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SARS Lessons Unlearned

Will SARS hit hard again this year or in the future? Experts go over what happened and what may be next.

An Incomplete Shield

Just in case, the WHO is supporting research on a SARS vaccine. Stöhr says the goal is to have a vaccine ready for testing in three years. But Koplan points out that even if such a vaccine works, the clinical testing process itself takes years.

And while doctors got a lot better at treating SARS, there's still no specific treatment for the illness -- and no drug that's proven to kill the SARS bug.

Low, for one, isn't worried that SARS will make a comeback.

"We have put this genie back in the bottle," he says.

But since SARS, public health officials everywhere are sleeping with one eye open.

"I think what we've experienced has definitely been a wake-up call with regards to the importance of being prepared for the introduction of new diseases: SARS and what the future will bring," Low says. "That was an incredible learning experience with a steep learning curve."

Canada, he says, has learned its lesson the hard way.

"One of the things SARS has done for us in Ontario and Toronto and spilled over into all of Canada is a recognition of the situation we have put public health in," Low says. "We have decimated public health and not let it grow at the rate science is growing. We live in such a global village. We have to be prepared today. Public health is absolutely essential for infection control. I think we will benefit greatly from this. Hopefully the U.S. will be able to take our example and use that as an argument as to why you have to support public health in the future."

Former CDC director Koplan says he hopes so, too. But he hasn't seen it yet.

"I don't see progress at this point," he says. "With 20% of the population uninsured or underinsured and lacking access to health care, the best bet is they will have to go to work and spread whatever disease they have without being diagnosed. Until we have adequate support for hospital care in public hospitals, they will be overcrowded and overburdened."

In particular, Koplan says, public hospitals lack enough equipment, staff, and surge capacity to deal with even a moderate public-health emergency. The line separating us from disaster, he says, is thin indeed.

"Our public health system is what stands between us and much greater illness and death rates," Koplan says. "We saw it with SARS. We see it this year with flu. And we will see it again. Just as after a crime wave people are quick to support the police, and after a bad performance by kids on standardized tests we want to support schools, after SARS we see that we really need to support our public health departments. They are the ones that give us a much better shot at surviving the next epidemic."

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Reviewed on December 17, 2003

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