INCREASE FOCUS ON MICROSCOPIC THREATS



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Last Updated

10 Apr 2003

Source: Baltimore Sun, April 10, 2003

OPINION

Increase focus on microscopic threats

By Alfred Sommer

FULLY 35 years after the U.S. surgeon general famously declared infectious diseases a thing of the past, we've seen no end of microbial threats to our health.

Ebola virus, a deadly hemorrhagic disease, inspired the Hollywood movie Outbreak. HIV/AIDS has consumed enormous research dollars, quite literally decimated populations and the economy of sub-Saharan Africa, and claims millions of new lives every year. Dengue fever, a mosquito-borne virus for which there is no vaccine or specific treatment, is creeping up the Latin American chain toward the United States. West Nile fever has, in a very few years, entered the United States and spread rapidly across the nation.

And now we have sudden acute respiratory syndrome, or SARS.

While the first cases seem to have occurred in southern China, this previously undetected virus quite literally exploded out of nowhere. It almost certainly represents a new strain of an old, less virulent virus that either mutated into this lethal state or acquired a new set of genes by mixing with similar viruses passed among animals, endowing it with the ability to make humans very sick and, perhaps worse, pass the virus to others.

It is the contagiousness of infected individuals that makes this more frightening than, say, anthrax.

People may even spread the disease before they feel ill, making it far more difficult to contain than smallpox; a smallpox patient becomes severely (and recognizably) ill before becoming infectious. SARS has shown just how powerful an infectious disease can be at sparking panic and destroying commerce. Housing blocks, hospitals, schools and workplaces are being closed or quarantined, and travel, so far only to Asia, has been extremely curtailed.

While SARS is unlikely to become anywhere near as deadly as the 1918 influenza pandemic, our present capacity for constraining its spread, through immunization or effective treatment, is little better than it was for the Spanish flu. Air travel has increased considerably the potential for spread. Otherwise healthy but infected passengers can disembark half a world away before becoming ill and potentially spreading the virus among their fellow passengers.

The answer is not alarm. Modern science should soon have an effective test to detect those infected and, soon thereafter, a vaccine to protect those at risk. Surveillance and containment activities of public health agencies seem, at the moment, to have been effective in those locations where they were activated early (which excludes the initial cover-up in Guangdong province, China).

There are many lessons to be learned, even as we scramble to protect the globe. The most obvious is that the microbial world will always remain a significant health threat, given its capacity to continue to mutate new, dangerous strains infecting man.

The second is that we need to be better prepared to identify and respond to initial cases of a potential epidemic. This will require greater investment in training our public health work force and providing them with better tools for monitoring the population's health. The threat posed by deadly infections or toxic agents depends upon the speed and adequacy of our public health response.

Preparation for a bioterrorist event is exactly the same as preparation for naturally occurring infectious agents. Until we are sufficiently prepared to identify and effectively respond to natural threats, we will never be in a position to deal effectively with those perpetrated by our fellow man.

Alfred Sommer, a medical doctor, is dean of the Johns Hopkins Bloomberg School of Public Health in Baltimore.