key: cord-0008602-zwg9ii5t
authors: Olowokure, Babatunde; Roth, Cathy
title: Mini‐Symposium Severe acute respiratory syndrome (SARS): Reshaping global public health
date: 2005-11-17
journal: Public Health
DOI: 10.1016/j.puhe.2005.10.004
sha: 5c1b6bdea74a2a48bbee1cdc46e19a98fcdd7263
doc_id: 8602
cord_uid: zwg9ii5t

nan

A single infectious agent demonstrated the global nature of infectious diseases in the 21st century. Severe acute respiratory syndrome (SARS) had an impact not only on healthcare systems but also on the humanitarian, economic, political, technological, scientific, social and cultural aspects of societies. Although SARS appears to be contained complacency must not replace vigilance, the threat of another global outbreak remains as SARS may reemerge from unidentified animal reservoirs, laboratories or via undetected transmission within the human population. 1 In this issue of Public Health five articles provide us with a timely reminder of the global impact of SARS and how the lessons learnt are reshaping local and global public health infrastructures. [2] [3] [4] [5] [6] SARS emerged as an atypical pneumonia of unknown aetiology in Southern China in November 2002. 1 Initially, the condition primarily affected close contacts of cases and healthcare workers (HCWs) who looked after them. In the first article, Ho documents the personal and unique experience of a HCW who became infected during the early days of SARS. 2 This provides an inside view of SARS in Guangzhou, China at a time when it was not yet known as SARS but was simply an atypical pneumonia called 'That Disease'. The interviewee worked in one of the hospitals in Guangzhou and his story poignantly illustrates the vulnerability of HCWs in the early stages of the outbreak.

As SARS spread it became clear that there were deficiencies in the infection control infrastructure in many countries. Universal problems included poor infection control infrastructure, lack of trained personnel and inadequate surge capacity. Shaw provides an extensive overview of the infection control measures used in healthcare facilities during the SARS outbreak. 3 In some countries, a lack of resources meant that innovative measures were introduced while in others new facilities were built within days to provide dedicated wards or hospitals for the management of SARS cases. 7-10 The wide variation in infection control practices and the disparity in the availability of resources are two of the reasons Shaw uses to illustrate the need for a global infection control strategy. 3 Deng et al. examined the knowledge and awareness of SARS among physicians who had staffed a SARS telephone hotline in Taiwan, China. 4 Although all respondents knew the causative organism of SARS, there was inadequate knowledge regarding the incubation period and information required to triage callers appropriately. Even though the majority of respondents indicated that they had received formal education and training regarding SARS, respondents identified hospital guidelines and the mass media as their most common sources of information on SARS. 4 HCWs are exposed to information from a variety of sources and must critically evaluate all the information received. In the outbreak context, hospital guidelines and the media may not have been reliable sources of information. It may be that active learning techniques, together with positive reinforcement, should be encouraged for all HCWs during rapidly evolving outbreaks. Further information on this issue from other areas that experienced similar large clusters of cases would be useful.

The transmission that occurred at a hotel in Hong Kong with subsequent dissemination by air travel to a number of countries illustrates the ease with which SARS, or any other efficiently transmitted emerging disease, may cause large outbreaks and cross international borders. The index case of SARS in Singapore had stayed at the hotel in Hong Kong and was admitted to hospital on 1 March 2003 and seeded a large nosocomial outbreak with cases in the community. 11 James and colleagues highlight the valuable lessons learned in Singapore from tackling SARS and uses them to vividly demonstrate that emerging infectious diseases such as SARS impact not only on healthcare, but all sectors of society. They also provide a summary of the various public education and communication measures used in Singapore to inform and gain the support of the public. These played a vital role in reducing panic by increasing public awareness of the disease and gaining acceptance of quarantine. 12 Singapore introduced a wide range of public health interventions in response to SARS and it is important that they are evaluated in order to provide further lessons.

In their description of the UK experience, Goddard et al address the issues encountered during SARS preparedness and response activities. 6 To provide strategic direction a multi-disciplinary UK-wide SARS Task Force was established. The availability of an infrastructure to coordinate the public health response to SARS and act as a focus for consistent information dissemination and resource mobilisation was crucial. Such command structures are now recognised as critical components of outbreak preparedness planning. Another issue identified in the paper by Goddard et al. was the acute shortage of epidemiologists and others with public health skills and the consequent lack of surge capacity to cope if a prolonged outbreak had occurred. 6 Similar personnel issues were identified elsewhere during and after the outbreak and highlight the need to increase training programmes and recruitment in epidemiology and public health globally.

Both James et al. and Goddard et al. are among those who have identified rapid information dissemination and international collaboration as key components of the SARS response. 5, 6 The Internet facilitated both these elements, as well as surveillance, and in doing so revolutionised the way global outbreak investigation and control was conducted. Updated situation reports, guidelines and other information were made rapidly available on WHO and other websites. [13] [14] [15] [16] Teleconferencing, videoconferencing, emails and faxes were utilised round-the-clock in order to maximise information exchange and dissemination as more experience and scientific evidence accumulated globally.

The effect of SARS on public health and healthcare systems worldwide was dramatic and a number of lessons can clearly be identified from the papers in this mini-symposium. Global threats require global action and this can only be achieved through a coordinated committed collaborative multidisciplinary effort that has an international focus. The newly revised International Health Regulations recently endorsed at the 58th World Health Assembly provides strong support for WHO and its technical partners within the Global Outbreak Alert and Response Network (GOARN) to investigate, verify and respond to global infectious disease threats. 17 The risks, challenges and even opportunities provided by the global SARS outbreak are therefore reshaping local and global public health infrastructures as they prepare to confront the looming influenza pandemic and other global microbial threats. However, identifying and responding to emerging diseases is difficult as it is not possible to predict when or where they will occur. Vigilance, as well as practical surveillance and response strategies are therefore critical in all countries as part of preparedness planning.

Learning from SARS: preparing for the next disease outbreak-workshop summary

I think I got 'that disease': an interview with a medical student who had recovered from SARS in Guangzhou

SARS outbreak and its impact on infection control practices

Severe acute respiratory syndrome (SARS): knowledge and sources of information among physicians answering a SARS fever hotline service

Public health measures implemented during the SARS outbreak in Singapore

Lessons learned from SARS: the experience of the Health Protection Agency

Environmental and occupational health response to SARS

Lack of SARS transmission among public hospital workers

Severe acute respiratory syndrome from the trenches, at a Singapore university hospital

Infection control practices for SARS in Lao People's Democratic Republic, Taiwan, and Thailand: experience from mobile SARS containment teams

Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts

Crisis prevention and management during SARS outbreak

World Health Organization. Severe acute respiratory syndrome (SARS)

Centers for Disease Control and Prevention. Severe acute respiratory syndrome (SARS)

SARS Severe acute respiratory syndrome

Resolutions of the 58th world health assembly, WHA58.3: revision of the international health regulations. Geneva: World Health Organization