Long Before Swine Flu, Asia Tackled SARS, Bird Flu

By MIN LEE / AP WRITER

HONG KONG — Before swine flu emptied restaurants and cinemas and made surgical masks a common sight in Mexico, similar scenes unfolded in Asia earlier this decade as it dealt with the back-to-back health emergencies of SARS and bird flu.

Both of those episodes offered lessons that have helped China, Vietnam and other countries prepare for the latest global health crisis, experts and officials say.

Among the chief lessons: countries must openly and honestly exchange information, vigilantly monitor for illness, aggressively quarantine suspected patients and thoroughly prepare emergency plans.

"If there's anything good that came out from SARS and avian influenza, it's that we now have better preparedness in China as well as in the rest of the world," said Hans Troedsson, head of the World Health Organization in Beijing.

"What is important is a transparency and an openness not only with the WHO but also with the public. It is very important that the public ... the common people, understand the situation" and not have the situation exaggerated, he said.

"The best way to do that is to provide information. That is the lesson we learned both in Vietnam as well in all other countries," he said.

Severe acute respiratory syndrome, better known as SARS, began as a mystery illness that sickened hundreds in the southern Chinese province of Guangdong in late 2002 and early 2003. Chinese officials were flummoxed by the new disease and failed to inform the World Health Organization of the outbreak for weeks, restricting media coverage in order to preserve public confidence.

The disease spread outside the mainland in February 2003 when an infected 64-year-old doctor checked into a Hong Kong hotel. He later died in a local hospital, but not before he had infected 16 other hotel guests. Among them were tourists from Singapore and Canada and an American businessman, who traveled to other places, transmitting the disease and spreading the virus internationally. Also infected was a Hong Kong resident, who became ill and later spread the virus to another 143 people.

Within weeks, SARS had spread worldwide, infecting more than 8,000 people from 37 countries before it disappeared. More than 770 people died—299 from Hong Kong alone.

SARS "gave us a lot of valuable insight and practical experience in managing a large-scale outbreak that eventually spread to other parts of the world. That certainly has prepared us very well for what may come," Hong Kong Undersecretary for Food and Health Gabriel Leung said at a news conference Monday.

In the wake of that epidemic, governments began writing a playbook for dealing with disease outbreaks. Hong Kong built a special hospital unit dedicated to handling infectious diseases and improved isolation facilities and ventilation at other hospitals.

An increased awareness of personal hygiene—wearing masks and washing hands frequently—during SARS also contributed to a sharp decline in regular flu cases in 2003, said Lo Wing-lok, a Hong Kong infectious diseases expert.

Thermal imaging equipment—to detect high temperatures—were installed at airports and border-crossings across Asia and elsewhere.

In Canada, where SARS killed 44 people in Toronto, the government created the Public Health Agency, whose mission is to prevent and control infectious diseases. Thousands of hospitals, schools and churches now have pandemic plans that they didn't have before SARS.

Countries have also built large reserves of anti-viral drugs. Canada has a national stockpile of 55 million dosages of anti-viral drugs. Hong Kong keeps 20 million dosages.

Governments moved more aggressively when only months after SARS a second major crisis hit Asia—avian influenza. Governments slaughtered hundreds of millions of poultry in a bid to contain the virus. Since then, near yearly outbreaks of bird flu have spread to Europe, the Middle East and Africa.

More than 250 people have died from bird flu, mostly from direct contact with infected poultry, but each human infection raises the chances that the virus will mutate, becoming more easily passed among humans and unleashing a global pandemic.

Not all lessons are applicable to the swine flu outbreak. Yuen Kwok-yung, a Hong Kong microbiologist who studied the SARS virus, said some people with swine flu may not show symptoms in the early stages, making it hard to know who and when to quarantine—a tactic widely used in controlling SARS.

Governments dealing with swine flu have drawn on these experiences and put into effect emergency plans. Hong Kong, Singapore, Thailand, Japan, Indonesia and the Philippines dusted off thermal scanners used in the 2003 SARS crisis to check for fever among arriving passengers from North America. South Korea, India and Indonesia also announced screening.

Public health officials are being more forthcoming with information.

"This is an illness that was recognized in Mexico around April 15. We heard about it around the world about 48 hours later," said Allison McGeer, director of infection control at Mount Sinai Hospital in Toronto.

"We've identified the pathogen, we've confirmed it, we've sequenced the virus and if you look at what's happening now, every physician across ontario and probably every physician across Canada has had notification from their public health unit about what's happening," McGeer said.

Even in China, which was sharply criticized internationally for suppressing information about the SARS outbreaks and dragging its feet on bird flu, the government has reminded officials nationwide to use the disease surveillance network and report any cases promptly.

"Once a suspected case is found in China, it must be made public in a timely way," according to a State Council notice on state broadcaster CCTV. "We must be highly vigilant and take strong monitoring and prevention measures."

Associated Press reporters Tini Tran in Beijing and Rob Gillies in Toronto contributed to this report.