TCS Daily


Plague Fighter

By Sydney Smith - March 21, 2003 12:00 AM

Suddenly, we're in the midst of a global epidemic. Shades of Hollywood and Robin Cook novels haunt us as news reports provide daily updates on the worldwide progression of a mysterious, contagious, and sometimes deadly disease. One moment it's confined to Asia; the next, it's in Europe, Canada, Britain, Australia, and the United States. Travelers are quarantined as they get off airplanes. All over the world people with a fever and a cough and a history of recent travel to Southeast Asia or intimate contact with people who have traveled there, are being closely observed, their contacts monitored, and their names added to the list of potential cases.

What is this mysterious ailment that has sent the world health community into overdrive? A flu-like illness, it begins suddenly with a high fever and a cough. But, unlike the flu, it quickly advances, attacking pulmonary cells to make them leak fluid into the airspaces of the lungs. Its hardest hit victims literally drown in their own cell fluids. The cause remains elusive, although pathologists in Germany and Hong Kong have independently identified a paramyxovirus in some of the victims, a family of viruses that includes measles and mumps as well as one of the viruses responsible for the common cold. It's as good a candidate as any. Paramyxoviruses have been implicated in newly emergent diseases before - most recently in Malaysia in the late 1990's when a mutated virus jumped from its normal pig hosts to humans, killing 105 people over the course of a year.

Whatever its cause, the disease appears to be highly contagious. Seven of its victims were connected only by having stayed in the sameHong Kong hotel, on the same floor. (It's believed a local man introduced it while visiting a friend.) Most of the victims, however, have been family members or healthcare workers who cared for an infected patient. As of this writing, there have been 264 suspected or probable cases worldwide, the vast majority of them in Southeast Asia. Of those 264, nine have died. That's a very small proportion of the world's six billion people, yet the World Health Organization announced a travel advisory last week in an effort to stem the outbreak before it grows to epidemic proportions.

This may seem like a lot of hullabaloo for such a small outbreak with such a low mortality, but the memory of the devastating influenza epidemic that swept the world in 1918 is never far from public health officials' minds. In that epidemic, millions died. Its spread was aided in part by international mingling during the Great War, and in part because officials dismissed the seriousness of the threat. In fact, the first thought was that the current mystery pneumonia could be a variant of influenza. The virus has a history of mutating into a virulent form every fifty years or so. By that calculation the world is overdue for a visitation.

But this isn't 1918. And this isn't influenza. We can immunize against influenza, but not against this. We have antiviral drugs that can soften the blows of influenza, but we have no drugs for this. The world health community is understandably jittery. The ease and speed of international travel make us all particularly vulnerable to newly emerging contagious diseases. No village is so remote, no island so isolated, that it can escape exposure to microbes from thousands of miles away. All it takes is a visit from one international traveler. What fifty years ago might have remained an isolated outbreak in rural China, today has the potential to become a global epidemic.

Fortunately, globalization also makes it easier to stop the contagion in its tracks. Thanks to the Internet, email, and fax machines, (not to mention press conferences), information about the disease has been quickly disseminated to healthcare professionals so that potential cases could be isolated. The CDC issued its warning on a Saturday. When I returned to the office on Monday morning, there was an email waiting for me from my hospital's infectious disease department with a rundown on how to identify potential cases and what to do with them. The World Health Organization established a network of 11 laboratories in 10 countries to search for the cause. They have even gone so far as to notify airlines of the symptoms so that potentially infected travelers can be quarantined. And these efforts appear to be working. Witness the never-ending media reports of the latest one or two cases from every continent, not to mention the speed with which the paramyxovirus was identified (although it has yet to be confirmed as the definite cause.)

For better or worse, we really are a global village. And as this current outbreak demonstrates, that's bad news when it comes to germs, but good news when it comes to technology. In this case, it just might save us from a real live plague.

The author is a family physician who has been in private practice since 1991. She is board certified by the American Board of Family Practice, and is a Fellow of the American Academy of Family Practice. She is the publisher of MedPundit.
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