NYT Article
Can SARS Be Stopped?
By LAWRENCE K. ALTMAN
Can the spread of severe acute respiratory syndrome be stopped and the disease eradicated from the world? Or will SARS join a long list of other infectious diseases that stay with us, entrenched, at some level, in most countries?
The answers are not clear. Although some experts contend that there is still time to stop SARS, others argue that it is too late for even the most effective quarantines to halt its march.
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Even in developed countries like Canada, where government officials say SARS is not out of control, some health officials have said that SARS is probably unstoppable.
Dr. Paul Gully, the senior director general of the population health and public health branch of Health Canada, said on Wednesday that SARS "probably is here to stay" and Canadians will "probably have to learn to live with it."
Dr. Gully also said that "we don't know when it will be over and if it will be over."
Dr. Jeffrey P. Koplan, the former head of the Centers for Disease Control and Prevention in Atlanta, said yesterday that doctors will probably never be able to eradicate SARS although they should be able to reduce the number of cases and deaths.
"What we can hope for is a suppression and minimization," Dr. Koplan told reporters in Hong Kong, where he is advising officials and scientists at Hong Kong University.
"To think that magically this government or any government or any scientist in the world could stop this, like you stop a car at a stop sign, is very unrealistic," said Dr. Koplan who now is vice president for health affairs at Emory University.
In many ways, the argument has some merit. Quarantines may not be 100 percent effective and can sometimes drive people with the disease underground, increasing the risk of spread. Also, at the moment, there is no effective treatment for SARS and, as a respiratory ailment, it can be much more difficult to control than disease spread through other routes, like blood.
But others, while acknowledging the difficulties and the many remaining unknowns about this new disease, still hold out hope.
Yesterday, two top officials of the World Health Organization refused to concede defeat and expressed hope that SARS could be contained if all countries maintained vigilance for the disease. SARS has to be viewed as a worldwide disease, not as one of any country, because its threat is so great to health care workers and systems in affected countries, the W.H.O. said.
"We don't really have a choice" except to use all available resources to prevent spread of the disease to more countries, said Dr. David L. Heymann, executive director of communicable diseases for the W.H.O.
Dr. Heymann also said the W.H.O. was deeply concerned about the possibility that SARS could become an added serious health threat in areas of Africa or Asia where AIDS is highly prevalent. The concern is that SARS could become another so-called opportunistic infection among the millions of people with weakened immune systems from the AIDS virus.
The current SARS death rate of about 6 percent would probably rise if SARS were to spread widely in third world countries that lack adequate supplies of mechanical ventilators and other medical equipment that are used to help support patients with severe breathing difficulties from the disease.
SARS has become such a burden on the health care systems of the countries in which it has appeared that the world "does not have the luxury of saying, Let's wait and see what it does," Dr. Heymann said at a news conference.
"We have a chance, we believe, to stop this disease if we all work together," Dr. Heymann said.
A main reason is that the pattern of spread of SARS, so far, has not been as vicious as influenza, which each year kills hundreds of thousands of people.
Nevertheless, Dr. Heymann said "our fear is that it will enter into a country where those systems are not so good to detect it, a country in sub-Saharan Africa or in Asia, that it will spread widely before we know it is occurring there."
