World Health Organization official who raised the alarm over severe acute respiratory syndrome
Infectious diseases expert Dr Carlo Urbani died from sudden acute respiratory syndrome just weeks after he had helped to identify it and alert the world to its dangers.
Urbani, who was a World Health Organization public health specialist in charge of malaria and other parasitic diseases, based in Hanoi, Vietnam, first came across the syndrome in a Chinese-American businessman. The businessman, who had arrived in Hanoi on 23 February, was admitted to the French hospital in the Vietnamese capital on 26 February with a suspected case of bird flu. But when his condition worsened, the hospital called WHO on 28 February and Urbani went over to examine him. Two days later, not only had the businessman's condition worsened, but several members of the hospital staff had developed similar symptoms: a dry cough, difficulty breathing, and a fever.
On 3 and 4 March, Urbani told the hospital to isolate all patients and staff with these symptoms to prevent spread of the disease. The hospital was closed to the public, with guards posted outside, while staff inside started to wear masks and other protective clothing.
“When people became concerned in the hospital, he was there every day, collecting samples, talking to the staff, and strengthening infection control procedures,” said Pascale Brudon, who heads the WHO regional office in Hanoi. “On Wednesday 5 March he said it was something very strange. We knew about influenza, but this was something different,” said Brudon.
The disease had been circulating in China's Guangdong province since November 2002 and reached Hong Kong, where the businessman was believed to have been infected by a Guangdong doctor with whom he shared a hotel floor. But at the end of February it was still not clear that this was a new disease, nor had the extent of the outbreak come to light. Despite fewer cases and deaths, the Hanoi outbreak was the first signal to the outside world that something was wrong. It took less than a week for Urbani to realise that there was something strange and to implement infection controls.
In consultation with Brudon, Urbani alerted WHO headquarters in Geneva. The pair quickly won the support of the Vietnamese authorities to bring in outside help and on 7 March asked WHO for international experts. An internal global alert circulated around WHO that day asking for experts to come to Hanoi to help tackle the outbreak. The WHO regional adviser for communicable disease arrived from Manila, the Philippines, on 9 March.
GUIDO PICCHIO/AP PHOTO
Over the next few days, some of the world's leading epidemiologists arrived in Hanoi to help contain and study the outbreak, including a team from the Centers for Disease Control in Atlanta. On 15 March, although cases and deaths were still few in number, WHO publicly declared the syndrome a “worldwide health threat.” Never had WHO reacted with such speed to an outbreak; in part this was thanks to Urbani and his colleagues in Hanoi.
As international experts poured into Hanoi, Urbani was due to fly to attend a meeting in Bangkok. He had been working flat out, visiting the French hospital nearly every day. Brudon told him he was “too exhausted” to carry on working and that he should go to the meeting.
It was on the flight to Bangkok on 11 March that Urbani first felt unwell. He had been in daily contact with people with the syndrome for nearly two weeks. As soon as he arrived in the Thai capital, he went straight to a hospital.
A few days before Urbani became ill, his wife, Giuliana, questioned whether he should be working so closely with patients with such a serious disease. Urbani, who had been posted to Hanoi in 2000, replied: “If I cannot even work in such situations, what am I here for? Answering emails, going to cocktails, and pushing paper?”
Urbani showed an early interest in working with poor and underprivileged people as a student, when he went to Africa. In the early 1990s, while he held a post in infectious diseases and parasitology at Macerata Hospital in the Italian city of Ancona, he organised a mission to Mauritania to collect baseline data on intestinal schistosomiasis to help the health ministry there control parasitic disease.
Dr Lorenzo Savioli, WHO's co-ordinator of parasitic diseases and vector control based in Geneva, invited Urbani on a WHO mission in 1993 to research the epidemiology of hookworms in the Maldives. After proving his “skill and dedication,” Urbani was sent on a series of WHO missions to control helminths (parasitic worms) and became the first person to report the transmission of Schistosoma mansoni in Mauretania.
In 1995, he joined the Swiss branch of Médecins sans Frontières working in Cambodia, where his pioneering work in the control of Schistosoma mekongi and foodborne trematode parasites helped bring him “on board” at WHO.
Urbani later became president of the Italian branch of Médecins sans Frontières and was one of a team of doctors who received the 1999 Nobel peace prize in Norway on behalf of the international organisation.
Carlo Urbani, public health specialist World Health Organization (b near Ancona, Italy, 1956; q Ancona 1981), died from sudden acute respiratory syndrome on 29 March 2003.