Learning the Lessons of SARS

By J.R. Pegg

WASHINGTON, DC,
May 30, 2003 (ENS) - The outbreak of Severe Acute Respiratory Syndrome (SARS) must serve as a wake up call for the world, warned global health experts, as humanity has created conditions ripe for the development and spread of infectious disease. Although the world has done an admirable job containing the spread of the disease, the revived concerns in Toronto have been "sobering," U.S. Centers for Disease Control Director Julie Gerberding told attendees of a global health conference.

"It only takes one infected person slipping through the cracks," Gerbering said. "We need to get over the idea that we will go back to the good old days when we do not have to these problems to worry about."

Speaking today at the Global Health Council's annual conference, Gerberding and others urged policymakers and health care workers to embrace the lessons of SARS and to be prepared for future recurrences and to be ready for new infectious diseases.

Today's discussion came one day after officials in Toronto quarantined some 5,000 individuals and reported more than 30 new cases and 29 suspected cases of the disease. Canadian - and world - health officials believed they had contained the spread of the disease and Toronto was removed from the World Health Organization's list of SARS-affected areas on May 14.

According to the WHO, some 8,371 individuals have contracted SARS and 754 have died from the new disease, which has been identified as a new form of coronavirus. Heymann

The World Health Organization's David Heymann the importance of communications in the coordination of the effort to combat SARS can not be underestimated. (Photo courtesy World Health Organization)
Despite concerns about the situation in Canada - and continued confusion over the extent of the disease in China - world health officials believe the respiratory virus has been contained in most of the 31 countries affected.

The WHO today removed Singapore from its list of areas with recent local transmissions, leaving only Canada, China and Taiwan on the list.

Canada's recurrence, explained David Heymann, WHO's executive director for communicable diseases, came because one patient with the disease was not identified.

This gives reason to believe that the disease can be quickly contained, he told conference attendees via a videolink from Geneva, Switzerland.

"It is possible Taiwan is on a downward slope," Heymann said, "but it is too early to confirm this."

Heymann applauded the coordinated efforts of health officials across the world in responding to SARS, which came to much of the world's attention in March. The respiratory virus spreads primarily through direct contact, but there is at least one direct case of an environmental transmission in Hong Kong. The disease is suspected to have spread through an apartment complex in Hong Kong via the sewage system.

Health officials are confident the disease originated in China's southern Guangdong Province and some believe humans were first infected by eating diseased animals. The disease has been found in civet cats, a mongoose like mammal, and the provincial government of Guangdong has banned the trading and eating of wild animals.

It would not be surprising to find that the coronavirus that causes SARS had jumped from animals to humans, explained Harvard Medical School researcher Mary Wilson, as animals are the source of many infectious diseases.

Wilson said it is important to understand the global conditions that make SARS - and other infectious diseases - serious threats to human health.

These conditions include the rise in population, increasing proximity to domestic and wild animals, growing urbanization and world travel.

"The world is simply more connected through travel and trade than ever before," Wilson said.

There are more elderly than ever before, Wilson said, and this can affect the spread of SARS and other infectious diseases - the mortality rate for SARS is considerably higher for the elderly Gerberding

CDC Director Julie Gerberding urged vigilance in combatting SARS and other infectious diseases. Photo courtesy Centers for Disease Control
"The current global environment favors the appearance and spread of new infections," Wilson said.

There is still no cure nor proven effective drug treatment for SARS, said WHO's Heymann, but scientists are confident the majority of infections come from close contact. Health care workers are still the primary population at risk.

Fears that the disease was spreading through ventilation systems on airplanes appear unfounded, he said.

Gerberding told attendees she was in Washington today to meet with officials at the U.S. National Institutes of Health to set up a formal research program to study the disease. Despite the current lack of treatment or cure, she said, the "ancient method" of detection, isolation and quarantine has proven effective.

The challenge of SARS, said Gerberding, is that it requires very high adherence to preventive measures as the virus is "very intolerant of any lapse in vigilance."

Heymann warned against allowing politics or economics to drive decisions about SARS warnings or future outbreaks and urged policymakers to keep "public health separate from other decisions."

The economic impact of SARS is still unknown, but Asian economies have been impacted by the disease and a sharp drop in global travel.

Zhang Oiyue, spokeswoman for China's Foreign Ministry, said Thursday that the SARS epidemic had had some impact on the Chinese economy, but that it will not disrupt China's economic growth.

It is China, which has more than 6,000 of the 8,300 known SARS cases, that could hold the key to the future of the disease.

"Successful containment now depends on China," Heymann said.

And the SARS lesson for the world, added Gerberding, is that "there are no borders for infectious diseases."