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Thursday, 1 August 2019

The unsung heroes of SARS

It will possibly be my last book, but Not Your Usual Science is going to be HUGE, close to 1.5 million words, equal to a dozen 'airport books', the thick tomes you buy to read on a long flight. It collects together many of the articles and essays that I have generated over the past 35 years, covering science, how science works and how what we now call science was put together. It even includes some of the blog entries that have appeared here. In due course, it will be released as an e-book.

Here's a small taste of it...

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On February 28, 2003, the Vietnam French Hospital of Hanoi, a private hospital of about 60 beds, contacted the Hanoi office of the World Health Organisation. They reported a patient with an unusual influenza-like virus, and hospital officials suspected an avian influenza virus.

They asked if someone from the WHO could take a closer look at the case, and Dr Carlo Urbani, a specialist in infectious diseases, answered that call. In 1999, Dr Urbani was president of MSF-Italy (the Italian branch of Médecins sans Frontières, Doctors Without Borders, usually referred to as MSF) and he was a member of the delegation in Oslo, Norway that accepted the Nobel Peace Prize that year.

Urbani’s courage in dealing with the new disease seems not to have been given proper recognition, but I would like to list him here as one of the heroes of 21st century medicine.

The patient he was asked to look at was the first case of the first recorded outbreak of SARS, and due to the actions that were taken by the MSF volunteers, quite deliberately and selflessly, Urbani and several other unnamed health workers died.

That was the cost: the benefit was that the outbreak in Vietnam was the first to be brought under control, after just 63 cases and five deaths.

Urbani concluded that the small private hospital was facing something unusual, and for the next several days, he worked at the hospital, documenting findings, arranging for samples to be sent for testing, and reinforcing infection control.

The hospital established an isolation ward that was kept under guard. Urbani worked directly with the medical staff of the hospital to strengthen morale and to keep fear in check as SARS revealed itself to be both contagious and virulent. Of the first 60 patients with SARS, more than half were health care workers.

The heroism came when many of the staff members made the difficult decision to quarantine themselves. To protect their families and community, some health care workers put themselves at great personal risk, deciding to sleep in the hospital and effectively sealing themselves off from the outside world.

In some ways, say MSF people who briefed me on this at the time, the SARS outbreak in Hanoi is a story of what can go right, of public health coming before politics. First-line health care providers quickly alerted the WHO of an atypical pneumonia.

Dr Urbani recognised the severity of the public health threat. Immediately, the WHO requested an emergency meeting on Sunday, March 9, with the Vice Minister of Health of Vietnam.

By March 19, a team of MSF workers was in place. Additional specialists from the WHO and the Centers for Disease Control and Prevention (CDC) arrived on the scene, and MSF provided staff members as well as infection-control suits and kits that were previously stocked for outbreaks of Ebola virus.

On March 11, Urbani began to experience symptoms during a flight to Bangkok. On his arrival, he told a colleague from the CDC who greeted him at the airport not to approach him.

They sat down at a distance from each other, in silence, waiting for an ambulance to assemble protective gear. He fought SARS for the next 18 days in a makeshift isolation room in a Bangkok hospital. Carlo Urbani died on March 29, 2003.

His decisive and determined intervention bought precious time and saved lives. Although he would be gratified that so much was accomplished to beat SARS in such a short time, he would certainly point out that the other diseases he worked with—such as the human immunodeficiency virus and AIDS, tuberculosis, and malaria, which kill millions of people each year—deserve to be treated with similar urgency. Such a man would undoubtedly have pointed to his colleagues who also died in the battle.

The MSF is a volunteer organisation, but needs funds to operate, and welcomes donations. Yes, that’s a hint.

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