Permanent Subcommittee on Investigations

SARS: BEST PRACTICES FOR IDENTIFYING AND
CARING FOR NEW CASES

Wednesday, July 30, 2003
9:00 a.m.

Good morning and thank you for attending the second in a series of hearings by this subcommittee aimed at helping the nation respond to the threat of SARS. At the first hearing on May 21st, the subcommittee heard testimony from a number of witness at the national, state, and local levels. The first panel consisted of three internationally known experts in epidemiology; Dr. Julie Gerberding, currently head of the CDC, Dr. Anthony Fauchi, currently head of the National Institute of Allergy and Infectious Diseases, and Dr. Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

Each of these experts testified that it was their opinion that the nation would face additional outbreaks of SARS during the regular flu season this fall and winter. For example, Dr. Osterholm testified that:

“…I am convinced that with the advent of early winter in the northern hemisphere in just six short months, we will see a resurgence of SARS that could far exceed our experience to date. If this projection is correct, we have every reason to believe that this disease may show up in multiple U.S. cities as we continue to travel around the world in unprecedented numbers and speed.”
…
Imagine now the possibility of simultaneous SARS outbreaks in multiple U.S. cities. You may ask how likely is this to occur? Honestly, no one knows. But, as a student of the natural history of infectious diseases I am convinced that like the early days of the HIV epidemic, the worse of SARS is yet to come.”

If these experts are correct in their assumptions that the worst of SARS is yet to come, and I believe they may very well be, then it is incumbent upon us to take immediate and urgent measures to protect our nation from this potential crisis.

Soon after that hearing, I requested that the General Accounting Office undertake a survey of best practices for identifying and treating SARS. Because of the short time frame for preparing for new cases, I asked that the study be completed by the end of July. At today’s hearing, GAO will release the results of that study. We will also hear from the Center for Disease Control and Prevention about the work that they are doing to properly inform local agencies.

I am especially concerned with the adequacy of response at the local level. There is a consensus that the quality of the first response is crucial to preventing any single case from leading to a more generalized outbreak. Local agencies must maintain a proper state of vigilance so that they can quickly identify new cases. They must also know what to do when a new case arises in order to prevent further transmission. At the same time, local communities need to be properly educated so that they can protect themselves in a rational manner.

A case of SARS implies that a large number of coworkers, schoolmates, and social friends and their families might potentially be infected. As soon as they learn that the parent of a schoolmate has SARS, parents will want to know whether they should keep their children home, send them to class wearing masks, or take other precautions. The lack of education can make it difficult for people to properly protect themselves from transmission. But it can also lead to a sense of panic and overreaction, stalling the economic activity on which all employment depends.

Intelligent education requires several steps. First, local doctors need to know how to recognize that new cases of SARS are appearing and need to know whom to turn to for information and support. At the national and international level, agencies must continue to develop information about the characteristics of SARS in order to treat patients and prevent its spread. The World Health Organization, the National Institutes of Health, and the Centers for Disease Control and Prevention perform this role well. Lastly, the information these agencies develop must be transmitted back to mayors, hospital administrators, and airport officials so that doctors, airline attendants, researchers, and average citizens know how to what to do in order to protect themselves. Today’s hearing is focused on this last step.

I believe we face three primary tasks. The first is to make sure that local heath officials are properly informed about the need to remain vigilant against possible SARS cases. Although no new cases have been reported recently, most experts believe that SARS has established itself in the population and reemerge. Unfortunately, its symptoms resemble those of other respiratory flues and tuberculosis. Unless local doctors remain mindful of the possibility of SARS, the first cases may not be isolated in time to prevent further transmission.

Second, we need to make sure that the average citizen can intelligently respond to SARS when it appears in his or her community. Individuals need to know what precautions to take at various stages of an outbreak. They also need to know what the true status of risk is, so that they do not over respond. In Asia the indirect economic costs of SARS far exceeded the direct costs of combating the disease.

Finally, we need regional and national plans for dealing with a large-scale outbreak of SARS. We saw in Toronto that SARS can quickly overwhelm even a modern health care system if the first cases are not quickly contained. When this happens, regional and national resources must be available to fill in the gap. Dr. Kanof will testify about some of the hurdles we face in developing such a plan. I am pleased that CDC is currently working hard to overcome these.

I want to take this opportunity to commend both of the organizations before us for their previous role in dealing with SARS. I have repeatedly heard of the great assistance that the CDC has provided to local agencies searching for information on SARS. With respect to this disease, it is hard to think of how the agency could have responded better. Doctors Gerberding and Hughes deserve our great appreciation for the great work that they and their staff have performed under tremendous pressure. In the report being released today and in previous reports and testimony, GAO has played a valuable role in keeping Congress informed of this fast-breaking development. Today’s report was completed in a very short time frame and I appreciate Dr. Kanof’s support in making it happen.