SARS: The Sequel?

Across Asia, governments and companies are getting ready

It has been a busy summer for Steve Vickers. Since June, more than 50 Japanese industrial companies, international banks and multinational manufacturers with operations in China have turned to his Hong Kong-based consulting firm, International Risk Ltd., for help in preparing for the possible return of SARS. The company develops customized anti-SARS plans that include everything from stockpiling surgical masks and other supplies to segregating business units so that one can keep working if another is closed down by the disease. "I believe [SARS] is going to become a fact of life, just like malaria or terrorist bomb threats," says Vickers, president and CEO of International Risk, which was spun off from PricewaterhouseCoopers last year. With the right anti-SARS precautions in place, he says, companies can "get on with business."

Across Asia, governments and companies are getting ready for SARS, the sequel. From last November through June, the first outbreak is believed to have infected more than 8,000 people in 28 countries and killed 774 in 11 countries. The fear is the virus is lying in wait for winter -- like many seasonal respiratory diseases -- before beginning a new round of deadly infections.


This time around, though, officials have the luxury of developing policies and procedures on their own time and not in the midst of a crisis. Public health authorities are zealously applying the lessons they learned in the heat of battle last spring, such as the critical importance of quarantine procedures in hospitals so that SARS can't use inpatient wards as a breeding ground. They're also keeping in place precautions such as remote heat-sensing equipment at international airports to spot passengers with high fevers.

Of course, there's only so much that can be done to prepare for an outbreak of a virus for which no diagnostic kit, vaccine, or cure has been developed. Yet Asian governments have accomplished a great deal in just a few months. Senior health officials in Singapore, Hong Kong, and Taiwan stay in touch daily with the regional World Health Organization headquarters in Manila through phone and e-mail. That will let them sound early alarms and give hospitals as much time as possible to snap into battle mode. WHO is working to bring all Asian governments into this real-time loop. In addition, Singapore, Hong Kong, China, and South Korea all have designated special hospitals to isolate patients. They also are ready to use their police and military to trace and quarantine those who have come in contact with SARS patients.

Perhaps the most progress has been made in Singapore, a city-state that depends for its survival on a constant flow of international commerce that an outbreak of SARS could quickly halt. Hospitals have mounted dispensers of hand-disinfectant liquid on the walls beside the entrance to wards. All health workers and long-staying hospital patients are being given flu vaccine to make it easier to avoid misdiagnosis of SARS. And Singapore is ready to take tougher measures, including installing video cameras in the homes of people who are quarantined. "Singapore is probably one of the best prepared countries in the world," says Dr. Hitoshi Oshitani, chief of the WHO's regional SARS task force.

SARS is the No. 1 topic at corporations throughout the region, too. Some are staging mock management exercises so executives can practice deciding which production line to shut down in the event of a SARS outbreak or where to source components if a supplier's plant is quarantined. ING Asia-Pacific, the Asian arm of Dutch investment banking giant ING Group, has provided its 60 employees in Hong Kong with PCs to take home so they can work remotely over the Internet. Motorola Inc., which shut down a production line at a cell-phone assembly plant in Singapore after a worker fell ill with SARS in March, now issues employees across the region "SARS kits," complete with masks and thermometers, when they travel on business. Cathay Pacific Airways Ltd., which lost 75% of its passenger traffic at the height of the first outbreak, has a dedicated SARS communications team that sends daily e-mails to the airline's 14,600 employees on the latest health developments.

Everyone's focus, however, is on China, where the SARS virus originated sometime late last year. Beijing must grapple with the Herculean challenge of getting thousands of far-flung hospitals to coordinate quickly in the event of an outbreak. Health Minister Wu Yi is haranguing provincial governments to keep their guard up and warning them not to cover up SARS cases. People arriving at the port of Tianjin near Beijing already are having their temperatures taken. In the capital, a disease control center has resumed 24-hour operation and the Xiehe Hospital has reopened a special ward for any patient with a fever.

In the Pudong industrial district of Shanghai, Semiconductor Manufacturing International Corp. has distributed thermometers to its 4,000-plus employees and installed infrared monitors to check the temperature of anyone who enters. One task remains: a crackdown on the thriving trade in wild animals for food. The virus may have originally been transmitted via such an animal. A ban on the trade imposed last July was lifted a month later.

Meanwhile, in Hong Kong, the international gateway through which SARS spread from China, a government-appointed panel admitted in October that the city had not yet developed an adequate contingency plan to deal with a second SARS outbreak. Neither has it established a clear chain of command within its highly decentralized hospital system.


As the countdown continues, there's still a remote possibility that all the preparation will prove unnecessary. Even if SARS doesn't stage a comeback, though, the increased sense of awareness will pay off in fighting other emerging health threats. "If it's not SARS, it will be something else, and we'll be ready for it," predicts Dr. Julie L. Gerberding, director of the U.S. Centers for Disease Control.

Yet the consensus is that SARS is on the way back. To get a sense of what the future could hold, health authorities are still running the numbers on the Hanoi hospital epidemic that allowed the WHO to first identify the virus in March. After Vietnamese authorities sealed off the hospital, isolating about 120 patients and health workers, about half of them fell ill, and five died. "If you take that kind of statistic and apply it to the whole world or any country, then it's quite worrisome," says Dr. Balaji Sadasivan, Singapore's Minister of State for Health. All of Asia is worrying, and waiting, and hoping that their preparations will be enough to prevent a repeat of last winter's worldwide health crisis.

By Michael Shari in Singapore and Frederik Balfour in Hong Kong, with Bruce Einhorn in Shanghai and John Carey in Washington

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