Coping With SARS
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JIM LEHRER: Dr. Heymann, welcome.
DR. DAVID HEYMANN: Thank you.
JIM LEHRER: How would you describe the state of the SARS epidemic right now?
DR. DAVID HEYMANN: Well, right now there are two important aspects to the epidemic: The epidemic itself and also the political commitment that’s building throughout the world to stop this disease from spreading. The epidemic is now being contained in certain areas, we believe. For example, Vietnam now has been 23 days without any transmission of the virus within the country, which to an epidemiologist, to people who study diseases, means that the disease has not… is no longer transmitting in Vietnam, and is gone from Vietnam. Hong Kong and Singapore and Toronto are making great efforts, also, and we believe they’ve seen a peak in the number of cases that will occur in those countries and that they’re on the down slope as well. But it will take time in those countries and the disease is still with us.
The big question on the epidemic front is China. We know that China has many, many cases throughout the country, increasingly reporting cases, and our concern is that there may be cases in the western provinces. And if that’s the case, the health systems there are weaker than in the rest of the country, and we may have a serious problem.
On the other aspect of the epidemic, the political aspect, the heads of state of the ASEAN countries, plus China and Hong Kong have just met two days ago in Thailand. I attended that meeting, and at that meeting there was a great commitment of these leaders, these heads of state to continue to fight this epidemic and to put it back in its box rather than have it continue as an endemic disease like TB or malaria or AIDS, one that’s with us in the long term.
JIM LEHRER: So you believe that it’s possible to take actions now to stop SARS as becoming a permanent disease in the world?
DR. DAVID HEYMANN: We have no choice but to try. We don’t know the answer to the question, but if we don’t, it may be that one or two countries continue to have this disease and continue to export it around the world causing us all to have problems in our health systems, because health workers are the first people that are attacked by this disease.
JIM LEHRER: Now let’s go back through some of the countries. For instance, Hong Kong now, Hong Kong is still reporting new incidents of the disease regularly, is it not?
DR. DAVID HEYMANN: That’s right. Today, Hong Kong has reported 11 cases. But that’s many, many cases less than they were reporting at the height of their epidemic, which was sometimes up to 40 cases per day. So we see that even in the area where there was another means of transmission, something in the environment, they’ve been able to tackle this disease and bring the incidents down and we hope continue on a downward path.
JIM LEHRER: Where you are now, in Toronto, what’s the spirit… we have a report, a wire report that there were two new cases there today. Is that correct? Can you confirm those?
DR. DAVID HEYMANN: That’s correct. The government has announced two new cases, but these are cases that are in health workers. So that’s good news in the fact that they aren’t cases in the community. And the second important fact about these is that these cases may have originated three to ten days ago, because that’s the incubation period of this disease. This doesn’t in any way change the recommendation that we’ve made that Canada is no longer on our list of countries to which travel should be postponed.
JIM LEHRER: In retrospect, did you all make a mistake by even warning people about… with your original warning about travel to Canada and particularly Toronto?
DR. DAVID HEYMANN: No, WHO didn’t make a mistake in making recommendation no travel to Toronto. This was based on the evidence, on three factors: On the prevalence of the disease in Toronto; on the fact that there was local transmission when we made our decision, transmission out of the health care system; and the third fact was that they had been exporting cases out of Canada into other countries.
JIM LEHRER: But what about, the credibility of WHO has been questioned on this, because you issued the warning, and then in less than a week, you took it away. And people say, “how could that be? How could it be so severe and then suddenly disappear?”
DR. DAVID HEYMANN: Well, we’ve used the term that most people use in epidemiology, the end of a transmission period is based on two of the maximum incubation periods of a disease. So two times ten, which is the maximum incubation period we believe for SARS is a period when we expect a country not to have transmission.
And in the case of Canada on Monday, this past Monday, they had been 21 days without local transmission in the community, although there was still transmission going on in health workers. That was one of the criterion. We were able to remove that from the criteria list.
The other was the exported cases, and the exported cases had occurred in late March and early April, and there have been no more confirmed exported cases. So that was the other criteria that we were able to remove from our list. And therefore, we could downgrade Canada. This was done based on the evidence.
JIM LEHRER: You’re comfortable with both decisions, the decision to impose it and decision to withdraw it?
DR. DAVID HEYMANN: In a disease which is spreading rapidly around the world which we’re trying to contain and trying to prevent from becoming endemic, we have to make maximum recommendations in order to do the job. And if this disease is exported from any country into a developing country which doesn’t have a health system to detect and respond to it, the world will continue to have this disease for a long time.
JIM LEHRER: Now let’s talk about China. That is really the heart of the problem right now, is it not?
DR. DAVID HEYMANN: China is the heart of the problem, and it’s the key to our success or failure. We believe that China is now addressing the situation. They’re reporting an increasing number of cases each day, and they’re also working with our teams– we have three WHO international teams in China– and what’s even more important is that the heads of state of the ASEAN countries have now set up a fund with which they will provide support to China to do the job if China needs that support.
JIM LEHRER: Do you feel that politically, China has now made the decision to reveal everything, do everything it that needs to be done to get this thing under control?
DR. DAVID HEYMANN: We believe they have. We were very patient with China for a long period of time, working with them in a very constructive manner, and we believe now that they are a full partner with us and the international teams who are doing the job there.
JIM LEHRER: But as a practical matter, success is still a long way away in China, is it not?
DR. DAVID HEYMANN: We believe it is, yes.
JIM LEHRER: Give us a feel for how serious the problem is.
DR. DAVID HEYMANN: Well, in Beijing, there are now over 1,000 cases which have been reported, and there’s great concern among the general public in Beijing. Some of the theaters, the movie houses have closed, some of the restaurants are closed, and people are taking it very seriously. And that’s always difficult, because many times the public perceives a greater risk than there actually is, and that adds to the confusion in a country.
What we know about SARS is that it passes by direct contact from person to person, and people need to avoid people who are infected. It probably isn’t spread by walking down a street and passing somebody on the street, yet people are now having a reaction that this might be the case in Beijing. And in addition to the seriousness of the epidemic, there’s also the seriousness of the concern of the local people.
JIM LEHRER: But in the case of China, that’s a legitimate concern, is it not?
DR. DAVID HEYMANN: It is a legitimate concern, because we don’t yet know where the disease is being transmitted, and that’s why people are so concerned. We know in other countries where it’s being transmitted, and what to do. In China, they don’t yet know, so they’re using maximum effort to prevent any type of possible spread.
JIM LEHRER: What’s the problem? Why do you not yet know?
DR. DAVID HEYMANN: We don’t yet know, because China has just recently begun to provide us information. We’re told by them that the reason they’re behind in their reporting and in their reaction is because help has been delegated to the provincial level. The central government had no reporting system for infectious diseases except for three diseases: Cholera, plague, and yellow fever. They’ve now added SARS to this reporting list, they’re now getting reports from the provinces, and in addition, they’re imposing on the provinces a certain way of working with the federal government… with the national government.
JIM LEHRER: What about the spread of disease from China to the rest of the world? What’s WHO doing about that?
DR. DAVID HEYMANN: WHO has made two recommendations for China: One, that they screen passengers leaving with a series of questions to determine whether or not they have been exposed to SARS, and if people are sick, we’re asking them to not permit them to fly.
And at the same time, we’ve made a recommendation that travelers postpone nonessential travel to China, which is what we had to make for China and the Guangdong Province previously because of the lack of information that we can use to see whether or not we should impose based on the three criteria which we used when we decided for Canada.
JIM LEHRER: Finally doctor, is there any way for you to project ahead as to when this SARS epidemic might be contained?
DR. DAVID HEYMANN: No one can project when the epidemic will contain. What we know is that we must continue to work to try to contain it and even drive it back into the box from where it came, if we can. If we can’t do that, this disease will remain endemic in some countries like TB or malaria, and it will continue to spread out of that country or those countries into others periodically causing outbreaks in those countries.
JIM LEHRER: I see. Dr. Heymann, thank you very much for being with us.
DR. DAVID HEYMANN: Thank you.