Death by silence: How lack of communication is aiding pathogen spread

By Em Maier

CHICAGO — Carlo Urbani died in a Thai hospital in 2003 from a disease without a name — a disease soon to be dubbed SARS (severe acute respiratory syndrome).

If the world had been ready for a public health emergency, Urbani might still be alive, said Scott Dowell, a friend of Urbani’s and the director of the Centers for Disease Control and Prevention's Global Disease Detection and Emergency Response program. Dowell spoke during a February 14 symposium on global health at the American Association for the Advancement of Science meeting in Chicago.

“The infection of Carlo and his death was really a large-step moment in public health and in global health security, and really shook up not just those of us who took care of him, but the world. [It helped us] in recognizing the risks of globalized travel and rapid spread of pathogens,” Dowell said. Urbani, a physician with the World Health Organization, was the first to recognize the signs of an outbreak in Hanoi, and quickly quarantined the area. Returning home, he fell ill, dying 18 days later in a makeshift isolation room.

Lack of field investigations from Vietnam, misguided research in China, and a scarcity of communication all contributed to the pandemic that would claim 774 lives in less than a year, Dowell said.

Dowell said that while 194 United Nations member-states agreed to the International Health Regulations in 2005, only 16 per cent have self-reported that they meet the core capacities. The IHR requires nations to report outbreaks as part of an international system that responds to public health risks.

Dowell’s team works to train public health leaders and create laboratories capable of responding to outbreaks quickly and effectively.

The program has made remarkable progress, as seen in responses to Ebola outbreaks in Uganda: In 2007, it could take two and a half months from the first known case before a preliminary investigation was initiated; now, it takes two days.

Concern over global health is not relegated strictly to the scientific spheres. Jennifer Yang, of the Toronto Star, said it’s a challenge even to report stories.

“One of the major lessons since I became a global health reporter is how little the general public understands about global health, and how minimally people are engaged,” Yang said.

Yang talked about a Toronto family devastated by SARS: The mother had acquired it in a hospital, transmitting it to her daughter before her death. Yet, the daughter — even after being forced into an early retirement due to complications — was still ignorant of the pathology.

“She had no idea where SARS had come from … she had never heard of this idea that the thing that completely ruined her life had come from a bat.”

Journalism may be adapting to view health as a social justice issue as well as a scientific one. Compared to 2010, there has been a 36 per cent increase of global health coverage in the Toronto Star.

“Our newspaper really woke up to the concept of global health security after SARS,” Yang said. Experts like Dowell are glad more attention has been paid to diseases like SARS, which were ignored for many years.

“And in large part, Carlo and many others paid for those failures with their illnesses and their lives,” Dowell said.

Em Maier is a senior at the University of Pittsburgh majoring in neuroscience and psychology, with minors in chemistry and children’s literature. Her work has appeared in Inc., Pitt Med, and The Pitt News. Maier is currently researching schizophrenia and color evolution in spiders (separately). You can reach her on Twitter at @MaierEm or at

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