HEALTH-BRAZIL: Precarious Sanitation Fuels Concern over SARS

By Mario Osava Reprint | | Print |

Mario Osava

RIO DE JANEIRO, Jun 9 2003 (IPS) - The possibility of a direct correlation between precarious sanitation services and the spread of Severe Acute Respiratory Syndrome (SARS) has generated fears of a disaster in Brazil if the epidemic were to reach this country.

The poverty in which one-third of the population of 171 million lives and the consequent malnutrition and compromised immunological defences, as well as overcrowded living conditions in ”favelas” (shanty-towns) and even middle-class districts where people live in close proximity in high-rise apartment buildings, could provide a fertile breeding ground for the spread of SARS.

But the data so far indicates that SARS, which first appeared in Asia, spreads less rapidly than the flu and other viral illnesses, epidemiologist Eduardo Costa with the Oswaldo Cruz Foundation, a Rio de Janeiro-based health research centre, told IPS.

Over 80 years ago, when international travel flows were a mere fraction of what they are today, and infinitely slower, the 1918- 1919 Spanish Flu pandemic claimed the lives of between 30 and 40 million people worldwide, including 18,000 in the state of Rio de Janeiro alone, pointed out Costa, a former Rio de Janeiro state secretary of health.

Memories of past pandemics and the aggressiveness of the SARS virus continue to cause alarm, said the doctor. He pointed out, however, that 10 years ago many predicted a catastrophe when cases of cholera appeared in Brazil, but the outbreaks were controlled and limited to a few areas, despite the shortcomings of the country’s sanitation system.

Although not a single case of SARS has been confirmed in Brazil and the World Health Organisation (WHO) has announced that the global epidemic seems to have peaked, concern about the disease was fuelled in this country by the publication two weeks ago of the book ”Water in the 21st Century, Confronting Scarcity” by José Galizia Tundisi, which provides a detailed picture of basic sanitation conditions in Brazil.

According to Tundisi, 33 percent of families with incomes of less than one minimum monthly salary (80 dollars) lack access to clean water.

The most serious problem is the lack of sanitation infrastructure, which is a problem for 59 percent of the poor, and even for nine percent of families with monthly incomes of 20 minimum salaries or more.

Over the past two decades there has been little investment in sanitation facilities, due to financial difficulties in the public sector and privatisation plans that have been put on hold because of the absence of clear regulations.

Inadequate sanitation systems can increase vulnerability to SARS, which is caused by a virus that can survive in human feces for two to four days, said veterinarian Telma Abdalla with the Oswaldo Cruz Foundation’s Biosafety Commission.

But little is known about the behaviour, transmission and incubation period of the coronavirus that causes SARS, she pointed out.

The outbreaks in Canada have made it clear that ”a set of factors,” and not only poverty and precarious sanitation conditions, are involved in the spread of SARS, said Abdalla.

That means prevention methods are essential, such as close vigilance in airports and ports and at land borders, so the necessary measures can be taken with travellers suspected of infection with the virus, said Abdalla.

So far, health authorities in Brazil have examined 48 people coming in from countries where SARS cases have been reported and who showed possible symptoms of the disease, according to the National Health Foundation.

Although two ”probable cases” of SARS proved to be false alarms in April, Brazil continues to appear in the WHO health bulletins as one of the 32 countries where the disease has appeared. The total number of cases worldwide stood at 8,404, including 779 deaths, as of Jun. 6, the last day the bulletin was updated.

The SARS epidemic has led to a 90 percent decline in sales of air travel tickets to Asian countries since the WHO issued its first warning about the disease in March, according to the Brazilian Association of Travel Agencies.

In mid-May, the Brazilian government stepped up its epidemiological vigilance measures, requiring a ”health declaration” from anyone entering the country, who must state whether they have experienced possible symptoms in the 10 days prior to their arrival, and declare where they will be over the next 14 days.

The main symptoms of SARS are a high fever and one or more respiratory symptoms including cough, shortness of breath, and difficulty breathing. The disease is primarily spread through coughs and sneezes.

Brazil now requires passenger transport companies to distribute the ”health declaration” forms to travellers on their planes and ships, as well as pamphlets providing information on SARS in Portuguese, Spanish, French and English.

In provincial capitals and other large cities in Brazil, hospitals have been set up to treat possible SARS cases, and the Oswaldo Cruz Foundation has a laboratory and technicians ready to carry out lab tests.

Although the virus is ”highly lethal,” with a fatality rate of around 10 percent, transmission of the disease is apparently slower than other illnesses, which makes SARS potentially less threatening than other epidemics, said Costa.