SARS
Editorial
Stabroek News
April 28, 2003
The worst case scenario for Guyana is a SARS-infected person in the early stages of incubation deplaning at the Timehri airport and transmitting the virus to a large number of people as he/she makes his way home to a crowded village or the capital city. Those infected then begin the multiplication of the transmission many times over spreading it to the interior and thus overwhelming health facilities and creating panic and chaos.
The probability of such an occurrence is what health officials here have to consider and act judiciously to limit.
First, there should be a reality check. Ever since it emerged in Guangdong, China last year, Severe Acute Respiratory Syndrome (SARS) has infected around 5,000 people in 20 countries and killed nearly 300. The cities affected by the disease have a total population in the tens of millions so the percentage of persons affected is minuscule. The big unknown so far is the extent of China’s underreporting of the scourge. Experts now believe that the underreporting was by a factor of five so that if this was applied across the board the figure is now 25,000 infections but with considerable more worry about whether these persons were quarantined quickly enough before spreading the infection far and wide in China’s vast interior and abroad. The other concern about the China cover-up was that it deterred investigators from making critical evaluations of early cases so that they could gain a real fix on the incubation/infectious period and the modes of transmission of the virus.
The latest expert information on SARS from infectious diseases expert Professor Roy Anderson of Imperial College London is that the virus is more deadly than previously thought but less contagious. Anderson’s mortality figure averaged around 10% while the World Health Organisation (WHO) has proferred a figure of around 6%. It is good news/bad news in the sense that while the disease might not be contracted as easily as touching an elevator button pressed by an infected person, once caught it could kill one in 10 persons. Anderson’s projections are based on an assessment of 1,400 Hong Kong cases. The contagiousness of SARS is a troubling unknown as in the early stages of its flare up several patients - so-called `super spreaders’ infected dozens of people. At Hong Kong’s Prince of Wales Hospital at least 50 health care workers were infected by a 26-year-old man. This included every, doctor, nurse or medical student who examined him and patients around him. This one man is believed to have infected 138 persons directly or indirectly. A woman in Singapore is believed to be responsible for 160 cases in that city state and a man she infected is believed to have snared 40 persons including doctors, nurses and patients in two wards.
It now transpires that the type of medical care the man at the Prince of Wales Hospital received contributed to his infectiousness. He was given drugs using a jet nebuliser which may have created a mist of infected droplets in the air around him so the large number of persons infected by him is not a typical case for assessing contagion. One technique now in employ at hospitals is ensuring that the rooms of SARS patients have negative air pressure thereby preventing air with infectious agents from leaking out.
Another worry for scientists though is the proclivity to rapid mutation of this particular family of viruses - the coronavirus - raising the prospect of new more virulent strains cropping up in various parts of the world.
Guyana is in no position to risk a SARS outbreak. Given the sprawling hinterland, the densely populated coast and the disconnect between the health ministry and the regional health system, a SARS eruption could be devastating. The situation therefore requires the greatest precaution to ensure that the infection doesn’t take hold here.
It means that all international ports are potential hotbeds of transmission and should be treated as such. If Brazil and Venezuela were to report significant cases then cross-border travel would be studded with jeopardy. The greatest danger posed at the moment is travel between Georgetown and Toronto. Toronto, Canada is the only city outside of Asia i.e. China, Hong Kong, Singapore, the Philippines, Vietnam, Thailand, Malaysia and Taiwan to have reported deaths. Canada has registered 20 deaths thus far and has around 340 cases. With the thousands of persons who travel annually between Georgetown and Toronto, the possibility of an infected person arriving here is not inconsequential. Guyana has endorsed the WHO’s travel advisory warning against non-essential travel to Toronto among other hotspots. Following Ottawa’s arm-twisting tactics, WHO has agreed to re-evaluate the travel advisory tomorrow but it is by no means certain that it will be changed. Experts believe that infected persons travelling from Canada have spread the disease to at least three other countries: the Philippines, Australia and the United States. Bulgaria is now reporting a possible case originating from Canada. Toronto is arguing that the advisory is unfair as SARS has not spread into the general population and has been contained to the original cluster of cases. This is the information WHO is expected to analyse tomorrow. Whatever the result, traffic between Georgetown and Toronto is the potential flashpoint for Guyana. Short of banning travel, health authorities here have to consider what should be done.
At Saturday’s Asian health ministers meeting in Kuala Lumpur, Malaysia, a call was issued for all departing passengers to be evaluated for the symptoms of SARS - a high temperature, dry cough and breathing difficulties - and barred from travelling if they appear to be carrying the disease. It is left to be seen if Canada will pursue these measures amid its attempt to reverse WHO’s advisory.
Whether or not it does, Guyana should take urgent measures to ensure that passengers from Toronto and other cities with infections do not spread the disease here. First, it should require all airlines operating into Georgetown to take specific measures at embarkation to ensure that passengers are not exhibiting SARS symptoms. Flights arriving here through Barbados and Trinidad would be just as vulnerable as direct flights since the Caribbean is still grasping for a uniform policy on handling passengers flowing into their tourism-driven economies.
Second, a health unit should be deployed at the Timehri airport to conduct basic screening such as looking for elevated temperatures and breathing difficulties in passengers. This unit would have to operate on the assumption that a passenger is infectious and would have to be equipped with protective gear. An isolation area would have to be set aside at the airport and immigration officials may also have to be protected.
Third, arriving passengers should be counselled in great detail about the disease and questioned on places of recent travel where they could have been exposed. Information should be solicited on where they could be reached if required and they should be given information on doctors to contact.
Fourth, the government has said that a ward at the Georgetown Hospital has been cleared for possible cases and steps must be taken to ensure that it can be sealed off and that adequate supplies of the anti-viral agents, which are now in use against SARS, are in stock.
Fifth, a meeting should be convened between the public and private health sectors to map out a strategy for treating cases and reporting on them. A strategy for coping with an outbreak in a remote interior area should also be developed.
Sixth, a public information campaign should be mounted locally.
A vaccine for SARS may be two or three years away and no country, least of all Guyana, can afford to let its guard down.
