In April, with SARS burning in North America and spreading quickly across Asia, a public-health expert predicted on Nightline that more than 60,000 Americans would die from the virus. Today, there is nothing but good news. Vietnam has beaten the outbreak and the total number of cases outside of China continues to fall. Closer to home, the WHO dropped Toronto from the list of SARS hotspots last week, while the United States remains without fatalities. Viruses are difficult to understand and even harder to predict, but this much is clear: SARS isn’t the Big One. But the outbreak offers us a warning no less significant than the first bombing of the World Trade Center.
SARS has been humbling. Despite our ability to map genomes, we still don’t have a confirmatory test for the disease. There is no vaccine — nor will there be one for years. Nothing has proven successful in treating the very sick; anti-virals and steroids don’t touch the infection. We are left with only the bluntest instruments for containment: isolation and quarantine. These measures make for a strategy of catch-up, like trying to stop a serial killer by only visiting past crime sites.
And herein lies the most important lesson to learn from SARS. North America is very vulnerable to infectious diseases. And vulnerability can prove costly. Consider: using only isolation and quarantine, it took Toronto more than two months to contain an outbreak caused by just one person with the illness — an effort that has included the quarantining of more than ten thousand people, the closure of two hospitals and the semi-closure of a dozen more. The economic fallout for Canada is approaching a full percentage off the GDP this quarter. What if the strain had been more virulent?
Thus, SARS reminds us of the importance of containing an outbreak in its country of origin. The international system for doing this, however, is inadequate. The months-long cover-up in China was unconscionable. Today, thirty-two countries report SARS cases. If Chinese authorities acted properly six months ago, SARS may never have left the remote villages of Guangdong.
Presently, international infectious disease control is pinned on self-disclosure by individual nations, effectively an honor system. We have seen the honor of Chinese officials. Do we expect any better from government bureaucrats in Syria or Zimbabwe should the next big disease arise there?
Harvard Professor Jerome Groopman suggests an international health concordat for the containment of infectious diseases, much in the way we have treaties to prevent the proliferation of biological and chemical weapons. That may be worth pursuing. But regardless of whether we can fashion a new treaty, the West must recognize its security depends on proper containment of contagious diseases. The United States and other Western countries have taken a hard-line on governments that support terror, using sanctions, diplomatic isolation, and even regime change to tame them. Why should bioterror — caused by negligence — be any different?
Now, we offer a carrot for good behavior. If any country suffers an outbreak, it can notify the World Health Organization and will be rewarded with careful attention by the brightest minds in science, medicine and public health. Any rational country would jump at the chance, but autocratic nations aren’t always rational. Thus, there must be a stick for countries that conceal outbreaks.
From this point forward, we should treat such nations as international pariahs. The United States formed a coalition of the willing to crack down on WMD proliferation; there should be a coalition of the healthy prepared to respond to disease proliferation with physical isolation and economic muscle. In a day and age when even the most backward and authoritarian countries seek trade, this threat would be taken seriously.
But even this might not be enough. SARS shows us that we must take steps to stop potential epidemics from entering North America in the first place.
It sounds simple enough, but even now with SARS little is done. Travelers entering Singapore are greeted by thermal scanners, teams of nurses, and the possibility of a ten-day quarantine. No wonder: in 99% of SARS cases, the first presentation includes a fever. Yet passengers arrive in most North American airports with limited screening.
This is unacceptable. SARS burned in Toronto’s hospitals for weeks before a thermometer came out in China’s airports — why should North American countries be dependent upon other countries for their public health? The free flow of passengers is crucial to world commerce. But when an uncontained outbreak occurs in another part of the world, homeland security includes homeland screening. In retrospect, officials at the CDC have been slow to act; their northern counterparts at Health Canada have been negligent.
CDC and Health Canada officials argue that airport screening is expense and time-consuming. They’re right. But looking at the deep problems faced by Singapore, Hong Kong, and Taiwan — all countries infected by travelers — it seems like a small price to pay. In the future, screening ought to be done the moment the WHO warns about an emerging epidemic. Future outbreaks may warrant even stronger measures.
Today’s screening is done in our airports; next time we could focus more on preventing the virus from landing on our soil. The CDC and its North American counterparts ought to certify airports around the world for proper exit screening. No plane then that took off at a non-certified airport would get landing rights on this continent. Of course, in an age of jet travel, a businessman could arrive today from Helsinki after attending a conference in Hong Kong yesterday and a meeting in Hanoi two days before. Just as airlines are required to report a travelers’ manifest (a list of their passengers and their recent travels) to assist with anti-terrorism, when an outbreak occurs, airlines ought to provide such a list to assist with infectious disease containment.
North America has porous borders and assumes confined plagues. That assumption fell apart this spring as quickly as SARS spread. This flu-like virus is a warning. September 11 shows us the consequences of unheeded warnings.
— Dr. David Gratzer is a Toronto physician and a senior fellow at the Manhattan Institute.