- The Washington Times - Monday, May 12, 2003

As public health specialists work to contain the outbreak of severe acute respiratory syndrome (SARS) in China, concern is growing that the illness could spread to crowded developing countries, such as those in Africa, with potentially devastating effects.

“This illness getting into a heavily populated developing country is a concern,” said Dick Thompson, spokesman for the World Health Organization. “They don’t have the resources that are needed to control the disease.”

“It is a real concern to people in the field,” added Dr. Ruth Berkelman, director of the Center for Public Health at Emory University’s Rollins School of Public Health.

SARS has infected more than 7,000 people and claimed more than 500 lives worldwide, according to WHO. In China, SARS cases continue to rise.

Officials there say five new fatalities yesterday took the death toll to 235. Almost 5,000 cases have been reported in that country so far.

Other affected areas appear to be getting the illness under control. Vietnam was declared free of the disease and cases are “trending downwards” in Canada and Singapore, Mr. Thompson said.

But, he said, “all it takes is one case,” for the disease to flare up in an area and spread.

Health specialists say countries in Africa, South America and other places may not have the money, equipment or public health infrastructures in place to deal with a potential SARS outbreak. And many of the world’s most densely-populated cities — Mexico City; Lagos, Nigeria; and Jakarta, Indonesia — are in developing countries, they note.

Dr. Berkelman said poor sanitation and inadequate housing could lead to a quick spread of the illness. She also said it is not clear whether there are enough trained health care workers who could recognize, test, diagnose and report a potential SARS case.

And she questioned whether there are enough gowns, gloves and masks to maintain the quarantine of a SARS outbreak.

In addition, a large number of people are infected with HIV in Africa.

It is not yet known if SARS is more deadly for people with HIV, but Dr. David L. Heymann, WHO’s director of communicable diseases, said this unknown is “why we’re working so hard to make sure it doesn’t enter sub-Saharan Africa.”

Mr. Thompson said it is possible to contain the disease in a developing country.

He pointed to the success in Vietnam, which instituted strict containment policies and was able to rid itself of the outbreak.

In late April, African leaders said those countries were tightening their surveillance to find SARS cases.

Dr. Ebrahim M. Samba, WHO regional director for Africa, said a number of countries already had put into place adequate measures to prevent and control of the disease.

There has been one reported case on the continent of Africa — in South Africa.

In South America, Colombia has reported one case and Brazil has reported two. But thus far, Africa and South America seem to have avoided the disease.

Mr. Thompson said there are conflicting reports coming from India about the number of cases there. Officially, the Indian government has reported one case to WHO, but Mr. Thompson said there are WHO officials in India “trying to clarify what the situation is.”

Dr. Dele Davies, a professor and chairman of pediatrics and human development at the University of Michigan, said “it’s hard to know if it’s truly one case” in India, or whether “a failure to recognize the disease or failure to report it,” is occurring.

“We’re not really sure how good the surveillance is in these countries,” he said.

But others note that developing countries have many other serious diseases to worry about — such as malaria, which claims the lives of 3,000 African children each day, according to a joint report released last month by the WHO and the United Nations Children’s Fund.

“The bottom line is in developing countries, [SARS] is just a small blip on their radar screen compared to the other diseases,” said Evan Simpson, communications director for the Program for Appropriate Technology in Health, an organization that works with developing countries to establish public health infrastructures.

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