SARS Epidemic: SARS Epidemic: A Global ChallengeA Global Challenge

Bong-Min Yang, PhD & Sung-il Cho, MD, PhD

ofSchool of Public Health

Seoul National University

Why significant global issue?Why significant global issue?

Multi-country outbreaks Spread through air travel and

human migration Causative agent still unknown Severity of illness Impacts on clinical and public

health services

David P. Fidler (2004)

“SARS was a crisis, but victory was achieved”

Political ImpactPolitical Impact

Multinational organizations, particularly WHO, become to have increasing influence on global governance– After successful control, much credit given WHO for

initiation and coordination of surveillance, research and control measures

WHO Initiated– Global Alert (12 March, 2003)– Travel Advisory (15 March, 2003)– Enhanced global surveillance– Global Outbreak Alert and Response Network (GOARN)– Specific Global Networks (Lab, Case management,

Epidemiology)

Political Impact 2Political Impact 2

Importance of global cooperation to an outbreak of infectious disease is fully realized – It validated the value of global public health networking

Weakness of China’s public health infrastructure was revealed– China first downplayed the extent and the risk of the

infection, then joined the international network to control Afterward, Chinese public health infrastructure

was strengthened a lot– Case reporting structure established– Strengthened emergency response system– Provide funding for prevention of SARS

Economic ImpactEconomic Impact

Direct costs– Medical treatment costs, and costs of some equipment and

supplies for prevention

Indirect costs– Travel/airline– Tourism– Trade/investment– Shrunk consumer confidence

Global indirect costs estimated to be around US$80 billion (McKibbin, 2003)

Estimation of the impact of SARS on selected Asian Economies

Economies

Estimated reduction in annual GDP

growth if SARS lasts for 1 quarter in

2003(percentage point)

Estimated reduction in annual GDP

growth if SARS lasts for 2

quarters in 2003 (percentage

point)

Estimated reduction in GDP

level if SARS lasts for 1

quarter in 2003 (US$ billion)

Estimated reduction in GDP

level if SARS lasts for 2

quarters in 2003 (US$ billion)

  2003 2003 2003 2003

East Asia 0.4 1.0 8.8 20.0

The PRC 0.2 0.5 2.3 5.8

HK, China 1.8 4.0 3.0 6.6

Korea 0.2 0.5 1.3 3.0

Taipei, China 0.9 1.9 2.5 5.3

     

Southeast Asia  0.5 1.4 3.2 7.7

Indonesia 0.5 1.4 0.7 2.0

Malaysia 0.6 1.5 0.5 1.3

Philippines 0.3 0.8 0.2 0.6

Singapore 1.1 2.3 1.0 2.0

Thailand 0.7 1.6 0.8 1.8

Source: ERD of ADB using OEF model, staff estimates

Chart 4

                                                                             

                                     

Korea’s exports have decreased, but not muchKorea’s exports have decreased, but not much

Lessons DrawnLessons Drawn

Importance of – early detection– quarantine and surveillance– informing the public in time, and correctly– Supporting basic and specific research– Increasing public health capacity:

manpower and facility– Promoting international cooperation and

collaboration

SARS Situation in KoreaSARS Situation in Korea

No death related with SARS– 3 probable cases– 17 suspected cases

Mostly those who visited China Overall 65 reports for assessment

Korean Strategies for SARS Korean Strategies for SARS PreventionPrevention

Early detection of imported cases– Quarantine– Surveillance

Prevention of secondary infection– Medical facilities– Protection of health care personnel (mask, etc.)– Isolation of patients

Information and education– Hand washing

Laboratory capability– Support laboratory diagnosis

SARS Management System

Headquarter

Chair: Minister of Health

Communicable Disease Task force

Emergency Response Team

Municipal/Provincial health director

Local Emergency Response Team

District health officer

Chair: NIH director

SARS Control Team

Chair : Municipal/Provincial vice mayor

Chair: Vice district chair

Local SARS Control Team

QuarantinQuarantinee

Questionnaire

Examination (fever etc)

Isolation room

Patient care Special

investigation

Identify passengers from high risk areas

Collaborate with immigration office

Examine air crews

For travelers

For visitors and immigrants

Media Travel

agencies

Follow-up Suspected Cases

InformationAssessment Isolation

Quarantine ActivitiesQuarantine Activities

Check body temperature for travellers from China (5,000/day)

Examine aircrafts (45 planes and 7,000 persons/day)

20,000 passengers/day screened, using infrared automatic body temperature thermometer

Patient SurveillencePatient Surveillence

Case report network

Education of health care workers

Monitor emergency rooms

Networking of infection specialists

http://dis.mohw.go.kr/sars_index.asp

Public Information and EducationPublic Information and Education

Tasks Underway after SARS Tasks Underway after SARS Epidemic Epidemic

Establish infrastructure for communicable disease control– New establishment of CDC– Strengthen public health care sector– Networking of quarantine office and CDC

Strengthening response capacity for emerging disease– Global monitoring– Laboratory capacity and research– Emergency response preparedness