A real threat

April 22, 2003

SINCE SEPT. 11, 2001, the United States has been doing a lot of shadowboxing with phantoms.

We're looking for terrorists at airport departure gates and Easter Egg hunts. We're vaccinating health care workers for smallpox, a disease no one in the world has caught since 1977. We're scouring Iraq for weapons of mass destruction once thought to be within the grasp of well-announced United Nations inspections.

Now, though, comes SARS, a nasty brute of a virus that poses a danger so real Americans face the prospect of quarantines for the first time in a half century. This is an enemy worth making sacrifices to defeat.

The odds of widespread infection here are difficult to calculate. So far, only 39 Americans have been identified with probable cases of Severe Acute Respiratory Syndrome, none of them in Maryland.

Further, spread of the disease is expected to be slowed by the warmer weather, which encourages people to be outdoors, away from close contact with others in confined spaces.

But SARS has already spread from China to 25 other countries, including some in the southern hemisphere, where the onset of winter creates a fertile breeding ground for the flu-like ailment.

By the time flu season arrives in Maryland next fall, a SARS outbreak is all but inevitable, says Dr. Harold Standiford, medical director of infection control at the University of Maryland Medical Center.

President Bush recently added SARS to the list of diseases for which public health officials can impose quarantines, which are likely to be necessary in some areas because no vaccine is expected to be available for at least a year.

SARS is not yet proven highly lethal; the death rate among those who contract it is five percent or less. But a SARS pandemic could affect so many people that five percent becomes a very large number.

In the meantime, what we can do as individuals and as a nation to be prepared?

SARS travels the world mostly by plane. But that doesn't mean Americans should stop flying, says Dr. Robert Edelman, director of travelers' health services at the University of Maryland. They should just avoid high risk destinations, such as Hong Kong, and be careful about who they sit next to.

SARS typically begins with a fever, headaches and muscle aches. It progresses with a dry cough and shortness of breath.

One person with SARS wouldn't infect a whole plane, but could easily pass along the virus to someone in close range. If a passenger nearby seems sick, Dr. Edelman suggests asking enough questions to determine whether there's some cause other than SARS -- and moving far away if there isn't.

U.S. health officials are credited with slowing the spread of SARS here by isolating more than 200 Americans with suspected cases.

Beyond that, hospitals need to be ready with respirators and other equipment for the SARS patients considered almost certain to come next winter.

Resources may have to be directed away from combating hypothetical villains such as smallpox.

There's little point in guarding against phantoms when an actual killer is on the loose.

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