Hala Sakr examines the causes and international ramifications of the SARS epidemic Fears of a global health crisis have been escalating since the World Health Organisation (WHO) alerted the world to an alarming increase in the number of cases of severe acute respiratory syndrome (SARS) on 15 March. In a report issued by WHO on 11 April, David L Heymann, WHO executive director for communicable diseases, stated, "if the SARS virus maintains its present pathogenicity and transmissibility, it could become the first severe new disease of the 21st century with global epidemic potential." In addition to claiming human lives, the SARS virus is also casting dark shadows on the Asian economy. Experts are pessimistic about growth forecasts for the region, which up to now, has been a world economic leader. According to economic experts, the drop in spending, tourism and business travel will strangle growth to an extent greater even than the Anglo- American invasion of Iraq. Mustafa Kamel El-Sayed, director of the Centre for Developing Countries and professor of political science at Cairo University, believes that, "the present SARS outbreak should not be taken as an indication of the failure of the Southeast Asian model of development." No model of development is perfect, he continued, "and hence these countries are still vulnerable due to the volatile nature of the international markets, particularly in relation to the short- term movement of capital, which could play havoc with employment levels and balance of payments. But the situation is not the same in every single [Southeast Asian country]." In an attempt to contain the outbreak and adverse impact on various sectors of society, leaders from China, Japan and members of the Association of Southeast Asian Nations (ASEAN) met in Bangkok on 29 April. The delegates at this meeting adopted an action plan in an effort to coordinate efforts and to express political will to fight the spread of SARS. SARS is a new form of atypical pneumonia which, according to Mangai Balasegaram, spokesperson for the Beijing office of WHO, in 95 per cent of cases is transmitted via droplet infection -- sneezing or coughing. She told Al- Ahram Weekly that, "the SARS virus is no different from any other virus. It is true that it is quite infectious, affecting people who are healthy, and not just the immuno-compromised and the elderly; yet it is not as infectious as, for example, the flu." In a statement released on 16 April, WHO announced that SARS was caused by "a new pathogen, a member of the coronavirus family [to which the common cold virus belongs] never before seen in humans." No treatment or vaccine has yet been developed, although WHO and "a network of 11 of the world's top laboratories" are working on a plan to tackle the many challenges related to the virus. According to the statement, these measures include "zeroing in on the cause of SARS" and developing a diagnostic test to "distinguish between those ... infected and those who are free". On 23 April it was reported on the CNN Web site that "the SARS virus is thought by many health experts to have made the leap from animals to humans in southern China's Guangdong province -- although how exactly that happened is one of the many mysteries yet to be solved." This declaration is a reminder of the HIV/AIDS virus, which is also reported to have made the same mysterious journey from the animal to the human population. "We are not as yet sure where the virus originated," said Balasegaram, who went on to mention that other viruses affecting humans, in addition to HIV/AIDS, have been known to follow the same route. This is a reference to the NIPAH virus -- named after the region in Malaysia where it was first detected in 1999 -- which can be transmitted from infected animals to humans. SARS, which was first identified in southern China only last November, is now affecting 28 countries. In our ever-shrinking mobile global village, SARS seems to be "emerging in ways that suggest great potential for rapid international spread under favourable conditions", according to Heymann. Dick Thompson, communications officer of the WHO communicable diseases division, told Al-Ahram Weekly that, "the good point is that there are just a handful of cases which [have been] quickly identified and isolated and it is possible to stop local transmission within countries." According to Balasegaram, the real threat comes from the novelty status of the SARS virus and the fear it engenders. "What if we compared the SARS [death] toll to a disease such as measles, which claims about one million lives a year. We do not regard this [measles] as an equal peril." She said. In an interview with BBC news, WHO Director-General Gro Harlem Brundtland said there would still be time to halt the global spread of the disease if affected countries took appropriate measures. China seems to be a key player in this respect. Heymann told reporters in Bangkok on 28 April that, "if China cannot contain it [SARS], then it cannot be removed." The Chinese government has recently been criticised severely for insufficient reporting of the actual situation for fear of the negative impact on its economy. The increase in the number of deaths and incidences of the disease, however, could not be covered up for long. On 27 April the Chinese Ministry of Health reported 161 new SARS cases, raising the total to 2,914. Nine new deaths were reported, increasing the death toll to 131. Both the Chinese minister for health and Beijing's mayor were dismissed for concealing information regarding the extent of the outbreak. Other officials were also dismissed in the last week of April. Wu Yi, politburo member and China's "Iron Lady", was appointed as the new health minister and commander in chief of the health campaign. A decade ago, Yi cast her steel print, when she conducted an extremely ruthless campaign to enforce the one-child policy in China's rural areas. "China has lagged behind other countries in the region regarding democratisation, despite the efforts of the ruling Chinese Communist Party to renew leaders of the state and party," said El- Sayed. "The late admission concerning the gravity of the SARS epidemic speaks volumes about the lack of transparency within the Chinese political system and the need for more accountability in relation to senior government officials." Tougher measures to contain the virus and restore the country's international credibility were adopted after the appointment of the new health minister. On 22 April a decree was issued by Bejing stating that those failing to comply with orders of the municipal health department could face prison sentences of up to seven years. The government has clamped down on travel and has closed down schools and recreational venues in its campaign to stem the spread of infection. The week-long May Day vacation "Golden Week" has also been cut short in an attempt to keep people from traveling and spreading the virus. An information campaign has been launched and authorities have started to disinfect public places. "We are working closely with the Chinese government to track down cases ... [to provide] both care and isolation," said Balasegaram. In a press briefing on 23 April, Isabelle Nuttall, medical officer for the WHO communicable diseases division stated that, "the reporting system [in China] has changed...Now we know there is a good reporting system." This is obviously the key issue with regard to addressing the spread of the virus. "The later we tackle the disease, the more difficult it becomes to contain the chain of transmission." El-Sayed points out that the delay in revealing "the reality of the situation ... is an indication that countries like China, who wish to continue to achieve impressive goals, such as increasing industrial and agricultural production, expanding exports and raising the standard of living, will have to impose basic reforms to ensure that a problem as large as SARS does not remain hidden from either the public or higher echelons of government. The price for failing to do this, in terms of the human condition, welfare and life expectancy, even the chances of life and death, will be great." On 23 April WHO's Heymann stated that the organisation's team in China is still " very concerned, because firstly, we do not have the manpower yet to accompany the Chinese to the provinces; secondly because the standard of healthcare in those provinces is lower than in the rest of China, causing us concern about the continued spread of the disease if it infects the healthcare facilities themselves." On 23 April Toronto became the first non- Asian city to be placed on the WHO list of "high risk areas". Along with Bejing, Chinese Guangdong and Shanaxi Provinces and Hong Kong, this city was tagged unsafe for visiting unless absolutely essential. Toronto, a city of three million people, accounts for about 20 per cent of Canada's total economic activity. According to the international agency, this travel advice is intended to limit the spread of the disease. Once a country is added to the list, it remains there for at least three weeks, which is equivalent to twice the incubation period of SARS. The Canadians reacted with anger to this classification. In a demonstration of defiance and in an attempt to reassure the public, the cabinet meeting which was held directly after the WHO declaration was relocated from the capital Ottowa to Toronto. Canadian Prime Minister Jean Chrétien said that they all "believe that WHO came to the wrong conclusion. We believe Toronto is a good place to visit. It is a safe city." In a letter addressed to Heymann on 24 April, J Scott Broughton, assistant deputy minister of the population and public health branch of the Canadian health authority, expressed Canada's concern and disappointment over the agency's travel advice. He stated that, "There is no evidence of any casual transmission of SARS in Toronto and every case of SARS can be linked to the original Canadian case." However, WHO's Thompson insisted that such travel recommendations were issued only when the organisation was concerned that a city had exported cases of SARS. "Toronto has exported cases and has set a local chain of transmission." "We have to act decisively to stop the spread of the disease into developing countries, where the health facilities will be rapidly overwhelmed," he explained. According to BBC news, Brundtland, of the WHO said that the organisation was "doing what is prudent and necessary ... before [the disease] becomes global and constant. If this outbreak reaches poor underdeveloped parts of Africa, we are in trouble." "Things are very problematic in countries where health facilities are more curative and urban-based," agrees Heba Nassar, director of the Centre for Economic and Financial Research in Cairo University. She continues by saying that there are usually more hospitals in urban areas and an insufficient number of smaller clinics and medical centres to serve the rural regions. "Prevention takes a back seat because of insufficient funding, personnel, facilities .. etc". But even when the SARS crisis has been resolved, new challenges will continue to emerge, challenges which can only be faced on a unified platform of cooperation between countries and organisations. Only in this way may global threats to humanity be contained. Included in the pan-Asian measures adopted by the Bangkok summit, according to Reuters news agency, are: * The pre-departure and arrival screening of international travellers * Establishment of an international emergency SARS hotline * Exchange of information * Cooperation on research and training * Meetings to devise other counter measures to combat SARS * Openness and transparency in dealing with the virus
