responses during chronic illness and infectious disease, including emerging infectious disease.

My lab uses single-cell sorting techniques, ribonucleic acid (RNA) sequencing and computational biology approaches to find immune biomarkers of protection or pathogenesis that can be used in therapies or drug and vaccine design.

How was that helpful with responding to the SARS outbreak?

Back when SARS hit in Toronto, my wife Cheryl (an assistant professor in the School of Medicine’s Department of Nutrition) and I were postdocs at Toronto General Hospital and were at the heart of one of Canada’s first immunophenotyping and genomic cores. We were working in transplant rejection at the time when SARS hit, and at a point where no one even knew what was causing it.

SARS hit our colleagues in transplantation very early in the outbreak due to a patient exposure. Practically overnight, we switched our immunobiology and gene expression analysis to this new disease.

Could you describe what your experience was like in Toronto?

The experience in Toronto made us feel a lot like what many of us are feeling today during the COVID-19 pandemic, although the scale today is a lot larger. The urgency was palpable; we helped enact an emergency research response to SARS with our colleagues.

Over the SARS outbreak, we were on call at 14 different hospitals to pick up research samples and process them safely at Toronto General Hospital. There was a similar fear of the unknown in Toronto, an unprecedented impact to the health-care community and patients and a sense of danger and unknown regarding how long this would last.

While a lot of our research has been published since, we still work on some of those original datasets and ideas in the face of new outbreaks, especially now with the new coronavirus.

What steps were taken to fairly rapidly contain that epidemic?

Some of the same steps we are taking now were taken in Toronto during SARS: contact-tracing, self-quarantine, social distancing, travel restrictions and limitations on non-essential activities. There wasn’t a template for this back then, and there were a lot of front-line public-health-worker heroes in action to contain SARS.

Some of this was helped along by the fact that SARS caused a much more serious illness than SARS-CoV-2 (COVID-19), and therefore didn’t have a chance to spread unchecked or untested as easily or widely. Toronto was the hardest hit by SARS outside of Southeast Asia.

What was learned from dealing with that virus that is helping to mitigate the current crisis?

Cameron has recently shared his knowledge and expertise with media, helping people around the world understand the outbreak. Here are a few examples of recent news outlets where Cameron has been featured:

Popular Science: How long will COVID-19 last?

cleveland.com: When will Ohio end its ‘stay-at-home’ order and other coronavirus restrictions?

Mashable: Americans are hitting the bars and bragging about not social distancing

Houston Chronicle: Yes, the coronavirus pandemic is different. Here’s why.

One of the big lessons learned during SARS, and in fact implemented in real time in Toronto over the course of the SARS outbreak, was the need for accurate information and testing, and with that, cooperation between hospitals and public-health systems to share that data for the common goal of stopping new infections. Proactive and intensive public-health communication and directives were at the heart of containing SARS.

Unfortunately, some of the close contact and personal protection directives were loosened too early in Toronto, leading to a well-documented second wave of infection, mainly originating within a hospital. Toronto’s SARS story is part of the conversation today and will be part of the difficult decision-making to come.

What can we take from the response to COVID-19 to lessen the impact of future super-viruses?

The sheer scope of the COVID-19 pandemic has us in both familiar and unfamiliar territory. For Cheryl and I, it’s familiar because of our serious experiences during SARS as residents and medical researchers in Toronto in 2003, but also unfamiliar in its worldwide impact outside of the city we live in, and in the unprecedented measures being enacted to contain it.

Apart from the galvanized public-health response to this pandemic, we are heartened by the research that hit the ground running with COVID-19, including some of our own that was recently funded as part of a Canadian Institutes of Health Rapid Research Funding Opportunity. This award was rolled in at a record pace to establish an international network of scientists collaborating on identifying new biomarkers to help diagnose and treat COVID-19 patients.

Other rapid research worldwide includes new clinical studies with antivirals, biologicals and vaccines. This research, along with the heroics we are seeing on the health-care professional front and even in our own communities, is the bright side in handling future outbreaks.

Readiness has to be improved and supported at all levels in the meantime, particularly consistency of funding to continue this research on coronaviruses and other microbial threats.


For more information, contact Colin McEwen at colin.mcewen@case.edu.