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The Honolulu Advertiser
Posted on: Sunday, May 11, 2003

SARS fears blown out of proportion

By Bruce Anderson

The risk of SARS needs to be put in perspective. People in Hawai'i and elsewhere in the United States are far more likely to die of influenza or from many other diseases we accept as everyday risks than from severe acute respiratory syndrome.

Schoolgirls protect themselves against SARS while shopping at a mall in Hong Kong, a region hard-hit by the illness.

Associated Press

Over the past few months, health officials in Hawai'i and elsewhere, combined with unprecedented media attention, have done a superb job of alerting Americans and most of the rest of the world to the health threat posed by SARS. Highly publicized actions taken to screen travelers and quarantine ill individuals and their contacts have, apparently, significantly reduced the spread of the disease.

Over the past few weeks, there have been no new cases in Toronto or in other areas of the world where aggressive actions have been taken to stop the spread of the disease.

During this period, the fear of SARS has had a devastating effect on the world's economy, particularly in Southeast Asia, and little effort is being made to put this disease in perspective relative to other diseases that have an effect on the world today.

Travel to much of Southeast Asia has been curtailed, which is having a significant effect on the economic well-being of these areas. Eventually, this will have an indirect effect on the health and well-being of millions of people in this part of the world.

Certainly, fewer visitors are coming to Hawai'i. Concern about SARS is often one of the reasons cited. Although we have not had any confirmed cases to date, rumors of unreported cases have adversely affected businesses in Chinatown. With all due respect to the efforts of Gov. Linda Lingle to allay concerns by eating there, facts may be more helpful than such demonstrations in putting concern into perspective.

At the time of this writing, approximately 7,000 cases of SARS have been cataloged worldwide, almost half of those in China and Hong Kong, and approximately 500 people have died. Most of those who died were elderly with predisposing heart disease, diabetes, cancer and otherwise compromised immune systems.

In the United States, 63 probable cases have been cataloged, and there have been no deaths.

In Hawai'i, six possible cases of SARS have been under investigation over the past few months. Of these, four have been ruled out and none has been confirmed. Considering the large number of travelers from Southeast Asia to our state, we should consider ourselves fortunate that we have not had any confirmed cases, as even one would have a significant effect on travel to Hawai'i.

As tragic as the deaths from SARS have been — a disproportionate number have been dedicated healthcare workers unselfishly caring for those who were ill — the numbers pale by comparison to the deaths caused by influenza and other diseases we often take for granted.

For comparison, every new strain of influenza that circulates around the world causes millions of people to die. In the United States alone, an average of 100 deaths a day occur from influenza, and more than 30,000 people die during a severe outbreak. Most people do not remember that 40 million people died from the influenza outbreak in 1914, including one out of every 20 people living in the United States at that time.

Why doesn't influenza get the same attention? I believe that the basic fear of the unknown, reinforced by daily headlines and television coverage and in combination with the improved disease-surveillance systems that have been put in place to combat bioterrorism, are some of the reasons.

Social psychologists would tell you that people fear most what they cannot see, do not understand and cannot control. Influenza is a disease everyone seems to understand and accept. Many people perceive SARS to be an incomprehensible and, as portrayed in the media, largely uncontrolled health threat.

The fact that SARS has infected and caused deaths among otherwise healthy healthcare workers in hospital settings also seems to be an important fear factor. This was the case with Lassa fever and Ebola, diseases that also terrified the public when they were first identified.

Fortunately, outbreaks associated with these viruses turned out to be self-limiting and were effectively controlled before they caused widespread illness. With SARS, it is time to take note of the tremendous progress that has been made to identify the cause and control the disease.

We now know the detailed genetic code of the coronavirus that causes SARS, the same virus that causes the common cold. We also know much about how it is transmitted, primarily through coughing and close personal contact, not through the air people normally breathe. Epidemiological investigations have found that SARS is more difficult to transmit from person to person than the flu, about 10 times harder, in fact.

Perhaps most important, we know it is possible to control SARS even without a vaccine, as was the case in Toronto, when appropriate and aggressive actions are taken. There is, of course, much more we need to know about the disease, but remarkable progress has been made in a short time to find its cause and how it is transmitted.

The U.S. Public Health Service has surveillance systems in place at airports. The state Department of Health is surveying major medical centers and clinics daily for new cases. Physicians and other health providers have been alerted and are watching out for suspected cases, and protocols have been established to protect healthcare workers and others. Plans have also been developed for isolation and quarantine when necessary.

Any uncertainties are being resolved in favor of protecting public health. In short, we have excellent systems in place to identify and control the spread of the disease should it be introduced into Hawai'i.

Today, we do know how to control the disease. It is important not to panic or overreact when we have a confirmed case in Hawai'i, which is likely to happen despite the aggressive screening and control measures in place: Do wash your hands frequently. Do postpone unnecessary travel to China, Hong Kong and Singapore. Move away from people who are coughing or sneezing. If you have a fever, a cough and shortness of breath, see your physician.

Most important, don't forget to get your flu shot.

Bruce S. Anderson, former state health director, is now with the John A. Burns School of Medicine at the University of Hawai'i-Manoa.