'A Matter Of Hygiene'

Each year, it seems, a new microbe emerges to strike fear in the hearts of microbiologists--and, every once in a while, the rest of us as well. SARS is only the most recent of a succession of new pathogens to have emerged in recent years. Health experts worry that our global culture means that many more, and more destructive, pathogens are on the way. NEWSWEEK's Anna Kuchment spoke with Robert Webster, professor of virology at St. Jude Children's Research Hospital in Memphis, Tennessee, about the threat. Excerpts:

As a virologist and influenza expert, what has occurred to you as you've watched this epidemic unfold?

I guess the key question in my mind is, is it going to become a pandemic? A pandemic is something that spreads throughout the entire world, and this seems to be heading in that direction. I have been watching this situation with great concern, because the worst pandemic that we know about is the 1918 flu pandemic, and the death rate in this thing right now [about 3.5 percent] is exceeding 1918. That's an alarming mortality rate.

A recent report from the U.S. National Academies, to which you contributed, warns of a coming "microbial perfect storm." What does that mean?

I think it's a perfect analogy. Just as with a meteorological storm, several factors have come together in this region of southern China, including high population density and a booming economy. You know, the Chinese are more wealthy now than at any time in their history. They eat much more meat and pigs and chickens and ducks, and that means many more animal-human contacts. This agent, I would bet, came from an animal source.

Why are scientists predicting more such epidemics?

If you go back over the past 10 or 20 years, you'll see there have been emerging infections all over the globe, almost every year. HIV is still the worst one that has appeared recently. Another scary one was the Nipah virus in Malaysia, which went from bats to pigs [to humans in 1996]. There was also the Hendra virus in Australia that went from bats to horses [to humans in 1994], and H5N1 [the 1997 flu outbreak in Hong Kong that came from birds]. As the population of the world goes up, we can expect more of these things to occur. We do things that make these things happen. We bring these things on ourselves, as it were. Not intentionally, but just by increasing our population density, by cutting down trees, traveling more in planes. These are the factors that bring these things to the fore.

What do you think of the World Health Organization's response so far?

I think they are doing a fantastic job. The rate at which they got this identified is a credit to them. The transfer of information between people is optimal. And so the next questions in my mind are: What have we learned so far about containment? Is it going to become a disaster, or are there things that we could do to reduce the spread? And in that sense, are there simple questions of hygiene that would reduce spread? It seems to me that there is more than just respiratory transmission here. I think it also requires direct contact with the person, with body secretions, in addition to droplet transmission. I wonder if there's not also fecal transmission involved.

How does one prevent those types of transmission?

Just by washing your hands after going to the restroom. There is a terrible lack of that going on these days. It's a matter of simple hygiene. When something like this is going on, the first step is biocontainment: increase your standard of sanitation to the highest possible level. I guess in that respect it's interesting to look at the countries of Asia and ask: Where is it? Where isn't it? All of those countries, particularly Japan [which, so far, has zero cases], have a very, very high standard of personal hygiene--probably the highest level of personal hygiene. [South] Korea is also very high. Surely, there were very, very many people that came through Hong Kong to Japan. These are the kinds of things that you start to pull together.

How effective and how common are quarantines and isolation?

Isolation does reduce the spread. Most every hospital has an infectious-disease isolation ward, and it is used quite frequently on a small scale. If we have measles cases or any infectious diseases that we don't want to spread through the rest of a hospital, we would put them in ICU. I think quarantines are rather rare. I don't know the figures, but yesterday when WHO announced that they were going to restrict people from traveling to Asia, that was the first time WHO had ever made that so. These are pretty rare recommendations. I think the last time I heard quarantine argued was during the AIDS epidemic, when some countries in the world decided to use quarantine and it was decided it probably wouldn't be effective.

So, is SARS the "microbial perfect storm"?

Time will tell, won't it? You're going to know in another month or so. At this stage, it's not looking like the perfect storm. But how would you like to be out on a boat, even in a bad storm?