- The Washington Times - Thursday, May 29, 2003

This week, SARS crossed the Chinese border into Russia and continued to spread in Asia. Its alarming reappearance and surprising resilience has lessons for both public health authorities attempting to stem this epidemic and policy-makers concerned about controlling natural or unnatural outbreaks of other infectious diseases.

At least 11 people have been infected in the new outbreak in Canada, which authorities suspect may have been spread by a 96-year-old patient misdiagnosed with pneumonia. According to the national Center for Disease Control, there are 66 probable cases of SARS in the United States. Globally, nearly 8,300 individuals have been afflicted by SARS, according to the World Health Organization (WHO). Some 750 have died.

SARS has also wreaked economic havoc in affected areas. In fact, given the negative effect that travel bans and quarantines can have on healthy individuals’ quality of life in such localities, it’s hardly surprising that they are eager to be declared disease-free. Such seemingly cold-blooded economic calculations must be made at some point during an epidemic, since a balance must be found between the danger of a resurgent epidemic and the economic harm of a citywide or even statewide shutdown. (Would Washington D.C. stay open if there were 10 cases of SARS? 100? 1,000?)

However, when disease-free declarations are made too quickly (Dr. Donald Low, chief of microbiology at Mount Sinai Hospital in Toronto admitted earlier this week, “In retrospect, we think we let our guard down too early”), an even costlier coin — the public trust — is devalued. Regaining that trust can be even more expensive than controlling the epidemic. In a seeming attempt to both stem the new outbreak and regain the public trust, Canadian authorities have quarantined over 5,000 individuals.

In China, the pronouncements of authorities have become so worthless that in some areas, panics have ensued and the tourism industry has collapsed. For instance, in one of the hardest-hit regions, the coastal city of Xaimen, so few individuals are visiting the local zoo that there is hardly any money to feed the animals. As a consequence, hungry tigers and lions are attacking one another. It will be some time before anyone truly believes China has contained SARS, regardless of what authorities might say.

Many questions about SARS remain, but it appears that the basic public health measures applied have been fairly effective in controlling its spread. According to two reports released a week ago in the journal Science, which modeled the epidemic, precautions and quarantines have already had a positive effect, and are likely to continue to do so.

Those measures, coupled with continued vigilance, may be sufficient to contain the SARS epidemic. Though the fight against this outbreak is far from over (it may have only fairly begun), authorities should take note of what has and has not worked. Given the current situation and the potential of bioterrorism, the failure to learn the right lessons from this outbreak is almost too costly to contemplate.

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