SARS Storm Spurs Surprising Strategies
Last winter’s outbreak of SARS—severe acute respiratory syndrome—triggered an unprecedented emergency medical response worldwide. Researchers put aside scientific rivalries and within weeks not only discovered the coronavirus that was responsible but also mapped the virus’s genomic sequence. After the outbreak had been contained, writer Barry Yeoman asked top medical scientists to reflect on the long-term lessons of the crisis.
Malik Peiris, microbiologist, University of Hong Kong, member of the team that identified the SARS coronavirus: In the 1960s, many believed that infectious disease had been conquered, but that has been proven wrong yet again. Today the scale of the threat is more global. Jet travel has increased exponentially, so somebody can pick up the infection here in Hong Kong and be in Singapore or Toronto in a few hours’ time. You hear about the globalization of economy; this is the globalization of disease.
Jessie Gruman, social psychologist and president, Center for the Advancement of Health, Washington, D.C.: There was real reluctance on the part of the pharmaceutical industry to do research until they were sure that it would be worthwhile financially. The government brought together all the big companies and said, “Please, please, work on this,” and they walked away. Eventually, some took a chance and did the development work. That’s not to say the market is a bad thing. It’s just that this is the kind of place where the market falls short, and then people die in the meantime.
Sanjay Kapil, coronavirus expert, Kansas State University College of Veterinary Medicine, Manhattan, Kansas: We have learned that it is not a good idea to come into contact with wildlife. SARS came from eating exotic meat, specifically the civet cat. Monkeypox was imported with Gambian giant rats and dormice. Viruses do not appear out of the blue: They have been evolving for millions of years in strange niches. When you are exposed under circumstances that work for a specific virus, the species jump happens.
Mark Rothstein, bioethicist, University of Louisville School of Medicine, Louisville, Kentucky: We’ve found out that our public-health system is not equipped to handle an emergency of the magnitude of SARS. We don’t have the facilities, the people, the know-how, to implement any large-scale form of quarantine. What would have happened if we had had to isolate 10,000 people at home? We’ve got to have a way to get food to them and to make sure they’re obeying the quarantine orders. We’ve got to have a way to replace their income, so people who live from paycheck to paycheck don’t try to sneak out the back way to go to work. There are a whole range of issues that we need to consider.
W. H. Seto, chairman of infection control, Queen Mary Hospital, Hong Kong: The SARS outbreak has reaffirmed my faith that basic infection-control measures work. Nearly 400 health-care workers were infected in Hong Kong, but my hospital, one of the two big teaching hospitals in the city, had only two infections—by far the lowest number of any staff. We just practiced the basics: wear masks, isolate patients, and wash your hands.
Barry Bloom, dean of faculty, School of Public Health, Harvard University, Cambridge, Massachusetts: If the principal role of public health is preventing disease, it is not the smartest thing in the world to cut the infectious-diseases budget of the Centers for Disease Control, as Congress did this year. Despite all that we have learned about SARS, AIDS, and Ebola, the CDC, our major public-health institution, is getting kicked in the head, which puts us all at risk. How did the CDC get 300 or 400 people manning the phones, running to China, going to Vietnam and Taiwan during the SARS outbreak? They pulled everybody they could get their hands on off every other disease. They did a heroic job—but we became enormously vulnerable to other infectious diseases, or terrorism, or anything else.
Robert Garry, virologist engaged in envelope-protein research that may lead to a SARS vaccine, Tulane University School of Medicine, New Orleans: We’ve learned that it’s good to support basic scientific research. Coronaviruses had never been associated with lethal diseases in humans before. Nevertheless, work on those viruses had been supported by the National Institutes of Health and other places, so we knew quite a bit about this family of viruses before the outbreak, which meant we were in a better position to make vaccines that could prevent another outbreak. If the basic research hadn’t been done, SARS would have been a much more serious threat.
Michael Lai, molecular microbiologist, Keck School of Medicine of the University of Southern California in Los Angeles: Viruses are smarter than virologists.
Motherless Eggs Created in Lab
Stem cell researchers performed a laboratory feat this year that was once deemed unthinkable: the artificial creation of egg cells. “An egg is the most sophisticated cell in an organism, carrying the genes from one generation to the next,” says Jose Cibelli, a biotechnologist at Michigan State University. The work was done with mice. But if the same can be done with human cells, the implications are extraordinary. Scientists would have an infinite supply of eggs for cloning vital tissues or organs and conducting fertility research—without needing human donors.
A team of developmental biologists led by Hans Schöler and Karen Hübner at the University of Pennsylvania placed densely packed clusters of stem cells from mouse embryos in a petri dish, using fetal calf serum as a growth medium and adding a gene protein that turns green when germ cells form. After four days, green flecks started appearing, “like a GPS system telling them where the eggs were,” says Cibelli, who observed the experiment. Just days later, the germ cells matured into egg follicles. Schöler and his team then found further proofs that the eggs were functional: the presence of estradiol, a chemical produced only in the follicles; meiotic chromosome division; and, by adding the hormone gonadotropin, simulated ovulation.
Schöler is confident it will eventually be possible to create test-tube human eggs. How viable the eggs may be remains to be seen, but the ultimate hope is that they be could be used to produce an infinite, affordable supply of embryonic stem cells. Those primordial cells, in turn, could conceivably be used to treat Parkinson’s and other cell-based diseases, as well as to clone vital tissues and transplantable organs. “In the past, we had to rely on women to donate eggs for this research,” says Schöler. “And that’s when you run into ethical issues such as the commercialization of human beings.”
Other scientists think creating test-tube eggs opens a new Pandora’s box of ethical concerns. “Genetically, this type of clone is still a member of our species,” says David Prentice, a cellular biologist at Indiana State University and cofounder of Do No Harm, a group of scientists favoring alternatives to embryonic stem cell research. “We need to have an open discussion in society on what we will and will not experiment on.” In theory, test-tube human eggs could help infertile couples who cannot produce their own eggs. If it works, women—or men—could have their genetic material inserted in an empty egg, cloned, and then fertilized with a partner’s sperm. Or, with the help of a surrogate mother, two men could conceive a baby.
“It’s all very speculative at this point,” says Cibelli. “One of the main problems is that we don’t know if the correct number of chromosomes would be produced. But who knows? Who expected scientists to produce eggs in a laboratory? It’s remarkable.”