BY LISA TREI
The United States can best protect itself against global epidemics by bolstering the defense capabilities of its allies, university experts said last week.
"The lesson from SARS, when it come to biodefenses, is not so much what we need to do within the U.S. but what we need to do internationally," said Michael Lynn, a visiting fellow at the Center for International Security and Cooperation (CISAC). "The better able countries are in dealing with their own epidemics, the better off we are. SARS is a gentle reminder that our fate is intertwined with that of other nations."
Lynn, a physician, discussed the worldwide SARS (Severe Acute Respiratory Syndrome) epidemic at a panel sponsored by the Institute for International Studies on June 4. At the time, 8,300 cases of the contagious virus had been reported, 5,350 of which were in the People's Republic of China, where it first appeared last fall. John Lewis, professor emeritus of Chinese politics; Douglas Owens, associate professor of medicine; and Margaret Race, a biologist and visiting CISAC fellow, also participated in the lunchtime discussion.
Although the broader U.S. medical community has understood the significance of SARS as a new kind of disease, Lynn said he was skeptical of the level of understanding among Washington policymakers.
"They've been congratulating themselves we've done such a fantastic job in this country ... [that] we've done everything right," he said. "I would argue that is exactly the wrong lesson to take from SARS. I think we've been exceptionally lucky [that no one in the United States has died from SARS] and that this will come back to haunt us if we're not careful next fall and winter. If SARS follows the traditional appearance pattern of influenza, I suspect we will see a lot more cases at that time."
According to Owens, SARS could become a "very difficult" problem during the upcoming flu season because both illnesses share the same symptoms. This spring in Santa Clara County, he said, 90 people were classified as "pre-suspect SARS" because they shared a relevant travel history to an area hit by the disease, and had a temperature or a cough -- but not both. These people were quarantined at home for 10 days. Nationally, California has had the highest number of suspected and probable cases of SARS -- 68 -- with 25 of those in the Bay Area and 7 in Santa Clara County alone. "We're in one of the places where SARS has shown the most because it's an entry point for travel from Asia," Owens said. "The health community is quite tuned into this."
Despite such expertise, diagnosis of SARS -- which is untreatable -- remains difficult. "No one has said a good diagnostic test will be developed by winter," Owens said. "It's going to be a major problem." Developing an effective vaccine "could take years," he added.
Lewis, a veteran China expert, cautioned that SARS could proliferate in a manner similar to the deadly Spanish influenza pandemic of 1918-19. Although Western sources report that 22 million died from the disease, Lewis said, Chinese figures state a far higher 70 million deaths because "huge numbers of deaths in Asia didn't get reported."
China is particularly sensitive to the global outbreak of SARS, Lewis continued, because in the spring of 1917, tens of thousands of Chinese workers were sent to the Franco-German front to dig trenches during World War I. According to Lewis, workers carried the flu virus, which then spread to soldiers. After the Armistice was signed in 1918, soldiers brought the disease home with them and it quickly spread worldwide. Lewis said this experience helps explain why Chinese authorities, after initially failing to face the SARS crisis, have launched a full-scale military response to the epidemic.
In his presentation, Lewis gave a chronological overview of how SARS first appeared and proliferated in the People's Republic of China. Although high numbers of random deaths began to be reported in Guangdong Province last December, officials decided not to cancel New Year festivities in February. Millions of people then traveled throughout China during the weeklong holiday and helped to spread the so-called "mystery disease." When the first two deaths were reported in Beijing on March 19, the city's mayor and the country's minister of health decided to put suspected cases in 72 hospitals in the capital. "They were like petri dishes that spawned the disease all over the city," Lewis said. "None of these hospitals were equipped for a highly contagious viral disease."
With the escalating number of reported SARS cases causing worldwide outcry, Lewis said, the Chinese Politburo met in "full battle crisis" April 19. In the following days, officials canceled upcoming May Day celebrations, fired the health minister and Beijing's mayor, publicly reported sharply higher numbers of SARS cases for the first time and established a national headquarters for the prevention and treatment of the disease. Under a new nationwide command bolstered by high-tech communication, officials organized the construction of a 1,000-bed "battlefield hospital" north of Beijing in just eight days. "It was a national television event," Lewis said. "It was the most dramatic mobilization of medical and construction workers you can imagine."
When Chinese Vice President Zeng Qinghong visited the hospital a day before it opened April 30, he described the battle against SARS in military terms. "We are going to be like minesweepers on the battlefield and clear the mines together," Lewis quoted the vice president from his speech at the hospital. "Yes, we're going to clear the mines."
Since April, China's firm response appears to have helped stem the epidemic. For the first time in six months, Lewis said, no new cases of SARS were reported June 3 and 4. On June 5, international health officials in Beijing declared that the epidemic appeared to be winding down.
Nevertheless, Lynn said, SARS should be a "wake-up call" to the potential threat posed by future epidemics. "We want to keep diseases out of this country," he said. "SARS has shown it's great to be lucky -- but we have to ensure our luck the next time round." To do this, he said, the United States should help pay for stockpiles of medicines, antibiotics, vaccines and antidotes to be set up in allied nations.
While such stockpiles would be ineffective against SARS, Lynn said they could be critical in combating other deadly epidemics in an interconnected world. "The fact remains that a smallpox outbreak anywhere in the world, for example, in Paris, is going to guarantee an outbreak in New York," he said. "While the cost of providing biodefenses is quite high, I think the cost of doing nothing will be prohibitive."
Stanford Report, June 11, 2003