Two Cases of SARS

With severe acute respiratory syndrome infecting some 2,300 people in 17 countries, the World Health Organization last Wednesday issued an unprecedented advisory against travel to China. China, the undisputed origination point of this disease with more than half the cases worldwide and, at 46, two-thirds of the deaths, promptly disputed the WHO by asserting with no supporting evidence that it is a perfectly safe destination for tourists and business travelers.

Denial is not a river in Egypt, but it certainly seems to run through the government of the People’s Republic. For good measure, China’s minister of health claimed, once again, that his country’s three-month delay in reporting the first outbreak in the southern province of Guangdong has not in any way held up the scientific search for a detection test or a cure. Never mind that an international team of researchers developed a preliminary SARS detection test within a week of China’s nominal cooperation and is making significant progress in identifying the virus and, then, a vaccine or a cure. Had China been forthcoming from the start, had it complied with the terms of its membership in WHO, there is little question that this life-saving work would be three months farther along.

At the other end of the response spectrum, quick and decisive action by health officials in Virginia is being credited with stopping the spread of SARS there before it began. A woman who had been in Guangdong in early February began experiencing severe flu-like symptoms shortly after her return. She was admitted to a Loudon County hospital that, because of its proximity to Washington and its experience in dealing with inhalation anthrax, had instituted rigorous procedures for dealing with bioterrorism.

Although SARS was still China’s dirty little secret, the medical team sensed something out of the ordinary and the patient was placed immediately in a respiratory isolation room – the ventilation system is totally separate from the rest of the hospital – and staff followed procedures to the letter. State and local health officials and hospital workers then launched a surveillance program to try to determine whether any of the hospital employees or family members who had contact with the woman had been infected. They had not. The woman was released about three weeks later and is recovering.

Not long ago, a disease such as SARS would have been a localized epidemic. Today, with modern ventilation systems (such as the one that spread SARS among 200 residents of one Hong Kong apartment building) and global airline travel, a disease such as SARS easily can leap oceans and cover the world. Only international cooperation and thorough preparation can answer this challenge. The former remains woefully absent in China; it is encouraging to see the latter to such a high degree in Virginia.