Severe Acute Respiratory Syndrome (SARS) - Multi-country outbreak - Update 44

World Health Organization ^ | 1 May 2003

[Nov3]

Severe Acute Respiratory Syndrome (SARS) - Multi-country outbreak - Update 44

1 May 2003

Disease Outbreak Reported

Situation in China, revised case definition, support to national labs

Situation in China
The number of new SARS cases continues to increase steadily in China, particularly in Beijing. Today, China reported 187 new cases and 11 deaths, more than half of which were in the capital.

WHO officials in China believe the development of a central database of operational SARS data would greatly aid in combating the disease. The next few months will prove crucial in the attempt to contain SARS worldwide, which now greatly depends on whether the disease can be controlled in China.

WHO is studying how best to support hospitals in some of China’s poorer western and northern provinces. Concern continues that hospitals in these resource-poor regions may not have the necessary facilities to properly isolate and treat SARS patients. More front-line hospital staff with expertise in dealing with infectious diseases may be required. Guidelines are also needed for China’s national health care system on the kinds of infection control measures needed to prevent continuing transmission of the disease.

Shanghai is to enforce stricter SARS preventive measures, including the enforcement of 14-day quarantine periods for travelers arriving from affected areas. These measures are even stricter than those currently recommended by WHO. Traffic checkpoints have already been set up to screen people coming into the city, where they are given temperature checks and asked to fill out health declaration forms.

WHO revises SARS case definition
WHO has today updated its case definition for SARS to take into account the appropriate use of results from laboratory tests. Several diagnostic tests have been developed by various laboratories for the detection of the SARS virus and antibodies to the virus. However, all presently available tests have specific strengths and weaknesses.

For this reason, WHO continues to advise clinicians that patients should not have their case definition category downgraded while awaiting results of laboratory testing or on the basis of negative results.

WHO is concerned that inappropriate use of laboratory results can have a negative impact on patient management and selection of an appropriate level of infection control. Therefore, negative test results for the SARS virus cannot be used to exclude infection in either suspect or probable cases. In contrast, positive results of quality-assured laboratory testing can add to the efficacy of SARS case management, provided tests are properly conducted and interpreted.

Positive virus results from lab tests demonstrate that the patient is excreting virus, or its genetic material, and thus might pose a risk of disease transmission to others. Consequently, suspect SARS cases with a positive lab result (virus isolation or PCR) should be classified and reported as probable cases.

Guidance for quality assurance, particularly for PCR tests, has been posted at the WHO website. See Recommendations for laboratories testing by PCR for presence of SARS coronavirus -RNA

WHO supports calibration of diagnostic tests
WHO, supported by members of its laboratory network for SARS diagnosis and the Robert-Koch Institute, Germany, is making standardized reagents available to improve reliability and support the quality assurance of diagnostic tests for SARS. Virological standards are being made available to ministries of health in countries with SARS outbreaks immediately, with shipment scheduled to begin on Monday 5 May. Serological kits will be made available by 12 May.

Ministries of health are invited to designate national laboratories and communicate their needs to WHO at sars virus@who.int or fax 0041 22 791 48 78.

The diagnostic standards will be made available to up to 3 laboratories in all countries. In China, however, the supply will be sufficient for all major laboratories in all provinces.

WHO is now planning an external proficiency testing programme to assess the performance of diagnostic tests and establish the basis for quality control.

Update on cases and countries
As of today, a cumulative total of 5865 probable cases with 391 deaths have been reported from 27 countries. This represents an increase of 212 additional cases and 19 deaths when compared with yesterday. The deaths occurred in China (11), Hong Kong (5), Taiwan (2), and Singapore (1). Poland reported its first case today.

The United Kingdom and the United States of America have been removed from the list of areas with recent local transmission. In both countries, the last instance of local transmission occurred more than 20 days ago. Tianjin, China and Ulaanbaatar City, Mongolia, were added to the list.

[Nov3]

Just a reminder that a foolproof test has not been developed. Certainly some of the cases included in the totals are almost definitely not SARS but viral pnuemonia. This is good and bad. It means the disease is not quite as widespread. It also means that the death rate is probably higher than the stats show because other diseases with the symptoms of SARS do not have near the death rate SARS does and as such dilute the results.

We have made amazing progress with this disease given how badly the ChiComs handled the situation.

[Beck_isright]

"It means the disease is not quite as widespread."

It doesn't? It's spreading through Florida one county at a time and a 12 year old boy who went to Toronto but did not visit any hospitals has contracted the disease in Central Florida (Polk County to be exact). And of course the health department and schools were clueless and now after spending several days in school, there is a huge concern. I think this is the tip of the iceburg. Thankfully there are not as many Canadians coming down here this time of year.

If I can find the map of SARS cases by county in Florida, I'll post it. They showed it on the news tonight and it is beginning to remind you of all the red and blue maps from the election.

[dark_lord]

The real question is this -- are the total cases in the PRC doubling every 2 weeks? Because if this is true, do the math and you will see some really, really big numbers come next fall.

[dc-zoo]

Well it was 3500 cases world-wide on April 25th and today (one week later) it is 6300 cases. Quite alarming IMO.

[dark_lord]

Hmmm...but lets say only every two weeks.
12,600 by mid May.
25,000 by June.
50K mid June.
100K by July.
200K mid July.
400K by August.
Lets hope not because if this trend occurred we are talking serious panic -- the kind where Russia and India might decided to "sterilize" the problem in the PRC -- and of course they can respond in kind.

[aristeides]

Isn't that increase mainly China catching up with its lies?

[dc-zoo]

The present case count could be much higher if they were all accounted for and reported. If the current progression continues we could be in for a disaster of biblical proportion.

[Dog Gone]

We have shown that SARS can be contained and controlled in large cities with quick reactions and excellent medical facilities, although it may cause several hundred health workers to get the illness in the process.

But since China allowed over a million people, some of whom undoubtedly were exposed to the virus, to scatter around the entire country, we're going to see what happens when it can't be addressed with those measures. It doesn't look encouraging, and perhaps the only realistic positive outcome would be to see that the virus is mutating into something less dangerous.

[keri]

Ping.

[Judith Anne]

I honestly don't think that the virus will mutate into something less dangerous. My theory is that this is the common cold mutated into something MORE dangerous, in the bacterial-viral soup of rural China.

[FITZ]

large cities with quick reactions and excellent medical facilities, although it may cause several hundred health workers to get the illness in the process.

It seems possible to me that it's the large cities and medical facilities themselves that might be what caused the illness to be severe and spread the way it did. It's hard to believe that a disease made it from Chinese hospitals to Toronto hospitals but skipped all the small towns and non-hospital areas in between.

[Judith Anne]

To the best of my knowledge, most if not all the SARS cases in Canada can be traced back to one person who came to Canada from China.

[Dog Gone]

We already know that it has evolved into two distinct strains. It stands to reason that it will continue to mutate, some becoming more benign, and some becoming even worse. Making a vaccine may prove impossible against so many different strains.

I'm hoping that the virus will weaken in rural China, and the illness will eventually die out. I don't have any reason to have that hope, but it's a nice thought, anyway.

[Judith Anne]

A very nice thought...

I'm headed out to the garden. We took down a leaning tree, time to stack firewood.

[FITZ]

I wonder if SARS testing has only been done on sick people ---maybe healthy people in those areas would demonstrate an antibody titer to SARS which means they were exposed but fought it off ---even without becoming sick. All of us have antibodies to diseases we never knew we had.

[Domestic Church]

Lets hope not because if this trend occurred we are talking serious panic -- the kind where Russia and India might decided to "sterilize" the problem in the PRC -- and of course they can respond in kind.

So unless this is contained by absolute isolation and barrier methods (and this means biting the economic bullet now not tomorrow regarding trade and travel) the odds of survival might not look good even for those who aren't at risk for the virus. Maybe it's time for nations to become isolationist for the duration.

[dark_lord]

I saw in heaven another great and marvelous sign: seven angels with the seven last plagues--last, because with them God's wrath is completed. (Rev 15:1)

Out of the temple came the seven angels with the seven plagues. They were dressed in clean, shining linen and wore golden sashes around their chests. Then one of the four living creatures gave to the seven angels seven golden bowls filled with the wrath of God, who lives for ever and ever. And the temple was filled with smoke from the glory of God and from his power, and no one could enter the temple until the seven plagues of the seven angels were completed. (Rev 15:6-8)

[Allan]

The news tonight from China:

Medical staff is not showing up at certain hospitals
hospitals are closing down
staff are not showing up
there are no more respirators
Peking is building a prefabricated 'hospitals'
(really plywood concentration camps)
people who get a high fever for any reason hide in their homes
for fear they will be thrown into one of those hospitals
where they will be left to die.

Early reports are that the peasants are tearing up the railroads.

[Mitchell]

Early reports are that the peasants are tearing up the railroads.

Where did you read or hear this?

[Allan]

The usual place. B and A.