SARS Under Control, But Could Return-WHO
Exact source yet to be pinpointed
KUALA LUMPUR
The SARS outbreak may be coming under control but there remains a high risk of resurgence, the World Health Organization has warned while admitting that scientists had not yet pinpointed the cause of the epidemic.
Despite studies linking the severe acute respiratory syndrome (SARS) to animal hosts, WHO director general Gro Harlem Brundtland said the coronavirus found in animals was "not exactly identical" to SARS and knowledge of the virus was still sorely lacking. "We can draw the curve. It is very positive but that does not mean it is all over," she said after wrapping up a WHO conference on SARS attended by more than 1,000 scientists, doctors, and officials June 17 to 18 in Kuala Lumpur.
She added: "We need to be vigilant to avoid a recurrence in places where the disease has already tapered off or is gone so that we don't have a reentry. We cannot become complacent because we think it is all over. As long as the virus is there and as long as patients are carrying the virus, it can be spread and as you know, there are a number of cases still."
WHO officials said China, where SARS originated late last year, held the key to containing the disease and public awareness was crucial amid fears that SARS could resurface during winter.
"It may be prevalent in winter but it dies out in summer and it may come surging back in Hong Kong and Guangdong province [where it first started] in November," said WHO official Dick Thompson. "In the absence of a diagnostic kit or a remedy and vaccine, there's only one way to contain this disease and that is through public awareness."
Glaring Weaknesses
On the first day of the conference, Brundtland said "unprecedented international solidarity" and vigilance had stopped SARS from becoming endemic.
But the outbreak also exposed glaring weaknesses in health-care systems worldwide and the countries' poor capacity to deal with emergencies, she said. "SARS will not be the last new disease to take advantage of conditions in the globalized world," she warned. "In the past two decades, new diseases emerged at the unprecedented rate of one per year and this trend is likely to continue. It is in our interest to strengthen our defenses against infectious disease threats in all dimensions."
The most compelling lesson the world must learn from SARS is the need to "report promptly and openly cases of any disease with the potential for international spread," she said.
Brundtland said the epidemic remained a challenge in Beijing and parts of China but "it is being dealt with very systematically." Despite its earlier move to conceal information on SARS, she said China's change of tack to become more transparent was an "important historical phase of development."
"I think it's a real breakthrough what has happened. It's not only China that could react this way but many other countries as well," she said.
But she said the world has learned a hard lesson from the damage caused by SARS and she believed states would be more open in the future. "Improved surveillance and reporting systems, mechanisms for collaborating research, hospital policies, procedures for infection control, and reforming and educating the public are part of the positive legacies of SARS," she said.
Artificial Source
Hume Field, a veterinary epidemiologist with the Animal Research Center in Queensland, said that further tests on animals in the wild were needed to obtain a true picture of the virus source. Current studies were based on "artificial sources" as animals were taken from the marketplace and not from the wild, he said. "The information that we have certainly leans to animal sources but it is premature to make conclusions," he added.
Experts said that SARS transmission could be halted provided there was no "asymptomatic reservoir, no chain infection and no seeding to new settings such as Africa." They called for accelerated efforts to develop diagnostic test kits that were sensitive and affordable, for stronger political will to boost health care, and for countries to share their SARS database more openly.
Delegates to the conference agreed that the SARS epidemic, which has killed nearly 800 people worldwide, was a "wake-up call" for countries to invest in public health care and correct structural deficiencies.
"It's too early to be overconfident. We have some way to go but I think the SARS has been a good wake-up call. It has alerted people to deficiencies, it will help us to plan better for the next one," said Alan Schnur, a WHO representative in China.
Dan Rutz from the Centers for Disease Control and Prevention in Atlanta added: "Infectious diseases are here to stay. We can't be complacent and pretend SARS will go away forever. New diseases will come and we have to be on our guard."
But upgrading health infrastructure comes at a cost and drawing workers to public health care where salaries are four to five times lower than in the private sector is a key problem.
Mohamed Said Patel, a consultant to the WHO Western Pacific office, said the world must "capitalize on the SARS outbreak and use it to lobby politicians and donor groups to give funding to strengthen preparedness."
"You can't strengthen preparedness for an outbreak unless you strengthen day-to-day routine structures in public health. While everyone agrees on preparedness, no one has put in the money," he said. "I think it's a shame to call SARS a blessing in disguise but if that's the best word that we have, then absolutely yes, it is," he added.
This was echoed by Brundtland, who urged rich nations and big corporations to raise investment for research, saying "the WHO is not a sack of money." She said significant military spending on medical research in some countries could also be marshaled towards broader public health investment.
The WHO chief also warned that travel advisories would be used again if the SARS virus returns. But she said there was a need for a "global agreement" on travel curbs to avoid unnecessary disturbances to international travel such as seen in sweeping restrictions imposed by some countries.
Asia Ill-Prepared for Epidemics
KUALA LUMPUR
Asia, which bore the brunt of the SARS epidemic, was ill-prepared to face new outbreaks due to a lack of commitment and resources, according to a senior WHO official.
Hitoshi Oshitani, WHO regional adviser in communicable disease surveillance and response, said the region appeared to have "crossed to the end of the SARS outbreak" in terms of new cases. But its disease surveillance system remains poor, infrastructure is weak, hospital control measures far from satisfactory and trained personnel in epidemiology and research work are lacking, he said.
"Things have improved dramatically over the past three months but we are still not well prepared for the next round. A lot of work needs to be done," he told AFP on the sidelines of a two-day SARS conference here.
"The surveillance system is not in place in many countries in the region. Hospital infection control is still weak in most countries and the health infrastructure is not strong enough to fight against these kinds of diseases. We need a very sophisticated system."
He said a "lack of commitment has resulted in a lack of resources" to fight SARS.
"Not only governments but the donors are not interested in these kinds of general programs to strengthen the surveillance mechanism in the region. It will take time," he said.
Oshitani cited China, where 346 SARS deaths have been recorded, as a key priority for the WHO. "China is one of the priorities. It faces basic structural problems. There is no centralized information collection system and many provinces lack resources," he said. "They need to improve their surveillance and build more capacity at the provincial and central level. These are long-term issues and we have to support China to build such capacity."
The WHO expects to have a clearer picture of the SARS outbreak late in the year, he added. China's vice health minister Gao Xiang said that the country had paid a heavy price as the SARS outbreak laid bare its fragmented health-care infrastructure, inadequate alert system, and insufficient laws.
But he said Beijing had learned its lessons and taken firm steps to strengthen its legal framework, upgrade its health and surveillance systems, and implement strict infection control measures. "SARS is a common disaster for mankind and China is its biggest victim. We have lost a lot but we have also learned a lot," he said. "However, the work of eliminating SARS is far from completed and the task of preventing a resurgence of the spread of SARS is still heavy."
Eileen Ng, AFP
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