April 11, 2003

SARS and the Global Village

By: James Santiago Grisolía, MD

SARS (Severe Acute Respiratory Syndrome) is a new illness, apparently caused by a new version of a common cold virus. The first cases occurred in Southern China last November, but in recent weeks have spread to Hong Kong, and then rapidly to the U.S, Canada, and other countries. According to the World Health Organization, as of April 7 there are 2,601 cases, so far with 98 fatalities. In the U.S., 148 cases are under investigation.

News stories have spread much faster than the infection itself. The overall death rate is 3-4%, with U.S. cases overall less severe. So far, only one American has required artificial ventilation. So far, all but 7 U.S. cases have occurred in travelers to Hong Kong or Guangdong Province. San Diego has just registered its first case, in a recent traveler to Asia. By comparison, some 35-50,000 Americans will die this year of the flu.

Symptoms begin with a high fever at the start, with headache, fatigue and body aches. A dry cough follows later, and in Asian cases this can then lead to severe breathing problems. SARS is much less contagious than the flu; breathing the same air at a distance is enough to catch influenza, but larger droplets seem necessary to spread SARS, so someone has to cough or sneeze immediately in front of you.

Anyone who develops these symptoms AND has had contact with a recent Asian traveler should call their doctor for instructions. You should stay at home, wear a mask or at least cover with a Kleenex carefully while coughing or sneezing. You and everyone in the household should wash hands carefully.

Global commerce and tourism has brought each of us into contact with the world’s germs. Last summer, we heard much about West Nile Virus, a bird virus that apparently entered the U.S. in commercial shipping containers. Guangdong is a breeding ground for new viruses, since many people there live in close contact with farm animals, especially pigs and chickens, so that mutated viruses can spread easily.

This certainly is not a terrorist weapon…Al Qaeda uses very conventional weapons, certainly has no access to recombinant DNA mutation technologies, and would scorn an illness with only 3-4% kill rate. By contrast, smallpox would have something closer to a 30% fatality rate, if the few remaining cultures ever got into terrorist hands.

Our global interdependence demands more resources for public health here and in the developing world, and more openness by countries like China, who concealed evidence of the new illness from November until recent weeks. It provides a strong reminder that true global security will come from the bottom up. Whether we speak of the terror of epidemics, or the political terrorism of the dispossessed, erasing poverty, malnutrition and illiteracy remains our best long-term defense.

Dr Grisolía is Communications Chair for the SD County Medical Society and Chief of Neurology at Scripps-Mercy Hospital.

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