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SARS Future Still Not Clear

U.S. 'Lucky So Far;' CDC Readying Quarantine Plans

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"Quarantine would be voluntary -- as long as there is compliance," Cetron notes. "If not, then it becomes mandatory. These are pretty Draconian public health tools. It hearkens back to the smallpox days."

More modern ways to control SARS simply don't yet exist, notes John Jernigan, MD, of the CDC's division of healthcare quality promotion. Jernigan notes that doctors still don't know the best way to treat SARS cases. However, he does know of one good way to keep from getting the disease.

"Airborne SARS transmission has been overrated," he said at the Emory meeting. "When the epidemiology is all done and settled, I think we are going to find that true airborne transmission contributes very little to transmission of this illness. Good old control techniques that don't require high-tech personal protection equipment -- like hand washing -- are going to be the most important thing."

Jernigan says that new alcohol hand gels are likely to be very effective in fighting SARS. Why hand washing? He thinks most transmission comes from large droplets coughed from the lungs of an infected person. These large droplets don't stay in the air -- but the virus can live for a day or more by clinging to hard surfaces.

What about a vaccine to prevent SARS? Coronavirus expert Mark Denison, MD, of Vanderbilt University, Nashville, Tenn., says some animal coronavirus infections can be prevented by vaccination. Unfortunately, vaccination worsens infection with other types of coronavirus. He thinks it may be possible to create a harmless live coronavirus vaccine, much like the polio vaccine. But testing such a vaccine would take years.

One problem with the SARS virus is that it is unlike any other known virus. CDC researcher Steven Oberste, PhD, is part of a team that today announced it had deciphered the genetic code of the SARS virus. Speaking at the Emory event, Oberste said the SARS virus is a type of coronavirus never before seen.

"It really has come from somewhere we don't know about," he says. "In fact, this virus is absolutely distinct and unique."

Finding where the SARS virus came from Oberste says, would be a big step toward finding an effective vaccine or drug treatment.

Whatever happens with SARS, Hughes warns that it is just a warm-up for the next really big epidemic.

"Remember that we are sure we are going to face another worldwide epidemic of influenza for which we are not real well prepared," he says. "This is a loud, loud wakeup call to be prepared for that epidemic."

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