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Coronavirus Biology and Pathogenesis
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SARS in the Context of Emerging Infectious Threats SARS in the Context of Emerging Infectious Threats
Future Perspectives on Emerging Infections
SARS and Public Health Systems

Marcelle Layton, NY City Department of Health
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Preparedness in New York
• Thirty thousand international travelers arrive at a New York airport every day; we must be aware of diseases that may not receive much attention in medical school.
• New York City has accelerated emergency-preparedness since the West Nile virus outbreak and now takes an all-hazards approach.
• Plans are being practiced for mass prevention and emergency communications.

Surveillance Systems
• Traditional surveillance depends on medical and lab communities to recognize something unusual and reporting it; the medical examiner's office reports any unexplained potentially-infectious deaths.
• Syndromic surveillance detects an increase in prodromal symptoms to try to detect outbreaks earlier, recognizing that people may go to a pharmacy or hotline before a doctor or hospital.
• A number of surveillance systems more reliably screens out artifacts; when many systems respond there is more cause for concern.

• A broadcast alert system is used to communicate with hospitals, keeping clinicians updated on what, when, and how to report and good triage protocols.
• Communicating uncertainties and handling the demand for information is important.

Contingency Planning
• There is partnership with other agencies to coordinate responses; legal, security, and logistical issues are being addressed to plan for an isolation and quarantine situation.
• Search capacity has been increased to mobilize response via hotlines, databases, lab tests and analysis, and teams to review charts and interview patients.
• Hospitals are being made to think through dealing with a surge of contagious patients, communication procedures, and training staff.
• Proposed changes to the NYC Health Code will strengthen the ability to do detention, isolation and quarantine.
• SARS teams are in place, doing active case and contact management; all staff are fit-tested to be able to do home visits.

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