Medical Victory
No cure or vaccine, but the battle against SARS is a remarkable achievement
By Richard Ingham
Agence France-Presse
PARIS
The most memorable events in medical history are those when terrifying diseases are suddenly vanquished-when antibiotics slew plague and tuberculosis or new vaccines miraculously shielded us from polio and smallpox.
If history were written by the winners, what can be said about the fight against severe acute respiratory syndrome (SARS)?
After all, this new, scary, lethal pneumonia-like disease has no cure and no vaccine. As far as is known, it has only been suppressed, not eradicated, and some fear it will rebound, possibly in a more vicious form. Even so, the opening battle against SARS should be justly enshrined as one of medicine's great victories.
Never before has a new disease been identified so quickly. And never before have scientists and governments around the world reacted to an emerging threat with such speed, vigor and collective will.
In a dozen top laboratories, experts set aside their traditional competitiveness and unselfishly pooled their knowledge.
Less than six months after SARS emerged in China-the early cases were kept secret, with disastrous consequences-the disease was pinpointed to a new form of coronavirus, making it a cousin of the common cold.
The virus's genetic code was then cracked open, paving the way for scientists, backed by lavish funds, to devise diagnostic tests and hunt for weaknesses that can be attacked with drugs and vaccines.
This is a remarkable achievement.
The tale of almost any other new, dangerous infectious disease is marked by ignorance, superstition, underfunding, selfishness, national pride, and social prejudice, all of them a fertile ground for creating a pandemic.
In half a year, SARS achieved a level of cross-border cooperation that took the AIDS campaign "seven, eight, 10 years or longer," lamented Seth Berkley, president of the International AIDS Vaccine Initiative (IAVI).
"We have learned that in an emergency health situation, introverted, competitive scientific research or academic research is not going to be the solution to controlling an emerging disease efficiently," said Klaus Stohr, a SARS fighter at the World Health Organization, which coordinated the battle.
As for prevention, governments around the world set in place quarantines, travel advisories, and health checks at frontier crossings.
The planet had to relearn basic hygiene and revive old-fashioned methods of isolating sufferers, noted former WHO head Gro Harlem Brundtland. "We're so used to there being an answer to everything, that there is either a medicine or a vaccine," she said.
For all that, the war against SARS will never be more than half-won until key questions are answered, say experts. Among them:
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How exactly does the SARS virus work? How does it travel to the lung and infect it, and is it helped by a secondary infection? What amount of virus is needed to infect someone, and why are some people more vulnerable or infective than others?
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Is there a natural reservoir for the virus? Some evidence suggests some species of wild animals, notably "exotic" mammals eaten for food in southern China, may harbor the SARS virus or something akin to it. If so, it means the threat from SARS will never disappear without a cure.
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How far can the virus mutate, thus making it a "moving target" for vaccine engineers? So far, the evidence is that SARS virus does not mutate significantly, but the data are not conclusive because so little time has elapsed since the agent was first identified.
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The SARS virus is known to be transmitted in large respiratory droplets delivered in proximity, such as by coughs or sneezes. But to what extent, if at all, can it be transmitted by droplets in the air, on surfaces, in water, or sewage?
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Can someone be a "silent carrier" of SARS, in other words carry the virus and infect others, but not have any of the typical symptoms of fever, muscle ache and headaches? "Right now, everyone's overwhelmed with clinic cases. I don't think that's been adequately investigated at this stage," said Linda Saif, an Ohio State professor and an expert on animal coronavirus.
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