- The Washington Times - Thursday, May 1, 2003

Severe Acute Respiratory Syndrome SARS has reached 27 countries, but only a handful have been severely affected, causing pandemonium, fear, mass quarantines, billions of dollars in lost GDP and entire populations to switch to surgical mask attire.
  The 5,000 cases and 274 deaths have occurred in China and other nations having significant trade, investment, cultural and tourist links with South China.
  In the early stages of a major airborne epidemic, the path taken by the virus can be very visible. Later, unless properly controlled, cases dart across countries in a manner that makes responsibility hard to pin down. Today, while blame is being apportioned to China for its predictable obfuscation, the reality is that like most epidemics, SARS is spreading and has a future that is almost impossible to predict, especially in the corresponding season next year. This is why some say that where it came from is interesting and always controversial but more important is monitoring and dealing with where it is going.
  SARS is caused by a highly infectious new coronavirus that is moving from human to human and is spread by droplets sprayed from coughs and transmitted between handshakes and from recently touched surfaces such as doorknobs. Given how small the virus is in comparison to the average mask’s pores, cloth and paper masks are primarily serving as reminders of agonizing concern and less as barriers to transmission.
  The issue now is to have a realistic strategy to deal with the problem of emerging infections, of which SARS is the latest illustrious class member, that include the West Nile encephalitis virus, Hantavirus, Influenza viruses, Ebola hemorrhagic fever virus, and HIV the AIDS virus. These new and often relentlessly mutating viruses are produced from the epidemiological brew that facilitates viral promiscuity wherein genetic material is exchanged between micro-organisms in birds, cows, pigs and other animals that are reared or live in close proximity to humans in some parts of the world.
  At repeated intervals, these viruses of animal origin are able to propagate into and by humans. This should not be surprising in view of Nobel Prize winner Joshua Lederberg’s finding that 400 to 500 retroviruses are firmly integrated into the human genome, something that may be shocking to racial purists.
  The World Health Organization, a specialized agency of the United Nations, must necessarily deal with 190 countries and with hundreds of diseases. And indeed it is expected to accomplish this with about $1 billion for the world’s population of 6 billion. That its budget is the same amount as that of the Massachusetts General Hospital in Boston makes it unrealistic to expect this or any future epidemic to be tackled solely by passing the buck to the WHO. Further, WHO has no legal authority to compel countries to do anything, indeed it is China that has forced WHO to list Taiwan as a province of China, making it impossible for direct contact by the agency with national authorities on the island nation.
  Fortunately, sensing the very visible danger, laboratories and health agencies in most affected countries have collaborated actively to identify the virus, sequence its genes and engage in health education, diagnosis and quarantine. And, the travel warnings by the WHO and the U.S. Centers for Disease Control have been heeded.
  The word surveillance conjures up images of the Mukhabarat and the Stasi, the eyes and ears of the deaths squads in the departed diabolical regimes of Iraq and East Germany. But whenpublic health surveillance is done properly, it is in fact the most important preventive tool against epidemics. However, the bureaucratic behavior thatpunishes honesty and disclosure is more widespread than in a few dictatorialregimes. Their legacy makes health workers scream out in official reports that all is well and that diseases are declining not skyrocketing. It will require a sea change in attitudes, reward structure, and management concepts for surveillance and epidemiological investigations to really work in most countries. So too will the future availability of new broad-spectrum diagnostics, particularly genomic chip-based, that can identify from one drop of blood or a sneeze the precise organism that is the culprit. This will need to be backed up by computerized databases and networking to share the information online. Developing vaccines and specific medicines are longer-term measures.
  An approach that triages special attention on the basis of tourism gravity and the extent of trade in services and goods, surrogate for business travel of humans and insect vectors, is the way to go not merely a geographical regional or global approach. Those human travel links are vital to understanding the progress of the epidemic and quantifying the magnitude of the human and financial costs.
  While no multilateral agency can make tourism or trade-based triage an official policy, a coalition of countries affected or soon to be impacted in view of their connections to the centers of gravity of the epidemic can make it a strategy of utmost value. By acting rapidly and firmly, the greatest threat posed by dangerous diseases can be contained for humanity and economies.
  New viruses will continue to emerge, as they always have in history, but if we are well prepared through a nimble approach, they will have to beat a hasty retreat.
   Sunil Chacko, M.D., a former Harvard University research faculty member, is a public health physician, pharmaceutical analyst and CEO of New Info Solutions University. He organized an international conference on emerging infectious diseases surveillance at the Rockefeller Foundation in 1998 with the World Health Organization and the Robert Wood Johnson Foundations.

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