BY RALPH ROBINSON

As my students returned from spring break, they had several questions. What are the chances of bioweapons being used in the Gulf war? What are the dangers of bioterrorism here at home? What are the risks from SARS? And, of course, what were the scores on their final exams? Other than the exam scores, these are concerns that were not on students’ minds until recently.

SARS (Severe Acute Respiratory Syndrome) is what I would like to address here. This outbreak started last October in Guandong Province in southern China and was initially thought to be a new strain of influenza. Many new forms of flu crop up in Southeast Asia, and this seemed to be just another rather nasty strain. Cases began showing up in Hong Kong in January, and the numbers steadily increased. Since Hong Kong is an international travel hub for the region, cases were exported rapidly to other countries, including the United States.

Because many of our students traveled through the region on spring break, their concerns were justified. Travel advisories were issued by the World Health Organization, and several countries began interrogating travelers arriving from infected areas. Airline flight crews were requested to report suspected cases among passengers, and planes have been quarantined for brief periods. Recently, President Bush gave the authorization to quarantine persons if they were found to be infected.

The public response has been rather dramatic as well. Residents of Hong Kong avoid public gatherings, and many people in the city are wearing surgical masks, as are most travelers on flights from the region. It is quite a sight at the Bradley Terminal at LAX to see passengers disembarking wearing their masks.

It is now known that SARS is a newly emergent disease in humans caused by a coronavirus, also associated with the common cold. But how this virus crossed over into our species is still a mystery. And we cannot predict if it will become established in the human population.
Some people think the fear of SARS has been overblown. Indeed, when compared to a new strain of influenza, the overall numbers have been low. As of April 17, there have been 3,389 cases of SARS in 25 countries and 165 deaths. An influenza outbreak would infect many more people and result in an average 250,000 deaths a year (36,000 in the United States alone).

So why have the health authorities responded with travel advisories and possible quarantine for this infection? It is the severity of this disease that has authorities concerned.

Influenza is typically fatal in less than 0.1% of the cases. So far, SARS infection has an overall death rate of 4.9%; and 40% of patients require hospitalization. Compare this to the Great Flu Pandemic of 1918, which had a fatality rate of just 3%.

We have been lucky in the United States. Most of the patients here acquired the infection overseas, and the cases have been relatively mild thus far.

Given that this disease is only a few months old, the strong and rapid response of the global health community has been remarkable.

Part of this stems from increased preparedness to possible bioterrorist attacks. SARS infection will likely show how well we can respond to an infectious outbreak and will allow us to modify our surveillance and response systems in the future.

Robinson is assistant adjunct professor in the Department of Microbiology, Immunology and Molecular Genetics.