SARS 10 Years Later: Are We Better Prepared for Outbreaks?

SARS raised the worldwide alarm for how vulnerable we are to disease epidemics. Did we learn our lesson?

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Bobby Yip / REUTERS

A passenger wearing a mask to ward off the SARS virus waits at a bus stop in Hong Kong on May 26, 2003.

SARS raised worldwide alarm a decade ago as it highlighted how vulnerable we are to disease epidemics. Did we learn our lesson?

In February 2003, in the French Hospital in Hanoi, Vietnam, an infectious disease specialist with the World Health Organization attended to a Chinese-American businessman who fell severely ill and needed a ventilator to keep him alive. The patient was transferred to Hong Kong, where he eventually died. Before he was moved, however, he infected dozens of health care workers, including WHO physician Carlos Urbani.

It was Urbani who noted the outbreak among his fellow workers. And he was the first to recognize that what was making them sick was an entirely new disease.

That ailment turned out to be SARS, severe acute respiratory syndrome. In just over a month, it would claim Urbani’s life as well. Ultimately, SARS infected thousands of people, killing more than 700 and costing $30 billion in losses, as businesses and travelers shuttered themselves out of fear of getting infected. The epidemic was a wakeup call, says Dr. Thomas Frieden, director of the Centers for Disease Control. As sobering as it was, it could have been much worse, he says. Frieden spoke to Healthland about how we got lucky in 2003.

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How vulnerable are we to epidemics like SARS?

We really are all connected by just an airplane flight. It only takes one person at the wrong place, at the wrong time, for an explosive outbreak to take place.

What do you mean when you say that SARS could have been much worse?

SARS is really a cautionary tale for today. We face what I describe as a perfect storm of vulnerability. We have emerging infections, drug-resistant microbes, globalization of travel, and increasing ease of creating threats in the lab. We got lucky that that none of the cases in the U.S. came from a super-spreader, that it was controllable in the early stages, and that we acted aggressively to isolate the suspected cases.

What lessons could we learn from SARS?

I think there are five things from 2003 that are relevant today. First, diseases emerge from anywhere, and if countries aren’t alert to them, we are all less safe. We are working hard with the WHO to increase adherence to the International Health Regulations. Adherence means that a country has a robust system to find and stop outbreaks and stop health threats. But only 20 countries are compliant.

In the case of SARS, the first case was in Guangdong months and months [before it was noted by Urbani]. One of the most important things we can do is to train epidemiologists in other countries on how to find and stop outbreaks before they spread.

Second are health-care associated infections. Health care workers have to know if they are infected, and we have to train them to take proper precautions to protect themselves and patients. If Urbani hadn’t sounded the alarm, for example, how much longer, further, and wider would SARS have spread?

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Third is the mystery [and our lack of understanding of] the super-spreader. We were lucky with SARS that we didn’t have super-spreaders, because there is a lot we don’t understand about them. As a tuberculosis doctor, I know that the phenomenon of super-spreaders has been around for a long time, where after doing sophisticated testing, they found that a few patients accounted for most of the infections. There is something to the idea of the super-spreading concept, but we still don’t understand it well enough.

Fourth, we need to continue investing in tools that allow us to identify pathogens as quickly as possible. What’s exciting is that we now have advanced molecular detection. These are fundamental ways to detect change in drug resistance and virulence. We need to go past the era where we waited weeks for a culture to test samples from patients. With next generation tools, we should be able to do that in hours, not days or weeks. But we need to invest in these technologies.

How can these new technologies help?

With these tools the CDC can find smoldering disease outbreaks we may currently be missing; we can solve disease outbreaks faster to protect communities, and we can better protect our food supply against infectious threats. With molecular-based science and bioinformatics we can also predict patterns of disease spread in real time to stop transmissions. And we can more effectively tackle microbial resistance before they spread.

And the fifth lesson we learned?

It’s the economic lesson. SARS killed hundreds of people — none in the U.S. — but cost billions of dollars for companies and airlines, and caused a dip in GDP for some countries. So we need to make sure that every country in the world has the ability to find, name and diagnose an emerging infection, with the help of the global health community. We have the potential for using innovations in molecular epidemiology, big data, and rapid communication to take some of these potential threats off the table.

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Are we now better able to fend off a threat like SARS, or whatever else may emerge from the microbial world?

Without a doubt, we are better prepared today than we have ever been, thanks to better coordination globally and the molecular innovations I mentioned.

But ironically and paradoxically, we are also at higher risk because global travel and trade bring new health risks to our door every day. We need to be able to detect and diagnose health threats in real time.

Do these threats make it easier to convince the public to take infectious disease seriously, and invest in making sure we’re prepared for the next outbreak?

It’s a double-edge sword. The public is certainly more attuned to risk. On the other hand, we’re still not investing adequately in this on a global basis to take some of these risks off the table, to protect businesses, patients and health care workers form the next pandemic.

Without question, future mystery illnesses will emerge. The questions will be the same — what is causing the illness, where did it come from, can it be contained, who is at greater risk? The cost in lives and economic upheaval from future mystery illnesses will depend in part on how quickly we can detect the threat and answer the questions of life and death.

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