Halt of SARS in Vietnam Could Hold Lessons for Other Nations

HANOI, Vietnam, May 5 – Doctors and nurses clustered around the bed of Nguyen Thi Men when she emerged in mid-March from a nine-day coma, urging her to stay alive.

HANOI, Vietnam, May 5 – Doctors and nurses clustered around the bed of Nguyen Thi Men when she emerged in mid-March from a nine-day coma, urging her to stay alive.”Breathe, breathe,” they said. “Keep trying. Your husband and your children are waiting for you.”She heard them and she tried, although she felt as if she were drowning, she said in an interview this weekend at her home.”I saw a lot of doctors looking at me and it really raised my spirits,” she said. “So many people looking after me. I was very touched.”What she did not yet know was that they had gathered to view a miracle. She was the only survivor from among the six most critically ill patients infected when SARS broke out in the Hanoi French Hospital more than two months ago.Her survival became a hopeful symbol for Vietnam, which on April 28 was declared by the World Health Organization to be the first nation to contain and eliminate the disease. Vietnam earned that distinction by going 20 straight days without a new case after recording 63 infections, including the six critical cases. Five people had died.”Vietnam has been able to show the world that there is hope that SARS can be contained,” said Pascale Brudon, the World Health Organization representative for Vietnam.The country’s success was not a miracle, said Aileen Plant, who led the fight against SARS in Vietnam for the World Health Organization. “This was real, old-fashioned infectious disease containment,” she said. “It all comes back to the same thing, which is stopping infected people from infecting other people.”After a crucial meeting on March 9 with members of the World Health Organization, the government decided to fight the outbreak openly and aggressively, Ms. Plant said. A task force was formed, information gathering was centralized and virtually the whole government was mobilized to deal with the infection and its consequences.”It was the speed, the leadership, the transparency, the flexibility, the intensity with which they educated people what to do,” she said. “It all sounds a lot easier than it is.”Vietnam’s luck was that the disease had entered the country through just one infected person, an American who brought it from abroad. The Vietnamese capitalized on this luck by moving fast to confine the outbreak to the hospital.That patient, Johnny Chen, a 50-year-old businessman, came to Hanoi in late February after a stay at the Metropole Hotel in Hong Kong, where many of the early cases were contracted.He fell ill and was taken to the privately run Hanoi French Hospital. He was later evacuated to Hong Kong, where he died. His illness was first identified as a new and unknown disease by a World Health Organization doctor, Carlo Urbani, 46, who later died of SARS himself.At the urging of Dr. Urbani and his colleagues, Vietnam closed the hospital to new patients and visitors on March 11. Most of the hospital’s staff remained inside, some falling ill, others watching their colleagues sicken and die.”The net effect probably was that they gave SARS to each other and not to the outside world,” Ms. Plant said.Ms. Men, 46, is a pediatric nurse at the hospital, but she often helped out in other wards. It is impossible to know exactly how she was infected, but on the evening of March 1, she said, she spent some time in the room of Mr. Chen, who was critically ill.In the following days she began to suffer headaches, fever, diarrhea and exhaustion. “It was strange,” she said. “A strange, overpowering tiredness.”When she checked herself into the hospital, two other nurses had already fallen ill, but, she said, “it never entered our heads that we could die.”They were friends in nearby beds and they joked, they gossiped, they sang and they left their rooms to wash their hair. But they grew sicker. One nurse, Nguyen Thi Luong, who would be the first to die, was put on a respirator in the next room. Ms. Men could hear it, “Beep-beep, beep-beep.”As the hospital’s doctors and nurses were falling ill, the government was coming to grips with the crisis.(Source: New York Times: By SETH MYDANS, 7 May 2003)