Feature Article

Lessons from the Microbial Mobass: Expect the Unexpected
by Daniel H. Gervich, MD

On February 11, 2003, little attention was paid to a report of some 300 cases of an atypical respiratory tract infection attributed to Chlamydia in Guangdong province, China. By March, ripples had already spread worldwide, as epidemics in Hong Kong, Hanoi, Singapore and Toronto of Severe Acute Respiratory Syndrome were being described. Thus far, all epidemics outside of mainland China ( excepting Taiwan), including Hong Kong, Hanoi, Singapore and Toronto, have occurred as a result of an infected healthcare worker from Guangdong province that stayed at one nice hotel in ,Hong Kong. This patient and a handful of other highly infectious secondary cases have propagated the epidemic in each of these several cities, in each case infecting numerous healthcare workers.

Every microorganism has its own personality and an epidemiological footprint and must be appreciated for its particular at- tributes. The agent of SARS has now been identified as a Corona virus. This Corona virus differs from the previously two identified antigenic groups of human Corona virus and most likely will prove to be an- other example of mutation in a non-human viral agent, permitting a trans-species transmission to continue as a new agent of human disease. This virus demands respect for a number of reasons, not the least of which is a mortality rate that is several hundred times higher than that of influenza A. Perhaps its most awesome hallmark, however, has been the enormous impact that it has had on the healthcare infrastructure of several large cities. In Singapore, a 1300-bed hospital was required closed for over a month, and the city's largest hospital (a 1600-bed institution) was nearly forced to close while sending dozens of it's ill healthcare workers to the hospital which had been closed to all but SARS- infected patients. Similarly, hospitals in Toronto were forced to shut down all elective procedures and limit admissions while struggling with epidemic SARS. Throughout these city epidemics, approximately 40% of those infected were healthcare workers. Outside of The Peoples Republic of China, almost all of the spread of infection has occurred within the hospitals. The vast majority of patients infected are not highly contagious, transmitting so little virus that the likelihood of the world sustaining a pandemic is not terribly high. On the other hand, a few individuals seem to shed an enormous amount of infectious virus in secretions and at times are capable of propagating virus beyond the three- foot radius attributed to droplet spread by sneezing and coughing. Aerosols from these super-transmitters of the agent become airborne and can travel greater distances in sufficient viable quantities to infect a large number of people. In addition, the stability of this virus in the air and on inanimate surfaces is substantially longer than had been previously appreciated with "cold" viruses. It is shed in feces as well as in respiratory secretions and, of course, hands are the most effective and common way to transmit this virus.

Currently, the only effective weapon we have against this virus is prevention, and the only preventatives avail- able are standard infection control pre- cautions, appropriate isolation techniques and quarantine.

In the United States, Ontario, Viet Nam, Singapore, Europe and throughout the world outside of China, the effectiveness of this approach is being f1rInly established. Ultimately, I believe that this will be the case in China as well, although the folly of denial will have exacted a heavy toll there. I am doubtful that this approach will see the eradication of the SARS corona virus from the face of the earth in the near future. A functionally smaller and more populated world has played a role in the spread of SARS; but a more tightly-knit community of epidemiologists, including the World Health Organization (federal, state, provincial, and local communities) should be capable of keeping epidemics of the SARS Corona virus in check until medical virology and immunology research provides us with additional tools.

His life was quiet, warm and enjoyable surrounded by family, children and friends. He is survived by his wife, Benji (Elaine), son John and wife, Mary Pat and granddaughter Kathy. His daughter Cathy Saylor and her children, Dan Saylor and Cathleen Saylor. It has always been a close family…enjoying each other and spending time together whenever life and work permitted.