- The Washington Times - Thursday, March 27, 2003

While coalition forces have been battling toward Baghdad, clinicians around the globe have been involved in a grim fight of their own against Severe Acute Respiratory Syndrome (SARS). To date, SARS has stricken 487 individuals from 12 countries, caused panic in some parts of Asia and raised fears across the globe.
The outbreak has also provided an important test of the U.S. public health system's ability to deal with such events, whether natural or man-made. While it is evident that authorities have made a number of improvements to their ability to discover and deal with such emergent diseases, others could still be made.
During any sort of outbreak, it is critical for authorities to provide timely, accurate information to physicians, the press and the public. On this score, the Centers for Disease Control and Prevention (CDC) has done well. According to Dr. Julie Gerberding, director of the CDC, it was scarcely a day before the agency had made calls to the clinicians and state health officials and scarcely a day and a half before it had issued guidelines for isolating patients with SARS. Since the anthrax attacks of 2001, public health officials have increased training for public health emergencies, developed computer systems to highlight unusual patterns of illnesses and stockpiled antidotes and treatments for potential bioweapons.
It is good that such preparations have been made, since dealing with outbreaks is rarely easy. First, the outbreak must be discovered. That is not as straightforward as it sounds, since it can be some time before specific syndromes emerge against the public health background. Clinicians must be alert to unusual events, or unusual clusters of disease in time or in place. While a single case of smallpox would signal an outbreak and a public health emergency, slightly higher than normal levels of flu or pneumonia (as in the case of SARS) might not be noticed immediately.
Then, clinicians must separate those stricken with the syndrome from those with similar symptoms. Diagnosis can be problematic at first, since a number of diseases, ranging from smallpox to SARS, start with fairly similar reactions, such as high fever and body aches.
Once clinicians have identified disease carriers, they can begin to determine the outbreak's cause. While identifying a known agent such as anthrax can be quite straightforward, Dr. Doug Hamilton, director of the Epidemic Intelligence Service Program at the CDC, pointed out that it often takes serendipity or an astute physician to determine the cause of a previously undiscovered disease. He noted that it was six months after a frightening outbreak in Philadelphia that the cause of Legionnaire's disease was discovered in 1976. AIDS was identified in 1981, but it was two years before HIV was identified as the cause. The exact cause of SARS is still uncertain.
Indeed, some aspects of public health preparedness must be improved. States must have the ability to get federal stockpiles of medicine in a timely manner to those stricken. The federal smallpox vaccination program is badly behind schedule. States should be conducting more training exercises, and there is a serious shortage of scientists trained to deal with such outbreaks.
The SARS outbreak has shown how much public health preparedness has changed for the better since the anthrax attacks of 2001. However, many improvements should be made. The next disease to emerge could be aimed at the United States, and might not be natural in origin.

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