COMMENTARY

SAMS -- Severe Acute Media Syndrome?

The SARS Epidemic

By DAVID BALTIMORE

Restaurants sit empty in Chinatowns. Parents keep children home from school in Toronto. Asian hotels and airlines reel at dramatic drops in bookings. Just as the media recently gave us a new and particularly intimate experience of war, we're now getting a new and particularly fearsome experience of a public health crisis with SARS -- in which a media-transmitted epidemic of concern for personal safety outpaces the risk to public health from the actual virus.

To be sure, SARS, or severe acute respiratory syndrome, presents serious challenges. It has likely emerged after circulating within some animal species for a long time. It is one of a large number of such viruses that suddenly infect the human population. Most burn themselves out (although Ebola still smolders in Africa, being particularly devastating to the great ape population). SARS may be worse because it is transmitted more easily, now perhaps through persistence after drying onto surfaces, making it harder to contain. Although much less lethal than HIV, it may therefore be the next virus to settle into the human population. That SARS may always be with us is a possibility we must be prepared to cope with.

But that doesn't mean its effects are not manageable. Given what's happened thus far, the appropriate response is to pursue targeted and aggressive public health measures, while the 99.9% of us not conceivably at risk go on with our lives.

This is where China's shocking cover-up has proven so costly. In any viral outbreak, early identification and containment is essential. It was our inability to spot and contain HIV that has led to the epidemic of more than 45 million infected people that the world faces today. Now that the Chinese leadership seems to be belatedly cooperating, the world community's overriding objective must be to stop SARS from achieving a similar trajectory.

There is good news in this regard. Advances in technology have helped health professionals get a fix on SARS much sooner than with previous viruses. It took years to identify and isolate HIV. Now, "libraries" of known viruses are stored on computer chips, letting researchers identify suspect strains in a matter of days -- a key to devising accurate tests and effective treatments. This progress, related partly to the post-9/11 focus on bioterror, suggests that defense-related technology spin-offs may soon be as frequent a boon to public health as they've long proved in aviation or electronics. As we mobilize for faster action against biological threats, it will prove as helpful when germs attack via nature as when they come from the diabolical schemes of terrorists.

Yet herein lies a tension. The chief means of avoiding an HIV-style scenario are strong and open public health measures. Openness, however, breeds fear and overreaction. This risk has to be managed by careful reporting and characterization -- a challenge for the media that may be as thorny as that facing health officials. Indeed, it's arguable that new media technologies are accelerating public anxiety about viruses even faster than new health technologies have enhanced our ability to cope with them. The Internet, e-mail, and satellite-enabled saturation media coverage have put public fear on steroids -- and lent a dark twist to the old dot-com hype about the promise of "viral marketing." As a result, people from Guangdong to Greenwich Village hunker down with herbal remedies, thanks to baseless rumors that these offer protections -- or that they need protection in the first place.

The de facto boycott of Chinese restaurants across America is the most alarming overreaction, since there's absolutely no reason to think SARS can be transmitted through food, or by people who happen to be Chinese. Your chances of being killed by SARS are remote compared to the chance you'll be killed in your car on the way to a Chinese restaurant. But media viruses are immune to rational inoculation. The anthrax scare of late 2001 was the preview. With Tom Brokaw and the Senate involved, it was no time before well-to-do mothers added stocks of Cipro and gas masks to the inventory of the compleat parent. That this anthrax episode claimed five lives -- when each year 40,000 Americans die in highway crashes, 400,000 from tobacco-related illnesses and 20,000 from flu -- doesn't seem to allay fears.

Scientists often complain that the public deals with danger not as a matter of statistical probability but as a function of media exposure. People fear whatever scary new thing TV shoves under their noses. But those of us professionally devoted to rational analysis need to do more than wag our fingers now that the press routinely swells the fear factor toward a level that could itself become a danger.

The power of these new "media viruses" presents a paradox. The press does perform a great public service by making virtually everyone on the planet aware of important information overnight. This raises the odds that authorities will take action, or be held accountable if they fail to. In the age before satellite television, for instance, it might have taken Chinese leaders many more months (and untold more SARS deaths) to begin to do their duty. But public health professionals may soon learn what those who conduct foreign policy know already: The distorting magnification of the modern media lens brings new risks as well.

This is an aspect of public health crises that our leaders can no longer ignore, and one for which scientists in particular have a special responsibility to educate the media. On a recent "Nightline," Ted Koppel provided a model for such discourse, framing the SARS discussion as a matter of thinking intelligently about the threat in light of the reality that this new disease's reach is far, far smaller than countless other risks we face routinely. The daily press should likewise reassure the public by highlighting this broader context of risk even as it shares the latest scary-sounding news.

We need to improve at striking this balance now. As the SARS overreactions suggest, the era in which public alarm can soar out of proportion to genuine risk is only beginning.