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Anatomy of an Epidemic (cont.)

Lesson 3
Long live Epidemiology 101

Despite the speed with which SARS was identified and decoded, scientific technology can’t take credit for curbing the epidemic. On the streets of cities like Hong Kong and Toronto, that success was the resultof the old-school techniques that Epidemiology 101 students have been learning for decades: surveillance (see sidebar), hygiene, isolation, quarantine.

“When it gets right down to it, we still have to count on that stuff,” says Trish Perl, MD, MSc, the chief epidemiologist at Johns Hopkins Hospital, with a joint appointment in Epidemiology at the School. She traveled to Toronto during the height of that city’s SARS ordeal to relieve exhausted colleagues. “That stuff has been shown to work time and time again. But for some reason getting people to believe that it’s as simple as that is really a challenge.”

One survey cited by Perl indicated that Toronto health care workers who contracted SARS were less likely than their colleagues to abide religiously by hygiene rules.

“Wash your hands—that’s probably the greatest maxim in all of public health,” says David Celentano, director of Infectious Disease Epidemiology. “But it’s a message that seems to be lost on every generation.”

In the age of genomics, who wants to talk about hygiene habits? Or strategies so old they date to biblical times? Celentano, ScD ’77, MHS ’75, recently traveled to Dubrovnik, Croatia, where he marveled at a stark, stone isolation facility built 1,400 years ago outside the city’s walls.

“People scream and yell nowadays about how harsh [quarantine] seems,” Celentano says, “but it works. That’s why we’ve been doing it for centuries.” To Celentano, SARS and bioterrorism should serve as warnings that countries around the world need to sort through all the modern-day legal and liability issues surrounding isolation and quarantine.

In a way, then, SARS brings public health back to the future. “The technology is great, but that shoe-leather epidemiology is still essential,” says Ron Brookmeyer. “You need to recognize a threat, identify it, track it. You still need all that Epidemiology 101 stuff to break the chain of transmission.”

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