SARS Has Spared the U.S.,
But Might Luck Run Out?
Mix of Mild Cases, Early Warnings, Luck
Has Kept It in Check; Doctors Still Worry
By BETSY MCKAY and MARILYN CHASE
Staff Reporters of THE WALL STREET JOURNAL
What has spared the U.S. from a more violent outbreak of SARS? A blend of sheer luck, mild cases, solid public health and advance warning. But there is no guarantee that good fortune will last.
With just 39 probable cases of SARS, the U.S. has avoided the worst effects of the respiratory disease. While the death toll is mounting in Asia and in Toronto, not a single person in the U.S. has succumbed. Few have been hospitalized. It's not even clear that all the reported incidents in the U.S. were actually SARS -- some already appear to have been cases of the common flu.
Part of the explanation is that the U.S. was able to get out ahead of the spread of the virus. By the time the World Health Organization issued its first warnings about SARS on March 12, the virus had yet to show up here. By contrast, a Toronto woman -- who had stayed at the same hotel in Hong Kong where the disease first erupted outside of mainland China -- had already brought it to Canada. She grew ill and infected her son, who passed it on to several others in the hospital where he went for treatment. Both mother and son died.
"We had the fortune of knowing about it ahead of the countries that got hard hit," says Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Md. "By the time it got here, we knew it could spread to health-care workers and person to person."
The Centers for Disease Control and Prevention threw itself into emergency mode two days after the WHO warning, and has made early detection and containment a priority since then. The Atlanta agency, criticized for its handling of the 2001 anthrax attacks, has met over 2,000 flights arriving in the U.S. from Asia over the past month, handing out yellow health-alert notices. The notices, in eight languages, describe symptoms of the illness -- fever accompanied by cough, or difficulty breathing -- and warn travelers from affected areas, such as China and Toronto, to monitor their health for 10 days. The health alerts are also handed out to people arriving by ship from affected areas, and four border points between the U.S. and Ontario, Canada.
The CDC has also urged doctors to get patients out of the way of others quickly -- and has asked SARS victims, or those believed to be victims, to isolate themselves at home for 10 days once they are discharged. "We are specifically advising travelers or others who know they have been in contact with SARS patients to not just show up in the doctor's office, but to call ahead," says Julie Gerberding, director of the CDC.
None of this means the U.S. is safe from a more severe outbreak in the future. "We're still in the midst of an evolving epidemic," says Dr. Fauci. "It could blow up tomorrow."
While good public health can moderate the impact of SARS, only a vaccine can control it -- and a vaccine could take years to develop.
As of Wednesday 105 people in Hong Kong had died of SARS, or severe acute respiratory syndrome. Revising their method of calculating mortality rates, Hong Kong officials said that the current rate is now 13.8%, far above earlier estimates of less than 5%. Altogether, the city has reported 1,458 cases of the virus.
Health officials say there is no evidence that the strain of coronavirus, which is believed to be the source of SARS, is different in the U.S. from elsewhere. Donald Burke, professor of international health and epidemiology at Johns Hopkins School of Public Health in Baltimore, says that so far timing and geography have given the U.S. a temporary advantage. If SARS is what it appears to be -- a seasonal disease like the flu -- the U.S. was fortunate this year in catching the tail end of the infection.
Another factor that may have helped: the absence of "superspreaders" -- infected people who transmit the disease to many others. So far, none have been found in the U.S., though it's not clear why.
Health experts say harsh medicines tried on patients in Hong Kong and Canada, such as a cocktail of ribavirin and steroids, may have made some patients there worse. But that hasn't been an issue in the U.S., because most patients here haven't been sick enough to need the drugs.
In fact, some reported cases already apear to be something other than SARS. Testing by the CDC of a sample from one of Colorado's two probable cases came back negative for coronavirus, says Ken Gershman, manager of the communicable disease program for the Colorado Department of Public Health. While the tests are still being refined and therefore not always foolproof, the results "strongly suggest" that the patient, a woman in her 30s who had traveled to Asia, didn't have SARS after all, he says.
Nor is the disease spreading like it has in Hong Kong, Singapore and Toronto. Of the 39 listed cases, all but two traveled to Asia or other affected areas, meaning they probably contracted the disease on their trips, according to the CDC. The remaining two are people who had close contact with SARS patients here: a health-care worker, and a "close contact," the CDC says. |
