To win the SARS War

small logo By Philip S. Chua, M.D.

The Philippines is no longer SARS-free. As of April 26, 2003, there were three confirmed cases of Severe Acute Respiratory Syndrome and a dozen or so suspected cases under observation in Manila, Cebu, Alcala (Pangasinan), Tarlac, Baguio, Maydulong (Eastern Samar), Tacloban, etc. Two of the three patients had returned from SARS-infected countries. One was a local transmission (a father who got it from his daughter, the very first SARS victim, both of whom died).

The scenario is obvious and expected. If we continue to allow the entry of travelers from (or with stopovers in) those SARS countries listed on the WHO travel advisory (China, Hong Kong, Canada, Singapore, etc), without a 10-day quarantine prior to these people stepping on Philippine soil, we are doomed to have a SARS epidemic in our country. It is most unscientific and illogical to think that only those with fever (38 and higher) are the only ones who harbor the SARS coronavirus and the only ones infective. We must remember that the incubation period of this deadly virus is between 2 to 7 days, and in rare cases, 10. Therefore, a person exposed to a SARS patient in another country, say, 3 or 6 days before the travel, who may not even have a fever at all (yet) and still feeling well, and allowed entry to the Philippines, could be symptomatic 24 hours after arrival. While on the plane or ship, this person could start spreading SARS immediately to fellow passengers, and upon deplaning, to customs and other airport personnel, to friends relatives, and to other unfortunate unsuspecting people the "carrier" comes in contact with. This could be in the hundreds, like the 865 contacts of nursing aide Adela Catalon, who was infected in Toronto and returned home town in Barangay Vacante, Alcala, Pangasinan, and died April 14th. The entire town had to be quarantined for two weeks. And we have not seen anything yet.

It is na´ve to think that if the thermal scanner used at the airports shows no temperature elevation (fever), the person examined is guaranteed not to harbor the SARS virus or is not infective at all. Our present strategy of screening passengers at the airports is not enough, and only gives the public a false sense of security. While it can catch those obvious suspects who have a high fever, the screening has its inherent loophole with which SARS carriers could easily slip through.

The weapon of mass destruction against SARS is quarantine. This weapon has been used for centuries, even in our more recent pre-antibiotic era, and it helped minimize the spread of diseases, from leprosy to smallpox, to the plague, to cholera, etc. Even today, "quarantine" works effectively at home when a family member develops a cold, the flu or even chicken pox. Strict isolation works, and so will pre-emptive quarantine. To quarantine people because they are suspect cases is a must, but it is, in my opinion, already a step too late, in precluding a SARS epidemic in the Philippines.

This writer is not dumb enough to think that the proposal we made two weeks ago for a 10-day quarantine for all Philippine-bound passengers coming from the SARS countries is easy to implement, convenient, or is fair to the travelers. We realize that this pre-boarding or post-arrival quarantine would impose great hardship on these travelers, majority of whom are our fellow Filipinos. We also know that this will mean added expenses for the travelers, for the airlines or other carriers, and for our government. We admit that this is a proposal that has great logistic implications and complications. But isn't this worth our goal of protecting our country and its people from killer SARS?

While this pre-emptive quarantine is not fair, it is just. It is just, because the welfare and lives of the 82 million Filipinos, the preservation of the health of our people, our industry, economy, and infrastructure takes precedence over the inconvenience of a few thousand home-bound kababayans or visitors of ours. To prevent an epidemic of a disease as deadly as SARS, we have to subordinate the convenience and rights of a few to the welfare and lives of the greater number of our people. This is not a time to be politically correct. Our legislators must have the spine and the resolve to utilize whatever weapon there is to prevent the importation of SARS. And we say there is one such a weapon: a pre-emptive quarantine for all inbound travelers.

We advocate calm and vigilance in dealing with SARS. Panic and emotions should not becloud our reasoning and wisdom. However, aware that historically, deadly epidemics have wiped out villages, cities, nations and even a civilization, we must use our most current scientific knowledge, and less of our personal biases and emotions, in waging a war against any deadly force or disease that threaten the very existence of our homeland and our people.

The preservation of the lives of the Filipinos and the nation's health and economy is every Filipino's concern and obligation, whether they are abroad or at home. In dealing with a potential national calamity like the onslaught of SARS, the issue of human rights is best served if we put things in their proper perspective: The human rights of the 82 million Filipinos at home is more important, mandatory, and therefore, overrides the human rights of a few hundreds or even thousands. Certainly, the 82 million of us have the right to be free from exposure to the deadly SARS infection. Unfortunately, we cannot accomplish this most effectively without imposing some hardship on our government and on those inbound travelers. Maybe, someday (when we have a cure for SARS), we can have it both ways. But not now. We are not there yet. Sadly, the smaller number needs to be sacrificed, for the moment, for the greater good. Besides, isn't a 10-day sacrifice only a small price to pay for the safety of the loved ones of these travelers themselves and their fellow Filipinos, not to mention our national security, economy and infrastructure?

In a dilemma of this nature, the government and its health agencies should play a timely and pro-active role to protect the nation and our people, by utilizing all the resources at their disposal, from pre-empting the ingress of potential sources of SARS, to rigorous public education, to providing adequate hospital facilities and equipment (like ventilators, N-95 masks and full protective gears for our healthcare providers), drugs and others supplies needed in this fight against SARS in all designated city and provincial hospitals. Our government and our people have to wage a full-blown war against this potentially deadly disease. We cannot deal with the situation halfway, with our guns half-cocked. We agree with President Arroyo when she declared that "the most effective way to defeat SARS is through a transnational effort." Part of this should be the urgent implementation of a multi-lateral pre-emptive quarantine procedures for outbound and inbound travelers, a double whammy against SARS.

The SARS situation in the Philippines appears to be in good and credible expert hands, and is fairly contained. What we have to do now is to prevent "importation" of more SARS cases or infective "silent carriers" from other countries because this will certainly overwhelm our health, social, economic and political resources. Before this happens, and time is running out, our government and the Health Department, and the military, if necessary, must step in with a pre-emptive strategy, utilizing the full force of the law, if we are to defeat the enemy.

We repeat: The only way to fight SARS, like all other diseases, is by prevention. And prevention means avoidance of exposure. And this boils down to a pre-emptive strike at the obvious potential source: the Philippine-bound travelers from the SARS countries. A 10-day quarantine of these inbound passengers, as impractical, horrendous, expensive, and difficult as it might be, is the only way to preclude SARS from becoming a killer epidemic in our country, where health facilities are very inadequate and people's lifestyle, behavior and discipline most conducive to a wider and faster spread of an illness like SARS. Most countries affected are fully equipped with modern healthcare facilities, drugs, supplies and other resources, and have saved many lives, but, in spite of all this, their death toll is still significant. It is easy to imagine what will happen if SARS becomes an epidemic in the Philippine. If that is allowed to happen because our national leaders are gutless and want to be politically correct, SARS would slaughter our people, ravage our country and its economy, cause our infrastructure to collapse, resulting in total devastation and chaos. Our death tolls would be the highest in the world.

An overkill proposal? To win the SARS war, our scientific crystal ball says it is not. Let's watch what happens. And may God have mercy on us.

©2003Raoul R. Diez, M.A.O.D.