The war may be global, but the battles are local

June 1, 2003

The news about SARS has circled the globe. We get reports every day from Hong Kong, Singapore, Canada, Taiwan and elsewhere about how many new cases there are, how many people have died, and what the latest theories are on transmission and detection. 

The Centers for Disease Control (CDC), the World Health Organization (WHO) and others are working continuously to identify and contain this deadly disease. They are collaborating with researchers around the world to evaluate treatment options and to create a reliable test for SARS. There is very little to be said about their efforts, other than they have done an excellent job.

But the CDC and WHOs view of this disease is a global one, a much different view than that of the medical laboratory professional in a community facility. It is in our laboratories, clinics and hospitals that the battle lines will be drawn in this countrys fight against SARS. This means that the local public and private health systems around the country must also coordinate across geographic and political lines in their preparations to fight against
SARS.

The CDC and the WHO cannot be everywhere. They are not directly responsible for the preparedness of our communities. And the public health system, while improved in the post- 9/11 focus on bioterrorism, is not yet ready to handle a full-fledged outbreak of an emerging infectious disease like
SARS. 

For an example, we need look no further than the smallpox vaccination program. The CDC is nowhere near the goal of vaccinating half a million first responders, despite its best efforts. Thats because the final decision-making power lies not in the CDC, but at the local level. Individual hospitals are deciding whether or not to participate, and just like with the smallpox program, individual facilities will be making the decisions about how best to be prepared for
SARS.

First, each hospital and laboratory must decide to renew its commitment to healthcare worker safety. As we have seen with SARS, significant portions of those infected were healthcare professionals. Without the commitment of proper resources to equipment and safety training, the difference between an isolated case of SARS and a full outbreak could be quickly and tragically realized. 

Also, if SARS teaches us only one thing, let it be that the link between the private and the public health systems is a vital one that needs to be improved. While it is clearly important to prepare, coordinate and respond globally, we must implement locally to successfully control an outbreak of SARS. Both the public and private health sectors must proactively work to improve the current antibioterrorism infrastructure in order to address the threat of a new, naturally occurring infectious disease.

Finally, the public health system is currently highly fragmented. The procedures for dealing with a SARS-like threat are different from state to state. We need a system for seamless reporting, so that our laboratories and hospitals and public health officials can have access to the most up-to-date information available. Without that information, the public health system cannot be expected to effectively distribute personnel and resources in response to an emerging infectious disease.

In any battle, the generals can lay out the game plan, but the soldiers on the frontlines are the ones who make the difference between victory and defeat. Without the proper training, without the needed equipment, and without clear and direct lines of communication, those frontline soldiers cannot expect to succeed. 

That is the challenge facing our hospitals and laboratories, this countrys frontline soldiers against SARS: the creation and use of those communications vehicles and the distribution of those needed resources so that our healthcare workers and organizations can be prepared to act. Without them in place, by the time a disease like SARS strikes, its too late.

Dr. Schwartz is the secretary-treasurer of the College of American Pathologists, chairman of the Colleges Task Force on National Preparedness and a member of the U.S. Department of Health and Human Services Clinical Laboratory Improvement Advisory Committee. He testified May 7, 2003, before the U.S. House of Representatives Energy and Commerce Committee, Oversight and Investigations Subcommittee on the issue of SARS preparedness.

As has been the history of MLOs Washington Report, this space will be
devoted in 2003 to keeping readers abreast of ongoing issues and new legislation affecting the clinical laboratory and its professional managers and technicians. If there is a particular legislative question or a legislative topic of special interest to your organization, please e-mail:
[email protected].

                                                                            June
2003: Vol. 35, No. 6

© 2003 Nelson Publishing, Inc. All rights reserved.

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