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Last Updated

08 May 2003

Source: Atlanta Journal-Constitution, May 8, 2003

Nonstop SARS investigation stretches CDC

Agency tries to guard own staff from burnout

By M.A.J. McKENNA, The Atlanta Journal-Constitution

The CDC's investigation of severe acute respiratory syndrome -- now in its eighth week -- has challenged the agency more dramatically than any event since the 2001 anthrax attacks.

In the agency's new emergency operations center, personnel are working in shifts around the clock. Over two months, more than 500 staff members have worked on SARS at least part time.

Researchers have been dispatched to a half-dozen countries and to World Health Organization headquarters in Geneva. The ongoing cost of the effort, according to one internal estimate, is $2 million a month.

But the SARS outbreak was recognized at the same time the war with Iraq began and fears of a terror attack escalated. It continues alongside the ongoing national smallpox vaccination campaign, and threatens to extend into West Nile virus season, which could begin this month.

So the challenge to the Centers for Disease Control and Prevention has not been assigning every staff member to the epidemic. Rather, it has been knowing how many to hold back.

"Our rules of operation, from the beginning, have been very clear," said Dr. Julie Gerberding, the CDC's director. "We could not put all our attention on SARS, knowing we could soon be dealing with another threat. We needed to have a parsimonious response."

In practical terms, that has meant putting staff members on SARS for specific time periods, instead of open-ended assignments. Many of the researchers now working abroad are the second or third group to go out; the first responders to the epidemic returned home in the past few weeks.

In the emergency operations center -- completed, with funding from Atlanta philanthropist Bernie Marcus, only a few days before the CDC joined the SARS investigation -- staff have rotated for a week to a month at a time into teams focusing on symptoms, travel, lab work and case tracking.

In an innovation for the CDC, Gerberding has created what she calls a "Team B," whose mission is not monitoring SARS, but watching the SARS researchers to gauge the toll the intense schedule may be taking.

"They are asking, 'Have we done a good enough job of scheduling personnel while sustaining the other responsibilities CDC has; are we paying enough attention to the mental health needs of the workers; are they working too long or too hard,' " she said. "This is a marathon. We cannot have people running 26-mile sprints."

The SARS outbreak has illuminated the Atlanta-based CDC's little-known ongoing relationship with the WHO, the agency that is to international health what the CDC is to the United States.

The WHO carves out policy and coordinates health initiatives across national borders, but it has few research resources. Even between epidemics, the CDC is the WHO's close partner.

"Of all the people we have detailed internationally to respond to SARS, we have the most people in Geneva working with WHO," Gerberding said. Still, the two agencies do not always agree: The CDC declined last month -- in diplomatic language -- to back the WHO's decision warning against travel to Canada.