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SARS Epidemic: A Global Challenge Bong-Min Yang, PhD & Sung-il Cho, MD, PhD of School of Public Health Seoul National University
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Why significant global issue? Multi-country outbreaks Spread through air travel and human migration Causative agent still unknown Severity of illness Impacts on clinical and public health ser vices
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David P. Fidler (2004) “ SARS was a crisis, but victory was achieved ”
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Political Impact Multinational organizations, particularly WHO, become to have increasing influence on global governance – After successful control, much credit given WHO for initiation and coordination of surveillance, research and control measures WHO Initiated – Global Alert (12 March, 2003) – Travel Advisory (15 March, 2003) – Enhanced global surveillance – Global Outbreak Alert and Response Network (GOARN) – Specific Global Networks (Lab, Case management, Epidemiology)
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Political Impact 2 Importance of global cooperation to an outbreak of infectious disease is fully realized – It validated the value of global public health networking Weakness of China ’ s public health infrastructure was revealed – China first downplayed the extent and the risk of the infection, then joined the international network to control Afterward, Chinese public health infrastructure was strengthened a lot – Case reporting structure established – Strengthened emergency response system – Provide funding for prevention of SARS
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Economic Impact Direct costs – Medical treatment costs, and costs of some equipment and supplies for prevention Indirect costs – Travel/airline – Tourism – Trade/investment – Shrunk consumer confidence Global indirect costs estimated to be around US$80 billion (McKibbin, 2003)
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Estimation of the impact of SARS on selected Asian Economies Economies Estimated reduction in annual GDP growth if SARS lasts for 1 quarter in 2003(percentage point) Estimated reduction in annual GDP growth if SARS lasts for 2 quarters in 2003 (percentage point) Estimated reduction in GDP level if SARS lasts for 1 quarter in 2003 (US$ billion) Estimated reduction in GDP level if SARS lasts for 2 quarters in 2003 (US$ billion) 2003 East Asia0.41.08.820.0 The PRC0.20.52.35.8 HK, China1.84.03.06.6 Korea0.20.51.33.0 Taipei, China0.91.92.55.3 Southeast Asia 0.51.43.27.7 Indonesia0.51.40.72.0 Malaysia0.61.50.51.3 Philippines0.30.80.20.6 Singapore1.12.31.02.0 Thailand0.71.60.81.8 Source: ERD of ADB using OEF model, staff estimates
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Chart 4 Korea ’ s exports have decreased, but not much
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Lessons Drawn Importance of – early detection – quarantine and surveillance – informing the public in time, and correctly – Supporting basic and specific research – Increasing public health capacity: manpower and facility – Promoting international cooperation and collaboration
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SARS Situation in Korea No death related with SARS – 3 probable cases – 17 suspected cases Mostly those who visited China Overall 65 reports for assessment
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Korean Strategies for SARS Prevention Early detection of imported cases – Quarantine – Surveillance Prevention of secondary infection – Medical facilities – Protection of health care personnel (mask, etc.) – Isolation of patients Information and education – Hand washing Laboratory capability – Support laboratory diagnosis
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SARS Management System Headquarter Chair: Minister of Health Communicable Disease Task force Emergency Response Team Municipal/Provincial health director Local Emergency Response Team District health officer Chair: NIH director SARS Control Team Chair : Municipal/Provincial vice mayor Chair: Vice district chair Local SARS Control Team
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Quarantine Questionn aire Examinatio n (fever etc) Isolation room Patient care Special investigation Identify passengers from high risk areas Collaborate with immigration office Examine air crews For travelers For visitors and immigrants Media Travel agencies Follow-up Suspected Cases Information AssessmentIsolation
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Quarantine Activities Check body temperature for travellers from China (5,000/day) Examine aircrafts (45 planes and 7,000 persons/day) 20,000 passengers/day screened, using infrared automatic body temperature thermometer
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Patient Surveillence Case report network Education of health care workers Monitor emergency rooms Networking of infection specialists
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http://dis.mohw.go.kr/sars_index.asp Public Information and Education
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Tasks Underway after SARS Epidemic Establish infrastructure for communicable disease control – New establishment of CDC – Strengthen public health care sector – Networking of quarantine office and CDC Strengthening response capacity for emerging disease – Global monitoring – Laboratory capacity and research – Emergency response preparedness
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