The outbreak of a mysterious respiratory disease has set off alarms worldwide. Hundreds of individuals have been affected by the malady, which can result, if untreated, in death. Its rapid spread has reignited concern about the dangers of bioterrorist attacks. Although there is no evidence to suggest that this is anything other than a naturally occurring disease, this is a sobering reminder of our vulnerability to such pathogens and the necessity of international cooperation to protect us from them.
International concern about the disease, which is thought to be a form of pneumonia, was triggered a few weeks ago when the first cases were identified. As of last weekend, the World Health Organization, or WHO, had received reports of 350 cases of Severe Acute Respiratory Syndrome, or SARS. The organization attributes 10 deaths to the illness since Feb. 1, with cases reported in Asia, Europe and North America.
China has reported 305 cases, including five deaths in Guangdong Province from November to Feb. 1. Apart from China, the bulk of the incidents have occurred in Hong Kong. More than 200 people in the Special Administrative Region have been reported as infected with the disease, and six have died. The rising number of health-care workers showing signs of the disease has intensified concern.
Little is known about SARS. Symptoms include shortness of breath, a dry cough and other flulike symptoms such as high fevers, muscle aches, sore throats and headaches that develop two to seven days after exposure. Health officials have been unable to pin the disease down, although medical researchers believe they have identified the virus responsible for the outbreak. They think the culprit is one of the paramyxoviridae, a family of germs that includes the pathogen for measles.
If so, it would explain the spread of SARS to health-care workers: It is so small that it passes through ordinary surgical masks. That the virus is heretofore unknown is not a cause for alarm in itself: Paramyxoviridae are one of the fastest growing families of viruses, with new varieties being discovered all the time. Last year, two new types were identified, and another unknown strain killed over 100 Malaysian farmers in 1998 and 1999.
The outbreak of SARS highlights the need for a coordinated international response to these outbreaks. Within days of the first reports of the disease in the Western press, it spread across the globe. The incubation period allowed infected individuals to travel from one continent to another by air. WHO has issued a rare health alert, calling SARS “a worldwide health threat,” and urged all countries to help in seeking its cause and control. The U.S. Centers for Disease Control and Prevention activated its emergency operations center, which allows it to coordinate information from other countries and to investigate suspected cases in the United States.
But an international effort to track and control the disease can be successful only if all nations participate fully and honestly. In the case of SARS, evidence points to a coverup by China as a key factor in the initial outbreak and its subsequent spread. Most scientists believe that the disease first appeared in southern China late last year when there was an outbreak of “atypical pneumonia” in Guangdong. Health statistics are politically sensitive in China, however, and reporting on disease outbreaks is frequently suppressed.
There are reports that the Chinese government ordered newspapers to ignore news both of the initial outbreak last year and the more recent upsurge in Hong Kong. China only agreed to WHO involvement in investigating the outbreaks two weeks ago, and international health officials say cooperation has been begrudging at best.
If the disease did originate in southern China, there is a good chance of another outbreak. Thus far, the main vector of transmission is believed to be through Hong Kong. But Guangdong is well-linked to other Chinese cities; there are about three dozen flights a day from the province to Beijing and Shanghai. Reports of two recent deaths from “atypical pneumonia” in Beijing and infections among health-care workers that treated the patients suggest that it is only a matter of time before the evidence becomes too large to ignore. Beijing and Shanghai are also international gateways, so outbreaks there are likely to spread worldwide.
China’s increasing integration into the world economy imposes obligations on the Beijing government. Old habits of secrecy must be abandoned. When it is ready to shoulder that responsibility, it will have help from the rest of the world. Concerted international action is the only way to combat diseases like SARS.
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