from asian Times SARS: The global spread continues

[Dave Farber <dave () farber net>]

http://www.atimes.com   
 
China 
SARS: The global spread continues
By Christopher Horton
BANGKOK - This weekend was a bad one for those who are trying to battle the
mysterious disease known as severe acute respiratory syndrome (SARS). A
flurry of new cases in Hong Kong, new fatalities in Canada and the death in
Thailand of the first doctor to identify SARS, rumors that the virus is
airborne, and fears that the epidemic is still in its infancy have shaken
both the affected areas and health officials worldwide.
Because of the nature of SARS, which can resemble common illnesses such as
colds or the flu and is believed to take up to two weeks before manifesting
symptoms, the available statistics from every region hit by SARS may
severely overestimate or, more dangerously, underestimat the number of
people infected. According to information released by the World Health
Organization last Thursday, combined with non-WHO updates from around the
world, more than 1,048 people had been infected and 56 people had died since
the disease emerged in China last November.
Thailand
On Saturday, Carlo Urbani, the Italian doctor who first identified SARS died
in Bangkok from SARS symptoms. Public Health Minister Sudarat Keyuraphan
said that despite its first death related to SARS, Thailand is still safe
from the disease. Health officials at Bangkok's Don Muang International
Airport are screening incoming passengers for the disease, Sudarat said.
Since the inception of the screenings, about a dozen people have been
quarantined. Most were released within a few hours of being quarantined, but
some were kept more than a day, she added. The airport screenings are a
reaction to the spread of SARS outside of Thailand rather than within the
country, Sudarat said.
Urbani, a Geneva-based WHO doctor, was receiving treatment for symptoms he
developed after he became the first person to identify SARS while in
Vietnam. The Chinese-American businessman who later became the first
confirmed SARS-related death was treated by Urbani in Hanoi, where the virus
quickly infected 46 people, including several health workers, such as
fatality No 7 in the SARS outbreak, a Vietnamese nurse who had been working
with Urbani in caring for the American patient.
As for those who treated Urbani in Bangkok before his death, Charal
Trinvuthipong, director general of Thailand's Department of Communicable
Disease Control, said 33 medical personnel took care of Urbani. Comprising
both Thais and foreigners, the medical personnel have been screened for the
disease and are still under close watch, Charal said.
Meanwhile, the Thai government urged its citizens not to visit Canada, Hong
Kong, mainland China, Taiwan, Singapore or Vietnam, the countries worst hit.
Thailand, which has a thriving tourism sector, would not only suffer a major
economic blow to the industry were it to develop new cases of SARS, but it
would also likely become a new global hub for the virus via Don Muang
International Airport, one of Asia's major air hubs. WHO has attributed at
least three confirmed SARS cases to Thailand.
Hong Kong 
In Kowloon, a portion of Hong Kong contiguous with mainland China, an
upscale residential complex witnessed the fastest localized outbreak of the
global epidemic. In the four-day period ending on Sunday, confirmed SARS
cases in the Amoy Gardens residences shot up from seven to 121. The chilling
speed at which the disease spread prompted numerous health officials to
surmise that SARS was spread through the air. Like most aspects of the
disease, however, the current information about how the disease spreads is
still no more than educated guesses.
As previously reported in Asia Times Online on March 18 (HK plays down
pneumonia fears), it took more than two weeks for Hong Kong Secretary for
Health, Welfare and Food Dr Yeoh Eng-kiong finally to admit that the SARS
virus has spread throughout the community. During the two weeks when Yeoh
and his associates repeatedly urged Hong Kong residents not to worry as the
virus was spreading only within isolated hospital wards, the number of
non-medical people infected by SARS quietly rocketed.
The rapid spread of SARS through Amoy Gardens led the US Centers for Disease
Control and Prevention (CDC) to say over the weekend that SARS may still be
an epidemic in its infancy.
"What we know about respiratory viruses suggests that the potential for
infection of a large number of people is very great," CDC director Julie
Gerberding said. "We may be at the very early stages of what could be a much
larger problem." 
China 
Mainland China is considered to be the origin of SARS, specifically
Guangdong province, an economically vibrant province adjacent to Hong Kong.
There is a growing feeling of resentment among residents and doctors of both
Guangdong and Hong Kong toward the mainland Chinese government regarding the
conspicuous lack of information that has been offered to the public. Indeed,
to this day Chinese officials maintained their tight-lipped posture
vis-a-vis a major health epidemic in the world's most populous country.
A crucial time in the spread of the disease in March may have been the two
weeks during which the National People's Conference (NPC), China's
legislative assembly, was held in Beijing. During the NPC, Beijing enforced
a strict media blackout regarding SARS. Other than a brief mention in
Chinese newspapers in February, SARS has had next to no presence in Chinese
media. 
Last Wednesday the Chinese government revised its SARS statistics for the
first time since admitting that five people had died since November.
According to the updated official statistics, 34 Chinese have died from
SARS, including three in Beijing, and 792 have become infected.
Last November, an outbreak of a mysterious illness widely believed to be
SARS affected Guangdong province, prompting panic-stricken residents to
clear store shelves of face masks and vinegar, which Chinese boil as a
disinfectant. 
Due to Beijing's previous silence about and denial of the epidemic coupled
with its massive population, there are also widespread concerns that SARS is
spreading at a rapid rate that is unreflected in the updated statistics.
According WHO, SARS has also spread inland to central China's Shanxi
province. 
Taiwan 
Taiwan, which is not officially a sovereign country, has become a victim of
the politics of China in the face of a global health epidemic. It has
complained repeatedly that it is receiving the cold shoulder from the WHO
and Beijing on an issue that should not be tainted by politics. All of
Taiwan's SARS cases that came from outside of the island are believed to
have come directly from the mainland.
During the four months that SARS was spreading within China, Beijing made no
mention of the phenomenon to the WHO, which is now attempting to work with
the Chinese government. In contrast, The WHO did little more than pass
Taiwan on to the US CDC, a move which baffled and insulted Taiwan's
government and people.
Singapore 
Some severe steps are being taken as both the Singaporean government and its
people become increasingly concerned about SARS, which had killed three
people there and made 89 ill as of late Sunday (Singapore time).
Last Wednesday the Singaporean government ordered the closure of schools
until April 6, affecting some 600,000 students in the city-state of 4
million people. There is already talk of extending the school closures.
Over the weekend, a sign at a pharmacy in the normally bustling Parco Bugis
Junction shopping center said it all: "Face masks out of stock". Outside the
same center, a line of taxis stretched halfway round the block, waiting for
patrons. 
"Few people are going out," said taxi driver Lim Teck Hua. "They are afraid
of the virus." He added that drivers had seen their earnings fall over the
weekend as there are so few clients.
But then again, he said, he and other drivers are themselves nervous. "If a
passenger starts coughing, we quickly open the windows," he pointed out.
But the abundance of taxis may also be due to another factor. The Health
Ministry announced last week that it was seeking a taxi driver who
transported an infected person to a hospital on Wednesday. The driver was
finally found on Sunday and put in quarantine.
The initial SARS cases in Singapore involved three women who had traveled to
Hong Kong. The most recent cases concern a designer who returned to
Singapore last Wednesday after visiting Hong Kong and Beijing and the fifth
person to import the virus: a 17-year-old Indonesian boy studying in
Singapore. With his parents and brother, 15, he left Singapore for Guangdong
and Hong Kong on March 15, a day after the Singaporean government advised
against traveling to SARS-hit areas. They returned on March 23, and on March
24, the boy was back in school. The following day, he and his mother came
down with fevers. They went to a hospital, where his mother remained and he
was sent home. On Thursday, health officials who checked on him at home
found that his condition had worsened. He was quarantined and diagnosed as
having SARS this past Saturday.
While some locals have been debating whether the government can do more to
combat the disease, Singaporean authorities have generally been praised by
international observers for their measures.
Vietnam 
Vietnam has proved to be the luckiest of the countries significantly
affected by SARS. Although it has had SARS cases for a month now, only four
people have died and 58 have been infected. Considering that Vietnam lacks
the funds and technology of Hong Kong and Singapore, which are faring poorly
in their battles against SARS, it is a small miracle that SARS has done such
little damage to this Southeast Asian country.
The containment of SARS in Hanoi is attributed to the close-knit community
within the hospital that received the first patient identified as infected
with SARS. "The French hospital is quite an enclosed community with people
working close together," said Aileen Plant, coordinator of the WHO team sent
to help Hanoi with the outbreak.
"It may be that rather than spreading the virus externally they infected
each other," Plant added. "In the end we're guessing and we won't really
know until the outbreak pans out in Hong Kong and Singapore."
The hospital's prompt reporting of the illness to WHO is also credited with
what has so far been a relatively successful containment of SARS.
Canada 
Canada is the hardest-hit country outside of Asia so far, with Toronto in
particular showing a disturbing increase in confirmed cases at 28, with
three fatalities. The Ontario provincial government has declared a health
emergency. Two of the three patients who succumbed to SARS were treated at
Scarborough Grace Hospital. Anyone who has been to the hospital in the last
two weeks has been asked by provincial health authorities to quarantine
themselves at home. There have also been SARS cases confirmed in the
west-coast province of British Columbia and in Ottawa, the national capital.
More than 40 Toronto-area homes have been quarantined by authorities.
United States 
The United States, unlike other countries, reports its suspected cases and
confirmed cases in one lump total, so it is difficult to interpret the 45
cases attributed to the US by WHO. What is known is that there are believed
to be five cases in New York City.
According to the Bureau of Communicable Disease of the New York City
Department of Health and Mental Hygiene (DOHMH), there are at least five
suspected cases of SARS in New York, ranging from a seven-year-old girl to a
67-year-old man. This does not include the Singaporean doctor who passed
through the city en route to Frankfurt, Germany, where he was quarantined.
Three of the New York cases, including the young girl, were not
hospitalized. The older man was discharged from the hospital, and another
man was still hospitalized as of Sunday night, New York time.
The DOHMH announced in a news release that it "is working closely with
hospitals and medical providers to increase their awareness of SARS and to
help them rapidly identify any cases that arrive in the city. As a
precautionary measure, DOHMH issued an alert this past weekend to hospitals
asking them to immediately report any illnesses suspected of being SARS.
Persons who may have recently traveled to Southeast Asia destinations within
the last 10 days should be aware of these main signs and symptoms of SARS.
Anyone who traveled recently to Southeast Asia and experiences symptoms of
SARS should seek medical attention."
(With additional reporting by Inter Press Service)
From February 1 to March 27, 17:30 GMT+1
Country     Cumulative number of case(s)     Number of deaths     Local
transmission* 
Canada      28     3     Yes
China +      806    34     Yes
China, Hong Kong     367     10**     Yes
China, Taiwan      6     0     Yes
France      1     0     None
Germany      4     0     None
Italy      2     0     None
Republic of Ireland      2     0     None
Romania      3     0     None
Singapore      78     2     Yes
Switzerland      2     0     To be determined
Thailand      3     0     None
United Kingdom      3     0     None
United States      45 §     0     To be determined
Vietnam      58     4     Yes
Total     1408     53      Source: World Health Organization
Notes: 
Cumulative number of cases includes number of deaths.

As SARS is a diagnosis of exclusion, the status of a reported case may
change over time. This means that previously reported cases may be discarded
after further investigation and follow-up.

*National public health authorities report to WHO on the areas in which
local chain(s) of transmission is/are occurring. These areas are provided on
the list of Affected Areas.

+ 792 cases, including 31 deaths, reported from Guangdong province cover the
period November 16, 2002, to February 28, 2003. These cases were compiled
from investigations as well as hospital reports and may include suspect as
well as probable cases of SARS.

§ Due to differences in the case definitions being used at a national level,
probable cases are reported by all countries except the United States of
America, which is reporting suspect cases under investigation.

**One death attributed to Hong Kong Special Administrative Region of China
occurred in a case medically transferred from Vietnam.

(©2003 Asia Times Online Co, Ltd. All rights reserved. Please contact
content () atimes com for information on our sales and syndication policies.) 

 

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