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June, 2003 Reporter Home

Limits on Duty Hours Main Topic at GRA Meeting

Post 9/11 Fallout: International Students, Patients Still Facing Scrutiny

Organ Transplantation: Modern Triumphs and Tribulations

Innovations in Medical Education: Spinning a Web in Simulation

Current & Choice: Filling the Pipeline

A Word From the President: Bridging the Quality Chasm

Viewpoint: What We Are Learning From SARS

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Scott Harris
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Elissa Fuchs
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Viewpoint: What We Are Learning From SARS

By Stephen Corber, M.D., Director, Division of Disease Prevention and Control, Pan American Health Organization

On Feb. 28, 2003, Carlo Urbani, MD, a World Health Organization (WHO) physician, was asked to see a patient experiencing flu-like symptoms in Hanoi French Hospital in Viet Nam. After reviewing the patient's symptoms, Dr. Urbani suspected the condition was something new and different. As hospital employees began contracting the illness, Dr. Urbani became increasingly concerned. He notified WHO, pressured the government of Viet Nam to take immediate aggressive action, and urged the collection of specimens for laboratory analysis. Today, Viet Nam is being praised as a good example of how to deal with containing the disease, but unfortunately Dr. Urbani died as a result of the virus on March 29. He was 46.

On March 12, Hong Kong's health director, Margaret Chan, MD, notified WHO that a high number of healthcare workers had called in sick with flu-like symptoms. That same day, WHO issued a global alert stating that an atypical pneumonia with rapid progression to respiratory failure was spreading within Asia. Healthcare workers appeared to be at the greatest risk. The cause was unknown but presumed to be an infectious agent. Antibiotics and antivirals did not appear to be effective.

By March 15, SARS cases were reported in Singapore and Canada. WHO circulated advice on case definition and surveillance, clinical management, hospital infection control, and travel re- cautions. Its 191 member countries began developing SARS protection and control plans. WHO coordinated 13 laboratories from 10 countries into a network. Within a month, researchers had identified a coronavirus as the causative agent and its genomic sequence. ELISA and immunofluorescent antibody tests were developed, and PCR primers were posted on WHO's Web site.

As of May 14, there were 7,628 probable cases of SARS reported from approximately 30 countries. Of the "original" five countries, it has been controlled in Viet Nam, Singapore, and Canada, and is in decline in Hong Kong. Of the "non-original" countries, including the United States, there have been a few reports of transmission to healthcare workers or close personal contacts. However, in the non-original countries, transmission has been limited to one generation (i.e., healthcare workers or family members) and there has been no spread into the greater community.

China, of course, has been the major exception. While an outbreak of a pneumonia-like disease had been reported in Guangdong Province in mid-November 2002, the Chinese government limited access to data and reported as late as April 3 that the outbreak was under control. Following intense international pressure, China announced in late April a policy of transparency, and international teams are helping to support its provincial efforts.

Notwithstanding the experience in China, the worldwide effort to contain SARS has achieved many successes:

the presence of WHO consultants available to countries and the well-accepted importance of reporting new outbreaks have allowed WHO to notify all countries of the impending outbreak at a very early stage;
worldwide communications - especially the Internet - have allowed countries to report suspected cases and WHO to provide guidelines and immediate consultation;
unprecedented collaboration among laboratories has resulted in the prompt identification of the causative agent; and
individual countries' preparedness has allowed them to implement control measures to prevent the spread of the disease in most cases.

Medical education's role

Medical educators can play an important role by:

including the latest global infectious disease epidemiology in medical curricula;
encouraging international experiences for medical students, thus broadening their understanding of other countries and improving the effectiveness and compassion with which we treat visitors to this country; and
training health professionals from developing countries and contributing, wherever possible, to training within their own countries - preferably by using tools and guidelines developed by WHO so standards are consistent, and levels of diagnosis and treatment are appropriate to the resources available.

It is still too early to predict the future epidemiological pattern of SARS. We do know, however, that emerging infectious diseases will continue to appear. Over the past 30 years, we have identified more than 30 "new" diseases, including HIV/AIDS, Ebola, and the West Nile Virus.

SARS has been an important test to the world's front-line healthcare workers, who have responded in unprecedented fashion. We have learned that local effects can have global impacts and that the best investment for our own protection is in strengthening individual countries' capacity to control disease where and when it first appears.

Editor's note: The Pan American Health Organization (www.paho.org) is part of WHO, which continuously updates a SARS Web site, www.who.int/csr/sars/en.