INTERNATIONAL RESPONSE

When new diseases develop and begin to spread, the threats they pose transcend national boundaries and require a coordinated, worldwide response. The World Health Organization, through its role as the United Nations' health agency, helps the international community work to contain and understand these new and emerging threats.

In the case of severe acute respiratory syndrome, the WHO helped facilitate the international research effort that lead to a Dutch team's confirmation of the identity of the virus that causes the disease less than two months after it was first identified. During that same period, individual governments were conducting efforts to halt the spread of the virus within their borders.

Identifying a new threat

The WHO received its first hint that a new disease would create what it would later call a "global threat to health" when China notified the group on Feb. 11 that 305 residents of its Guangdong Province had contracted a mysterious pneumonia-like illness. After learning of the outbreak, the WHO dispatched two doctors to China to further investigate the illness, intending for them to go to the Guangdong Province to examine patient records and visit hospitals treating those with the disease. However, the doctors were unable to conduct their investigation due to restrictions from the Chinese government, according to WHO spokesman Dick Thompson.

SARS was first identified just a few days after the doctors were dispatched to China, when Dr. Carlo Urbani, a WHO epidemiologist who later died of the disease, examined a patient in Hanoi, Vietnam suffering from a severe pneumonia with no known cause.

Over the next several weeks, the WHO learned that hospital workers in Hong Kong and Vietnam had also become ill with an unknown disease that might be SARS. Health care workers in China were similarly vulnerable to the illness that had struck in their country -- comprising 30 percent of those infected in the Guangdong Province.

On March 12, after the WHO teams in Hanoi, Hong Kong and Beijing assessed the situation in Asia, the WHO issued a global alert warning of a "severe atypical pneumonia" that appeared to pose a high risk to health care workers. The alert listed the disease's symptoms and recommended that patients suspected of having the disease be isolated and reported to national health authorities.

Just three days later, the WHO increased the level of that alert and issued a rare emergency travel advisory that urged travelers and airline crew to be aware of the disease's symptoms. The WHO requested that travelers who think they might have SARS seek medical attention and asked airlines to alert the destination airport if a passenger or crewmember was suspected of having the disease. The alert was an attempt to prevent further international spread and contain the outbreaks that had already occurred.

The scientific community responds

After the March 15 alert, the WHO facilitated collaboration among 11 laboratories trying to identify the cause of SARS. Although they were working in different countries, researchers shared preliminary results with one another through WHO-coordinated online sessions.

The WHO also organized communication between investigators researching how the disease was spread. A third group the WHO established included 80 doctors from 13 counties where SARS is present. These doctors exchange their observations from treating those suffering from the disease.

As with other outbreaks, many of the WHO's efforts were coordinated through its Global Outbreak Alert and Response Network. That network provides a means for institutions to pool their resources to quickly identify and respond to outbreaks. Members of the network include scientific institutions, U.N. organizations like UNICEF and UNHCR, the Red Cross, and nongovernmental organizations like Doctors Without Borders.

In the early days of the SARS outbreak, the WHO used the network to identify the scientists it asked to investigate the disease. Doctors from the U.S., Germany and France all worked side by side in Hanoi as part of the WHO-coordinated effort.

Individual countries react to SARS

Beyond the WHO's efforts, individual countries and local governments also worked within their borders to control SARS. Since those infected with the disease can infect others, many countries have made attempts to prevent those exposed to SARS from spreading it. In Canada, the provincial government in Ontario asked everyone with even one of SARS's symptoms to stay home over the Easter weekend. In Singapore, those suspected of being exposed to SARS have been confined to their homes -- a measure that is sometimes enforced with Web cams and electronic bracelets.

While the U.S. has not needed to institute these more stringent measures, President Bush did sign an executive order on April 4 allowing for a forced quarantine, if necessary, of those who might have been exposed to SARS or a number of other diseases. The order calls for the "apprehension, detention or conditional release of individuals to prevent the introduction, transmission or spread of suspected communicable diseases."

A few days before that order was signed, Secretary of Health and Human Services Tommy Thompson said that such measures didn't yet appear warranted in the United States.

"If there is a virus that is explosive ... and the only way to control it is by quarantine, we have to consider it," he said. "But we're not there yet."

Many governments are also working to prevent anyone already infected with SARS from entering their country. Singapore is screening all travelers arriving from areas the WHO designated as being affected by SARS. Taiwan is taking the temperatures of all those who arrive by air from China. The government in Hong Kong, one of the areas hardest hit by the disease, has begun taking the temperatures of airline passengers leaving the country to prevent those who have the disease from flying.

In the U.S., air passengers arriving from affected regions are not screened for SARS, but the Centers for Disease Control and Prevention is giving them cards that explain the symptoms of the disease. The U.S. is also advising that people planning nonessential trips "to mainland China and Hong Kong; Singapore; and Hanoi, Vietnam may wish to postpone their trips until further notice."

-- By Karyn Schwartz, Online NewsHour
April 2003