Top U.S. public health officials say the country is better prepared to fight a new SARS outbreak, if the virus should re-emerge. But there is still much work to do.
Officials at the U.S. government's Health Department say they are in a frenzy of activity to control any reappearance of SARS, the respiratory ailment that killed more than 900 people around the world earlier this year.
No one can predict if SARS will come back, but Health Secretary Tommy Thompson says it is prudent to prepare for it. "The seasonal reoccurrence of other respiratory diseases calls for us all to be aware of the possibility that the re-emergence of SARS could happen," he said. "We hope not. We have no proof that it is going to. The possibility is there."
At the U.S. government's disease tracking agency, the Centers for Disease Control, Director Julie Gerberding says she has never known of a germ that has disappeared on its own. She suspects the SARS virus is no different.
"We have to expect that somewhere, sometime, this coronavirus is going to rear its ugly head again," she said. "We can't say where, but given that it showed up once in Asia, it's a good bet that it would be the most likely place for it to emerge again."
To prepare for the possibility, hundreds of U.S. government researchers are trying to develop a rapid diagnostic test and create a SARS vaccine. Others are screening existing antiviral drugs and tens of thousands of other compounds to find medicines to treat the illness. Health officials have also funded private SARS drug research.
In addition, the Centers for Disease Control has prepared draft guidelines that would help hospitals react quickly to an epidemic. The recommendations call for surgical masks for SARS patients and hospital visitors with respiratory problems. Hospitals would also be asked to isolate respiratory patients from others. The guidelines would also ask people to cover their noses and mouths when coughing and sneezing in public.
Infectious disease specialist Keith Woeltje of the Medical College of Georgia helped advise the government on the guidelines.
"These recommendations are actually in line with current recommendations," he said. "Some facilities already do similar things, but there has never been a national push to do this kind of practice in physicians' offices, emergency rooms, any place where patients might be seen."
Dr. Woeltje says U.S. medical facilities may be better prepared for a mass health problem than those in other countries because of the government's drive to coordinate the response to a potential bioterrorist attack. But he notes that problems remain in preparing for SARS, because most U.S. hospitals do not have adequate isolation facilities.
"What we'll have to do is make plans for, should we get large numbers of patients, how we would convert a wing or a floor or part of a floor to an isolation unit," he said. "Certainly, they did that in Toronto, ultimately very effectively, so we'll have to make the same kind of plans."
Because this year's global SARS outbreak had minimal impact in the United States, with no deaths, U.S. doctors have little experience recognizing it. But Dr. Woeltje says Toronto health workers overcame that problem when faced with the illness. Presumably, so would others.
Julie Gerberding says the recent outbreak taught that containing SARS requires the first cases to be recognized immediately, so isolation and treatment can begin.
"We also learned that connectivity and collaboration are absolutely critical to our success. So, the networks of communication that have gone on among the laboratory scientists, among the public health officials, among the ministers of health in all these countries have to be continued," she said. "We are all talking about SARS preparedness collectively. One country or one agency can't do this alone."
In one instance of collaboration, the Centers for Disease Control is working with officials in east Asian countries hardest hit by SARS to determine the animal source of the virus.
Dr. Gerberding says she is optimistic a new SARS outbreak would be contained because the world is expecting it and it is likelier to be detected earlier than before. "Preparedness for SARS is going to pay off sooner or later, because, if it's not SARS, it will be something else" she said.