SARS Epidemic: A Global Challenge Bong-Min Yang, PhD & Sung-il Cho, MD, PhD of School of Public Health Seoul National University

Why significant global issue?  Multi-country outbreaks  Spread through air travel and human migration  Causative agent still unknown  Severity of illness  Impacts on clinical and public health ser vices

 David P. Fidler (2004)  “ SARS was a crisis, but victory was achieved ”

Political Impact  Multinational organizations, particularly WHO, become to have increasing influence on global governance – After successful control, much credit given WHO for initiation and coordination of surveillance, research and control measures  WHO Initiated – Global Alert (12 March, 2003) – Travel Advisory (15 March, 2003) – Enhanced global surveillance – Global Outbreak Alert and Response Network (GOARN) – Specific Global Networks (Lab, Case management, Epidemiology)

Political Impact 2  Importance of global cooperation to an outbreak of infectious disease is fully realized – It validated the value of global public health networking  Weakness of China ’ s public health infrastructure was revealed – China first downplayed the extent and the risk of the infection, then joined the international network to control  Afterward, Chinese public health infrastructure was strengthened a lot – Case reporting structure established – Strengthened emergency response system – Provide funding for prevention of SARS

Economic Impact  Direct costs – Medical treatment costs, and costs of some equipment and supplies for prevention  Indirect costs – Travel/airline – Tourism – Trade/investment – Shrunk consumer confidence  Global indirect costs estimated to be around US$80 billion (McKibbin, 2003)

Estimation of the impact of SARS on selected Asian Economies Economies Estimated reduction in annual GDP growth if SARS lasts for 1 quarter in 2003(percentage point) Estimated reduction in annual GDP growth if SARS lasts for 2 quarters in 2003 (percentage point) Estimated reduction in GDP level if SARS lasts for 1 quarter in 2003 (US$ billion) Estimated reduction in GDP level if SARS lasts for 2 quarters in 2003 (US$ billion) 2003 East Asia The PRC HK, China Korea Taipei, China Southeast Asia Indonesia Malaysia Philippines Singapore Thailand Source: ERD of ADB using OEF model, staff estimates

Chart 4 Korea ’ s exports have decreased, but not much

Lessons Drawn  Importance of – early detection – quarantine and surveillance – informing the public in time, and correctly – Supporting basic and specific research – Increasing public health capacity: manpower and facility – Promoting international cooperation and collaboration

SARS Situation in Korea  No death related with SARS – 3 probable cases – 17 suspected cases  Mostly those who visited China  Overall 65 reports for assessment

Korean Strategies for SARS Prevention  Early detection of imported cases – Quarantine – Surveillance  Prevention of secondary infection – Medical facilities – Protection of health care personnel (mask, etc.) – Isolation of patients  Information and education – Hand washing  Laboratory capability – Support laboratory diagnosis

SARS Management System Headquarter Chair: Minister of Health Communicable Disease Task force Emergency Response Team Municipal/Provincial health director Local Emergency Response Team District health officer Chair: NIH director SARS Control Team Chair : Municipal/Provincial vice mayor Chair: Vice district chair Local SARS Control Team

Quarantine  Questionn aire  Examinatio n (fever etc)  Isolation room  Patient care  Special investigation   Identify passengers from high risk areas   Collaborate with immigration office   Examine air crews   For travelers   For visitors and immigrants   Media   Travel agencies Follow-up Suspected Cases Information AssessmentIsolation

Quarantine Activities  Check body temperature for travellers from China (5,000/day)  Examine aircrafts (45 planes and 7,000 persons/day)  20,000 passengers/day screened, using infrared automatic body temperature thermometer

Patient Surveillence  Case report network  Education of health care workers  Monitor emergency rooms  Networking of infection specialists

Public Information and Education

Tasks Underway after SARS Epidemic  Establish infrastructure for communicable disease control – New establishment of CDC – Strengthen public health care sector – Networking of quarantine office and CDC  Strengthening response capacity for emerging disease – Global monitoring – Laboratory capacity and research – Emergency response preparedness