ENCYCLOPEDIA OF Espionage, Intelligence, and Security Volume ...

Communicable Diseases, Isolation, and QuarantineHong Kong and the Guangdong province of China. Therecommendation, sought by infectious disease specialists,was not controversial within the medical community,but caused immediate concern regarding the potentiallywidespread economic impacts.World attention—focused largely on the ongoing warin Iraq—began to focus on SARS. Within China, under anew generation of political leadership, a politically uniqueevent occurred when a Chinese official publicly apologizedfor a slow and inefficient response to the SARSoutbreak. Allegations that officials covered up the trueextent of the spread of the disease caused the dismissal ofseveral local administrators including China’s public healthminister and the mayor of Beijing.Mounting reports of SARS showed an increasingglobal dissemination of the virus. By April 9, the firstconfirmed reports of SARS cases in Africa reached WHOheadquarters, and eight days later, a confirmed case wasdiscovered in India.Scientists scrambled to isolate, identify and sequencethe pathogen responsible for SARS. Modes of transmissioncharacteristic of viral transmission allowed scientiststo place early attention on a group of viruses termedcoronaviruses—some of which are associated the commoncold. There was a global two-pronged attack on theSARS pathogen, with some efforts directed toward apositive identification and isolation of the virus, and otherefforts directed toward discovering the genetic molecularstructure and sequence of genes contained in the virus.The development of a genomic map of the precise nucleotidesequence in the virus would be key in any subsequentdevelopment of a definitive diagnostic test, the identificationof effective anti-viral agents, and eventually a vaccine.The development of a reliable and definitive diagnostictest was considered of paramount importance in keepingSARS from becoming a pandemic. A definitive diagnostictest would not only allow physicians earlier treatmentoptions, but would also allow the earlier identification andisolation of potential carriers of the virus. Without advancedtesting, physicians were forced to rely on lesssensitive tests that were unable to identify SARS prior to21 days of infection—- in most cases too late to effectivelyisolate the patient .In mid-April 2003, Canadian scientists at the BritishColumbia Cancer Agency in Vancouver announced thatthey that sequenced the genome of the coronavirus mostlikely to be the cause of SARS. Within days, scientists atthe Centers for Disease Control offered a genomic mapthat confirmed more than 99% of the Canadian findings.Both genetic maps were generated from studies ofviruses isolated from SARS cases. The particularcoronavirus mapped had a genomic sequence of 29,727nucleotides—average for the family of coronavirus thattypically contain between 29,000 to 31,000 nucleotides.Proof that the coronavirus mapped was the specificvirus responsible for SARS would eventually come fromanimal testing, as rhesus monkeys were exposed to thevirus via injection and inhalation, and then monitored todetermine whether SARS like symptoms developed and ifsick animals exhibited a histological pathology (i.e., anexamination of the tissue and cellular level pathology)similar to findings in human patients. Other tests, includingpolymerase chain reaction (PCR) testing helped positivelymatch the specific coronavirus present in the lungtissue, blood, and feces of infected animals to the exposurevirus.Identification of a specific pathogen can be a complexprocess, and positive identification requires thousands oftests. Testing is conducted with regard to testing Koch’spostulates—the four conditions that must be met for anorganism to be determined to the cause of a disease. First,the organism must be present in every case of the disease.Second, the organism must be able to be isolated from thehost and grown in laboratory conditions. Third, the diseasemust be reproduced when the isolated organism isintroduced into another, healthy host. The fourth postulatestipulates that the same organism must be able to berecovered and purified from the host that was experimentallyinfected.Early data indicate that SARS has an incubation periodrange of 2 to 10 days with an average incubation ofabout four days. This innoculation period allows the virusto be both transported and spread by an asymptomaticcarrier. With air travel, asymptotic carriers can travel toanywhere in the world. The initial symptoms are nonspecificand common to the flu. Infected cases then typicallyspike a high fever (100.4°F) (38°C) as they develop acough, shortness of breath, and difficulty breathing. SARSfulminates (reaches it maximum progression) in a severepneumonia that can cause death.As of May 1, 2003, no single therapy was demonstratedto show clinical effectiveness and physicians couldoffer only supportive therapy (e.g. administration of fluids,oxygen, ventilation, etc.).Before the advent of vaccines and effective diagnostictools, isolation and quarantine were the principal tools tocontrol the spread of infectious disease. The term ”quarantine“derives from the Italian quarantine and quarantagiorni and dates to the plague in Europe. As a precautionarymeasure, the government of Venice restricted entryinto the port city and mandated that ships coming fromareas of plague—or otherwise suspected of carryingplague—had to wait 40 days before being allowed todischarge their cargos.The legal basis of quarantine in the United States wasestablished in 1878 with the passage of Federal QuarantineLegislation in response to continued outbreaks ofyellow fever, typhus, and cholera.The public discussion of SARS related quarantine inthe United States and Europe renewed tensions betweenthe needs for public heath precautions that safeguardsociety at large and the individual liberties. During the250 Encyclopedia of Espionage, Intelligence, and Security