The world may not have seen the last of the severe acute respiratory syndrome (SARS) virus. Some health officials worry that we may not have even seen the worst of it.
There are concerns in the infectious-disease community that the recent outbreak was merely what some experts call a ``herald wave,'' and that the virus could come back with a vengeance for next winter's flu season.
``SARS is probably here to stay,'' said Dr. Llelwyn Grant of the Centers for Disease Control and Prevention (CDC).
Dr. Don Burke, a professor at Johns Hopkins University's School of Public Health, said ``if you accept the notion that a lot of respiratory viruses are seasonal, and decline with or without human intervention, you have to consider that when the environmental conditions permit, it could re-emerge.''
How will we know?
``Look very closely in the places it's persisting, like China,'' Burke said. ``Low-level transmission of mild SARS cases'' could still be going on in China today, he said.
``We need to use gene-amplification techniques to see if people are making antibodies for SARS,'' Burke said. ``If there were only a few cases, that can be the final step to eradication. If it's more serious, then we have a heads up for next season.''
Burke said that there is no definitive evidence to prove that the virus will return, but that surveillance must be conducted to make sure no stone is left un-turned.
``It's entirely possible that SARS is eradicated - but if there were more than 10 active strains going on through the summer with minimal intervention and we did nothing, that's the worst possible outcome,'' he said.
``If we believe in preemptive action, this is as compelling a case for it as I know.''
Both Burke and Grant stressed a need for improved testing procedures. Burke said that gene amplification techniques which detect production of antibodies for SARS need to be standardized in order to achieve meaningful results.
Grant emphasized the importance of cooperation between different sectors of the community in general. ``We need to engage the medical community and the pharmaceutical companies to develop tests to identify SARS,'' he said.
This cooperation paid big dividends when the United States combatted SARS. ``We coordinated on the state and local level and worked with non-traditional partners like the travel industry.''
Grant said the travel industry had been extraordinarily helpful in isolating travelers that the CDC had pinpointed as potential public health risks because of their exposure to SARS.
``There's still so much unknown, and it's hard to predict when the next wave will be - we need to have the proper mechanisms in place,'' he said.
``If it does come back, it may come back in a much worse epidemic than we had last year. SARS didn't really take off until later on in the respiratory virus season,'' Burke said.
``If it had gotten started earlier and built up steam, the total impact could be much worse.''
