Date: March 16, 2003
Source: New York Times
Abstract: As a mysterious respiratory illness spread to more countries, the World Health Organization yesterday issued a rare health alert, declaring the ailment "a worldwide health threat" and urging all countries to help in seeking its cause and control.
The agency said that in the last week it had received reports of more than 150 new suspected cases of the illness, now known as Severe Acute Respiratory Syndrome, or SARS. The syndrome has caused at least nine deaths, the last one a nurse in Hanoi. Some victims have recovered but no one has been up, around and healthy in the past two weeks.. It apparently does not respond to antiviral and antibiotic drugs.
Reported cases have come from Canada and six countries in Asia — Hong Kong and elsewhere in China, Indonesia, the Philippines, Singapore, Thailand and Vietnam, the health organization said. There have been no reports of the illness in the United States. But yesterday, an ill passenger and two companions who traveled from New York City were removed from a flight after it arrived in Frankfurt and put in isolation in a German hospital.
The ill passenger is a doctor from Singapore who treated one of the earliest cases there, and who flew to a medical meeting in New York City, said Dick Thompson, a W.H.O. spokesman. The doctor may have gone to a hospital in New York — the agency is not certain which one — before flying back to Singapore via Frankfurt with his wife and another doctor. Before boarding the flight, the doctor called a colleague in Singapore to describe his symptoms, and the colleague notified the World Health Organization.
The cause has not been identified, and scientists do not know whether it is a virus or even an infectious agent. Although health officials have suspected avian influenza, which has infected a small number of people sporadically in Hong Kong since 1997, laboratory tests have not detected that rare strain, known as influenza A(H5N1). As a result, laboratory scientists are focusing on the possibility of a previously unknown infectious agent.
Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention, said in a news conference yesterday that it appeared to take direct and sustained contact to transmit the illness from an affected individual to other people. "There is no evidence to suggest that this can be spread through brief contact or assemblages of large numbers of people," she said.
Asked whether this might be an instance of bioterrorism, she replied, "We are keeping an open mind."
In an emergency advisory issued yesterday, the World Health Organization, an arm of the United Nations based in Geneva, said that "there is presently no indication to restrict travel to any destination."
But Dr. Gerberding said, "We are advising persons planning nonessential or elective travel to affected areas that they may wish to postpone their trip until further notice."
Updated information will be posted on the centers' Web site, www.cdc.gov/travel.
W.H.O. and American officials urged all travelers to be aware of the main signs. In addition to the breathing problems, the illness can cause a dry cough and other flu-like symptoms that are thought to develop two to seven days after exposure. They usually start with a sudden onset of high fever and go on to include muscle aches, headache, sore throat and shortness of breath.
Standard lab tests often show low numbers of white blood cells and platelets, which help blood to clot.
The health agency said any passenger or airline crew member who developed such symptoms should immediately seek medical attention and ensure that information about their recent travel was passed on to the health care staff. "Any traveler who develops these symptoms is advised not to undertake further travel until they have recovered," it said.
If a passenger became ill on a flight, the agency asked airlines to alert the airport of destination and to refer any ill passengers to airport health officials.
"There are currently no indications to restrict the onward travel of well passengers, but all passengers and crew should be advised to seek medical attention if they develop" symptoms, the agency said.
In another rare step, the Centers for Disease Control and Prevention activated its emergency operations center in Atlanta, including sophisticated communications technology, to enhance its ability to coordinate information from other countries and to investigate any suspect cases in this country.
The C.D.C. has used the operations center only twice before, for the mosquito-borne West Nile fever epidemic last year and the anthrax attacks in 2001. The last time it issued a global health alert was in 1993, to enhance measures to control tuberculosis. W.H.O. officials said they could not recall the last time an emergency global travel advisory was issued.
The secretary of health and human services, Tommy G. Thompson, said his department "is applying a full-court press to learn more about this outbreak and how it might impact on the United States."
The C.D.C. and New York City health officials are now investigating the travel histories of the passengers now in a German hospital as well as one of the eight cases suspected to be the new syndrome in Toronto and Vancouver, British Columbia.
Two hours before the plane landed, the W.H.O. notified German health officials, who had the plane moved to a separate runway where the doctor, his wife and a colleague disembarked and were taken to a nearby hospital. German health officials advised the other passengers to monitor their health and gave them a telephone number to call if they developed any symptoms. Officials did not release any information on his condition.
Mr. Thompson, the spokesman for the W.H.O., said the cases in Toronto involved a family who returned home after flying to Hong Kong. A woman, Kwan Sui-chu, died shortly after her return. Five other family members who had not been to Hong Kong have since become ill; four are still in the hospital while the fifth, Mrs. Kwan's son, Chi Kwai Tse, died on March 13, according to Toronto Public Health officials.
Toronto health officials said they were aware of two other cases in Vancouver, both people who had recently traveled to Hong Kong. C.D.C. officials are aiding in the investigation because Mrs. Kwan's daughter, who is being treated in Toronto, had flown to Atlanta recently, Mr. Thompson said.
So far, laboratory scientists have not been able to identify a known or novel infectious agent, said Dr. David L. Heymann, a W.H.O. official.
Japanese officials said their tests showed that the influenza virus was not the cause of the illness. But Dr. Heymann said samples from more victims needed to be tested, because it can take weeks for the immune system to produce influenza antibodies, the proteins that are formed to fight invading microbes.
"We have not ruled out influenza definitively," Dr. Heymann said.
Tests of victims' samples have found no evidence of mycoplasma or similar microbes that are the usual causes of atypical pneumonia. Additional tests have shown no evidence of Ebola or any of the other viruses that cause hemorrhagic fevers, hanta virus and bacteria.
In Hong Kong, an American businessman died on Thursday after passing through Hong Kong and falling ill in Hanoi, where 30 doctors and other medical personnel have fallen ill at the hospital where the businessman was initially treated (New York Times, 2003).Title: China Reveals Much Larger Outbreak Of Mysterious Illness
Date: March 26, 2003
Source: Seattle Times
Abstract: For the first time, Chinese government officials revealed today that nearly three dozen people have died and almost 800 became ill in a mysterious outbreak that Western medical investigators confirm was the beginning spread of a new flu-like disease.
The new numbers raised the worldwide death total from severe acute respiratory syndrome, or SARS, to 51, with 1,325 cases since mid-November.
Until now, Chinese authorities said only five people had died from a pneumonia-like illness that struck southern Guangdong province. The new count of 34 includes three deaths in Beijing.
“Everything we’ve seen so far indicates it’s the same disease,” said Dr. Meirion Evans, member of a WHO team that has studied the cases in southern China.
“We’re getting a more complete picture. It’s certainly been one of the objectives of the mission to clarify whether the outbreak in China was the same disease as what’s been seen outside of China.”
For weeks, Chinese officials said only 305 people were sickened in an outbreak that started in November.
But a spokeswoman for the Guangzhou city government, who identified herself only by the surname Ye, said today that 792 cases of atypical pneumonia were reported in the province by the end of February, putting the worldwide case number at more than 1,300.
Health authorities in Hong Kong have said the disease spread when a sick Beijing professor stayed at the Metropole Hotel in late February, infecting six other guests, who then carried it to Singapore, Vietnam and Canada.
World Health Organization scientists say the disease spreads when victims cough or sneeze in close contact with others. Most SARS victims have been family members of those who have the disease or health workers treating them.
But the spread among strangers in the Hong Kong hotel and among nine tourists on a March 15 China Air flight from Hong Kong to Beijing has heightened fears.
Numerous schools in Hong Kong and Singapore have closed and hospitals are straining to treat their own doctors and nurses. Hong Kong media reports say about 60 schools are closed, although government officials have not confirmed that. Singapore’s school closings, from day-care centers to junior colleges, will keep a half-million students temporarily out of class.
“On purely medical grounds, there are currently no strong reasons for closing all schools,” said Teo Chee Hean, Singapore’s education minister.
But he said parents are fearful.
Singapore also has imposed a 10-week quarantine on 740 people exposed to the disease. The U.S. State Department is urging against travel to Vietnam. Officials in the Philippines urged travelers from countries hit by the disease to stay home for a week. Tens of thousands of Filipinos work in Hong Kong and Singapore, many as domestic helpers.
WHO officials say signs continue pointing to a virus causing the common cold as the most likely bug behind the illness. Labs for the U.S. Centers for Disease Control and Prevention and Hong Kong University said they had found the coronavirus in specimens from SARS patients. The coronavirus can be blamed for about 10 percent to 20 percent of common colds.
Today, virus experts at the Bernhard Nocht Institute for Tropical
Medicine in Hamburg, Germany, backed up that evidence with their own
research (Seattle Times, 2003).