Bracing for a Second Round of SARS

New report says U.S. not prepared for an epidemic

FRIDAY, Dec. 5, 2003 (HealthDayNews) -- When the viral respiratory illness that came to be called SARS first surfaced in Asia last winter, public health officials in hard-hit nations had no way of knowing how quickly they'd have to scramble to contain the epidemic.

Before it was brought under control, the outbreak had lasted 114 days, sickened approximately 8,098 people, and killed 774 individuals worldwide. In the United States, there were an estimated 192 cases, with no deaths.

Now, a new report suggests this country isn't fully prepared to handle a major SARS outbreak. The analysis, commissioned by the U.S. Centers for Disease Control and Prevention (CDC), cites several shortcomings, including a lack of public health doctors and nurses and epidemiologists to effectively deal with a significant outbreak.>

"We're taking a look at the report and taking it under advisement, says Von Roebuck, a spokesman for the CDC.

The report, released this week, was prepared by researchers at the University of Louisville.

Last spring, public health experts worldwide breathed a sigh of relief when the World Health Organization officially declared the epidemic contained. But they knew that SARS -- for severe acute respiratory syndrome -- could become a recurring scourge.

"To our knowledge, there is no known transmission of SARS in the world" right now, says Dr. Umesh Parashar, lead medical officer of the CDC's SARS task force, which was created four months ago.

"Whether SARS will return or not is not an issue that is resolved at this point," he adds. "There is a possibility that SARS might have a seasonal pattern. It's also possible that SARS may never return."

Nonetheless, CDC officials, working with state and local public health officers and hospitals, have been drawing up preparedness plans in case an outbreak strikes the United States.

SARS is mainly spread by close person-to-person contact, the CDC says. The virus that causes it is thought to be transmitted most easily by respiratory droplets, produced when an infected person sneezes or coughs. Or, a person can become infected by touching an object or surface that bears the infectious droplets and then touching his or her mouth, eyes or nose, the CDC says.

The disease typically begins with a fever higher than 100.4 degrees Fahrenheit. Headache, body aches and overall discomfort can also occur. A week or less after exposure to the virus, a dry cough may develop. Most patients also catch pneumonia. There is no specific treatment, the CDC says.

While no one can predict if SARS will return, Parashar says the first outbreak could prove mild compared to future ones. "If it does happen again, we may be dealing with a more serious situation, with a larger outbreak," he says.

The U.S. campaign to prepare for another outbreak has many components, Parashar says. "We have been working very closely with hospitals and state and local health departments, for developing guidelines on how to screen a person" to see if they are infected, he says. That should help public health officials identify more quickly the extent and seriousness of an outbreak and take needed measures, such as quarantines, he says.

"The other key activity has been improving hospital preparedness," he says. "We are working with various hospital and medical associations, to work through detailed steps in developing a SARS preparedness plan for a hospital setting."

The plan addresses numerous issues, Parashar says, including early detection, infection control, and appropriate handling of patients, such as isolation or quarantines.

The American Hospital Association (AHA) has been actively involved in the preparations, Parashar says.

Roslyne Schulman, the AHA's senior associate director for policy development, says, "Hospitals deal with infectious disease all the time." However, the CDC plan for SARS calls for a more rigorous response, she says.

If SARS is suspected, the patient would be isolated immediately, Schulman says. "They would be asked a series of questions," she says, such as details about any recent travel to a SARS-infected area. The hospital would also increase surveillance of other patients for SARS-like symptoms.

"I think we now have a much better understanding of how SARS is transmitted. So, that being the case, hospitals can better contain it," she says.

In addition to hospital preparedness, the CDC response plan for SARS has included efforts to improve lab diagnostics to confirm the presence of the disease. During last winter's epidemic, most of the testing was done at the CDC. "Now most of the states, close to 100 percent, have everything they need to do testing themselves," Parashar says.

Despite those steps, the new University of Louisville report concludes that more work is needed to ready the nation for an outbreak. The researchers based their assessment on how hard-hit nations -- Canada, China, Hong Kong, Singapore, Taiwan and Vietnam -- dealt with last year's outbreak.

Among the report's conclusion's -- the current shortage of public health-care workers would lead to a lack of caregivers if a SARS epidemic struck the United States.

The researchers also suggest there should be more discussion about states' ability to limit the travel of infected persons. While federal statutes spell out how Washington, D.C., can control such travel, the states' powers aren't well-defined, the report says.

Another priority, the Louisville researchers say: Keep the public informed about any emerging epidemics, anywhere in the world.

What can people do to help the effort?

"The key thing would first to stay aware of current developments," Parashar says, noting that the CDC's SARS Web site is a good source of information. Know if and where SARS reemerges, he says. Get the latest information, Parashar advises, "especially if you are traveling."

More information

To read the draft version of the new SARS plan, visit the U.S. Centers for Disease Control and Prevention. The agency also has plenty of information about SARS.

SOURCES: Umesh Parashar, M.D., lead medical officer, SARS task force, U.S. Centers for Disease Control and Prevention (CDC), Atlanta; Von Roebuck, spokesman, CDC, Atlanta; Roslyne Schulman, senior associate director, policy development, American Hospital Association, Washington, D.C.
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