Such are the simple tools deployed against severe acute respiratory syndrome in the so-called developing world. Even rich countries haven’t exactly produced a lightning victory against the disease. Last week, just as the World Health Organization lifted its travel advisory for Toronto, Canadian health officials announced two new cases. And scientists in Hong Kong raised the frightening possibility that patients who have already recovered from the disease may still infect others. What if SARS holds another punch for the world’s poorest countries?
The prospect has health experts in South Asia and Africa, in particular, on edge. So far India has kept its 19 mild cases from turning into an epidemic, and only one case has cropped up in Africa. With the disease on the wane in Vietnam and leveling off in Bangkok, it’s possible that SARS won’t become a pandemic. But it’s far from a sure thing. The epidemic is still raging in China, only a plane ride away from vast populations of vulnerable people. Thirty million HIV-infected Africans, who have compromised immune systems, are sitting ducks for the disease, warned Luc Montagnier, one of the discoverers of the AIDS virus. Millions more people sick with malaria, hepatitis and bilharzia are similarly at risk. A recent report from the World Health Organization sounds an ominous note: “Nearly two thirds of all the patients who die in all age groups already suffered from chronic diseases.” Dr. Alfred Jumba, who works in the eight-bed Vipawa Medical Center, one of the main health-care facilities in the teeming Nairobi slum of Kibera, says, “This is potentially devastating.”
The Philippines is better off than many –developing countries, but it is hard-pressed to defend itself against SARS. Unlike Hong Kong, which has erected virtual holiday camps for its SARS victims, or Singapore, which has installed video cameras to police urban areas, it makes do with the 2 percent of its annual budget that goes to health care. Officials say they can’t afford to buy gloves and masks for nurses. The Philippines’ trade minister said last week that the country has run out of N95 face masks. “We are hoping that the WHO will help us out,” says Dr. Troy Gepte, a government spokesman. People are turning to home preventions like papayas and ginger-and-garlic infusions.
Indian health officials have even more cause to be jittery. None of the country’s 19 SARS victims so far has died. But with a billion people crammed together, a fifth of them in megacities like Mumbai and New Delhi, the Subcontinent is ripe for a SARS epidemic. Only a quarter of all Indians have toilets; SARS, scientists suspect, can be spread by feces. A major outbreak of SARS –would overwhelm India’s health-care system. The country has fewer than five physicians per 1,000 people and one small community health center for every 80,000 people. The government’s drive to promote family planning has starved other health services of funds. “The danger is extremely great,” says Ghanshyan Shah of Delhi’s Jawaharlal Nehru University. “Over time the health system has become weaker and weaker.”
Because most Indians aren’t covered by health insurance, many may wait too long before reporting to the rudimentary health clinics serving rural areas. India’s plan to use airports as a first line of defense doesn’t inspire confidence either. Although all arriving passengers are required to fill in questionnaires, many say they haven’t been asked any questions once they’ve landed.
African health officials cast a worried eye toward India. Here’s their nightmare scenario: An expatriate Indian from Nairobi returns to Mumbai, where some SARS patients live, for a visit. He comes home and infects his housemaid. She in turn spreads the virus to Kibera, Kenya’s largest slum. There, working in shacks with signboards out front, local staff are trained to diagnose familiar diseases like flu or malaria–but not SARS.
Whatever the route might be, Africa lacks the ability to fight SARS. Suspected carriers should be quarantined, and victims need an intensive-care unit and an isolation ward, equipped with respirators and staffed by specialists trained in so-called barrier nursing. But even in Kenya, one of Africa’s best developed countries, only 10 respirators are available for isolation rooms. Ghana, another well-off African country, is equally at risk. “In the whole of Ghana there are only a few isolation units with respirators,” says Dr. Peter Ottengraf, who works in the capital, Accra.
The presence of HIV makes the situation potentially catastrophic. Most AIDS patients in South Africa, which has the world’s highest incidence of the disease, go untreated. State hospitals are overwhelmed with tuberculosis patients, many weakened by AIDS. “We are already living a nightmare here,” says Dr. Steve Andrews, a Cape Town AIDS specialist. “Six hundred people are dying each day from AIDS in South Africa, but if SARS comes into a community, it may be as bad as the 1918 influenza outbreak.”
The South African government, Africa’s best-heeled administration, has deployed its defenses quietly in order to avoid sowing panic. With no fanfare, it opened a 24-hour clinic at Cape Town airport for checking international visitors for SARS symptoms. All airports are now required to check each airplane from an outbreak country. A public-heath officer boards the plane, addresses the passengers and hands out cards listing SARS symptoms and phone numbers to call for help. Health officials will track those who seem ailing. The government has also created outbreak-response teams and designated hospitals for suspected SARS patients. “People now know about SARS, they are worried about the symptoms and those who fly here with the disease will let medical people know immediately once they feel sick,” says one South African specialist. “But what about their gardener or maid, who lives in the township, and goes home that night with a cough?”
