Presentation on theme: "Reporting Incidence of Severe Acute Respiratory Syndrome (SARS)"— Presentation transcript:
1 Reporting Incidence of Severe Acute Respiratory Syndrome (SARS) Created by the IDEESE Project, Funding for the International Dimensions of Ethics Education in Science and Engineering Project comes from the National Science Foundation through grant number Any opinions, findings, conclusions or recommendations expressed here are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.You are free to use and modify these slides under a Creative Commons, Attribution-Noncommercial-Share Alike License
2 What is SARS? Definition: Symptoms: “Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV).”Symptoms:high fever (> 100.4°F/ 38.0°C) at outset withheadache, overall feeling of discomfort, & body achessome experience mild respiratory symptoms, diarrhea, & dry cough.most develop pneumonia.Source: US Center for Disease Control and Prevention SARS Factsheet
3 A Global ContextOutbreaks of infectious diseases can attain epidemic proportions in many countries more quickly than in previous centuries.Increased speed of travelLarger numbers of travelersThus, limiting the spread of infectious diseases requires a *joint effort*
4 Controlling Spread of Disease Success requires that governments:identify outbreaks of an infectious disease soon after the initial cases appearisolate persons who have the disease or have been in close contact with others having the disease until they are no longer contagiousminimize the number of non-infected persons who come in contact with currently infected persons or any place where germs are likely to be presentwarn other governments so they can take action to ward off spread to their countries
5 The World Health Organization “the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.”WHO Website (emphasis added)in , WHO authority to address outbreaks was based on the International Health Regulations of 1969
6 International Health Regulations of 1969 Regulated international cooperation to prevent spread of diseaseBUT did not give the WHO any enforcement powersRequired reporting outbreaks of infectious diseasesBUT only specifically listed diseases, not any new disease likely to spreadEstablished a system of mutual assistance so that all states could get help from WHO in identifying causes of infection and developing methods of treatmentBUT states were not obliged to let WHO teams visit disease-stricken areas or have their medical labs participate in collaborative work.
7 The Outbreak 8,141 cases in 31 countries resulting in 769 deaths at a cost of$40 billion worldwide in lost trade and tourismMap from Bill Marsh, The New York Times, 2003
8 National Responses Compare and contrast: the slow and private actions of Chinathe immediate actions of Vietnamthe very public and cautious actions of Canadaas shown on the next few slides.
9 SARS in China November 2002: Identifies “atypical pneumonia” February 14, 2003: Reports 305 cases and 5 deaths to WHO; claims spread is under controlFebruary 18, 2003: Dr. Hong Tao concludes that the new disease is a variant of the chlamydia virusFebruary 20, 2003: Chinese Academy of Military Medical Sciences (AMMS) researchers believe Tao’s theory is wrong; decide to conduct further research before making public statementsFebruary 21, 2003: Chinese SARS-treating doctor travels to Hong Kong hotel; infects other guestsearly March, 2003: AMMS scientists find additional support for coronavirus; again decide to continue research before criticizing Government acceptance of Tao’s theoryContinued….
10 SARS in China March 10, 2003: Health Ministry requests WHO assistance March 21, 2003: AMMS publicly reports findings to Army Logistical Department and Ministry of HealthMarch 21, 2003: Health Ministry requests additional WHO assistance; WHO sends 5 peopleMarch 25, 2003: WHO team is barred from Guangdong ProvinceMarch 27, 2003: Guangdong Province issues guidelines on community prevention and controlMarch 28, 2003: Health Ministry grees to work with WHOApril 3, 2003: Health Ministry allows WHO teams to visit infected sitesMay 13, 2003: CNN International special on SARS that criticized the Chinese government’s response to the illness is censored in ChinaEnd result: 7,083 cases and 644 deaths
11 SARS in Vietnam February 26, 2003: First case identified February 26, 2003: Asks for WHO assistance; WHO sends teamMarch 6, 2003: USA sends team from Center for Disease ControlApril 29, 2003: SARS declared contained in VietnamEnd result: 63 cases and 5 deaths
12 SARS in CanadaNovember 27, 2002: Canadian Global Public Health Intelligence Network (GPHIN) relays media reports of atypical pneumonia in Guangdong Province to WHO Global Influenza Surveillance NetworkJanuary 21, 2003: GPHIN Report is translated to EnglishMarch 5, 2003: First case identified in TorontoMarch 17, 2003: Health Canada announces 11 cases of SARSApril 11, 2003: Canadian Blood Services refuses donations from persons who have been to Southeast Asia recently (even though there is no evidence of bloodstream transfers of SARS infection)April 13, 2003: Michael Smith Genome Sciences Centre posts SARS genome sequence onlineApril 20, 2003: Canada's largest trauma unit stops accepting new patients after at least four health-care workers show signs of SARSContinued…
13 SARS in CanadaApril 23, 2003: WHO extends travel warnings to Toronto for 3 weeks, double the incubation time of SARSMay 1, 2003: WHO's director of communicable-disease surveillance and response writes an opinion article saying that the Toronto travel advisory could ultimately harm the fight against SARS because less-transparent countries will be afraid to report outbreaks, fearing economic costs.May 14, 2003: Canada removed from WHO list of SARS-affected countriesMay 24, 2003: Reports of new SARS cases; state of emergency declared in Ontario; More than 500 people ordered into quarantine in TorontoJuly 2, 2003: WHO removes Toronto from list of SARS affected areasEnd result: 251 cases and 43 deaths
14 DiscussionChina, Canada and Vietnam dealt with the spread of SARS in very different ways. Consider each country’s approach when answering the following questions:Where did international regulations break down? Where did they work?How would you redesign an international reporting system?Who asked for cooperation and who did not?What arguments did countries use support their decisions to, or not to, cooperate with the WHO and other governments?What would you have done the same or differentlyAs a bench scientist in China? in Canada?As a managing health official in China? in Canada?Who is to blame for allowing SARS to spread as far as it did?