Sat, 05 Apr 2003

Pandemonium and paranoia

Rina Jimenez-David, Philippine Daily Inquirer, Asia News Network, Manila

A domestic worker comes home from Hong Kong and admits on her yellow health card that she's been coughing and having difficulty breathing. At once she's taken into the "quarantine" room at the airport and, so TV reports said, questioned intensively by doctors for about two hours. Upon finding that the domestic was also running a fever, the doctors decide to transport her to the San Lazaro Hospital in Manila for confinement.

The TV news showed the woman, frantically trying to cover her face from the glare of TV lights and to outrun pursuing reporters, practically sprinting to a waiting ambulance.

Now how many other returning domestics, businesspeople or tourists will be motivated to fill up the health cards truthfully, or answer the questions of quarantine doctors fully, after what the woman went through.

It's hard enough to come down with any ailment, even the "regular" flu or pneumonia, while you're traveling, without having to contend with pandemonium and paranoia upon your arrival.

Of course, given the speed with which Severe Acute Respiratory Syndrome (SARS) spreads and the "mystery" surrounding its origins, public health authorities were right to have taken precautions. But they could have been more discreet, if only to encourage travelers to be more forthright about their possible health problems.

For one thing, did they have to let media have so much access to the quarantine room? "Quarantine" means isolation, right? And was it wise to let so many people hover outside a room from where possibly infectious microbes could waft out?

The key to containing outbreaks of infectious diseases is public cooperation. Public health authorities rely on getting factual information from people who had come down with the disease (and presumably survived it), or from people who had come in contact with possible carriers. This is so that health authorities could establish a "chain" of infection that could tell them not only who needs to be isolated to prevent them from further spreading the infection, but also how and why the disease spreads, how long the illness lasts, what factors account for survival or death.

It's thus important to stress that possible carriers need to come forward and tell health authorities everything they know, especially who they had come in contact with before and after they were infected. This not only because it helps public health people keep track of the disease's spread, but also because it will help them save lives, including the informant's. But if people see someone who is only suspected of harboring the SARS virus treated like a prisoner and pariah, then they may decide it's not worth coming forward even if their throats are scratchy, they're coughing and they're running a fever. And if they haven't lately been in Guangdong, Hong Kong, Vietnam, Singapore or Toronto, or been around people who've been to these places, chances are, they've probably contracted only the common flu.

I can understand why the doctors at the airport were so accommodating to the media, and why TV news crews were allowed access to the returning passengers and to the beleaguered domestic. The government is understandably anxious to reassure the public that "everything" is being done to prevent the entry and spread of SARS here.

But the coverage, at least as seen from the last two days or so, seems to be generating hysteria rather than calming fears. The way the public mind works, the more precautions taken and the more draconian these measures are, then the greater the chances that the disease is already here.

To his credit, Health Secretary Manuel Dayrit has so far reacted calmly to the potential crisis. He and other Department of Health personnel have not been able to stress enough that so far, "no Filipino in the Philippines" has yet been detected as coming down with SARS. I'm also assured by moves it has taken that the department is taking the threat seriously.

Dayrit has also succeeded in brushing off suggestions, largely from the alarmist media, that the government take drastic measures against SARS, from turning back planes and ships from SARS-affected areas, to closing schools and issuing face masks to the public.

Reports say the virus causing SARS has been identified, making it easier for the World Health Organization (WHO) and other medical personnel to determine the best course of treatment. Early reports say SARS is spread in much the same way a cold or the common flu is transmitted: Through droplets in the air expelled when an infected person sneezes or coughs.

And despite the early fears generated by reports that the disease "kills" swiftly and that no cure as yet exists (still true), it turns out that so far, based on the number of people who've been confirmed as coming down with SARS and those who've died of it, SARS is less deadly than dengue fever or measles, common diseases that Filipinos have come to take for granted.

Which brings me to the way awe value and understand health issues. As a society, with considerable encouragement from the media, we tend to get all hysterical in the face of a new, unfamiliar infectious disease, or signs of one, as in the "outbreak" of flu that supposedly hit exclusive schools last year. Legislators are quick to jump on the bandwagon, excoriating health officials for not responding quickly or thoroughly enough.

But once the disease becomes familiar or commonplace, we forget all about it even if, as with dengue and measles or TB, the disease continues to kill and debilitate thousands each year.

Will this happen with SARS, too?