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Anatomy of an Epidemic

School Faculty Share Five Lessons from SARS

Emerging from a remote corner of China, SARS wreaked havoc in 28 countries—killing hundreds, infecting thousands, quarantining millions, and costing billions. What does SARS mean for the future of public health?

By Jim Duffy
Illustrations by Sandra Dionisi

If there was a single moment when SARS turned the corner from frightening mystery to known malady, it came during the last days of Carlo Urbani’s life. SARS didn’t even have a name on February 28, when the Italian physician with the World Health Organization (WHO) saw a patient named Johnny Chen at a hospital in Hanoi.

Speculation at that point about mysterious cases popping up in Asian cities centered on a rumored outbreak of avian flu in China. After examining Chen and learning how he’d infected at least 22 hospital workers, Urbani had his doubts about the flu theory and shared them with WHO colleagues. He convinced Vietnamese officials that they likely had a public health emergency on their hands.

So much has been learned about SARS in the last few months that it’s difficult to appreciate Urbani’s insight. In fact, SARS took a simple, straightforward route to Hanoi. Johnny Chen caught it from Liu Jianlun at a Hong Kong hotel. Liu was a physician at a Chinese hospital that had seen patients with a mysterious respiratory ailment that first appeared among chefs and butchers working with exotic meats in the Guangdong province of southern China.

But those revelations came later. “One important thing we’ve learned here is what an incredible difference key individuals can make in these situations,” says Neal Halsey, MD, professor of International Health. “Everything Urbani did—the way he used his clinical expertise, the way he sounded the alarm, his willingness to ask for help—proved so, so important.”

Urbani himself began showing symptoms while on a flight to Thailand. Scott Dowell, MD, MPH ’90, was with the emergency-response team that rushed to the airport and then sped Urbani to a nearby hospital. Director of an emerging infectious disease program jointly operated by the U.S. Centers for Disease Control and Prevention (CDC) and the Thai Ministry of Public Health, Dowell knew next to nothing about the disease that would soon be dubbed SARS, for severe acute respiratory syndrome.

“We’d had a briefing, but that was about it,” he recalls. “Our indoctrination into this disease came in taking care of Carlo in a makeshift isolation room. He went from a really mild illness to a little respiratory distress to severe distress. Despite everything we tried, it was just an inexorable progression toward death.”

Urbani died on March 29, shortly after the WHO issued its now-famous global travel alert. That alert commenced a whirlwind for the world of public health—the first new global epidemic of the 21st century was here.

At the School, an overflow crowd gathered May 14 to hear a panel of faculty experts discuss the new infectious disease that was dominating global headlines. Dean Alfred Sommer, MD, MHS ’73, drew a round of bittersweet chuckles with his introduction to the session.

“This is pure public health,” he said. “For once we don’t have to explain to people what public health is and why we’ve devoted our whole lives to it.”

SARS infected nearly 8,100 people and killed 774 before its advance slowed in June, but the public health whirlwind it caused still hasn’t let up. Too much remains unknown, uncertain—not the least of which is whether and how seriously SARS will return this winter.

This summer faculty members and alumni reflected on what public health has learned thus far about SARS and how the epidemic might shape the future of the field.

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