Posted on 04/23/2003 12:09:21 PM PDT by aristeides
Australian Broadcasting Corporation
LATELINE
Late night news & current affairs
TV PROGRAM TRANSCRIPT
LOCATION: abc.net.au > Lateline > Archives
URL: http://www.abc.net.au/lateline/s837819.htm
Broadcast: 22/4/2003
Aust virologist leads WHO's fight against SARS
Tony Jones speaks to Professor John McKenzie from Hong Kong about the outbreak of the deadly SARS virus. Professor Mckenzie is an internationally recognised virologist from the University of Queensland and was sent to China less than a month ago by the World Health Organisation to work as their team leader in the country before the extent of SARS was known. You could describe Professor McKenzie and his team as "virus detectives". He is also the interim CEO of the new Australian Bio-security Centre for Cooperative Research, which has been funded, but unfortunately is not yet operative.
Compere: Tony Jones
Reporter: Tony Jones
TONY JONES: John McKenzie, as you heard we've referred to you and your team as virus detectives.
What was the actual task of the WHO team that went in to China?
PROFESSOR JOHN McKENZIE, WORLD HEALTH ORGANISATION: Well, Tony, let me just take this off first.
This is what the well-dressed Hong Kong people are wearing today.
It's a bit more pleasant without it on, I must confess.
We went to China for a number of reasons.
We knew there had been an outbreak of atypical pneumonia and we wanted to know if this atypical pneumonia outbreak was the same as the SARS outbreak that was occurring at that stage in Hong Kong.
The idea was to go to China and find out if we could what was happening in Guangdong, if the case of atypical pneumonia was the same as the WHO case for SARS and if it was just how far back did cases go.
TONY JONES: What did you find out exactly?
PROFESSOR JOHN McKENZIE: We found out that the outbreak they had, particularly which peaked in February, was indeed SARS.
There's no question in our minds at all.
We also found that the earliest cases that we could recognise were back in mid-November.
So it had been around in Guangdong for three or four months before it appeared here in Hong Kong.
TONY JONES: So were the health authorities in China simply ignoring the fact they had a potential SARS epidemic or was something else going on that we don't know about?
PROFESSOR JOHN McKENZIE: I think a number of things were happening.
One is that they had cases of H5 influenza, which was of some concern, which obviously muddied the waters a little bit.
They also had cases of atypical pneumonia which is probably true atypical pneumonia which they have every year but not to this extent this time.
So I think what happened here was, were a were a number of issues.
They hadn't at that stage realised it was a novel disease outbreak and I think once the cases occurred in Hong Kong there was a certain degree of rushing back to see what had happened in Guangdong.
Unfortunately I think the system they use in China is very antiquated for disease surveillance and tracking these cases.
So I think a lot was really unknown but they were getting very concerned themselves.
TONY JONES: We know that a number of very senior heads have now rolled over an apparent cover-up relating to the extent of this disease.
Was it because you proved to them that this was SARS that they finally acknowledged that this is what they were facing?
PROFESSOR JOHN McKENZIE: I think there was a gap in between.
I think they acknowledged it had to be SARS fairly early on when we gave our report to the government.
The trouble there is a provinces are very powerful, the ministry is much weaker.
So to get the information from provinces was not easy.
Nevertheless, they did make the disease into a notifiable disease under category B - that, is the diseases that have to be notified to the central Health Ministry, which helps.
They also did send out the case definition that had been agreed to, to the provinces.
What happens after that is somewhat murky and I suspect partly due to the rather bureaucratic system that takes place in China.
Nevertheless they did start reporting cases a few days after we left but nowhere near the true number.
Now I think two or three things happened there.
One is the fact that the large number of cases we now know were in military hospitals and military hospitals don't come under the ministry of health, they're the ministry of defence, so I guess they didn't know about those cases necessarily.
They also covered up some cases in Beijing.
They must have been aware of the number of cases in Beijing and this belief in China that you don't let the general public know what's happening.
That might cause panic and of course affect trade.
There was some degree of cover-up, there's no way to dismiss that.
TONY JONES: What's happening now?
Are they doing enough now and have we seen the full extent of the SARS epidemic or as some people are saying are we going to see many more people in coming days?
PROFESSOR JOHN McKENZIE: I think we'll see many more people.
For two reasons - one is that they had the Chinese lunar new year at the peak of the Guangdong epidemic and there was so much travel at that stage in China, that people must have been travelling from Guangdong to various provinces, there's no question in my mind at all that there were cases sent back to provinces at that time.
That's one major reason I guess.
The other one of course is that we haven't heard about what's happening in Shanghai.
I can't believe there have been haven't been a large number of cases there and some of the other provinces too.
So my belief is that we have nowhere near reached the peak of the cases at this stage, known cases, in China, I also believe they've been too slow to react and I believe we'll see far more cases yet before they bring it under control.
TONY JONES: Your team went right into Guangdong in southern China looking, as I understood it, for the origins of the disease.
I think it's a little more complicated than that, though.
What can you tell us about what their aim was?
PROFESSOR JOHN McKENZIE: OK, well, I had left the team by that stage because I had other commitments in Washington, but at that time, they went to Guangdong and the idea was to certainly try to get some idea of what had been happening in Guangdong.
We'd already had a report from the epidemiologist who looked into the outbreak, but they really wanted to see for their own eyes, if you like, what hospital facilities there were - were there different levels of hospital - what types of barrier-type nursing they had in place and also, when the people from Guangdong looked at the professions involved in cases that year in the atypical pneumonia outbreak, which we now know as SARS, compared to the atypical outbreaks in the past two years, two groups seem to come forward which hadn't been obviously in the previous years.
One was health care workers - and this is not surprising because in other countries they're the most at risk of SARS in other countries.
The other group, strangely enough, which came through, were people involved in food preparation.
So this immediately gave us some concept that possibly SARS originated from an animal source - either from the food itself, probably from probably chicken, perhaps, or beef, we don't know, or ducks, or it would have been could have been from contamination during food preparation.
Now since there were very few cases, in fact, amongst farmers, if any, we believe that most of the problem was probably in food preparation.
But this is only a supposition at this stage.
Until we can go back with better techniques which are becoming available - to actually test animal species to see if there's evidence of SARS in certain species - we won't know until we can do this.
TONY JONES: There is speculation that rodents may have been involved and possibility, once again, in perhaps less than clean environments where food is being prepared.
How possible is that and could there be other cases for example in Hong Kong where that thesis might be borne out?
PROFESSOR JOHN McKENZIE: Well certainly there's some suggestion in Hong Kong that rodents might have been involved in Amoy Gardens.
There's an environmental team from World Health Organisation which will look at this in more detail.
They've certainly found the virus in rat droppings in a number of cases in Amoy Gardens and they've also found the virus in the cats, suggesting they had eaten rats that had been infected or, has also been affected.
Then also in Guangdong, rats are quite often on the menu, in fact.
And people do eat them.
So that's another possibility that the virus came in that way.
Certainly a number of instances of restaurants, I think, have been shown to have quite a number of resident rats, if you like, coming in and out of the restaurant.
So, yes, I think rats are a very strong possibility at this stage.
TONY JONES: Has it actually been proven yet that there is no airborne spread of the disease?
PROFESSOR JOHN McKENZIE: Probably yes.
I think had there been airborne spread of the disease, we'd have seen far more cases from infected individuals in aircraft.
We've seen really very few cases originating from people travelling in aircraft.
I think aircraft travel is generally very safe.
Nevertheless there have been a couple of cases and those were almost always cases which were related to people sitting close by.
So there seems to be no aerosol in the sense that we would see with influenza say.
I don't think normal aerosols are sufficient to spread the disease.
TONY JONES: But you are getting it from people coughing or sneezing from droplets is that right?
PROFESSOR JOHN McKENZIE: Coughing I think is a problem, because coughing you get lower respiratory tract mucus and this is where the virus can also be found.
And, obviously, in the polite way we have in our society, we tend to put our hand in front of our mouth when we cough.
We don't then go to wash our hands, instead we tend to just kind of wipe it on our trousers, or just rub our hands but that's about it.
Then you have infected hands and you shake hands with somebody else or you go to the door and turn the knob, or you go to an elevator and press the button, all of these ways can transmit from that cough to these other hard surfaces and the virus can remain viable, we believe, for quite a number of hours in dried mucus on these surfaces.
So I think that's much more likely as a way of transmission.
TONY JONES: Dr Luc Montagnier, one of the scientists who discovered the AIDS virus the existence of the AIDS virus has warned of looming catastrophe in China if the virus spreads to the population the quite large population in China who are HIV positive.
Do you agree with that assessment?
PROFESSOR JOHN McKENZIE: I think it's very likely.
After all, people with HIV are immunosuppressed.
So they're much more susceptible to inflection, and I suspect they would be to the SARS virus as well, so yes, I think he's probably correct.
TONY JONES: There are two aspects to this.
He said that could increase dramatically the number of people dying from the disease but also the virus would live longer he thinks in people whose immune systems are suppressed, they simply couldn't fight the virus, and they could become what is known as a 'superspreaders'.
PROFESSOR JOHN McKENZIE: I think it's a little bit difficult to comment on that.
I think that certainly they will be more susceptible.
Certainly the virus would not be, shall we say controlled in the body so readily by the body defence mechanisms so therefore could possibly last a lot longer.
Whether we would say they're likely to become superspreaders I think we just don't know at this stage.
TONY JONES: What will happen - I don't want to be alarmist - if the virus gets out of control in China and particularly in the poorest and most impoverished and crowded parts of China?
PROFESSOR JOHN McKENZIE: This is what I think many of us fear.
Once it goes into this country which are very impoverished which have little health care, the control of the whole outbreak will be very much harder.
So many of us are concerned that this will happen.
TONY JONES: One quick final question, I imagine you've read some of the comments that have been made today by one of the doctors, Australian doctor indeed who was in Hong Kong has now come back to Australia and he says Australia is not actually prepared for an outbreak of the virus.
You've obviously spent a lot of time recently here.
I think you were part of the team that monitors the potential spread of that virus in Australia.
Do you think we're prepared here in this country?
PROFESSOR JOHN McKENZIE: I think we're probably much more prepared than most other countries.
We've been having almost daily tele-conferences of the public health laboratory service and the communicable diseases network of Australia with the chief health officer, Dr Smallwood or Dr Matthews when Dr Smallwood has been away.
There's been a transparent and open communication at all levels.
So I think Australia has been much more able to cope with anything than people perhaps give credence to.
There are things we can do in the future.
One, for instance, I think we can put more resources certainly into emerging diseases and I think the CRC, for Australian by security CRC, is one way we can do this.
I hope the health department will give good support to that.
I think overall the way we are prepared just now and what we've done in the past six weeks has really been very effective.
TONY JONES: Professor John McKenzie in Hong Kong, thank you for taking the time to explain that to us and joining us tonight.
Thank you very much.
PROFESSOR JOHN McKENZIE: My pleasure.
Last I checked the death rate is about even withthe ever so important Lacie Peterson and Dixie Chicks threads...but not as high as all the Garafalo threads. Hope that helps.
From Dr. Robert Lee article entitled "SARS E2 Spike-protein Phylogeny". Link appears to be down.
I can't find anything related to it in the literature.
The NEJM has published a couple of articles with information on the SARS virus. One of them, (Ksiazek et al. N Engl J Med 2003;10.1056, A Novel Coronavirus Associated with Severe Acute Respiratory Syndrome.) has a nice diagram showing the phylogenetic relationship between known coronaviruses.
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