CIA report looks at SARS comeback scenarios

Sep 8, 2003 (CIDRAP News) – A recent US intelligence report envisions three possible scenarios for a return of SARS (severe acute respiratory syndrome) this winter, ranging from small outbreaks in a few countries to a repeat of the widespread outbreaks that occurred last winter and spring.

The report does not predict a SARS comeback, but discusses the implications for the United States if the disease does return. It was prepared by the National Intelligence Council, part of the Central Intelligence Agency, at the request of Health and Human Services Secretary Tommy Thompson and Jack Chow, deputy assistant secretary of state for international health affairs.

Titled "SARS: Down But Still a Threat," the report notes that many experts fear that SARS could return this fall. "The possible presence of animal reservoirs of the coronavirus that causes SARS and the lack of a reliable diagnostic test or a vaccine preclude eradication," it states.

The most optimistic of the three scenarios in the report is that SARS could resurface in the fall but be limited to "random outbreaks in a few countries." Rapid activation of local and international surveillance systems and isolation steps could render the outbreaks "more of a public health nuisance than a crisis."

Initially, however, "Some cases might elude detection by hospital workers and airport personnel, who have relaxed screening procedures since the disease ebbed," the report says. Also, some countries would be tempted to hide their outbreaks, as China did for several months last fall and winter.

"Paradoxically, keeping SARS out of the United States might become more difficult as fewer cases are seen, because health, transportation, and security workers are more likely to drop their guard on monitoring for infected people if only a few cases pop up now and then," the report says.

A second possibility is that SARS "could gain a foothold in one or more poor countries, potentially generating more infections and deaths than before but with relatively little international economic impact," according to the report. Few poor countries have had to deal with SARS so far, but such countries are at risk because of weak healthcare systems and vulnerable populations.

Most poor countries would have trouble implementing control measures such as isolation, home quarantine, and tracing of exposed people, the document notes. Repressive countries might use military force to quarantine entire towns or imprison quarantine violators.

In the third scenario, "SARS could stage a comeback this fall in the main places it hit before—such as China, Hong Kong, Taiwan, and Canada—or gain in a foothold in other places with extensive international travel and trade links like the United States, Japan, Europe, India, or Brazil."

Although this would have political and economic effects, Asia might suffer less disruption than it did the first time, the report says. "The resurgence of SARS in Asia probably would cause less disruption as citizens, companies, and governments learn to live with it, as they have with other diseases, unless the transmissibility or lethality rose substantially."

A new wave of SARS in Asia probably would cause some companies to "modestly" reduce investments there. But few companies would be likely to pull plants out of China unless SARS debilitated or killed large numbers of workers, the report predicts.

Sizable outbreaks in the United States and Europe, which were not greatly affected by the first wave of SARS, would probably generate more public fear than new outbreaks in Asia. "The economic costs of SARS probably would skyrocket if fears grew about the transmission of the disease in planes or on objects," the report says. Because of the high political and economic stakes, "some jurisdictions probably would try to fudge health data in an effort to avoid official health warnings or get them lifted more quickly."

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