Jeff Drazen, M.D., editor-in-chief of the New England Journal of Medicine, listened intently to the morning news on March 16. A physician from Singapore had been pulled off a plane in Frankfurt, Germany, exhibiting acute respiratory symptoms. This incident was part of an emerging pattern as a mystery illness spread around the globe.

Over the next 24 hours, the Journal mobilized its network of international connections to assemble and submit reports on related case clusters. Within a week, the first paper arrived from Canada and soon after a second paper from Hong Kong.

"There was a lot of speculation," Dr. Drazen said, reflecting upon the first weeks of the severe acute respiratory syndrome (SARS) epidemic. "We wanted to get the best information possible to physicians as soon as possible, so they could deal with these events in a realistic and well-informed manner."

On March 31, just 15 days after SARS made international headlines, the Journal published the first peer-reviewed clinical descriptions of the outbreak on its website. Dr. Drazen also penned an editorial about the illness now galvanizing the world's health system.

World Medical Community Takes Note
The next day, the head of the World Health Organization (WHO) called Dr. Drazen, impressed with the quality of the articles and the speed with which they were published. The medical community also responded, with one e-mail from Canada describing a scene in a hospital: "Everybody was carrying [the articles] this a.m., and every nursing station had 20 copies. Big impact on-site here."

During the first two days, these articles yielded more than 150,000 downloads. In addition, close work with the China Medical Tribune ensured rapid translation and dissemination of these articles in Chinese -- an important effort as China was the likely locus of the disease.

The Next Wave of Reports
As the illness rapidly spread, a larger case cluster report from Hong Kong was submitted, peer-reviewed and published on the NEJM website on April 7.

At the same time, investigation results into the causative agent of SARS were arriving from the WHO and the Centers for Disease Control and Prevention researchers. Two reports identifying a novel form of coronavirus as a potential causative agent were published online on April 10, after another round of expeditious review, editing and production.

"While it's difficult to know if the publication of these reports altered the course of SARS, we do know that in the month of April alone, there were more than 700,000 downloads of the SARS articles," said Dr. Drazen.

- Kent Anderson