FROM THE PRESIDENT
Institute of Medicine
SARS and the Threat of Emerging Infections
Imagine being the director of a major teaching hospital, and you are informed one morning that 12 staff working on a single floor of the hospital have called in sick, many with a fever and cough. By 2 p.m., the number has risen to 50. What would you do?
This was the situation that confronted the leadership of the Prince of Wales Hospital in Hong Kong one day this past March. That fateful day signaled the arrival in Hong Kong of what came to be known as severe acute respiratory syndrome, or SARS.
Eventually, the world became fully aware of SARS, and public health authorities mobilized aggressively in a number of affected places, including Hong Kong, Singapore, Vietnam, Taiwan, and Toronto. In a matter of weeks after the disease had spread internationally, scientists identified the causal agent -- a coronavirus -- and then sequenced the genome of the organism. By virtue of assiduous tracing and quarantining contacts, special precautions in clinical care, and isolation of patients, the outbreak eventually subsided, but not before more than 8,000 patients were afflicted, more than 800 lives cut short, and billions of dollars lost.
No one knows whether SARS will return next winter. Quite certain, however, is that at some time, in some place, other new infectious diseases will emerge.
This expectation was one key message of the recent IOM report Microbial Threats to Health, released coincidentally at the time of the first media reports of SARS. The report argues that an effective national response to microbial diseases must be global in scope. Failure to monitor and report outbreaks in any one nation can, and does, affect others. Federal agencies must enhance disease surveillance and collaborate on diagnostic methods with other nations. And at home, the public health infrastructure should be shored up so that disease outbreaks can be detected, monitored, and managed expeditiously.
This report stands in a long tradition of work at the IOM on infectious diseases. The Institute is also providing ongoing guidance to the CDC on the smallpox immunization campaign. And earlier this summer, NAS President Bruce Alberts and I co-hosted a workshop on new strategies to devise drugs against smallpox. In these, and many other ways, the National Academies are working to protect the nation against biological threats to health. Fortuitously, many of the steps that guard against bioterrorism simultaneously protect against natural threats, and nature can be the most fearsome bioterrorist of all.
HARVEY V. FINEBERG
Institute of Medicine