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Last Updated

04 Jun 2003

Source: Wall Street Journal, June 4, 2003

SARS: CONTAINING THE OUTBREAK

Taking Over CDC, Current Director Institutes Quick Response to Crises

By BETSY MCKAY and MARILYN CHASE, Staff Reporters of THE WALL STREET JOURNAL

ATLANTA -- Not long ago, the federal Centers for Disease Control and Prevention was often criticized for slow response to public crises. "Everything could wait until Monday," says Georges Benjamin, executive director of the American Public Health Association.

No longer. In a sharp reversal, the CDC spits out new information almost as soon as it gets it. Local public-health officers -- the front lines in any health crisis -- praise the agency for its frequent updates and advice on SARS. Even former critics note that the culture of the CDC has started to change, from a ponderous bureaucracy to an efficient source of information during health crises.

Behind the shift is Julie Gerberding, who has managed to burnish the agency's profile after less than a year as CDC director. With 17 televised press conferences and several appearances in SARS-related hearings on Capitol Hill since mid-March, 47-year-old Dr. Gerberding, with firm backing from Washington, has become more visible than any CDC director in history.

Advising the public to be both vigilant and calm in dealing with the new disease, she is playing a role previously filled by a federal health official in Washington.

No one has died of SARS in the U.S., but the CDC isn't letting down its guard. In fact, Dr. Gerberding may face her biggest challenge in a few months, when she and other health officials -- including her boss, Health and Human Services Secretary Tommy Thompson -- fear that SARS may re-emerge with greater force and produce fatalities in the U.S. and Europe.

When Dr. Gerberding took on her new post in July 2002, the nation's top disease-fighting organization was struggling to regain the public's confidence. A slow, disjointed response to the anthrax attacks had left many wondering whether the agency was equipped to defend the country from a major outbreak or attack. Since then, armed with new funding to prepare for bioterrorism, Dr. Gerberding has used major disease threats such as West Nile virus, smallpox and SARS to prod the agency to adopt a responsive role.

An expert in infection control who cut her teeth in San Francisco during the early days of the AIDS epidemic, she believes that the CDC needs to augment its undeniable scientific prowess with better service to both the public and health professionals. "One of the major things we've learned since anthrax is that in an emergency you cannot dot every 'i' and cross every 't' " before sending out information, she says.

After learning on March 14 that SARS had spread to Canada and possibly other parts of the world, she quickly activated a new high-tech emergency-operations center built in the basement of the CDC's Atlanta headquarters. Within 24 hours, health alerts had been sent out, hotlines set up and the media briefed. Regular conference calls with clinicians were initiated to share the latest information on SARS. This week, the CDC released a SARS diagnostic test it developed to about 100 laboratories across the country.

The new approach is welcomed by clinicians and local public-health officials. Martin Fenstersheib, the health officer of Santa Clara County, Calif., where nine cases of SARS were reported, says he used to have to wait weeks for guidance on issues like flu-vaccine shortages. With SARS, he says, he finds daily updates on the agency's Web site (www.cdc.gov/ncidod/sars/1).

The CDC's go-fast approach raised some eyebrows when the agency filed for a patent on its genetic sequence of the coronavirus, a move rarely made by a government body. Dr. Gerberding defended the patent application, saying the CDC had done it to prevent a private company from doing so and taking the information out of the public domain.

The aggressive battle plan sometimes taxes an agency that has been handed one new challenge after another. Some programs have been slowed this spring as more than 600 people out of a work force of 10,000 have been mobilized to combat SARS. While the agency reaped new funding for bioterrorism, its overall budget was cut from $7.73 billion in 2002 to $7.16 billion this year as some of its functions were shifted to other agencies.

With the number of new SARS cases dwindling in the U.S., Dr. Gerberding is still acting as if the good luck can only last so long. Trouble could appear overnight from just one highly infectious patient, she says. To prepare for such threats, Team B, a group Dr. Gerberding formed to devise longer-term strategies, pondered a difficult question on a recent day. How should doctors and hospitals respond next winter, when thousands of people complain of fever, cough and muscle aches -- vague symptoms that could indicate SARS but could also be a sign of the latest flu? One proposal: Hospitals could erect tents outside, where patients with flu-like symptoms would be screened by nurses in gowns and masks.

To make it easier to distinguish SARS from flu, other CDC scientists are racing to learn more about the SARS virus. Respiratory symptoms normally begin three to seven days after initial symptoms, like fever and aches. Oxygen in the blood is low, and the virus settles in the low part of the lungs. All of those confirmed by late April as having SARS had fever and cough, 83% had chills and aches, 67% had headaches and diarrhea, and only 17% had sore throats. "Runny nose, sneezing and sore throat don't seem to be suggestive of SARS," says John Jernigan, a CDC expert overseeing the research.

Every SARS case, even those only suspected of having the disease, is a desired subject for CDC investigators. Blood, urine, stool and other samples are taken twice a week for four weeks from recovering patients to search for antibodies and to determine under what circumstances and how long the virus remains in the body. People who sat near SARS patients on airplanes are tracked down through airline manifests for interviews and samples.

Other CDC disease experts are quietly preparing states for the possibility they might have to seal off hospitals or even residential areas. The moves the CDC is encouraging include helping regions to develop outbreak plans -- designating one medical facility as the SARS hospital, for example. "We need to be prepared to take additional steps," Dr. Gerberding says.