Over the past 2 decades, emerging infectious diseases—including SARS (2003), H1N1 (2009), and COVID-19 (2019)—have severely impacted global health, economies, and security.Reference Li and Gao1 COVID-19, first detected in Wuhan in late 2019, spread globally, with 89,926 confirmed cases and 4,710 deaths in China by August 18, 2020, and over 22 million cases and 778,657 deaths worldwide.Reference Hui, Azhar and Madani2 The WHO declared it a Public Health Emergency of International Concern (PHEIC) on January 30, 2020.
SARS, H1N1, and COVID-19 share characteristics: they are respiratory diseases caused by single-stranded RNA viruses, highly contagious, and affect all age groups. Effective response relies on early surveillance, timely reporting, and rapid government action.Reference Zhang, Wang and Wang3 This study compares key response timelines (hospital reporting, pathogen identification, and government action) for SARS and COVID-19 in China and H1N1 in the U.S. to highlight progress and gaps.
Methods
Resources
The data during the SARS period came from relevant research literature. The data on the H1N1 in the United States was collected from the academic literature, announcements reported by the WHO, and data remained on the American CDC website. The confirmed cases of H1N1 in America came from the remained data on the American CDC website.4 About the COVID-19 outbreak of public health incidents in Wuhan, which came from the WHO report and official website (for example, China Center for Disease Control and Prevention [http://www.chinacdc.cn/en/]), and related research literature.Reference Petersen, Koopmans and Go5 The selected patients in the article all meet international diagnostic criteria.
Criteria
The six critical time points in the entire process from the discovery of the first case to the initiation of health emergency response in the SARS, H1N1, and COVID-19 were compared. These include hospitalization time for the first case, time to report to the local disease control center, time for pathogen identification in the laboratory, time for pathogen re-examination, the time of pathogen identification and notification, and the time of emergency response by the local government.
The 6 key time points were selected based on three critical aspects. First, the timing of the first case hospitalization and reporting to the CDC reflects the sensitivity of initial outbreak detection. Second, pathogen identification and genomic sequencing are fundamental for developing diagnostics and vaccines. Third, early public awareness of the spread is essential for gaining cooperation and improving the effectiveness of control measures. Therefore, we choose the time of pathogen identification and reporting and the local government’s emergency response time as key nodes.Reference Zhu, Wang and Zhang6
The selection of SARS, H1N1, and COVID-19 is based on three criteria. First, comparing SARS and COVID-19—both originating in China—highlights changes in China’s emergency response over 20 years, while H1N1 (U.S. origin) reveals gaps compared to developed nations. Second, all are highly contagious positive-sense RNA respiratory viruses that caused global health and socioeconomic crises. Third, each can be accurately detected via RT-PCR, ensuring diagnostic reliability. Their similarities enable valid comparative analysis with minimal bias.
Analytical Method
This study used the method of case comparison study to set 3 key periods for emergency response to public health emergencies from 6 key time points: the time when the hospital reports the case to the local CDC; the time when the regional CDC laboratory performs Pathogen detection and review time; and the time required for government response. At the same time, the number of days at each time node was calculated based on the reference of the hospitalization time of the first patient. According to the changes of different days, the emergency management response and interval time of public health emergencies were evaluated and analyzed.
Results
Comparative analysis using 6 critical time nodes and 3 critical time periods
The comparison results of the 3 critical periods of the SARS outbreak in Foshan, the H1N1 swine influenza outbreak in San Diego County and the COVID-19 outbreak in Wuhan are shown in Table 1. The entire early surveillance and public health emergency response process for COVID-19 cases was 64 days shorter than SARS cases (47 days vs 111 days) and 19 days longer than H1N1 cases (47 days vs 28 days) (Figure 1).Reference Huang, Wang and Li7–9
A comparison among the SARS, the H1N1, and the COVID-19 at the critical time point for emergency response
Comparison of time delays (in days) in key public health response phases during the SARS, H1N1, and COVID-19 outbreaks.
Hospital Reporting Timelines
SARS: According to the retrospective investigation of the Chinese health department, it was confirmed that the first case was found on November 16, 2002 in China, and was admitted to the Foshan First People’s Hospital on November 25, 2002. Since January 2, 2003, the Guangdong Provincial Center for Disease Control and Prevention has conducted a retrospective investigation in Foshan City after receiving reports from the Zhongshan Center for Disease Control and Prevention of an unexplained disease outbreak.
H1N1: On March 30, 2009, the first confirmed H1N1 patient, who was a boy aged 10 years old in San Diego County, presented to the outpatient clinic with cough, fever, and vomiting. On April 13, 2009, the American CDC was notified of the disease situation.
COVID-19: According to the report of The Lancet, the first new case of the new coronavirus in Wuhan was found on December 8, 2019. On December 26, 2019, Wuhan Hospital of Integrated Traditional Chinese and Western Medicine reported 4 abnormal cases to the District Center for Disease Control and Prevention.
Pathogen Identification:
SARS: On March 21, 2003, the University of Hong Kong discovered the virus from the patient, and it was initially suspected to be a coronavirus. On March 23, 2003, the Chinese Center for Disease Control and Prevention initially identified coronavirus-like particles.
H1N1: On April 14, 2009, the American CDC received clinical specimens and determined that the virus was H1N1. On April 24, 2009, the American CDC uploaded the complete gene sequences of the H1N1 virus to a publicly accessible international influenza database.
COVID-19: On January 5, 2020, a new type of coronavirus was initially identified by various agencies. On January 7, 2020, the Chinese Center for Disease Control and Prevention isolated a new type of coronavirus in samples from patients.
Government Response Time:
SARS: On April 16, 2003, the WHO announced the causative pathogen of the new SARS coronavirus. On April 23, 2003, the National Command for SARS was established.
H1N1: On April 25, 2009, the WHO declared this a public health emergency of international concern. On April 22, 2009, the American CDC activated disease Emergency Operations Center.
On April 26, 2009, the American CDC’s Strategic National Stockpile began releasing 25% of the supplies in the stockpile that could be used to protect and treat influenza.
COVID-19: On January 8, 2020, the pathogen was identified as a new type of coronavirus by the National Health Commission. On January 23, 2020, Hubei Province launched a secondary emergency response to public health emergencies.
Discussion
According to the research institute, this is one of the few studies in the world comparing the advantages and disadvantages of public health emergency response during the epidemic of SARS, H1N1, and COVID-19. In this study, we mainly investigated 3 key periods that affect the efficiency of emergency management of public health emergencies. China showed significant progress between SARS and COVID-19: faster hospital reporting, shorter pathogen identification (30 days faster), and quicker government response (15 days faster). This reflects improvements in emergency systems (for example, “one case, three systems” framework) and digital tools like big data.
However, the more rapid 28-day response to the H1N1 pandemic underscores significant disparities. This efficiency is attributable to several factors: preexisting research on swine influenza, its simultaneous multistate emergence which prompted immediate national action, and robust collaboration between U.S. laboratories. In contrast, the COVID-19 response was protracted during key stages; hospital reporting lagged by 4 days; and the government’s official response was delayed by 14 days compared to the H1N1 timeline.
Conclusion
China’s public health response improved from SARS to COVID-19, but faster pathogen identification and government action are needed to match global benchmarks like H1N1.Reference Li10 For every country in the world, it is necessary to encourage the use of big data, artificial intelligence, and other digital technologies to play a better supporting role in epidemic monitoring and analysis, virus trace ability, prevention, control and treatment, and resource allocation. Global collaboration and refined emergency systems are critical to prevent future pandemics.
Author contribution
Zhicheng Liu: Study Design, Manuscript Writing; Dingqi Li: Data Analysis; Jinhua Li: Figure Preparation, Manuscript Writing; Yue Du: Study Design and Guidance; Li Wang: Manuscript Revision, Language Polishing; Jiarui Si: Manuscript Guidance, Final Review.
Funding statement
General Project of National Social Science Fund of China for Pedagogy [BIA230221].
Competing interests
None.
