Keeping a lid on SARS

日本のSARS対策

A number of precautionary measures are in the works. On May 1, halfway through the Golden Week holiday season, the health ministry said it would request that returnees from China and Hong Kong stay at home for about 10 days. It decided to recommend hospitalization for those sus pected of having contracted the disease.

The ministry plans to take stronger action in tandem with local administrations. Cooperation between central and local authorities is necessary to find and treat patients early on to prevent the spread of an infectious disease. Teamwork is required to keep the public properly informed and pro tect patients' human rights.

The SARS virus is said to have an incubation period of about 10 days at most. So any returning vacationers infected with it will probably develop flulike symptoms in the first half of May. It is reassuring that national and local health officials will be working closely together in this period.

Nevertheless, the government cannot avoid criticism that it has been slow to act. The meeting came nearly two months after the World Health Organization had issued a SARS warning. Some officials, after complaining that information from Tokyo offices was not always new, have requested that vital updates be provided by e-mail.

Beyond that, the health ministry and local administrations face a couple of delicate questions: How much information about a SARS patient should be released and how the patient's human rights should be protected.

The ministry calls for a two-step approach. In the case of a suspected case, disclosure would be limited to the following basic data: residence (prefecture), sex, age, region visited and clinical condition. As for a confirmed case, additional information, such as flight numbers, would be published. The patient's name would be withheld, although some officials worry that an identity might become known anyway in a town or city with a relatively small population.

Disclosure of accurate information is essential to control an infectious disease. The sharp rise in SARS cases and deaths in China is attributed largely to inadequate responses during the initial stage of the crisis. However, disclosure must be limited so that it does not violate the privacy of patients and their families.

It is vital to "respect patients' human rights while providing them with appropriate care," notes the Infectious Disease Law. The 1999 legislation was enacted in light of the history of social discrimination and prejudice suffered by patients of Hansen's disease and AIDS. In this sense, provisions of the law are an indictment of the quarantine policies of the past. SARS patients should not be isolated as they have been in some countries.

Preventing the spread of the SARS virus requires an orchestrated effort to pre vent secondary infections at hospitals and clinics. Vietnam offers a successful example. The first case was reported there in February, about the same time as in Hong Kong, but by the end of April the WHO declared Vietnam the first affected country to contain the disease.

The Infectious Disease Law, revised in 1999 for the first time in a century, aims at meeting new challenges posed by infectious diseases in the age of globalization. The SARS outbreak, however, has brought into focus a number of potential problems.

At least three problems need to be addressed: (1) the limited number of medical institutions that can deal with contagious diseases like SARS, (2) the lack of a working system of cooperation between general and specialized institutions, and (3) the absence of a well-developed information network. To tackle these problems, closer cooperation is needed between the central and local governments.

The Japan Times Weekly
May 17, 2003
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      厚労省は先に、中国、香港からの帰国者に対し10日間は外出しないよう求め、感染の疑いがある人には入院を勧告することを決めた。

      SARSには10日間程度の潜伏期間があるといわれる。したがって最近の帰国者が感染していれば5月の前半に発病する可能性がある。

      政府のSARS対策は遅すぎた。国と地方自治体の対策会議が開かれたのは、世界保健機関(WHO)がSARSについて警告を出してから2ヵ月も過ぎてからだった。

      SARS対策には、患者に関する個人情報の取り扱いと人権保護という重大な問題がある。厚労省によれば、感染の疑いのある人については、居住地（県名）、性別、年齢、旅行先、症状のみを発表し、感染が確認された患者については、利用航空便などの追加情報を発表するという。

      正確な情報の発表は感染防止に重要だが、患者と家族の人権を保護するため公表する情報の内容は制限しなければならない。エイズ、ハンセン氏病患者に対する偏見、差別の歴史をふまえ99年に施行された改正感染症法が人権保護の根拠になる。

      SARS対策には、病院、診療所などでの二次感染防止が肝要である。そこで参考になるのはベトナムの成功例だ。ベトナムでは香港と同じころ、2月に第1号患者が発生したが、WHOは4月末にベトナムのSARS制圧を宣言した。

      国内では、SARSのような強力な感染症に対応できる医療機関の不足、一般・特殊医療機関の協力体制と情報伝達体制の不備が指摘されている。これらの問題に対処するため、国と地方自治体の協力が欠かせない。