No Quick Fix for SARS
By Bruce Einhorn
Chinese government officials are finally coming clean and admitting that they have a problem with severe acute respiratory syndrome (see BW, 5/5/03, "SARS: An Amazing About-Face in Beijing"). Still, Hong Kong has the dubious distinction of being the world's SARS capital, with more confirmed cases than any other city in the world. To help find a way out of the crisis, the Hong Kong government recently invited Jeffrey Koplan, former head of the Centers for Disease Control & Prevention in the U.S. and now vice-president for academic health affairs at Robert W. Woodruff Health Sciences Center at Emory University, to visit the city and offer advice. Last Friday, Koplan met with reporters at the University of Hong Kong shortly before he was scheduled to fly out of town.
While he was trying to be upbeat, Koplan had some bad news for anyone hoping that SARS will just go away. Some experts have said it's possible that the disease won't be an ongoing problem, since with effective government action it can not only be contained but even eradicated. Koplan wasn't buying.
"Maybe the existing measures will be effective, and [new cases] will go to zero," he said. "But I would be shocked if that's the case. To be realistic, we could hope for suppression, minimization. To actually eliminate it, I don't see that happening with our current tools."
DON'T RUSH TO JUDGE.
Clearly eager to be a polite guest, Koplan went out of his way to avoid criticizing local officialdom. By contrast, on the morning of his press conference, Hong Kong's leading English-language daily newspaper, The South China Morning Post, launched a front-page campaign to raise money for protective suits for health-care workers, who account for about a quarter of the city's 1,500 or so cases. Hong Kong's hospital authority hasn't been able to get the suits fast enough. One headline: "We've been lobbying for weeks, say doctors in the firing line."
Yet Koplan explained that people shouldn't rush to judge Hong Kong's hospital bureaucrats, since people elsewhere were facing shortages, too. "The difficulty in getting protective equipment is worldwide," he said. "In our own hospitals [in the U.S.], there has been a run on this stuff. The amount of use is immense. The need for face masks is in the thousands for every hospital. There's a huge worldwide run for a limited amount of supplies."
For all his determination not to offend, Koplan did manage to work in a none-too-subtle jab at the mandarins across the border in mainland China. These are the officials who, during the crucial early months of the outbreak, engaged in a massive coverup -- and as late as last week were still denying that a problem existed, allegedly hiding SARS patients from World Health Organization inspectors in Beijing.
When asked about what lessons the world should learn from the SARS crisis, Koplan indirectly criticized the Chinese officials who bear much of the responsibility for SARS becoming a global problem. "Early identification of disease and cases is helpful to everyone," he said. "It's important to share that information."
Koplan offered a view on why the world has reacted so strongly to the SARS outbreak, which has crippled some of Asia's most dynamic economies: "I've often thought about what makes one disease scarier. Why do we suddenly focus on one thing over something else?" One possible reason, Koplan theorized, is the very newness of SARS. "When something new comes along, it increases our concern and worry. Also, with the symptoms [of SARS], we're not sure who else has it. With some diseases, there are high-risk groups, and you can say, 'If I don't go there, I'm not at risk.' With this, it could be any age, any population."
Indeed, it's the banality of SARS symptoms that makes the disease so frightening. After all, people with far deadlier diseases are much easier to identify. But the early stages of SARS don't have dramatic symptoms that traditionally alarm doctors and nurses. "The danger of transmission for health-care workers is made more difficult by the nature of the symptoms," said Koplan.
For some diseases, it's obvious that a person has a problem. Oftentimes, someone with SARS just has a cough or diarrhea or muscle pain or a fever -- the sort of symptoms common to many illnesses. Given the worries about bioterrorism, Koplan says, "if someone comes in with a horrible rash, then you think of smallpox." SARS is much harder to spot. "When someone comes in with a cough, or malaise and fever, most doctors have seen this every day of their career."
One debate now raging between doctors in Hong Kong and Koplan's former colleagues at the CDC is whether the combination therapy that Hong Kong has devised -- a mix of steroids and the antiviral drug ribavirin -- makes any difference for SARS patients. The CDC says no. Hong Kong says yes (see BW Online, 4/4/03, "'A Pretty Good Understanding' of SARS").
Koplan assured us that this sort of dispute is normal. "It's not atypical in the early course of a disease" for physicians to argue about what works, he said. "Doctors are so passionate about trying to save patients' lives, they try a variety of things. The jury is out on what medications are useful and what are not useful."
Ideally, researchers would be able to conduct a study and give some patients treatment A, some patients treatment B, and give others treatment C, which is no treatment at all. That may be good science, but good luck trying to tell unlucky residents of Amoy Gardens -- the Love Canal of Hong Kong's SARS outbreak -- that they or their families fall into group C. "It's tough to do, but it needs to be done," said Koplan.
He acknowledged, though, that these tests will have to be done somewhere else. "It's much harder to do when people expect [treatment]," he said. "It's easier to do in a population where they haven't started any type of treatment yet." Given the global spread of SARS, many other places may have the unfortunate honor of being the testing ground for the best treatment.
Einhorn covers technology from Hong Kong for BusinessWeek. Follow his weekly Online Asia column, only on BusinessWeek Online
Edited by B. Kite