The United States has yet to see the worst of severe acute respiratory syndrome, or SARS, and must remain vigilant in its effort to contain the outbreak, say infectious-disease and public health authorities.
"SARS is an epidemic that is still in its evolutionary phase," says Anthony Fauci, M.D. "It would be distinctly unusual for a respiratory disease that is spread this way to all of a sudden just disappear."
Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. He made his comments May 21 during testimony before the Senate permanent subcommittee on investigations.
Julie Gerberding, M.D., director of the Centers for Disease Control and Prevention in Atlanta, and Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, Minneapolis, also testified.
"While our experience to date with SARS can be interpreted as having been successful in our efforts to limit its impact in this country, I must also admit that we have been lucky," Osterholm says. "I am convinced that with the advent of early winter . . . we will see a resurgence of SARS that could far exceed our experience to date."
Gerberding says, "I hope he is wrong, but I fear that he is correct."
As of May 26, there were 8,202 cases of SARS worldwide, resulting in 725 deaths, according to the World Health Organization. As of May 22, the United States had 65 probable cases, with six confirmed, and 290 reported suspect cases being followed by state and local health departments, according to the CDC.
No one in America has died from SARS, but the SARS death rate overall is "alarmingly high," Fauci says. Mortality for influenza in a normal year is less than 1% and was just 3% to 4% during the 1918 pandemic, he says. The death rate for SARS is about 8% and could go as high as 14% to 15%, Fauci says.
Emergency funding of $16 million from Congress to fight SARS, along with the $1 billion in federal money granted last year to bolster bioterrorism preparedness, have helped the U.S. response to the virus, Gerberding says. But she says it only takes one person to start a "cascade of transmission."
"When future outbreaks happen, our ability to contain it and survive it will largely depend on the local responders who treat the first cases," says Sen. Norm Coleman (R-Minn.), subcommittee chairman.
Jared Schwartz, M.D., on May 7 told members of the House that even if public health agencies are doing well, the system will fail if physicians in the private health sector aren't prepared.
"It is critical to recognize that your local laboratory and community hospital are the first line of defense against this new disease," says Schwartz, a practicing pathologist in Charlotte, N.C., and chairman of the College of American Pathologists National Laboratory Preparedness Committee.
It is appropriate to spend billions to improve the public health system, Schwartz says, but the reality is that patients with SARS symptoms will present to private physicians and emergency rooms.
"The physicians have somehow got to get hospital administrators and leadership to understand if they don't respond quickly and vigorously to making sure nurses and technicians and lab personnel are well-trained and protected, the place that provides care for a given community could be shut down and quarantined."
SARS triage guidelines
- Surgical masks should be placed on patients until other infection-control steps can be taken.
- Healthcare personnel should wear gowns, gloves and eye protection for patient contact.
- In the absence of airborne precautions, such as an isolation room and the use of filtering respirators for those who enter the room, healthcare personnel should wear surgical masks.
- Patients should not be hospitalized solely for infection control.
- Between healthcare facility and home setting, patients should wear surgical masks and limit interactions with others.