1. Preparedness against SARS in Norway Preben Aavitsland Department of Infectious Disease Epidemiology Division of Infectious Disease Control Norwegian Institute of Public Health (May 22, 2003)

2. Current strategy against SARS Detect cases Isolate cases Trace contacts Follow up contacts –Based on available knowledge –May be adjusted –Lowest effective level

3. The roles of NIPH (Communicable Diseases Control Act § 7-9) Surveillance –In Norway –Internationally Guidance and services –General guidance on infectious disease control –Reference laboratories –Vaccination programme Research

4. Surveillance for SARS Starting March 16 –mandatory reportable to NIPH –phone 22 04 23 48 plus fax/letter According to WHO definitions Reporting to EU, WHO

5. Guidance and services for SARS Guidance to public, health services and authorities –www.fhi.no –”MSIS-rapport” –Epidemiologist on call 22 04 23 48 –Telephone, e-mail –Public hotline 22 04 22 00 –Conferences –Mass media Reference lab –appointed by MoH

7. Research Virology Specific immunoglobulin (with Affitech) Vaccine (with Bionor) Scenarios

8. Are we prepared?

9. Positive features of Norwegian society Well organised Knowledgeable population Wealthy people and government Sparsely populated Good health system Advanced science Democracy Free press Trust in Government Strong state Modern communicable disease law Not dependent on tourism

10. Negative features of Norwegian society Complacency? Never had a problem like this Never tested our preparedness Not mentally prepared for extreme measures Egoistic? Xenophobic? Infectious disease epidemiology not very well developed Used to 100% security; accept no less

11. Scenario Municipality of 5000 Man 45, fever, malaise and diarrhoea after trip business trip to Singapore Patient’s delay two days Been to cafeteria, cinema, work place, friends’ homes etc. while mildly sick

12. Scenario continued Admitted to hospital for diarrhoea 300 beds, 1000 employees Misdiagnosed as enteritis for two days in hospital Waited in emergency room Been in single room and X-ray department Episodes of diarrhoea in bed

13. Do we have the municipal capacities? Personell –for contact tracing and follow up –for dealing with mass media –for dealing with the worried well Gloves, masks, gowns Thermometers Ambulance for bringing the next patients to hospital

14. Do we have the hospital capacities? Personnel –for caring for many patients –for replacing sick staff and contact staff –for contact tracing and follow up –for dealing with mass media –for dealing with the worried well –for supporting health care personnel Gloves, masks, gowns Isolation rooms ICU beds, respirators

15. Do we have the national capacities? Personnel –for supporting the health services –for informing the public –for dealing with mass media –for dealing with the worried well –for conducting surveillance

16. Conclusion Strategy is clear –Detect and isolate cases –Trace and follow up contacts Information level is high Norway is seemingly well prepared SARS is an extreme threat Extreme capacities may be needed Are we prepared for ”the big one”?