# Presentation: 423437

## SARS Community Outreach

**Arthur P. Liang, MD, MPH**
**National Center for Infectious Diseases**
**Centers for Disease Control & Prevention**

## Every medication has 2 effects. . .

-  The one you want

- The one you don’t want

## Quarantine/Isolation

**Limit transmission**

**Individual liberties**
**Economic loss**
**Social isolation**
**Social Stigma...**

## Quarantine/Isolation

**...****unintended consequences?**

**Limiting transmission**

**Maintaining transmission**
**e.g., HIV, leprosy**

## Quotations from Callers

- "Has CDC recommended staying away from Chinese markets/restaurants/etc.? That might help.“
- “Is it safe to go to Niagara Falls because I know alot of Canadians go there?”

## Data: Is there a problem?  How big?

**Seven discussion groups with:**
** **
- over 60 Key API Opinion Leaders
- National, State Local Community Based Organizations
- Governmental Agencies
- Chambers of Commerce
- Trade Associations
- Airline and Health care workers
**CDC Hotline**
**HSPH Survey**

## CDC Hotine Calls by Categories, April 29- May 14N = 2111 calls

| # of calls | Category of concern |
| --- | --- |
| 2111 | ALL |
| 133 | Asian business & products (e.g.,grocery, restaurants, etc.)     |
| 101 | Living near, work, school with Asians |
| 58  | Public Places (e.g., church, school, work, shopping/movie theaters, theme parks |
| 53 | Being on cruise ship/airplane |
| 28 | Quarantine/close borders against Asia |
| 12 | Quarantine/close borders against Canada |
| 12 | Quarantine all suspects |
| 7 | Fear of getting SARS from healthcare worker |
| 6  | Fear/quarantine airline workers |
| 27  | Other Fears/Stigma |

**78% think being on airplane with SARS case is risk.**
**73% think eating food that has been prepared by someone who was infected with or had been exposed to SARS**
**45% think SARS is very easily spread**
**32%  (16% are very concerned) may get SARS during the next 12 months.**
** **

**Harvard School of Public Health Telephone Survey**
**Preliminary Results **
**April 11 – April 15, 2003**

## Results:

**Fear in general population mild to moderate **
**Fear within API Community, HCW, Travel industry**
**Risk?  Transmission?  Prevention practice?**
**Look to public health to provide leadership and coordination**

## Health problem: SARS	

Control Tendency to Stigmatize	

Support the Stigmatized	

- Control Tendency to Stigmatize
- Support the Stigmatized

- Public health strategies to control disease
- Early recognition, treatment, and prevention
- Health education and prevention messages
- Communication to enhance compassion/reduce blame
- Dispel myths and correct perceptions of risk
- Partnerships with affected populations
- Peer Support Groups
- Community Support

**Adapted from Weiss & Ramakrishna, “Stigma & Global Health,” 2001*

- What to do?

## Control Tendency to Stigmatize

- The Virus
- A new, severe respiratory illness has been reported worldwide. Etiology: Coronavirus, SARS-CoV

- The Behavior
- “Travel from a SARS affected area & having an exposure to a person infected with SARS”

## Recommendations and Guidelines for People Who May be Affected by the SARS Outbreak.

**R**ecommendations and Guidelines for People Who May be Affected by the SARS Outbreak.

- For individuals considering travel to areas with SARS
- For individuals who must travel to an area with SARS
- For individuals who think they might have SARS
- For family members caring for someone with SARS:
- For health-care workers
- For institutions or organizations hosting persons arriving in the US from areas with SARS
- For schools

- Control Tendency to Stigmatize

## Develop simple and specific SARS prevention messages
		*We have developed simple messages, definitions, FAQs, 	fact sheets, MATT articles, sample letters

Develop  translated SARS information materials in various Asian languages 
	 	*In-language FAQs, fact sheets, guidelines, on-line 	materials, translation of reports and support to other teams

- 		*We have developed simple messages, definitions, FAQs, 	fact sheets, MATT articles, sample letters
- Develop  translated SARS information materials in various Asian languages
- 	 	*In-language FAQs, fact sheets, guidelines, on-line 	materials, translation of reports and support to other teams

- Control Tendency to Stigmatize within API Community

## Support the stigmatized groups

- Disseminate SARS information to API community through multiple and culturally appropriate channels of communication
- 		*Community visits, stakeholders, listserv, panels, town 	hall meetings, Chinese TV program,  articles
- Partner with local API CBOs to educate the community
- 		*Discussion groups, community visits, information sharing
- SARS infection control and occupational teams conferenced with Clinicians and Airline workers

## Balancing acts. . .

- Must be honest that understanding of the epidemic, it’s nature, and cause still evolving
- “The lady doth protest too much, methinks”
-  Shakespeare’s Hamlet

## Conclusion

**Targeting versus stigmatizing**
**Care in all communications**
**Minority with fear out of proportion to current threat.**
**Leading to episodes of over reaction.**
**Public health officials, clinicians & the community must combat fear, stigma and discrimination through health education and communication.**