STATEMENT OF SENATOR CARL LEVIN (D-MI)
RANKING MINORITY MEMBER
PERMANENT SUBCOMMITTEE ON INVESTIGATIONS
HEARING ON
SARS: HOW EFFECTIVE IS THE STATE AND LOCAL RESPONSE?
May 21, 2003

Today, the front lines of the SARS battle in the United States are drawn at our airports, our border crossings, our hospitals, and the local doctor’s office. Our local health care providers need resources and training to protect our country from a SARS outbreak. We’ve been relatively lucky so far, but we need more than luck to keep this public health threat under control. We need resources and planning.

Right now our knowledge of SARS is limited. We don’t know where the disease came from, we don’t know how to rapidly and reliably test its presence, and we don’t have a cure. But we have learned that if we identify SARS patients quickly and isolate probable cases, we can prevent the disease from spreading. That means our first and most important line of defense is having first-responders who are trained to spot SARS symptoms, have adequate resources, and workable, sensible plans to safeguard the public.

We also know that some countries have done a better job than others at preventing the spread of SARS. We know that China was not, at first, up front with its citizens about the disease and as a result, both confusion and the disease have spread. In contrast, Vietnam successfully contained a possible SARS outbreak through swift action. To protect our own country, we need to learn from the experiences of others, as well as devise ways to support other countries’ efforts to stem their SARS infections.

When we look here at home, the facts paint a complex picture of our readiness to fight SARS. The good news is that we have a public health system that is engaged in this battle and taking many of the steps needed. Few cases are being found, and no fatalities to date. But on the other hand, we have inadequate resources to support the good intentions and planning of our health care system.

In my own home state of Michigan, the SARS readiness picture is a promising one, but one that requires further development and support. Out of a total of 43 persons evaluated in Michigan for SARS to date, only 4 suspected cases have been identified. All four cases are being treated, with no fatalities to date.

Michigan has also taken a number of steps to mount an effective response to the SARS threat. It has determined that it has legal authority to quarantine individuals posing an imminent public health threat. The Michigan Department of Community Health has assigned responsibility for combating SARS to a specific state office, the Public Health Preparedness Office. The state has issued guidelines to Michigan hospitals on how to identify and treat suspected SARS patients, and sends out regular e-mail updates to hospitals and all 64 local county health departments.

The University of Michigan Medical School has also taken a proactive role. For example, it has created a SARS working group that meets weekly and includes representatives from local community health departments. The working group has set up a communications line called Telecare that takes calls from people with questions about SARS. They have developed a questionnaire for health care providers to screen emergency room patients by asking about their travel history, exposure to potential SARS patients, and symptoms. They are also working on locating a facility that could be used to quarantine a large number of SARS patients, were that to become necessary.

These precautions are essential, in part because Michigan is the largest single area for border crossings between the United States and Canada. Canada is the United States’ top trading partner with over $1 billion worth of goods and services crossing the border every day, and more than 40% of that trade moving between Michigan and Ontario. To give you some idea of the potential impact SARS could have on Michigan, every day over 36,000 vehicles – trucks, cars, and buses– depart Canada and travel to Michigan. Furthermore, every day the number of people coming into Michigan from Canada on trains, cars, and buses exceeds 70,000. In addition, Great Lakes marine traffic and the Detroit international airport bring in cargos and passengers from all over the world. Together, these border crossings make Michigan a key gateway that must be protected to keep the United States safe from SARS.

To limit SARS risks at its border crossings, Michigan is working actively with CDC, Customs, Border, and port personnel to screen persons entering the United States. If persons crossing the border show symptoms of SARS, for example, Michigan and the CDC have designated three local health departments in Chippewa County, St. Clair County, and Detroit to evaluate and care for suspected patients, including possible hospitalization and quarantine.

Many of these steps represent new and important improvements, and the near absence of SARS in Michigan shows they seem to be working. But our officials have also uncovered major shortcomings that need to be addressed. For example, when the City of Detroit drew up an Action Plan for Homeland Security, one of the first such plans for a major city in the United States, it determined that the city does not currently have a computerized database system that can detect emerging public health problems. Detroit Mayor Kwame Kilpatrick has now called for establishing a citywide disease surveillance system that, consistent with privacy protections, can track both infectious diseases and bioterrorism incidents, and communicate directly with health care professionals, state officials, and the CDC.

Another ongoing issue is training and protections for local health care providers. In some countries, hospital workers such as nurses have suffered SARS infections despite using recommended safeguards. More work needs to be done to understand how they became sick and to protect them. One part of the problem may be that only certain types of surgical masks provide adequate protection from SARS droplets, and these masks need to be fitted carefully and changed daily. An even more basic issue is to ensure that health care workers and family members have adequate supplies of masks as well as other key health care equipment such as respirators.

Another issue of importance is that, right now, Michigan doctors have to send their SARS diagnostic tests to CDC labs in Atlanta for analysis. Michigan laboratories want to set up an in-state testing service to speed up the results and reduce the burden on CDC labs. Another open issue is who will pay for significant testing and quarantine costs, should those become necessary.

Resource needs on the local level show how far we still need to go to protect this country against SARS. They are more than matched by questions on the international and national level. How do we assist China in getting its SARS outbreak under control to reduce SARS risks worldwide? Should the World Health Organization be given additional authority to monitor in-country disease outbreaks and quarantine procedures? How do we encourage rapid development of a SARS vaccine?

We can isolate our patients, but we can’t isolate our country. We need to work with the world community, and we need the world community to work together to reduce the threat of SARS and other diseases which know no boundaries, just as we need the world community to pull together in the war on terrorism.

Recent press coverage indicates that the SARS threat may be coming under control worldwide, and I hope that is true. But responsible government calls for taking steps today to prevent the SARS problem from becoming a public health care nightmare tomorrow.

We need the political will to take those preventative steps. Last week, the Senate voted for more than $350 billion in tax cuts over the next ten years. To help pay for its proposed tax cuts, the Administration has proposed cutting spending on a number of important programs, including for public health care. That is a short-sighted mistake.

We can’t rely on private philanthropy to deal with the public’s need. One example shows why. After the 9-11 and anthrax incidents in 2001, a U.S. citizen who is also a co-founder of Home Depot, Bernard Marcus, took a tour of the CDC’s laboratory facilities in Atlanta. He was so disturbed by their dilapidated state that he personally pledged $2 million to enable the CDC to equip a state-of-the art emergency response center, which has played a key role in the battle against SARS. It is incredible that a private citizen had to step in to make up for the inadequate resources of the federal government in such a vital area. While the generosity of Mr. Marcus has made a real difference, we can’t rely on that approach to construct a workable disease surveillance system that can identify, monitor, and evaluate the severity of infectious disease outbreaks in the United States.

I was a member of the Detroit City Council during the 1970's. I know that if a contagious disease were to have broken out in my city during those days, my phone would have started ringing and not stopped. The experiences of local health care professionals can tell us a lot about what is and is not working, and I commend Senator Coleman for holding this hearing today – his first, by the way, in Washington as Chairman of the Permanent Subcommittee on Investigations. I look forward to hearing today’s testimony.

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