SARS: Are We Ready?

The

27-year-old doctoral student who tested positive for severe acute respiratory syndrome (SARS) in Singapore last week was probably a one-off case, according to Singaporean officials, possibly caused by an accident in the disease-research lab where he worked. The World Health Organization (WHO) said the case was "not an international public-health concern." But Singapore's stock market dropped 2.6% in a day, temperature checks at various airports were revved up, and the region got an early warning that SARS could make a comeback.

Is Asia prepared for another epidemic? The news on some fronts is heartening. Airports have invested in health-screening devices, and hospitals in areas hit hard by the virus first time around have acquired quarantine facilities and equipment needed to protect hospital workers. For example, in Hong Kong, where hospitals were initially overwhelmed by last spring's SARS outbreak, more than 500 isolation rooms capable of housing some 1,300 SARS patients will be completed by November. China's Guangdong province, ground zero for the virus, is spending more than $180 million to rebuild the provincial Center for Disease Control and add isolation rooms to hospitals. Properly prepared health facilities are key in keeping a minor outbreak from becoming a big one—SARS spread most rapidly among medical workers. "Without the trauma in hospitals there would have been no major outbreak last time," says Dr. Hitoshi Oshitani, the WHO regional adviser for communicable disease.

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Another important step is readying the "software" of disease control: an open, international surveillance network capable of quickly identifying the first cases. The biggest problem there is that the symptoms of SARS are so variable, making it hard to spot. Singapore's newest patient, for example, had a fever and a dry cough but lacked the telltale pneumonia of most cases. Even the best early diagnostic tests are slow and at most 80% reliable. The good news is that China, which tried to hide the extent of its outbreak last spring, has a new attitude. Guangdong has begun regularly sharing its infectious disease data with Hong Kong, and the WHO is helping to set up a national SARS surveillance system that will streamline medical reporting.

Vigilance is essential. Medical researchers say there is a good chance SARS is laying in wait and could resurface during winter months. One reason: civet cats and other wild animals that tested positive for the virus and could be its original source are still on sale in Chinese markets. The virus could also be inadvertently released in a lab accident, as may have happened in Singapore. Dr. Henry L. Niman, a bioengineer at Harvard University, suggests that even now the virus could be spreading undetected through people who carry it without developing symptoms, only to become deadly again during the colder months. (Scientists theorize that SARS cases might spike in the winter, as cold and flu viruses do.) Like a Trojan horse, the revitalized virus could produce a sudden spate of cases, challenging even the best-prepared health-care systems. That's a worst-case scenario, but managing Asia's next medical crisis will require determination and imagination.