Spotlight
Senator Kennedy Holds SARS Briefing at HMS
(Photos by Liza Green, HMS Media Services)
The message for residents of Massachusetts on severe acute respiratory syndrome (SARS) is twofold: be calm but be careful.
At an April 4 briefing and press conference organized by Senator Edward Kennedy (above) and held at HMS, health care leaders discussed the nature of the disease, the status of the outbreak, and public health measures to control it. In opening remarks, Kennedy said that he would take insights from the panel presentations to a Senate hearing on SARS on April 7 with Julie Gerberding, director of the Centers for Disease Control and Prevention, and Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "We can discuss the key steps we need to take in Massachusetts and the nation to respond to SARS," Kennedy said.
Public Health First-hand
Panel member Donna Fisher, a pediatrician at Tufts and the Baystate Medical Center in Springfield, described the case of a Chinese baby recently adopted and brought to Massachusetts, who had a suspected case of the disease. The child was admitted to the medical center in late March, but already had been discharged and was at home, quarantined and improving, she said.
Because most cases have occurred in China, connections to that country are stirring apprehension. Speaking of residents in Boston's Chinatown, Anita Barry, director of communicable disease control at the Boston Public Health Commission, said, "The biggest challenge right now is fear and rumor and panic." She described a rumor, totally untrue, that two customers at a Chinatown restaurant were carried out on stretchers. The distortions emphasize the need for good information, she said, a fact-sheet on SARS in Chinese, for example.
Kennedy said that he would take the suggestion to Washington.
The Bug Itself
HMS dean Joseph Martin asked about the molecular identity of the virus and got the reply that within two weeks the New England Journal of Medicine would publish an article on the identity and genetics of the bug, determined to be a novel coronavirus. Taking a different tack, HSPH dean Barry Bloom suggested that the SARS outbreak emphasizes the need "to convince this country that infectious diseases are global."
Epidemiologist Megan Murray, HSPH assistant professor of epidemiology and HMS instructor in medicine at Massachusetts General Hospital, gave estimates for some of the quantitative parameters of the disease. "The question is, is there going to be community-based transmission?" she said. She and her colleagues think the answer is yes. The R0 value for the virus, a measure of its infectiousness, may be as high as 5. That is the number of people expected to become infected by one infectious person in a completely susceptible population. Since the virus is new, it is likely that everyone is susceptible. Measles, which is highly infectious, has an R0 of 16; smallpox has an R0 of 4. But any bug with an R0 greater than 1 could cause an epidemic if left unchecked.
Command and Control
The potential spread of SARS focused the panel on the groundwork for dealing with an outbreak. A diagnostic test for SARS will take a matter of months, though a vaccine will take much longer. Yet technology was less an issue for the panel than resources, such as adequate capacities for lab testing, isolating infected individuals, and caring for a surge in patients. Other panel members were Stephen Calderwood, HMS professor of medicine (microbiology and molecular genetics) and chief of the Division of Infectious Diseases at Massachusetts General Hospital; Kenneth McIntosh, HMS professor of pediatrics and assistant director of the Infectious Disease Division at Children's Hospital; Carol Sulis, head of communicable diseases at Boston University Medical School; Alfred DeMaria, director of the Bureau of Communicable Disease Control at the Massachusetts Department of Public Health; and Ralph Timperi, an adjunct lecturer on epidemiology at HSPH and also of the Massachusetts Health Department Laboratory.
Despite the concerns, the Massachusetts Department of Public Health had reported only six suspected cases in the state as of April 8; none of them was serious. The disease observed in the U.S. up to this point appears to be milder than its Asian counterpart. To protect the Harvard community, provost Steven Hyman has issued a University-wide request that travel to the SARS-affected regions of mainland China and Hong Kong, Singapore, Vietnam, and Ontario, Canada be postponed until the disease can be better controlled.
--Robert Neal