SARS UPDATE: Pneumonia bug poses global threat

BBC via Daily Times-Pakistan ^ | Monday, March 31, 2003 | By Chris Hogg

[InShanghai]

HEALTH: Pneumonia bug poses global threat

By Chris Hogg

It is a disease that has killed at least 17 people since the beginning of February and infected hundreds more.

In Singapore it has led to the confinement of more than 700 people to their homes, simply because they had close contact with someone who fell ill with it.

In Hong Kong schools have been closed with some sending home their students for a week.

We still do not know what causes it, how you catch it, or how you treat it. There may be no cure. Yet with the eyes of the world on the conflict in the Gulf, the condition that has been called ‘Severe Acute Respiratory Syndrome’ or ‘SARS’ has been largely ignored in the West.

Not so in the East. Reports from Singapore suggest a population ‘on the edge of panic’. Those unfortunates confined to their homes for the next ten days face a £1800 fine if they venture out, double that for a second offence.

The WHO says it is still gathering information about each of the 456 patients believed to have been infected with the condition. But at this stage it still cannot confirm that every case can be explained by ‘close contact’.

‘Close contact’ can include sitting next to someone who is infected.

What is concerning the authorities is that unless and until they can establish such a link for every single case, they cannot rule out the possibility that SARS is airborne. That would be far more serious. It would have an implication for air travel for instance.

The pattern of infection at the moment suggests that only those sitting next to or perhaps directly in front or behind an infected passenger is at risk. If whatever causes this disease is airborne then it becomes more likely that it could be transmitted through an aeroplane’s ventilation system.

With data being collected and analysed by 11 different laboratories in nine countries that evidence is constantly under review. This almost unprecedented global collaboration has put two viruses in the frame. One is from the paramyxoviridae family - the viruses that cause amongst other things mumps and measles.

The other is from the corona virus family that causes the common cold and other more serious respiratory diseases.

Tissue taken from patients has contained either or both of these pathogens that raises some intriguing possibilities.

Firstly, that this is a new form of either virus, which is more virulent than its predecessors.

Until scientists can be certain of how it is transmitted, they cannot rule out the possibility that it is more virulent than it appears at present

But these are both common viruses and scientists concede they do not know enough yet to rule out the possibility that neither is actually causing the disease.

Currently SARS has a mortality rate of 4%. That is not that high, But WHO officials point out that the true mortality rate may be higher.

The current figure is low in part as a result of the immense clinical effort that has gone in to providing supportive care for those who have fallen victim to the disease. One Hong Kong hospital has 150 patients with the disease, 30 of whom are being treated in intensive care.

Many of these are on ventilators. The WHO says several would have died already without mechanical ventilation.

In Vietnam the situation is ‘contained’ the WHO says. In Singapore it is ‘controlled’. Hong Kong and China it is still ‘very concerned about’.

Firstly, if the Corona virus does prove to be responsible that might make it far harder to produce a vaccine or a cure.

Years of research have failed to produce a cure for the common cold after all.

Secondly, until scientists can be certain of how it is transmitted, they cannot rule out the possibility that it is more virulent than it appears at present.

That is why travel advice from national governments is reported to be under review on a daily basis.

More draconian restrictions to help prevent the spread of the disease cannot yet be ruled out. —BBC Online

[InShanghai]

More draconian restrictions to help prevent the spread of the disease cannot yet be ruled out.

Anyone want to speculate on what further restrictions would become necessary if this does become a major epidemic?

[thatdewd]

This thing reminds me of "Captain Trips" - from 'The Stand' (shudder).

[InShanghai]

E-mail titled SARS FACTSHEET from the US Consulate in Beijing:

---

To American Citizens in the Beijing Consular District

This is one of an occasional series of messages from the U.S. Embassy's American Citizen Services unit to American Citizens registered with the U.S. Embassy in China.

1. The U.S. Department of State encourages American citizens traveling or residing abroad to familiarize themselves with the information available from the
Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) about Severe Acute Respiratory Syndrome (SARS). This Fact Sheet updates the March 21, 2003, version and reflects changes in the
geographic spread of SARS cases and includes additional information. In light of the evolving nature of the SARS situation, American citizens should regularly consult the CDC website http://www.cdc.gov/ and the WHO website
http://www.who.int/ for updates.

2. In Hanoi, Vietnam and Hong Kong, the appearance of SARS has had an impact on medical facilities, due to the closing and/or quarantine of hospitals and the spread of the disease to health care workers. Medical evacuation
of SARS patients currently is not available by commercial carrier; additionally, the number of countries willing to accept SARS patients is very
limited.

3. Prospective parents of adoptees from mainland China and Vietnam should consult the appropriate link on adoptions at the CDC website,
http://www.cdc.gov/ncidod/sars/adoption.htm.

4. In addition to Vietnam, Hong Kong, mainland China and Singapore, the CDC has received reports of outbreaks of SARS elsewhere in Asia and in Europe and North America, including Canada, the United States, Thailand, Germany,
and Switzerland. Most cases appear to involve health-care workers caring for SARS patients and close family contacts. CDC is working closely with WHO and country partners to define the origin of this infection, to track patterns of its transmission, and to determine effective strategies for its control and prevention.
Local health authorities should be notified of all suspected cases of SARS.

5. The CDC has identified the following three criteria, which must ALL be present, by which a potential SARS case may be identified, for those with the onset of illness after February 1, 2003:

--Fever greater than 380 C (100.40F), AND

--One or more signs or symptoms of respiratory illness including cough, shortness of breath, difficulty breathing, hypoxia (low oxygen in the blood), x-ray
findings of pneumonia, or respiratory distress, AND

-- One or more of the following within 2-7 days of the onset of symptoms: Travel to mainland China, Hong Kong, Singapore, or Vietnam; and/or close contact*, with a person who has been infected with SARS (*close contact
means having cared for, lived with, or having had direct contact with respiratory secretions (such as coughs and sneezes) and body fluids of a person with SARS).

The incubation period between exposure to infection and the development of symptoms appears to range from 2-7 days. For more specific information regarding case definition updates and empiric treatment clinicians should consult and monitor the CDC's and WHO's web sites.

6. Currently, prevention of new cases is based on individuals avoiding close contact with SARS-infected persons, as described above. Persons matching the case description for SARS should be promptly evaluated by medical personnel and, if indicated, admitted to a hospital. Persons suspected of having SARS should limit their interactions outside hospital settings.

Contact Information for the CDC:

Public Inquiries:
English (888) 246-2675
Spanish (888) 246-2857
TTY (866) 874-2646
Mon-Fri 8am-11pm EST
Sat-Sun 10am-8pm EST

[InShanghai]

Another E-mail titled SARS In Asia from the US Consulate in Beijing:

To American Citizens in the Beijing Consular District

This is one of an occasional series of messages from the U.S. Embassy's American Citizen Services unit to American Citizens registered with the U.S. Embassy in China.

SARS In Asia

This Public Announcement is being issued to alert Americans that the CDC has issued a travel advisory, and health alert notices, which are being distributed at ports
of entry to people returning from the three affected regions. CDC advises that people planning elective or nonessential travel to mainland China and Hong Kong;
Singapore; and Hanoi, Vietnam, may wish to postpone their trips until further notice. This Public Announcement expires on June 26, 2003.

The Centers for Disease Control (CDC) and the World Health Organization (WHO) are tracking SARS's origin and method of transmission as well as determining how its
spread can be contained. In light of the continually evolving nature of the geographic spread of SARS, American citizens should regularly consult the CDC website
http://www.cdc.gov/ and the WHO website http://www.who.int/ for updates.

American citizens currently in or planning to travel to SARS-affected areas of Asia should consult the Department of State's Fact Sheet on SARS, Public Announcements, Travel Warnings, and Consular Information Sheets for China, Hong Kong, Singapore, and Vietnam, all of which are available at the Consular Affairs Internet web site at
http://travel.state.gov. American citizens may also contact the Department of State toll-free at 1-888-407-4747, or if calling from overseas, 317-472-2328, for SARS information.

[EternalHope]

The worst case is too scary to speculate on.

Given how widespread this already is, it may be impossible to keep it out of the general population. At some point travel restrictions become pointless because we are all going to be exposed anyway.

No one believes China's claim from last week that there are "No new cases after March 11th". China is likely to be the first to be hard hit, so we may all be looking to YOU for information on how things are going.

[InShanghai]

Fortunately, this is nowhere near as deadly as Captain Trips!!!!

[Dog Gone]

The WHO says it is still gathering information about each of the 456 patients believed to have been infected with the condition

All other recent stories put the figures at almost 4 times that number.

[cebadams]

SARs status:

http://www.freerepublic.com/focus/f-news/880332/posts
Sars symptoms are a lot like those of the flu -- very high fever, shortness of breath and a dry cough. The disease is spread by close contact and antibiotics do not seem to work. The incubation period for the virus is said to be two to seven days. Some 80 to 90 per cent of infected people recover on their own, but there has been a 4 per cent casualty rate so far. SARS is poised to trigger a worldwide health emergency following reports of airborne transmission that has brought disease into the United States and Canada.

http://www.freerepublic.com/focus/f-news/880329/posts
"The longest possible incubation period that we've seen is 14 days," (WHO) spokesman Dick Thompson said March 30th in an interview from Geneva.

http://www.freerepublic.com/focus/f-news/880380/posts
The pattern of infection at the moment suggests that only those sitting next to or perhaps directly in front or behind an infected passenger is at risk. If whatever causes this disease is airborne then it becomes more likely that it could be transmitted through an aeroplane?s ventilation system. Currently SARS has a mortality rate of 4%. That is not that high, But WHO officials point out that the true mortality rate may be higher. The current figure is low in part as a result of the immense clinical effort that has gone in to providing supportive care for those who have fallen victim to the disease. One Hong Kong hospital has 150 patients with the disease, 30 of whom are being treated in intensive care. Many of these are on ventilators. The WHO says several would have died already without mechanical ventilation.

http://www.freerepublic.com/focus/news/879955/posts
TORONTO (March 30, 2003) -- The Ontario government will use police if necessary to restrict access to Toronto hospitals as part of new measures announced yesterday to try to contain an outbreak of Severe Acute Respiratory Syndrome (SARS). The WHO also announced yesterday that Dr. Carlo Urbani, who worked as a public health officer in Cambodia, Laos and Vietnam, had died of of the disease . Dr. Urbani was the first WHO officer to identify the outbreak of the illness, in a U.S. businessman who was hospitalized in Hanoi.

http://www.freerepublic.com/focus/f-news/880264/posts
The Canadian province of Ontario has 100 possible cases of the illness -- the highest caseload outside Asia.

http://www.freerepublic.com/focus/f-news/880292/posts
Hong Kong - Director of Health, Dr Margaret Chan, has ordered Block E of Amoy Garden in Ngau Tau Kok, Kowloon Bay, to be isolated for a period of 10 days starting from 6 am this morning (March 31) to prevent the spread of Severe Acute Respiratory Syndrome (commonly known as atypical pneumonia), a Government spokesman said. The decision was taken because of the continued steep rise in the number of cases of infection in the building in the past few days.

http://www.freerepublic.com/focus/f-news/880264/posts?page=10#10
CDC (March 30, 2003) - Sars, which has affected some 1,600 people worldwide, appears to spread more easily than was first thought, according to the CDC.


Frequently Asked Questions About Severe Acute Respiratory Syndrome (SARS)
http://my.webmd.com/content/Article/62/71651.htm?wbc_purpose=Basic

(CDC) Number of Suspected Cases Under Investigation in the United States
http://www.cdc.gov/od/oc/media/sars.htm
(WHO) Number of Suspected Cases Under Investigaion throughout the World
http://www.who.int/csr/sarscountry/en/
(CDC) SARS Fact Site
http://www.cdc.gov/ncidod/sars/
SARS Online - Information and Discussion
http://www.sarsonline.com/

[InShanghai]

I think they have information for all of the cases except the 456, or at least I hope they do.

[Alberta's Child]

. . . and antibiotics do not seem to work.

I can't believe the number of times I've heard or read a "report" on SARS that includes this idiotic statement.

Antibiotics are used to treat bacterial infections -- they are useless against a viral infection. The only way to treat a viral infection is to let it run its course until the body's immune system eventually fights it off.

Which is why AIDS by its very nature is such a devastating disease -- when the disease "runs its course," it destroys the one thing (the body's immune system) that would eventually fight off the infection.

[Dog Gone]

More than 100 people in Canada are now suspected of having contracted the new form of pneumonia which has been sweeping parts of east Asia.

The virus has now spread to the west coast

Four people in Ontario have died of the illness known as Severe Acute Respiratory Syndrome (SARS).

A senior government health official in the province of Ontario says more cases are appearing there every day, most of them among hospital workers.

Two Ontario hospitals have been closed down and staff at others have been ordered to wear masks and gloves at all times.

Ontario is experiencing the most serious outbreak of SARS outside of south-east Asia.

Officials say there are 81 suspected cases but admit that the figure is likely to be much higher.

Now, there is a fourth death.

There are few details being released about the person who died.

Quarantine

Doctor James Young, Ontario's commissioner of public safety, confirmed the latest fatality:

"What we are quite certain of in this case, though, is that SARS played some role in this death, and that this death is linked back to the outbreak at the Scarborough Grace hospital."

MYSTERY BUG

At least 54 people dead and 1,550 cases in 13 countries

Originated in southern China

Spread by international travellers

Scarborough Grace is considered the epicentre of the outbreak.

The building has been closed and medical staff there have been made to wear face masks, goggles and other protective clothing.

Thousands of people who have come into contact with the hospital have been put under a 10-day quarantine.

A second city hospital has also been closed and others are severely restricting visitors.

Nationwide spread

But it seems Canadian authorities have been unable to contain the virus.

There are now four suspected cases in British Columbia, on Canada's west coast, including one person in a serious condition.

On the other side of the country, in New Brunswick, a school has been closed and a teacher thought to have the illness has been put under quarantine.

People returning from trips to south-east Asia are thought to have been the source of the outbreaks.

The Federal Health Ministry is now working with officials at Canadian airports to try and devise a programme to screen people leaving and arriving on international flights.

[InShanghai]

Thanks for all the information. If the airlines' were concerned about a war affecting their business, this will seriesly put a damper on world travel.

[cebadams]

Frankly, I point to the "cure AIDS" crowd for dumbing down the public. The notion that HIV is the cause of AIDS, that HIV is a virus, and that a cure for HIV can be found leads directly to the conclussion that there must exist an anti-body as the cure.

I'm not surprised that this same quick fix mentality is now the predominate way most people think about cures for viral infections.

[Alberta's Child]

It's kind of ironic that this SARS story has made headlines just as the U.S. Supreme Court is reviewing a challenge to an anti-sodomy law. If SARS becomes a global epidemic, can anyone guess which group in the U.S. is going to be hit the hardest?

[cebadams]

No, if this becomes a global epidemic everyone will be affected.

-- Fever greater than 380 C (100.40F), AND
-- One or more signs or symptoms of respiratory illness including cough, shortness of breath, difficulty breathing, hypoxia (low oxygen in the blood), x-ray findings of pneumonia, or respiratory distress, AND
-- Close contact with a person who has been infected with SARS

[nanny]

You are right, but (1) many people expect antibiotics for everything (2) many doctors prescribe antibiotics for everything.

They are probably just alerting them to not ask their doctor for it - and maybe alerting doctors not to help the pharmacutical companies by prescribing antibiotics when they will not help.

[Alberta's Child]

No, if this becomes a global epidemic everyone will be affected.

Even an epidemic doesn't necessarily infect everyone. The most devestating impact will be felt among groups that have compromised immune systems.

From what I understand, the new strains of antibiotic-resistant tuberculosis hardly infects anyone outside those groups.

[Alberta's Child]

Sometimes it actually makes sense to "treat" a viral infection with antibiotics. Not to treat the viral infection itself, but in cases where a virus is often accompanies by a secondary bacterial infection.

[goldstategop]

Yup. In most healthy people the virus will pass through the body as it produces antibodies to ward off future infections.

[capitan_refugio]

(1) No air traffic into or out of infected areas.
(2) Strict quarantine of infected individuals and those who came in contact with them.
(3) Public health announcements to urge people to wash their hands - constantly (If you think I am crazy, ask a health professional about what is the most common methods colds and flu are spread - hand to hand to mouth).
(4) Surgical masks seem to be helping in S.E. Asia. Proably not so much to protect one, but to stop an infected person from sneezing near others!