Waiting for Disaster.(dealing with SARS in the developing world)

The killer SARS virus traveled to Barangay Vacante from one of the world's most modern cities. Adela Catalon probably caught the virus in Toronto, where she worked at a nursing home, and brought it to the Philippines when she returned to care for her ailing father. She visited three provinces before falling fatally ill. Her father, Mauricio, whose immune system had already been weakened by a bout with abdominal cancer, also died from SARS. Police ordered 210 Barangay Vacante residents to stay home, and local health officials went door- to-door twice a day to check up on them. That didn't stop some residents from slipping away on foot to shop in the nearby market town of Alcala. To persuade them to stay put, the government rushed in dried fish, rice and canned goods.

Such are the simple tools deployed against severe acute respiratory syndrome in the so-called developing world. Even rich countries haven't exactly produced a lightning victory against the disease. Last week, just as the World Health Organization lifted its travel advisory for Toronto, Canadian health officials announced two new cases. And scientists in Hong Kong raised the frightening possibility that patients who have already recovered from the disease may still infect others. What if SARS holds another punch for the world's poorest countries?

The prospect has health experts in South Asia and Africa, in particular, on edge. So far India has kept its 19 mild cases from turning into an epidemic, and only one case has cropped up in Africa. With the disease on the wane in Vietnam and leveling off in Bangkok, it's possible that SARS won't become a pandemic. But it's far from a sure thing. The epidemic is still raging in China, only a plane ride away from vast populations of vulnerable people. Thirty million HIV- infected Africans, who have compromised immune systems, are sitting ducks for the disease, warned Luc Montagnier, one of the discoverers of the AIDS virus. Millions more people sick with malaria, hepatitis and bilharzia are similarly at risk. A recent report from the World Health Organization sounds an ominous note: "Nearly two thirds of all the patients who die in all age groups already suffered from chronic diseases." Dr. Alfred Jumba, who works in the eight-bed Vipawa Medical Center, one of the main health-care facilities in the teeming Nairobi slum of Kibera, says, "This is potentially devastating."

The Philippines is better off than many --developing countries, but it is hard-pressed to defend itself against SARS. Unlike Hong Kong, which has erected virtual holiday camps for its SARS victims, or Singapore, which has installed video cameras to police urban areas, it makes do with the 2 percent of its annual budget that goes to health care. Officials say they can't afford to buy gloves and masks for nurses. The Philippines' trade minister said last week that the country has run out of N95 face masks. "We are hoping that the WHO will help us out," says Dr. Troy Gepte, a government spokesman. People are turning to home preventions like papayas and ginger-and-garlic infusions.

Indian health officials have even more cause to be jittery. None of the country's 19 SARS victims so far has died. But with a billion people crammed together, a fifth of them in megacities like Mumbai and New Delhi, the Subcontinent is ripe for a SARS epidemic. Only a quarter of all Indians have toilets; SARS, scientists suspect, can be spread by feces. A major outbreak of SARS --would overwhelm India's health-care system. The country has fewer than five physicians per 1,000 people and one small community health center for every 80,000 people. The government's drive to promote family planning has starved other health services ...