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Last Updated

02 May 2003

Source: New York Times, May 2, 2003

Lessons of Anthrax Attacks Help U.S. Respond to SARS


WASHINGTON, May 1 The government's daily SARS briefing takes place each morning at 10:15, inside a secure high-tech command center that did not exist six months ago. Tommy G. Thompson, the secretary of health and human services, presided on Wednesday, surrounded by 60-inch-wide plasma screens and a collection of giant maps that plot the epidemic's march around the globe.

"Julie told me there was a new outbreak in Taiwan. Is that true?" Mr. Thompson asked, referring to Dr. Julie L. Gerberding, director of the federal Centers for Disease Control and Prevention, a branch of the health agency. C.D.C. officials, participating by satellite video from their headquarters in Atlanta, said they were looking into it.

The scene is the direct result of the hard knocks the Bush administration's senior health officials took during the nation's last major health emergency, the anthrax attacks of October 2001. Then, critics accused Mr. Thompson and the disease centers of bungling their response, perhaps resulting in the deaths of two postal workers. Those same critics now give the government high marks for its aggressive handling of SARS.

With just 56 probable cases and no deaths, the United States has been largely spared from the mysterious new Asian respiratory disease. Mr. Thompson and the disease centers cannot claim complete credit; luck has played an important part. And if a large outbreak should occur in an American city, many experts say hospitals and public health laboratories would quickly be overwhelmed.

Yet the anthrax wake-up call put the nation on a permanent wartime footing with respect to infectious disease. Mr. Thompson, who estimates he spends as much as 15 percent of his time on SARS, speaks of "a whole new feeling of responsiveness" a sentiment experts say is undoubtedly helping to control the epidemic.

"With anthrax they were slow to mobilize, in terms of this being a national crisis," Dr. Peggy Hamburg, a health official in the Clinton administration, said. "With SARS, no time was lost in adopting that crisis-response mentality. One almost wonders, if they had that intensity and focus and central coordination, whether they might not have put the pieces together sooner" during the anthrax outbreak.

Most experts say SARS has been less of a challenge. The anthrax attacks, in which the deadly germ was sent through the mail, came without warning and caught the authorities off guard. But because SARS, or severe acute respiratory syndrome, first emerged in China, American health officials had time to prepare.

And unlike Canada, where a single SARS patient infected dozens of others, the United States has apparently had no such "super spreaders."

"We were very fortunate," said Michael T. Osterholm, director of the Center for Infectious Disease, Research and Policy at the University of Minnesota. "Toronto could just as easily have been Minneapolis, Buffalo or Chicago."

Some, including Dr. Osterholm, worry that SARS could wane in the warm months, then come roaring back in the fall. Mr. Thompson is worried as well. "If this thing spreads as rapidly as flu does," he said, "with a 6.5 percent lethality rate, that's a lot of deaths."

So his agency is leaving little to chance. Mr. Thompson ordered the daily briefings on March 15, the day the World Health Organization declared SARS a "worldwide health threat." He has met twice with President Bush to discuss the epidemic.

Doctors, who complained bitterly that the disease control centers did not give them fast guidance on how to handle suspected cases of anthrax, received guidelines on SARS the day after the W.H.O. alert. Scientists from Canada and the disease control centers have since cracked the genetic code of the virus that causes SARS, leading to the development of tests that can confirm infection.

"This has been an unprecedented mobilization of the international public health community," said Dr. Alfred DeMaria, director of communicable disease control for the Department of Public Health in Massachusetts, which has 17 suspect cases of SARS and 2 probable cases. "I don't remember anything like this, going so quickly and consistently before."

Last year, in the wake of the anthrax attacks, the Bush administration awarded states $1.1 billion in grants to prepare for bioterrorism. Each state was required to develop detailed plans for responding to an attack, a process Dr. DeMaria said had proved useful in handling SARS.

But just as the White House is increasing financing to prevent bioterrorism, cash-strapped states are cutting public health budgets. The Bush administration is also proposing more than $100 million in cuts for the disease control centers, prompting complaints from some Democrats in Congress, including Representative Henry A. Waxman, of California, who sent Mr. Thompson a letter on the matter today.

Asked about that, Mr. Thompson shrugged. "We could use some more resources, but we're getting along," he said. He added that states "have not been as aggressive as we would like," in spending the bioterrorism money. So far, he said, only 50 percent of the money has been spent.

Dr. Gerberding, meanwhile, said the nation was far better off today than two years ago. "The public health system was neglected for decades," she said, "and we can't rebuild it in the short term."

Perhaps the most lasting lessons of anthrax attacks are the importance of a clear news media message and public trust in health officials ingredients experts say are essential if people are to follow orders that help curb the spread of disease.

Many experts say trust in the disease centers was seriously eroded during the anthrax attacks after the agency incorrectly decided postal workers did not need antibiotics; two workers later died. And Mr. Thompson was roundly criticized for his early television appearances, which gave the impression that his top scientists were muzzled.

In the SARS outbreak, news media appearances have been dominated by two respected scientists: Dr. Gerberding, who took over at the disease control centers in July, and Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.

"We're letting people who do this for a living handle it," said Dr. Georges Benjamin, director of the American Public Health Association, who was health secretary in Maryland during the anthrax attacks.

The strategy appears, for the most part, to have been effective. According to a poll released this week by Harvard University, 83 percent of Americans know SARS is a disease that requires quarantine to keep from spreading, and 94 percent would agree to be isolated for two or three weeks if they had SARS.

"People have been paying attention and they really got most of the messages," said Robert J. Blendon, a professor of health policy who conducted the poll. He said the government had done "a strong job," adding that in a severe outbreak, "they'd have a lot of public support for closing down a school or an airport."

At the Department of Health and Human Services, officials are carefully watching Mr. Blendon's numbers. In the Wednesday morning SARS briefing, Bruce Gellin, an aide to the health secretary, said that 62 percent of those responding to the Harvard poll believed, incorrectly, that SARS could be contracted from a blood transfusion.

Upon hearing that, Dr. James M. Hughes, an official of the disease control centers, paused. "There's clearly a communication problem," he said, "if 62 percent of people believe that."