SARS: How Ready Are We?

THE FACTS

While the war to oust Iraqi Strongman Saddam Hussein was on, a new threat to the survival of our globalized world was playing out in the Guangdong province of China and in Hong Kong. Severe Acute Respiratory Syndrome or SARS as it is simply called is a highly infectious respiratory illness that primarily affects the lungs. In the early phase of infection, the patient gets a high fever of more than 38 degrees, with headaches and chills. Within a week to 10 days most patients develop a dry cough and have severe difficulty with breathing. At this stage death can come in hours.

SARS is spread by droplet infection and can be contracted from any close contact with an infected person including breathing the same air in a confined location and handshakes. SARS is said to be caused by a variant of the coronavirus family, which are common in animals and until now only caused mild illness in humans. Obviously this variant of the coronavirus has made a successful jump of the animal/human species barrier and is potentially capable of wreaking havoc in the human population. There is no known cure for SARS. Not all who get infected with SARS will die. The death rate in infected persons was previously stated at about 12%. However recent revisions are talking of much higher figures of anything up to 55% in certain parts of Asia.

THE MALTHUSIAN THEORY This column has in the past reviewed the theory of Rev. Thomas Malthus. The Malthusian theory is one that postulates that human population increases in geometric ratio while food production increases in arithmetic ratio. Rev. Malthus said that human population will continue to increase tremendously and will be curbed only by famine, wars and disease. In the past we have taken pride in disproving the Malthusian theory, but it appears that despite all the advances in science and technology, the dreadful spectre he paints will continue to haunt mankind long into the future. With new variants of viruses appearing every few years the grim alternative of culling the human population by disease appears potentially more prevalent.

ORIGIN OF SARS Unlike the HIV/AIDS virus, which has a long incubation period, the SARS virus has a relatively short incubation period. It was therefore very easy to identify the initial source of the outbreak of the disease as being from Asia and more specifically China. The origin of HIV has in the past become a political issue, with many racist medical researchers doing all in their power to gather evidence to prove that AIDS is a sickness of African origin. As if that mattered. Whatever the origin of a disease, in today’s globalized world concern should concentrate more on finding a vaccine or cure rather than the political argumentation as to the geographical origin of the disease.

DEADLY THREAT SARS if it is not contained in Asia and Canada where it is presently attempting to spiral out of proportion, could become a deadly threat to the entire human population. It could wipe out millions of people as the Bubonic plague did in Europe in the middle ages. Because of the mode of spread it is not really a disease of individual choice like AIDS. It is possible by some attitudinal change to lower ones risk of infection from HIV/AIDS, not so SARS. In Asia the SARS virus has been found in sewage and can be spread much like cholera. It can also be spread through saliva, especially in environments such as ours where people are unrestrained in expelling huge globs of sputum just about anywhere. It spreads easily in congested and unsanitary environments through droplet infection. The cocktail that aids the spread of SARS exist abundantly in the slums of Ajegunle, Agege, Nima, Sodom and Gomorrah, Treichville and all the popular West African Ghettoes. This is like a tinderbox waiting for the flame. The critical question therefore is “how ready are we?” And I am afraid the answer is ‘totally unprepared.’ HOW READY ARE WE? Just last week, the hardworking MP for Hohoe South Kosi Kedem raised the red flag, calling the nations attention to the potential threat posed by SARS. He requested the Minister of Health as a matter of urgency to come to the floor of Parliament and let the nation know the steps that have been taken so far to prevent the arrival of the virus into our country and to contain it if it does enter. It is clear that officialdom does not as yet understand the danger that could threaten this nation in the event of even a single SARS case appearing here. The media should be commended for carrying out its watchdog role in this matter. A few weeks ago a TV crew lugged their camera and equipment to the Kotoka International Airport to assess our state of readiness in the event of any SARS infected persons arriving in the country. The images we saw were of a doctor assuring the nation that all precautions had been taken and that the nation was prepared for any arriving cases of SARS. This was at a time when the virus had just been identified and the medical world was just beginning to understand how difficult the battle against this virus was going to be. Officialdom is always very quick to reassure the populace that there is no cause for concern. Unfortunately we find that this naive attempt to prevent panic rather leaves us unprepared and has dire consequences when eventually the drama unfolds. We shall not accept the official reassurances in this matter. There is extreme cause for alarm. In a country where even the outbreak of cholera, which is caused by microbes that are responsive to antibiotics is difficult to control, a SARS outbreak will be a medical health apocalypse.

It is clear that Ghanaian officialdom is yet to fully grasp the dreadful nature of SARS. In a recent scare when it was reported that a Ghanaian couple suspected to be infected with SARS were being repatriated from Japan, the Minister of Health and a team of Doctors were reported to have charged to the airport. Wearing a mask across his face, the Minister led his merry band aboard the aircraft to receive the patients. Luckily the couple were not on the aircraft. It made good images for the TV cameras, but the minister indeed took a foolish risk with the doctors. As the general commanding an army he could have been one of the first casualties of SARS even before the war against the disease has started here in Ghana. In Asia and in Canada whole hospitals have been set aside to deal with only SARS cases. Doctors and other health workers are one of the groups at highest risk from infection. In hospitals where suspected SARS patients are quarantined, health workers are covered from head to toe in full protective suits. At the end of the day, they enter a disinfecting chamber where the entire exterior of the suit is disinfected before they step out of them. Extreme care is being taken to protect health workers. There are known cases where health workers have gotten infected through inadvertently handling the exterior of non-disinfected protective suits. PROTECTING OURSELVES Aside from the setting up of an Inter-agency task force, very little more has been heard about our state of readiness as a nation. In most advanced countries, digital thermometers are used to record the temperature of arriving passengers from known SARS locations. Passengers with temperatures above normal are quarantined for observation. Whole hospitals have been built to receive only SARS patients. The WHO travel advisory to postpone non-essential travel to SARS areas has been adequately publicized to all the citizens. This has resulted in a significant drop of air traffic to Asia from other regions. Body suits have been provided to health workers and other airport staff who have to deal with suspected SARS cases. They have also been educated on their proper use and how to avoid infection. Sewage and other unsanitary waste are cleared or sprayed with disinfectant to avoid infection. Tracking and quarantine procedures are in operation. Where a patient is identified, all the persons they have been in contact with over a certain time frame are identified and strictly quarantined either in their homes or in hospital. In Canada tracking the infection revealed that one single woman who had visited Hong Kong on holiday accounted for virtually all the hundred and over SARS cases in the Toronto area. Mass education about the disease is going on to make people understand the nature of the disease. In the current endemic areas, close human contact through handshakes, hugging, kissing are being discouraged. People are encouraged to keep their homes well ventilated. In the SARS hotspots, schools have been closed down, stadiums, theatres, discos, restaurants and other activity that bring large groups of people together are not allowed to operate.

Even a casual look at the protective measures required to identify and contain the SARS disease, must tell any observer that we are totally unprepared for this disease. Our socio-cultural setting, including the high illiteracy rate, congested accommodation especially in the compound house style, general unsanitary environment especially in the urban areas, are all a great challenge to how we respond to this virus if it does arrive on our shores.

Considering that early symptoms of SARS are elevated temperature, headaches and chills which are similar to malaria and the tens of tropical diseases we have in Africa, distinguishing and catching SARS victims early is going to represent a major challenge for our health system. NO CURE So far there is no known cure for SARS. Patients are given supportive treatment to enable their own immune systems fight the virus. Health workers provide fluids to prevent dehydration and in some cases give ventilators to ease breathing difficulty. Whether one survives SARS or not depends on how resilient ones immune system is. The virus can survive for 24 hours on external surfaces.

Already serious work is going into finding a cure or a vaccine. It is believed that an effective cure or vaccine is not less than two years away, considering the necessary animal and clinical trials etc. For now our hope is that the areas in which the virus has been found will be able to contain its spread. The WHO is doing a great job with the countries where SARS has been identified to try to contain the epidemic. So far this has been successful. We can only hope and pray that the way the Ebola virus has been contained and restricted to very isolated outbreaks in parts of East and Central Africa, so too will SARS not only be contained in Asia but be eradicated by identifying every single case and quarantining the patients.

We expect an immediate response to Kosi Kedem’s statement from the Minister of Health on the floor of the House about our state of preparedness to confront and contain SARS if it does spread into Ghana. Until then we shall not accept any assurance from the authorities that all is well and will continue to ask the relevant question - “SARS: How ready are we.”