HEALTH: SARS Vigilance Grows as Flu Season Starts

By IPS Correspondents Reprint | | Print |

Katherine Stapp

NEW YORK, Nov 25 2003 (IPS) - Public health officials worldwide say they are better prepared for a re-emergence of the SARS virus, but concerns persist that developing countries might lack the resources to quickly respond to an outbreak.

SARS, or severe acute respiratory syndrome, is a flu-like illness caused by a corona virus. First reported in Asia in February 2003, it quickly spread to more than two dozen countries in Asia, Europe and North and South America, mostly via infected travellers.

Symptoms of SARS include high fever, headache and respiratory problems. Doctors believe it is transmitted through the coughing or sneezing of infected patients, most of whom develop pneumonia.

According to the World Health Organisation (WHO), during the 2003 outbreak 8,098 people worldwide became sick with SARS, and 774 died.

Although the virus was eventually contained, with the last infection reported Jun. 25, public health experts warn that it could re-emerge, particularly with the onset of winter in the northern hemisphere.

"I think the developed countries are generally well prepared to deal with SARS if it comes back, although there will once again be substantial reaction and concern if new cases start to arise," said Dr. Arthur Reingold, head of epidemiology at the School of Public Health, University of California at Berkeley.

Ruth Berkelman, director of the Centre for Public Health Preparedness and Research at Emory University in Atlanta in the State of Georgia, agreed.

"It is unlikely that countries that lack a sound public health infrastructure have been able to prepare adequately for an epidemic of SARS," she said. "One question would also be how quickly an epidemic in these countries could be identified."

In China, where 75 percent of the SARS fatalities occurred, officials are erring on the side of caution – after coming under criticism for initially covering up the spring 2003 outbreak.

Beijing has resumed 24-hour surveillance to receive daily SARS updates from all area hospitals, and plans to set up an Internet-based reporting system to link 60,000 hospitals and local disease control centres around the country.

At some of the nation’s airports, officials are again scrutinising travellers to identify those who might be sick, although no new cases have been reported so far.

But on Nov. 20, senior Chinese officials in Beijing – which saw more than 2,000 SARS cases and nearly 200 deaths during the outbreak – warned that the public health system is still incapable of rapidly responding to another SARS outbreak.

Speaking at a conference in the city, Vice Mayor Niu Youcheng pointed to inadequate funding, a generally slow response to public health crises, weak sanitary facilities and the absence of health facilities in rural areas.

"Beijing still lacks open and transparent monitoring networks and information reporting systems to cope with emergency health crises," Niu said.

But even adequate resources are not a guarantee of success against SARS, as the city of Toronto discovered when three waves of the virus claimed the lives of 38 people and spooked tourists and business travellers planning to travel there.

Officials say SARS gained a foothold in Canada’s largest city due a lack of coordination and communication between government agencies in the crucial first weeks of the outbreak.

For example, when local health officials discovered the first cluster of cases late one night in March, they did not have the emergency phone numbers for Health Canada or the WHO. Nor did they have phone numbers for Toronto doctors.

Canada, which had 438 confirmed SARS cases altogether, just suspended airport screening measures – like thermal scanners to detect fever – but says it will reinstate them should any new cases crop up anywhere in the world.

In Hong Kong, one of the epicentres of SARS, the government has reportedly spent 60 million dollars on isolation wards in hospitals and a rapid communications system to share information about new cases.

Dr. Paul Lusamba-Dikassa, regional adviser for communicable diseases surveillance and response at the WHO Regional Office for Africa, said the WHO has conducted orientations to strengthen national surveillance systems and guidelines on hospital infection control and management of SARS.

"In a number of countries, SARS epidemic preparedness and response plans were developed and implemented," Lusamba-Dikassa told IPS. "Measures taken in South Africa and Zambia enabled the isolation of patients, contacts tracing and containment of the disease."

There are currently several laboratory tests to detect the SARS virus. However, the WHO notes that the system for global alert is weakened by the fact that at least one-half of the world’s population has no access to services that can perform simple chest X-rays.

"A major concern is the occurrence of cases in resource-poor settings, where health infrastructures might not be able to cope with the demands of case detection, isolation, intensive care and contact tracing," said the agency.

"Developing countries might not experience explosive increases in cases for the same reasons as seen elsewhere. Many other factors, such as crowding on wards and lack of adequate isolation facilities, could contribute to so-called ‘super-spreading’ events.."

The Asian Network of Major Cities for the 21st Century (ANMC 21), a grouping that includes some of the hardest-hit urban centres, agreed earlier this month to step up efforts to prevent cross-border transmission of the virus, continue surveillance efforts and early identification and quarantine of suspected cases, and to create a website of SARS-related information.

At a recent meeting in Geneva organised by the WHO, public health experts agreed that finding a vaccine for the virus remained an important part of prevention. This week, Chinese researchers announced they had identified a candidate vaccine, which will be tested in human trials next month.

"The quick progress of many groups in the area of SARS vaccine development is outstanding and most encouraging," Marie-Paule Kieny, director of the WHO Initiative for Vaccine Research, told IPS.

"This being said, it is unlikely that a commercial SARS vaccine would be available before one to two years from now," she added.

"Therefore, in the possibility of another outbreak, governments and public health institutions would have to face the emergency with measures such as those deployed during the past epidemic.

"Fortunately, we are better prepared, diagnostic tools are available, and potential drugs could be on track."