WASHINGTON – The United States is woefully unprepared for an outbreak of the SARS respiratory disease, according to a new report, but Maryland county health officials say they have enough trained staff to ward off disaster.
The 160-page report, commissioned by the Centers for Disease Control and Prevention, warns that a U.S. shortage of epidemiologists and public health nurses “will reach a crisis stage” if there is an epidemic of Severe Acute Respiratory Syndrome.
Budget cuts to state and local health departments could also mean “an otherwise containable epidemic may spread rapidly,” the report said.
But local health officials said they are confident they have all the epidemiologists they need — even if there is not one in every county in Maryland — and that nurses are better trained to handle disease outbreaks than they were before the Sept. 11 terrorist attacks.
“We’re getting there,” said Mary Novotny, spokeswoman for the St. Mary’s County Health Department. “Compared to 9/11, we’re 100 percent better.”
Worcester County, for example, does not have an epidemiologist but trains much of the staff in epidemiology, said County Health Officer Debbie Goeller. While Anne Arundel County has only 12 nurses in its communicable disease program, it trains all 193 health department nurses on how to respond to an outbreak, said Evelyn Stein, a spokeswoman for the department.
SARS first appeared earlier this year at a conference in Hong Kong. It eventually infected 8,000 people in 25 countries, killing 780. The closest the disease got to the United States was an outbreak in Toronto.
The virus has been dormant for several months, but health officials warn that a projected severe flu season raises the possibility of an outbreak in the United States.
The CDC report said the epidemic highlighted a serious nationwide shortage of epidemiologists and other health professionals.
David Blodgett, a physician-consultant with the Anne Arundel County Health Department, agreed that it was a major feat to find an epidemiologist for his county, which just hired one to fill a slot that had been vacant.
St. Mary’s County does not have an epidemiologist, but “in this day and age,” the county will probably have one eventually, Novotny said. The department had epidemiologists in the past, but did not have a lot of work for them to do, she added.
Short of an epidemic, it might be hard to justify an epidemiologist in every community, said Rod MacRae, a Washington County Health Department spokesman. His county, with more than 130,000 people, does communicable disease surveillance but does not have an epidemiologist. In a county with fewer than 30,000 people, he said, the cost of an epidemiologist would make even less sense.
The report also said poor communication among health officials could hamper response to a SARS outbreak. But MacRae noted that Maryland’s small size allows him to know personally his counterparts in other counties, and that they have gotten into the habit of working with one another.
Many communities have prepared for SARS the way they have prepared for bioterrorism and other communicable diseases, MacRae said.
“It’s like planning a vacation,” he said. “Something will come up that hasn’t been anticipated.”
If a SARS outbreak requires quarantining patients in their homes, for example, someone would have to make sure those patients had enough food to last.
“You tell them to go home, but you need a mechanism to let them stay home,” MacRae said. “You don’t think of that as role of government, but who else?”
Novotny said St. Mary’s Hospital in Leonardtown is prepared for a SARS quarantine, should it ever be needed, and the county has taught emergency medical teams the symptoms of the disease and will encourage them to wear masks if there is an outbreak.
But for now, St. Mary’s County probably will not take any special measures with SARS until there is a report of an actual case nearby, Novotny said. The department does not want the public to overreact.
“It’s very difficult to judge the true threat,” MacRae said. “There’s so much to think about. Why think about something that hasn’t happened yet?”