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By Debra Rosenberg
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It was 2:30 a.m. on Saturday, March 15, when Dr. Michael Ryan, a contagious-disease specialist at the World Health Organization in Geneva, was jolted out of bed by a phone call. The WHO's regional office in Manila was on the line, alerting Ryan that the mysterious new illness spreading its way through Asia might now be hopping continents. A 32-year-old Singaporean physician had attended a conference in New York and was on his way home--and he was exhibiting suspicious respiratory symptoms. Reports of cases in Canada and Singapore had recently made their way to Geneva; the predawn call made the situation all the more urgent. Ryan worked the phones, tracking the man to a Singapore Airlines flight, due in Frankfurt at 9:30 that morning. By the time the plane touched down, quarantine specialists in goggles and jumpsuits were waiting to take the doctor and his two travel companions to an isolation ward. "It was the first time we've ever worked faster than a virus," says Ryan.
Welcome to the new era of high-speed medical detective work. It took seven years after Lyme disease appeared in 1975 to identify the agent that caused it; AIDS, in 1981, took three. The pursuit of severe acute respiratory syndrome--or SARS--by contrast, has moved at a lightning pace, fueled by dramatic advances in technology, unprecedented scientific cooperation and a pressing sense of international crisis. Within just seven weeks, SARS was identified, named and its virus genetically mapped. The disease is still a formidable threat: late last week there were more than 3,000 cases in 25 countries and more than 150 deaths worldwide. And there is no cure. Still, the battle to attack it swiftly and head-on has been "extraordinary," says Dr. Peter Hotez of the George Washington University School of Medicine. "It's the medical equivalent of shock and awe."
American health officials are motivated by the burdens of the past. Health Secretary Tommy Thompson says he is haunted by the 1918 flu epidemic, which killed 25 million to 40 million people worldwide. Much more recently, the anthrax scare blindsided public-health experts, delaying their response. So when Thompson heard the first buzz about a pneumonia outbreak in Asia in February, neither he nor officials at the Centers for Disease Control and Prevention took the news lightly. Two statistics in particular stood out: the "attack rate" of health workers (doctors and nurses who got sick after treating patients) was an alarming 56 percent in Hanoi. "We never see that kind of rate," says CDC director Julie Gerberding. And while the death rate seems modest at 4.9 percent, it is higher than the 1918 flu rate, which was just under 4 percent. By mid-March both departments had set up SARS control centers and began holding daily conference calls. CDC scientists were deployed to Asia to join the WHO. And U.S. doctors were briefed on symptoms.
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The WHO, in the meantime, was bolstering global communication and cooperation. The day the Singaporean doctor landed in Frankfurt, the agency issued a global travel alert, identifying the illness as SARS for the first time, and calling it a "worldwide health threat." Two days later top-notch epidemiologists from around the world, including the CDC, joined Klaus Stohr--the lead scientist on the WHO crisis team--on a conference call and agreed to lay aside traditional rivalries for funds, fame and profit. They began flooding a secure WHO Web site with patient data--case histories, blood samples and treatment regimes--so scientists could learn from each other. "These are all famous microbiologists whose life's dream is to discover a virus, put their name on it and win the Nobel Prize," says Stohr. "But they understood that our only chance to put this thing back in the bottle is if we all work together."
--One of the most exciting Web postings: the virus's complete genome, announced first by a team of Canadian scientists on April 12 and then, days later, by the CDC. Using a high-tech sequencing machine and just a millionth of a gram of genetic material extracted from a SARS patient in Toronto, researchers at Canada's Michael Smith Genome Sciences Centre in Vancouver decoded the virus's 30,000-base sequence in just six days. Yaron Butterfield, a member of the team, worked nonstop, subsisting on midnight snacks of soy nuts, rushes of adrenaline and a celebratory "veggie wedgie" pizza with his lab mates. The genome successfully decoded, scientists were able to positively identify the SARS pathogen, and last week announced it was a new member of the coronavirus family.
A long road lies ahead. Scientists need to develop precise diagnostic tests, find effective treatments and, ideally, design a preventive vaccine. The greatest challenge for now is in containing the disease, especially in hot spots like Hong Kong and the Toronto region of Canada, where the Roman Catholic diocese recently banned shaking hands and drinking communion wine at church. And then there's China. Months after the first cases, the country finally caved to world pressure, admitting it had a serious outbreak on its hands.
Scientists are by nature curious, hardworking and smart--qualities they have exploited in their campaign against SARS. They're also realistic. Even today, microscopic pathogens can outsmart us. And more are likely to emerge. "SARS," says Dr. Andrew Simor, of Toronto's Sunnybrook and Women's College Health Sciences Centre, "is just a dress rehearsal for the next one." We can only hope we'll be ready.
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