Severe acute respiratory syndrome (SARS) has given the Greek public health system a jolt. Despite the reassuring words of Health Minister Costas Stefanis, the state of readiness is not encouraging. At Evangelismos, for instance, the largest hospital in the country, work on a ward to treat SARS sufferers in an environment that contains the disease is not complete. The same goes for most large hospitals in Athens and Piraeus. A unit is being completed at the Ippocrateio Hospital in Thessaloniki, and special negative-pressure wards are in operation at university hospitals in Patras, Ioannina, Thessaly and Iraklion. The administrators of 17 hospitals which were ordered to set up the special wards are racing against time as, even though the cost is low – around 59,000 euros – difficulties have arisen with installing units according to World Health Organization specifications, due to lack of time and space. Large hospitals in Attica, which are being prepared to meet the requirements of the Olympic Games, have not yet received orders to set up such wards and no hospital has a negative-pressure intensive care ward in operation. We are lucky that SARS hasn’t reached Athens, because the city is undefended. As the health minister said a few days ago, it is purely a matter of luck, since airport inspections are not sufficient to keep the epidemic out of countries such as Canada, which has a very effective health system. There are also problems with supplies. Due to the pressure on suppliers from all hospitals, there is a delay in the delivery of special uniforms and masks for doctors and other staff. «If there are cases in Greece of healthy carriers of the virus,» Dimitris Trichopoulos, professor of epidemiology at Athens and Harvard told Kathimerini, «then whether there will be cases in Greece is closely linked to the extent of the epidemic abroad and is a matter of time. If the percentage of healthy carriers is small, which would be surprising, then vigilance might protect us.» If SARS cases appear in Greece, it will test the health system to the limit, says Trichopoulos. «The question is whether we have cases of individuals who haven’t traveled to countries where the virus has appeared but have been infected in Greece.» Every effort is being made, he says, but that cannot make up for the many years of downgrading public health. «This is not only the health agencies’ responsibility. Look how, with the threat of an epidemic, we have chosen to fill the streets of a city of 4 million people with rubbish. If there were an epidemic, that would be adding fuel to the flames. «We have to stop kidding ourselves. Have we done anything about cancer prevention or our diet? We don’t need the threat of a specific epidemic or to hold the Olympic Games to think about public health.» Public health is the poor relation of the system, absorbing only 0.5 percent of total budget expenditure. Scattered existing services – the Central Public Health Laboratory that operates under par, regional laboratories that are not yet completed, the Control of Special Diseases Center (KEEL) and university laboratories – all face serious shortages of funds and coordination. So far, the examination of suspect SARS samples has been undertaken by the microbiology laboratories at the universities of Athens (under Professor Nikos Legakis) and Thessaloniki (Professor Antonis Antoniadis). But there are not enough facilities to deal with more cases. SARS has revealed the absence of a lifeline between the provinces and the Health Ministry. «Our information has been coming from the media, since most health centers don’t have access to the KEEL site,» Bodosakis Merkouris, director of the Nea Madytou Health Center in Thessaloniki told Kathimerini. «We don’t have a public health system,» he added, explaining that prefectures don’t have public health doctors on their staff. «Prefectural hygiene directorates issue permits to cafes and souvlaki outlets when they should be constantly on the alert, monitoring epidemics in each area, from road accidents to flu and infectious diseases. That’s what public health is about,» says Merkouris. Let us hope the SARS epidemic acts as a wake-up call to Greece to invest in the health system and ensure the epidemic does not have disastrous consequences for the country.