Public health officials from around the world are meeting in Geneva to prepare for a possible return of Severe Acute Respiratory Syndrome (SARS). The experts say the world is better prepared for a new outbreak of the disease, but they point out that there is still a lot to learn about the virus and how it spreads.
The Geneva meeting has brought together dozens of specialists in a variety of health fields for two weeks to determine how to improve diagnosis, treatment, and containment of SARS.
World Health Organization figures show that the respiratory ailment infected 8,000 people and killed nearly 800 between last November and July. The vast majority of cases occurred in southern China, where the disease originated, and Hong Kong, Singapore, Vietnam, and Canada.
In a telephone news briefing Tuesday from Geneva, Dr. Joseph Sung of the Chinese University of Hong Kong said most experts expect a return of SARS.
"A majority of the people in the group believes that there is a fair amount of chance that SARS will come back. But many countries have already implemented their precautionary measures," he said. "So, personally, I believe that if SARS ever comes back, it won't be such a massive outbreak as we had in the spring. But high vigilance should be kept."
Between now and November 1, Dr. Sung and the other experts will decide what leading questions about SARS still need answering. Subgroups will focus on research priorities, laboratory issues, treatment methods, and prospects for vaccine development. One of the conference organizers is John MacKenzie, the head of the World Health Organization's laboratory group.
"We've been very successful in controlling the epidemic and finding the factors we needed to control the epidemic toward the end," he said. "Now we need to address ourselves to what might happen in the future. So the whole purpose of this meeting was to start to put together a list of major issues that we need to find more information about."
Among the key areas of interest are developing a standard diagnostic test for SARS to avoid confusing it with influenza or pneumonia, when to quarantine patients, and how to conduct clinical trials to identify the best cure. Dr. Sung says investigators must also determine how the coronavirus that causes SARS first infected people in China. An animal source is suspected, but how can the particular animal be identified?
"This is not an easy task because wild animals are difficult to follow. But we also realize that we have to follow animals on the farm as well as domestic animals," he said. "The other very useful surveillance is to monitor the animal handlers in the market and see whether there is any change in their disease pattern. I think this will be a very important research tool to early diagnose whether there will be a second outbreak coming."
Another topic at the Geneva meeting is how to keep laboratory samples of SARS out of the reach of bioterrorists. John MacKenzie of the World Health Organization says the experts must suggest standards for choosing which laboratories hold strains of the virus.
"In terms of the biosafety, there should be some national process whereby laboratories have to get permission to either work with or hold the virus," he said. "I think we really are concerned that if the biocontainment conditions are not met, the whole world can be vulnerable."
The Geneva meetings follow a recent World Health Organization report summarizing what public health experts have learned about SARS. The main conclusions are that the main route of transmission is not through the air, but by direct contact among people; that SARS rarely infects children; and that health care workers are at special risk.
Another finding useful for choosing treatment and containment options is that the risk of transmission is greatest around the tenth day of illness and disappears 10 days after fever ends.
Dr. John Nicoll of Britain's Health Protection Agency says such knowledge has provided the Geneva conference participants with some confidence that SARS can be contained again.
"But there was no sense of overconfidence and we had no idea whether SARS will reappear," he said. "We felt we just need to make sure we were prepared."