By Alan Zelicoff
Physician and Scientist
Sometime in the next few weeks the first anniversary of the beginning of the SARS outbreak will pass unnoticed.
This isn't because memories are short, or because the personal tragedies and economic impact of the epidemic were insignificant.
Because the phobic Chinese leadership in Beijing suppressed news of scattered cases of fatal respiratory illness in the fall of 2002 in Guandong Province, we don't know exactly when, where or how SARS began. Even its source— from an animal? from random mutation of a benign bug?— remains a mystery.
It was only when previously healthy individuals became severely ill in Vietnam, Taiwan, Singapore and Hong Kong— and doctors started calling for help— that epidemiologists at the World Health Organization in Geneva began to suspect that something unusual was brewing in the crowded cities of eastern Asia.
Despite the continued obsession with secrecy in Beijing— patients were literally moved from hospital to hospital to hide them from visiting WHO officials— once SARS spread beyond the mainland's borders, the disease was quickly detected.
What followed was nothing less than a minor miracle. Within three weeks the causal organism was isolated, its genome fully decoded, and its mechanism of spread identified. A diagnostic test based on antibodies generated during the course of illness in patients was developed and distributed worldwide.
Experimental treatment protocols were put in place (this was a new virus that had never before been known to cause serious respiratory disease in humans) and the WHO dispatched infection control and research teams to each of the epicenters of the disease.
Our SARS experience has turned some longstanding beliefs about the management of serious disease outbreaks upside down. Public health officials have long advocated enormous investment in new laboratory facilities in major population centers everywhere around the world in order to counter the arrival of novel, communicable organisms.
Bioterrorism experts believe that automated air and environmental sampling— an extraordinarily expensive proposition— is the essential next step in preparing for attack with anthrax or smallpox.
But the key to the successful containment of SARS was much simpler— the unfettered exchange of common clinical data via the Internet.
Laboratory scientists in Germany and the United States, physicians in Hanoi and Toronto, and public health experts in Geneva and in every location dealing with SARS (except China) solved a puzzle that in years past would have taken many months.
The staffs of the New England Journal of Medicine and the Centers for Disease Control, understanding the need for rapid dissemination of knowledge and embracing Internet technology for the first time, hosted a Web site forum for exchange of technical information. Perhaps most surprising of all, authoritative peer-reviewed papers from three countries were "published" on the Web site long before the printed version showed up in mail boxes around the world.
Even health officials in Taiwan, officially excommunicated from the WHO, received the crucial information they needed to wall off its own SARS epidemic from the Journal of Medicine's Web page.
Undoubtedly there will be resurgence of SARS in some places, and there will certainly be yet more novel viruses that afflict humans and animals, so complacency is inappropriate. But to limit the adverse impact the infectious diseases of the future, the world needs a widely distributed, inexpensive surveillance system that will reside on the computers and handheld devices that are becoming as ubiquitous in medicine as stethoscopes.
As patients with symptoms suggestive of communicable disease are seen, healthcare providers can report their conditions with a few taps on the screen while public health officials use readily available statistical tools to analyze the data in hours and provide timely advice to clinicians and national decision-makers.
Sens. Joseph Biden and Bill Frist envisioned such a system and drafted legislation in 2001— the Global Pathogens Bill— to fund it. But despite our latest wake-up call, the bill hasn't yet passed. The costs are a tiny fraction of monthly expenditures for new laboratory equipment and CAT scanners in the United States alone.
A few years ago when I served on the U.S. delegation to the Biological Weapons Convention in Geneva, I met informally with technical advisers in the delegations from Iran, Brazil and India and showed them a prototype disease monitoring system then in early testing.
After the demonstration was completed and scientific issues explored, I asked if the reluctance among political leaders to share potentially embarrassing information could be overcome.
"We must first have a major catastrophe to convince our leaders that infectious disease respects no borders. Once that happens, no one will be able to live without it," said my Iranian colleague, and the Indian readily agreed. Might SARS be a sufficiently loud warning?
Ironically, the lessons of mismanagement have probably been best learned in China, which still suffers from the SARS outbreak long after the last patient died or went home from the hospital. Uncertainty engendered by absence of information has hampered trade and investment there, just as happened in India in 1994 during an outbreak of plague that turned out to be a non-event. (It took months for paranoid officials to release the data).
But with or without the Chinese, much of the rest of the world has demonstrated a capacity to overcome political barriers when a major infectious disease threat appears. It is hard to imagine a better time for Congress to pass Biden's bill.
We may continue to dally, but we can be certain that next killer virus won't.
Alan Zelicoff is research professor in the Department of Political Science at the University of New Mexico. The opinions expressed here are his own.
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