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Dr. Anthony Fauci, NIH, speaks about his concerns with SARS and AIDS (part 1), 6-2-03 - 2003-06-02


VOA-TV’s Carol Pearson talks with Dr. Anthony Fauci, Director of the National Institute Of Allergy and Infectious Diseases, about SARS.

Ms. Pearson
Dr. Fauci, we've been hearing about SARS, reading about SARS. SARS has claimed lives in the hundreds. AIDS has claimed lives in the millions. Why is it that we are so focused on SARS and not on diseases that are much more deadly, like AIDS or malaria?

Well, I wouldn't say that we are not focused on diseases like AIDS and malaria. There has been an extraordinary amount of focus on HIV/AIDS for a number of years. You have to understand that the SARS epidemic is still evolving.

We don't know where it's going. We don't know its capability. You don't know if it's going to disappear and then come back next year or whether or not it's just going to continue to go along at the rate that it is, plateauing or perhaps essentially regenerating another epidemic within an epidemic.

These are all unknowns. So, the concern that you're seeing, that we know that it's transmitted by the respiratory route, we know that within a matter of weeks to months it has become global, up to 30 countries have been affected with SARS, we know that certain regions of the world have a very, very serious problem.

So, it's more not the numbers, because there have been short of 800 deaths so far and about 8,300 cases of probable SARS, many of which have been documented to be definite cases. Numbers-wise, that is not a lot. But the potential and the uncertainty of where this is going to go is the thing that is instilling concern in individuals and health officials, but it is also the reason why we have to be taking this very, very seriously.

Because when you're talking about SARS, you're at such an early phase of the evolution of this new disease that it's very difficult to predict what's going to happen. So, it's the uncertainty more than anything else that is driving the concern.

Are there any other diseases or any other epidemics that you can compare SARS to?

Retrospectively, you can make all the comparisons in the world. A year and a half, two years from now, you can say, ah, yes, SARS is like this or SARS is like that, but, as I mentioned, we're still in the evolution of this epidemic, so it is not possible nor appropriate to compare it to anything else because we don't know exactly where it's going.

It has some similarities with the kinds of epidemics that we have had experience with. It's a respiratory-borne infection so, in that, it has similarities to influenza. Apparently, given the number of documented cases that we have within a several-month period from when it was recognized, now, retrospectively, in late November, mid-November, in China, to the now springtime of 2003, the relative number of cases is small.

That's dissimilar to influenza. Because if this were influenza and it was spread with the ease of influenza, you would be seeing tens of millions of cases worldwide right now. That's not the case. The difference with influenza is the extraordinary death rate. It can range anywhere from 8.5 to 9 to up to 15 percent totally, and in elderly individuals it could be as high as 40 to 50 percent. That's very unlike influenza, which even at its worse, even in the really bad years of influenza, you don't have any more than a 1 to 2 percent or 3 percent mortality. The famous flu pandemic of 1918 only had about a 4 or 5 percent mortality.

So, the seriousness of this disease is different than influenza, whereas the communicability or the transmissibility is not as great as influenza. So, there are similarities and dissimilarities. It's too early to say. At the end of the period of time when you could actually look back retrospectively and more properly evaluate the SARS epidemic, then we will see how we can put it into its proper perspective with comparisons to other diseases.

We've said a lot and read a lot about people fleeing areas that are heavily inflicted with SARS, hospital staff that will not work in the hospital. Does this disease warrant that kind of fear?

Well, some of the most vulnerable people to getting the SARS virus are health care providers. The general public, walking in the street, there is really not that much risk at all. It's a very, very low risk, a very, very low risk.

Yet, because of the fear of a new disease, the reports of the high lethalities and mortalities associated with it, has generated concern if not panic in some portions of the world, some sections of the world, where people essentially, as we have seen in China, are evacuating Beijing and other major cities in China, probably unjustifiably so but somewhat understandably so when you realize that they don't fully understand or appreciate how this virus is transmitted. So, that is the kind of thing that unfortunately you expect when there is lack of complete understanding. And that is the reason why education should be a very important part of how you can meet this public health threat.

And education meaning what, wash your hands?

No, no. Education for the people about how it is transmitted. The highest risk people are people who are household contacts, who have very close face-to-face contact with someone. And the most vulnerable are the health workers who take care of the patients if they don't properly gown, mask, put on gloves, put on eye shields, and have the proper capability of protecting themselves.

The difficulty that occurred in China and then in Hong Kong and then in Toronto was that a lot of people who were infected went into the hospitals prior to the hospital personnel knowing that this was a highly contagious disease for health workers. So, there was a lot of damage done before there was the realization of what you needed to do to protect yourself.