HEALTH: Three Months Later, More Questions than Answers on SARS

By Baradan Kuppusamy Reprint | | Print |

Analysis - By Baradan Kuppusamy

KUALA LUMPUR, Jun 19 2003 (IPS) - After all the speeches at this week’s first global conference on SARS, the diagnosis has to be that although three months of unprecedented international cooperation has stemmed its spread this time around, much more remains unknown about the deadly virus.

There remains no definite answers to any of the key questions about the origin, natural reservoir and survivability of the Severe Acute Respiratory Syndrome (SARS) virus, which has killed more than 800 people and infected nearly 8,500 in some 32 countries.

A cure is years away at best. SARS probably can never be eradicated, they say. The best defence still is isolation, quarantine and travel restrictions – which struggling economies find unpopular and want to avoid because of the huge financial losses involved.

Hope for the best and prepare for the worse as winter approaches, Margaret Chang, director of health in Hong Kong, told 1,200 world experts and public health officials at one session at the World Health Organisation (WHO) conference that ended here Wednesday.

But among the fears most often aired in the conference and the corridors outside it was the concern that poor countries that have little or no capacity to fight the infection would be unable to cope if and when a second outbreak occurs, and that SARS would become a poor person’s disease.

Certainly, WHO experts kept saying, the virus has only been contained but not eradicated, even if worst-hit places like China have seen new infections drop sharply and Taiwan was taken off the travel restrictions list on Jun. 17.

"These countries with weak health infrastructure need urgent help now to improve surveillance, isolation and clinical facilities," said WHO Director General Gro Harlem Brundtland.

The tremendous global interest in SARS has not necessarily helped address the problem, because much of it is fed by fear and lack of knowledge.

The number of hits to the WHO website alone has jumped from 12,000 hits or visitors before the outbreak to about 10 million a day. But WHO experts say that much of this interest is fuelled by fear and an exotic fascination with the new and and unknown. Privately, one expert remarked, the fascination borders on ”celebrity status”.

They also worry that the blaze of publicity has sidelined larger issues like the public health dimensions of the outbreak and the capacities of poor economies to meet the challenge.

”This huge interest should translate into concerted cooperation and sharing of knowledge to help poor countries come to grip with the dangers of emergent viruses like SARS,” said Dr Angus Nichols from the Health Protection Agency in Britain.

An equally important issue, experts say, is the reluctance of the cash-rich private research organisations and pharmaceutical giants to share their resources and knowledge with public health officials of poor frontline countries like Vietnam and even China.

Already, a wide gulf has opened up between those who know and have the capacity to know fast and those without both capacities.

Among the range of suggestions along this line were the creation of a bank of SARS cells from all infected persons, and the creation of a central database that all researchers can use. Experts also proposed that SARS screening methods and other guidelines be standardised and international cooperation be used to develop a single, reliable test kit.

But these proposals may remain just that without badly needed funds. "We are not a money bag…we are depended on allocations and our resources are severely limited," said Brundtland.

Meantime, health and science experts’ efforts to track the SARS virus will continue, although key answers remain unanswered: What really is the SARS virus? Who is its natural host or hosts? How and why did it jump species?

Several SARS mysteries were also topics of much discussion here – including why some patients deteriorate rapidly and others do not, why children are uninfected when adults die. Another puzzler is the phenomenon of so-called ”super-spreaders”, who infect dozens of people while other infected persons do not infect anyone. "We have contained the disease…now we are looking for possible ways to eradicate it," said Dr David Heymann, the director of communicable diseases at the WHO. "But to make the first moves to eradicate we need to know a lot more about the SARS virus, its origin, natural host and why and how it jumped species."

Even SARS’ animal origin – supposedly from the civet cat – is not a 100 percent certainty. "It is even possible that a small and isolated group of humans are the natural host," said Australian veterinary epidemiologist Dr Hume Field. ”We need to do more studies…more systematic testing.”

Some public health experts like Hong Kong’s Margaret Chang, who have to fight the infection and protect people, are uncomfortable with the abundance of theories, probabilities and hypothesis. "Frankly, it (theorising) has not been helpful for us (public health decision makers)," she said.

They worry that the virus will exploit the low level of hygiene and sanitation in poor societies and end up as a poor people’s disease.

"SARS has forced us to rethink the sanitation conditions of entire societies and also the conditions of work of people like sewage workers, slaughter houses and animal and food handlers. What was safe before is no longer safe after SARS," said Dr Jamie Bartram, WHO expert on water, sanitation and health.

One real fear is that SARS would spread and take root in poor countries and become endemic like malaria. It would be a huge disaster given poor water and sanitation conditions made worse by civil strife and lack of political will. "There is a urgent need now for such an emergency," Bartman said.

WHO officials say the fear of SARS and the economic cost of an outbreak is changing official attitudes about improving health capacities, but that the resources being committed remain insufficient.

"It is a shame to call SARS a blessing in disguise but yes, it is true," said Mohamed Said Patel, a WHO expert. "We should capitalise on it and lobby politicians for funds for disaster preparedness and public health."