In Hanoi we forget that it is spring!

Interview of Pascale Brudon, Director of the Hanoi WHO Office

How did the epidemic of severe acute respiratory syndrome (SARS) all started ? On 28 February we received a phone call from the French hospital of Hanoi. They informed us that they had a patient who had symptoms they didn’t recognize but which could look like the chicken sickness that had appeared two years ago in Hong Kong. My colleague Dr. Carlo Urbani, who was an epidemiologist, went immediately to the hospital in order to look at the patient. He went there everyday for about one week. Each evening we discussed the evolution of the sickness, which seemed to be gaining ground. Not only was the patient getting worse, but several of the employees of the hospital had the same symptoms. Less than one week after we had been called by the French hospital, we decided to act, based on the samples, which had been analyzed and the situation which was deteriorating.

How can a small office like the Hanoi one launch a worldwide alert ? We didn’t launch this alert. It was WHO Geneva who did it on the basis of our recommendations.

What happened then ? We had to convince the Vietnamese government to accept an international team of experts. On Sunday 9 March, namely ten days after the phone call from the French hospital, we had a discussion with the Deputy Health Minister of Vietnam in charge of transmissible diseases, whom we succeeded to convince that the situation necessitated international aid.

How did you convince him ? First, because he trusted the WHO office. We have been working together for several years and he knew perfectly that we were not taking this decision lightly. Furthermore he knew that Carlo was a very good professional and that he was an expert in transmissible diseases.

What was happening in the meantime to the first patient ? His family had asked that he be repatriated in Hong Kong where he died on 12 March.

And Dr. Urbani ? He had to go to a meeting in Bangkok. Just before catching his flight he called me and told me that he felt tired and that he might have some fever. I tried to reassure him and as a matter of caution, I called my colleague in Bangkok, who called the Thaï authorities. When Carlo arrived in Bangkok, an ambulance was waiting for him. He was isolated in a hospital in Bangkok. Despite everything that has been done, be it by the Thai doctors or by WHO that had a reanimation specialist fly in, he died on 29 March. It is certain if we had had a better knowledge of what was happening in the south of China at that time, Carlo would today still be alive. Thanks to his action at the French hospital of Hanoi, WHO succeeded to take measures which prevented the epidemic to spread throughout the world at a faster pace. Carlo has surely saved many of lives.

How did you react to the death of your colleague ? It has been very very hard. We worked together for many years. He was a wonderful person and an very good professional. Until the last minute I was sure that he would survive. For the whole team it had a devastating effect.

What happened to the other sick people ? Out of the 62 cases, which we have had in Vietnam by 13 April, 5 died and more than 40 went back home. The situation of the other patients seems to evolve positively. For the time being the epidemic seems to be under control. But we are not safe from another outburst because China is not very far … we have to continue to be cautious.

How does it feel to be at the center of such an epidemic? Each individual reacts in his/her own way. Many are scared; many are anxious, nobody is “insensible”. It was even more a shock as nobody was prepared for it.

And you ? For me it is hard to say. First, since the beginning of the crisis I have worked really a lot, which means that I have no time to be afraid; and, if one is careful the danger is limited … Furthermore I feel that many people count on me; therefore, I cannot permit myself to be in this mood. In addition this crisis situation implies that one is totally out of phase with the rest of the world. I am constantly waiting for news coming from the hospitals. How many new cases? How is the health of the patients? Is it getting worse or better? What will happen tomorrow? What has been found about the virus? Etc ... I live in a world where one forgets that spring is here and flowers are blooming. A world relatively cut from the rest of the world except for what is happening on the epidemic front. I just spent a few days in Europe to go to the funeral of Carlo, but I feel totally out of phase here. My only wish is to go back to Vietnam among my colleagues who fight for the epidemic to be contained as quickly as possible. Furthermore, here in Europe people seem to be scared just to come near me as if I were plague - stricken, it is a very strange feeling.

And the role of WHO all this ? I must say that I have been extremely impressed by its capacity to react. Those who speak about the slowness of UN or WHO bureaucracy should think it over. In less than 10 days after the phone call from the French hospital here in Hanoi alerting the index case, a team of 14 international experts arrived in the city with all the necessary equipment to assess the situation and the alert was given at the international level. I think it is the first time in history that an organization succeeded in alerting the world as a whole about the dangers of an epidemic; putting into place all the coordination mechanisms to try and avoid it spreading; identifying the virus; and studying treatments. It is a sad “Grande première!”

Interview by Jean Michel Jakobowicz.