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Last Updated

14 Apr 2003

Source: Pasadena Star-News, April 13, 2003

Technology aided response to SARS

By Mariko Thompson, Staff Writer

Around 8 a.m. March 15, Jonathan Fielding caught a TV news report on a World Health Organization global alert warning of a new and dangerous virus originating in Asia. Los Angeles County's director of public health immediately picked up the phone and rousted a half-dozen senior staff members.

From home, one began drafting an alert for local hospitals. Another called the Centers for Disease Control and Prevention in Atlanta for more information on the pneumonia-like disease. Around noon, the group held a conference call to address the looming threat of SARS severe acute respiratory syndrome.

When the meeting ended, the team sent an alert by fax and through the EMS radio system to hospital emergency rooms and doctors of infectious disease throughout the county.

"Los Angeles is a major gateway from Asia to the U.S.," Fielding said. "This is a new, emerging infection and we want to do everything we can."

From local to international levels, public health officials say technology both in communications and in the laboratory allowed them to respond to the SARS virus with unprecedented speed. Since the terrorist attacks of Sept. 11, 2001, public health agencies and hospitals have geared for major catastrophes stemming from bioterrorism, preparations they say aided in the response time to SARS.

While the county agency was quick to respond to the most recent concern, a report released last week by the Little Hoover Commission, an independent state oversight agency, found that California, as a whole, is ill-prepared to respond to environmental hazards, bioterrorism and emerging infectious disease. The commission called for the fragmented system to be consolidated under a California surgeon general. Fielding agreed that the preparedness levels probably vary from county to county.

"We have more capacity than any other county department to deal with these issues,' he said. "We are not smug about it. We have to continue to work on preparedness every day.'

Even with the most sophisticated technology, containing infectious disease in an age of air travel is a Herculean task.

"This virus can't spread (around the world) without jet propulsion," said Dr. John Zaiz, chair of the virology division at City of Hope Medical Center in Duarte.

The origin of SARS has been traced to the Guangdong Province in southern China where the illness first struck in November. Since then, SARS has hit at least 19 countries, including Vietnam, Singapore, Canada, Australia, Germany and the U.S. Worldwide, there have been more than 2,960 reported cases and at least 119 deaths. So far, there have been more than 166 suspected cases in the U.S. but no deaths.

Of the suspected cases in the United States, the majority have occurred in California -- 36 as of April 10. One California man who had traveled to Hong Kong tested positive for the virus and has since recovered.

Earlier this month, President George W. Bush signed an executive order that added SARS to a list of quarantinable diseases in the United States. In addition, hospitals such as UCLA Medical Center and Huntington Hospital have adopted protocols to handle SARS and prevent infection of health workers and other patients.

At Huntington Hospital in Pasadena, doctors and nurses who treat patients complaining of SARS symptoms don protective goggles, masks and gowns. Patients with SARS will be isolated and treated in a negative- pressure room available in the ER and the main hospital to keep the germs from spreading in the air, said Mary Mendelsohn, Huntington's infection control coordinator. The negative pressure prevents air from exiting the room or circulating to other rooms, Mendelsohn explained.

"We're used to dealing with (communicable) diseases. It's actually very manageable for us," Mendelsohn said.

At Los Angeles International Airport, city officials recently announced that flights arriving directly or indirectly from Asia are being screened for SARS cases and that all passengers will receive notices describing symptoms of the disease.

While WHO and CDC investigators are uncovering more information about the SARS virus and its spread, public health officials have been scrambling to counter misinformation and quell panic.

"There's been a lot of concern about transmission," Fielding said. "In the Asian community, it's rumored to be spread in Chinese food. I'm working hard to debunk the myths."

Fielding said county public health workers have reported a "substantial increase" in phone calls from residents concerned about SARS, though he had no figures readily available. The CDC has logged more calls on SARS than it received at the height of the anthrax scare in 2001.

The number of people worldwide who have contracted SARS pales compared to the millions who come down with the flu every year. And many other diseases now considered commonplace have taken far more lives. An estimated 36,000 Americans die from flu-related complications each year. In 2000, HIV/AIDS took 14,478 lives while lung cancer claimed 156,900.

"It's the things we don't know about that make us nervous,' said Dr. Ralph Frerichs, professor of epidemiology at the UCLA School of Public Health. "Once we know about something, we're no longer afraid of it.'

So far, researchers have linked SARS to an unknown form of coronavirus, which can cause the common cold in humans. SARS symptoms resemble the flu and include fever, chills, headache, body ache, shortness of breath and dry cough.

"How the SARS virus arose whether it was two or more different coronaviruses combining or a new one isn't known," said Dr. David Pegues, an infectious disease specialist and hospital epidemiologist at UCLA Medical Center.

Right now, the most critical piece of information doctors are pursuing is the patient's travel history, whether he or she has been to infected areas of Asia within the last 10 days or had contact with someone who has, Pegues said. Doctors also look for signs of pneumonia with chest X-rays and white blood cell counts.

As with the common cold, the main source of transmission is believed to be droplets expelled by coughing and sneezing. However, the disease appears to be more contagious than the common cold virus and investigators have not ruled out some form of airborne transmission.

"The most critical unknown is why people are dying," Zaia said.

Most people who contract SARS recover on their own. Among reported cases, SARS has a 3 to 4 percent mortality rate. The cause of death is lung congestion and an inability to take in enough oxygen. Only a fraction of patients with SARS have required hospitalization or oxygen through a mechanical ventilator, Pegues said.

Unlike bacterial infections which are treated with antibiotics, few specific treatments exist for viral diseases. The effectiveness of antiviral drugs such as ribovirin are being tested on SARS patients, Pegues said. National Institutes of Health researchers have started working on a SARS vaccine, but it will likely be a year or more before one is ready.

While researchers continue to study the virus in the lab, others are working in the field to better understand the nature of the disease and how it spreads. At ground zero in China, a World Health Organization team functions as detectives, interviewing patients to discover commonalities and to trace the chain to the original cause.

"Let's say your house catches on fire and someone asks you what caused it," said Dr. Ralph Frerichs, professor of epidemiology at the UCLA School of Public Health. "You say your neighbor caused it because a spark came from his house to yours. But the fire marshal goes to where the power line went down or where the arsonist lit the match. Epidemiology works the same way. Each case is attributed to another case."

CDC officials say they have no way of predicting the eventual scope of SARS. The worst pandemic in U.S. history, the influenza of 1918, killed more than 600,000 Americans and 20 million people worldwide.

In 85 years, the ability to combat infectious disease has improved exponentially. Today's weapons include powerful antibiotics, laboratory analysis of microbes, creation and distribution of mass amounts of vaccines, and instantaneous communication.

But in the war against disease, there are no guarantees, Fielding said.

"We have better tools today to reduce and control the spread," Fielding said. "I'd never speculate on what is possible.'

While public health workers must be prepared for emergency outbreaks, agencies can't neglect their battles on other fronts. Rising obesity rates threaten to overwhelm the health system with chronic conditions including type 2 diabetes, hypertension and heart disease. Too many children in Los Angeles still don't get immunized for preventable diseases such as polio, tetanus and diphtheria, Fielding said.

"We have to keep a reasonable balance," he said. "Most of our morbidity and mortality are due to chronic diseases. We're terribly under-resourced in our ability to deal with those problems, and they're getting worse."

Staff Writer Becky Oskin contributed to this story.