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Health officials lay in wait for SARS redux
- Howard Dicus
The flu keeps coming back. Will SARS? The World Health Organization thinks it might, and intends to be ready.
WHO held the first meeting if its SARS Scientific Research Advisory Committee this past week in Geneva. More than 30 leading SARS researchers attended.
"Participants expressed a great need to ensure that the world can recognize and respond to a recurrence of SARS in ways that work faster to achieve control and are less costly and socially disruptive," WHO said.
Severe Acute Respiratory Syndrome killed fewer people this year than the flu will, but it brought travel in the Asia-Pacific region almost to a standstill earlier this week. The economies of Hong Kong and Singapore got sick from it.
"Participants agreed on the priority research questions to be addressed in the coming months," WHO said. "Questions fall into the main areas of epidemiology, laboratory diagnostics, outbreak management, case management, including treatment outcomes and infection control, and social impact. The research agenda, which will undergo further review by participants, is expected to be finalized for public release within a week."
False-alarms are fully expected and have already occurred, the researchers said. In one sense, they said, this is good news: it gives reassurance that the alert system is working well. But participants agreed that sporadic cases of SARS may not be detected early. "Mild SARS cases and cases with atypical symptoms could be initially missed, hence the importance for several lines of defence in which the intensity of surveillance is determined by the level of risk (zone of re-emergence, nodal areas, and low risk areas). Moreover, the system for global alert is weakened by the fact that at least half of the world's population has no access to services that can perform simple chest X-rays," WHO said.
SARS and air travel
Airline experts may be consulted by medical experts soon.
Any major transportation hub near an international airport could be the scene for a similar seeding of international spread," the researchers said. They recommended studying traffic patterns to see what cities might be vulnerable because of this.
In other words, if SARS arises from China again, and spreads from China and Hong Kong again, there would be heightened risk in cities that get a lot of flights from there.
Hawaii's lack of direct commercial passenger airlift from Hong Kong could actually be a good thing in this regard, insulating it from sudden spread of SARS to the islands.
Studies of coronaviruses in a number of animal species indicate that some of these viruses readily cross from one species to others, lending weight to theories that the SARS virus originally jumped from some natural animal host to humans, researcher said.
"Recent experimental studies have easily infected two animal species with the SARS virus, suggesting that the range of animal hosts where the SARS virus could 'hide' between outbreaks is much wider than initially suspected," WHO said.
Super-spreading events remain poorly understood, but the researchers believe they know more about rapid spread than they did during the outbreaks. In Hong Kong, for example, transmission was amplified in hospitals where certain aerosol-producing procedures, including the use of nebulizers, were performed during the earliest days of the outbreak.
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