We don't know if all patients infected with the virus become seriously ill. We don't know how it is transmitted in all cases. We do know, however, that it is highly infectious and that the virus responsible is a "new" virus previously unidentified. Such a "new" virus is probably an animal virus, bred in the congested piggeries and poultry barns in China, that has mutated slightly and thus become infectious to man. Mutations come about because of faulty replication processes or damage to DNA that alter the genetic code of an organism. Most such mutations are meaningless, but occasionally the change permits an activity because host organisms can't recognize the new organism and have no innate immunity.
The situation is reminiscent of the time red measles (rubeola) was introduced into the aboriginal communities of North America. People perished at rates much higher than in the Europeans, who had a herd immunity. The current world populations will be like those aboriginal populations, much more susceptible.
Foci of infection have been linked to a certain housing complex, to a hotel, and to an apartment building. In Toronto rapid spread through the hospital system has resulted in closure of some units and the deaths of several doctors. Also, the spread into a religious order has resulted in mass quarantine of large numbers of people. It would appear that health authorities in Beijing tried to play down the extensiveness of the epidemic, and they have been fired.
As I write (April 20, 2003), I am well aware that by publication date my data will be old and may require correction. Currently the virus responsible is recognized as a "corona" virus of a RNA type not previously identified. There is no specific medicine for this disease. About 10 percent of those contracting the disease become critically ill, and about 6 percent have died. In Canada, despite state-of-the-art facilities in Toronto, the death rate is twice the world average. At the time of this writing, about 35 confirmed cases exist
in the USA, yet no deaths have occurred.
The potential for disaster is what all the "fuss" is about. In your question you ask what about HIV/AIDS, heart disease, and diabetes. Patients with these disorders are precisely the ones who would be smitten most severely were they to contract SARS. It doesn't require much imagination to envisage the nature of an epidemic of SARS should it rampage among Africa's 25 million whose immune systems are compromised by AIDS.
Without specific treatment, management becomes supportive. So intense is the infection that health care will be swamped out-that is, if the epidemic cannot be contained.
Rather than disputing the seriousness of the outbreak, we would be wise to preemptively reduce its potential, because its potential is the major threat at this time. Most cases have occurred as a result of face-to-face contact with a SARS patient. It is wise to be aware, though not anxious. These measures may be helpful and are suggested by many authorities:
1. Avoid unnecessary travel to affected areas.
2. Avoid, if possible, crowded situations in which mixtures of diverse populations are present such as airplanes, airports, and, if in Asia, mass transit systems. Some suggest the wearing of a mask (infection in droplets sneezed or coughed into the air can spread the virus).
3. Wash one's hands frequently, especially after contact with other people's hands or public surfaces; for example, those in restrooms. The use of alcohol hand disinfectants may be useful.
4. Avoid meetings that bring large groups together from many locations, especially from places like Hong Kong, Singapore, Toronto, and most parts of eastern Asia.
It is with sadness that we report the death of a faculty member, Hugo Wong, from our Hong Kong Adventist College in Hong Kong, to this disease.
In light of this epidemic, many Adventist meetings in the Southern Asia-Pacific and Northern Asia-Pacific divisions have been postponed. Not because any individual is frightened, but because an outbreak among the world leadership could contribute to devastating spread around the world, massive closures, and quarantine restrictions. Such restrictions indicate our awareness of our civic and public health responsibilities.
A vaccine will take at least a year to formulate, though diagnostic tests probably will be available much sooner. It goes without saying that prevention is always better than cure. The "fuss," as you call it, is probably better worded as "precaution," and the life saved is always one of God's loved ones.
Much of the security against the international spread of disease comes from the International Health Regulations of the World Health Organization (WHO).
When cholera epidemics overran Europe between 1830 and 1850, multilateral cooperation in public health became relevant, and the first International Sanitary Conference was held in 1851 in Paris. One hundred years later, updated regulations were adopted by the WHO member states. In 1969 they were renamed the International Health Regulations, and in 1973 and 1981 they were modified.
Though of the six diseases-cholera, plague, yellow fever, smallpox, relapsing fever, and typhus-only the first three are today notifiable, the principles of their containment still apply to a disease like SARS.
The good news is that travel restrictions, awareness, and the big publicity coverage given to the disease appear to be working. Epidemic curves at the time of this writing show that world-wide (and in most countries) the numbers of new probable cases has declined from a peak in the end of March and beginning of April, to lower levels by mid-April. By the time you read this, the disease progress will be much better known. Let us hope and pray containment takes place, or else we could be facing very stringent controls.
Updates on SARS are provided by many agencies. An easy route to access them is to go to www.health20-20.org where links are provided, along with an update on SARS from time to time. As I write, the total number of cases is reported as 3,861 worldwide, with 217 deaths. That can be a reference point when you check the new status after reading my response to you.
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Allan R. Handysides, M.B., Ch.B., F.R.C.P. (c), is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of health ministries.
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While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.
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