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Coalition Forces and the Fog of War

First Base
Coalition Forces and the Fog of War

Kevin Davies, Ph.D.Editor-in-Chief THE TELEVISION IMAGES are grim and disturbing: mounting casualties, a spreading conflict, and civilians donning protective masks. While allied forces talk of the "worldwide threat" amidst fears of a global economic meltdown, coalition leaders direct ground forces from a technology-rich war room in a desperate manhunt to neutralize the enemy before it wreaks even more havoc.

The war in Iraq? No, it's the outbreak of a highly infectious disease that has been dubbed SARS, or severe acute respiratory syndrome. The disease arose six months ago in Foshan, a city in the southern Chinese province of Guangdong, only for Chinese authorities to scandalously hide the news for three months. Since then, SARS has spread from Vietnam to Vancouver, Singapore to San Diego, leaving almost 200 people dead (as of mid-April) and thousands more infected. Among the victims was Carlo Urbani, the World Health Organization (WHO) physician who first identified the disease in Hanoi on February 28.

The alarming spread of SARS, which is atypical even by "atypical pneumonia" standards, has hurt business, too. The American Association for Cancer Research abruptly cancelled its annual convention in Toronto last month, stranding thousands of scientists. And the spring event calendar in Asia has been decimated, including planned shows by Intel and the Rolling Stones.

No sooner had the SARS threat been identified than forces from the bio-IT coalition came together to repel the enemy. Two decades ago, the search for the virus that causes AIDS degenerated into a bitter international déjà vu dispute between the French and Americans. In contrast, the hunt for the SARS agent has engendered a degree of international dŽtente and technological cooperation that Centers for Disease Control and Prevention (CDC) Director Julie Gerberding hailed as "absolutely unprecedented."

From a new $7-million command center, the CDC has coordinated research among a dozen laboratories around the world, speeding communication to health workers, epidemiologists, and scientists through a secure Internet and daily videoconferences, as well as disseminating breaking news to the general public.

Halo Effect: The newly notorious SARA virus.
The CDC turned to the latest technology to help unmask the mystery virus by asking Joseph DeRisi, a University of California at San Francisco microarray expert and protégé of Stanford University's Patrick Brown, to screen patient samples using his diagnostic "virochips." These are powerful DNA microarrays containing 12,000 viral gene sequences that can identify almost any viral samples (a prototype was published last year; see Wang, D. et al. PNAS 99, 15687-15692; 2002). Within 24 hours, DeRisi's team matched SARS patient samples to coronavirus gene sequences. Michael Bishop, UCSF chancellor and Nobel laureate, hailed the findings as "bench-to-bedside research at its very best."

Subsequently, two teams — from Canada and the CDC — have sequenced the viral genome in record time, allowing researchers to probe the 29,000-plus bases for clues to combat the disease (see our news story, page 18).

Constant Surveillance
The coronavirus was first discovered in 1937 and commonly infects animals, but it is usually associated with only minor respiratory or intestinal disorders in humans. The SARS virus appears to be a new form of coronavirus, one that has been shown to produce SARS-like symptoms in infected monkeys. But despite the rapid progress in identifying the putative pathogen, an effective vaccine could still be anywhere from one to three years away.

The SARS outbreak raises extreme concerns about national surveillance of sudden disease outbreaks. In New York City, the Syndromic Surveillance System, a software program administered by the Department of Health and Mental Hygiene, recently flagged a suspicious spike of respiratory diseases based on its analysis of hospital visits, 911 calls, and prescription purchases, identifying patterns that could escape human detection. This particular outbreak proved to be a false alarm, resulting from a variety of unrelated conditions (not SARS), but such a system belongs in the nation's healthcare arsenal.

That the SARS epidemic has been relegated to a crawling footnote on television is understandable, given the world's preoccupation with a war that ironically was justified, in part, by the threat of biological weapons. On the other hand, the SARS epidemic must be kept in perspective: Influenza, for example, claims 20,000 to 40,000 American lives each year, even with an effective vaccine available.

But the SARS episode is a stark reminder of the urgent need for vigilance and medical preparedness. "The rapid dissemination of [SARS] around the world should be considered a rehearsal for the next pandemic of influenza," warned two expert virologists in a British Medical Journal editorial.

The WHO Commission on Macroeconomics and Health wants to set up a $1.5-billion fund for global health research, specifically on "research and development into diseases ... that are concentrated in poor countries." But even if such an investment were likely in the current economic clime, it would be pocket change compared to the exorbitant cost of extinguishing one presumed source of biological warfare. What if those resources could be applied to combat nature's very own nefarious weapons of mass destruction: AIDS, tuberculosis, malaria, and emerging threats such as SARS?

Now that would truly justify the term "shock and awe."

Kevin Davies, Ph.D.
Bio·IT World

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