Nancy Davis Lewis: SARS: IMPACT ON HAWAII, CHINA, SOUTH ASIA AND WORLD

Date: 04-04-2003

Three East-West Center researchers discuss below the impact of SARS on Hawaii, China, South Asia and the world. Facts about SARS are also included at the bottom of this report.

1. SARS: HAWAII'S GEOGRAPHY MAY INCREASE RISK BUT PROBLEM REMAINS SMALL IN ISLANDS
Tourism-Dependent Areas Face Special Challenges

Nancy Davis Lewis, East-West Center Director of Research and specialist on the geography of health and disease, can be reached at lewisn@EastWestCenter.org or (808) 944-7245.

For almost half a century, from the advent of the widespread availability of antibiotics to the recognition of the global threat of HIV/AIDS, the world had become complacent about humankind's ability to triumph over infectious and vector-borne disease. Despite tremendous advances in medical science, the last two decades have proven that idea wrong with the spread of HIV/AIDS, Legionnaire's Disease, drug resistant T.B., Ebola, West Nile Virus and now Severe Acute Respiratory Syndrome (SARS).

The dengue outbreak in Hawaii last year is an example of a long-established, vector-borne disease that may be extending its range. In large parts of the world, the same holds true for malaria.

Dengue had not occurred in Hawaii since World War II. The recent outbreak probably started with a Maui resident returning from French Polynesia. Given the speed of air travel and the incubation periods for different diseases, as more and more people travel, this is an important piece of the mosaic in the risk for infectious and vector-borne disease. This may be especially true here in Hawaii with travelers moving both east and west across the Pacific.

Nations and states heavily dependent on tourism, international business and foreign investment face special challenges as infectious-disease risks not only occur but are broadcast internationally. The economic impact of SARS in Hong Kong is predicted to be large with reverberations throughout Asia, and thus in Hawaii.

There have only been four to five suspected SARS cases in Hawaii and none have been confirmed. The health risk of SARS in Hawaii is probably, at this time, not great, but we still need to be both vigilant and reasonable. We also need to be aware that this is probably not going to be the last time we face this kind of challenge.

2. SARS: POTENTIAL FOR ECONOMIC AND POLITICAL INSTABILITY IN CHINA IF OUTBREAK DOES NOT SUBSIDE WORLDWIDE Chris McNally, East-West Center Research Fellow and specialist on China and international political economy, can be reached at mcnallyc@EastWestCenter.org or (808) 944-7239.

The outbreak of SARS in Guangdong Province and the subsequent official silence on the matter by Chinese authorities has led to strong criticisms of Chinese health authorities. Actually, at the beginning of the outbreak, text messaging, cell phone calls and Internet chat rooms spread news about SARS rapidly in Southern China, creating a certain amount of panic in and around Guangzhou, the capital of Guangdong Province and the suspected epicenter of the disease.

The health authorities' response was to assure residents that the disease was under control and to subsequently repress any information concerning its development. This response stems from a long held penchant in China for burying bad news and manipulating statistics to contain social instability. It, however, also expresses that China, in particular Guangdong Province, has become heavily enmeshed in the global economic system. Authorities feared that any panic created by SARS would affect foreign investments and international economic transactions.

This reaction to the SARS outbreak has now backfired. SARS' spread to Hong Kong and beyond has alarmed the international community. Already there are reports of Taiwanese engineers and managers unwilling to travel to Guangdong to look after their operations there, many of which are high-tech and at the cutting edge of China's export machine. Similarly, no American, European or Japanese investors seem willing to travel to Guangdong at this time.

The insufficient amount of information and cooperation forthcoming from Chinese authorities only aggravates the perception that the world does not know the extent of the SARS epidemic in China. Repression of information there has therefore created a minor economic crisis, which, if the outbreak does not subside worldwide, could hold the potential to create major economic and political instability in China.

As history has shown, large-scale outbreaks of diseases hold the potential to bring down governments and even whole civilizations.

3. SARS COULD WREAK HAVOC IN SOUTH ASIA, AFRICA, AREAS WITH WEAK PUBLIC HEALTH

Vinod Mishra, East-West Center Research Fellow and specialist on Asia population and health problems, can be reached at mishrav@EastWestCenter.org or (808) 944-7452.

The SARS situation at the moment is very fluid. New cases are being reported by the hour. As of April 4, there were 2,353 reported cases of SARS in 16 countries, and the disease has killed at least 84 people.

Reports say most other countries are taking precautionary measures, but there is potential for the epidemic to get out of control, especially if it sets foot in poorer countries of Africa and South Asia with relatively weak public health infrastructure.

Eighty-five percent of the cases have been reported from China (including 1,220 cases mostly in southern China, 761 cases in Hong Kong, and 15 cases in Taiwan). Singapore has reported 100 cases, Vietnam 59 and Thailand a small number.

The disease has also made its way to several countries in North America and Western Europe. Canada has reported 69 cases and seven deaths. As of April 4, there were 100 suspected cases of SARS in the United States. However, thus far local chains of disease transmission have been reported only in China, Singapore, Vietnam, and Canada. In the United States and in the other 11 countries, all suspected cases of SARS appear to have been transported into the countries.

Signs indicate that with proper screening and quarantine, the disease can be contained. Moreover, there is a possibility that scientists may soon find a test to diagnose the disease. But, in the meantime, SARS may cause considerable damage both in economic and public health. It is already hurting tourism and business travel to and from the countries hit by SARS.

Facts about Severe Acute Respiratory Syndrome (SARS):

WHAT IS IT? An acute respiratory illness that causes atypical pneumonia. The disease appears to be transmitted mainly through close contact with an infected person through coughing or sneezing. Most cases have been reported among close relatives and hospital caregivers. It is not known how long before or after the illness symptoms a patient can transmit the disease.

SYMPTOMS: Fever often accompanied with chills, headache, body aches, and general feeling of discomfort. After a few days, the patients may develop dry cough and difficulty breathing.

CAUSE: General agreement that the disease is caused by a virus. A previously unrecognized coronavirus is the prime suspect at this time, but other viruses, such as paramyxovirus, are also being investigated.

DETECTION: No clinical tests to detect SARS. The diagnosis is being done by excluding other diseases. Itt is likely that some of the reported cases may turn out to be non-SARS cases after further investigation. The new coronavirus is being tested against several antiviral drugs to find an effective treatment.

Information on SARS and travel advisories are available at the following Websites:

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This is an East-West Wire, copyright East-West Center