[SARS] April 25, 2003 daily thread

I haven't see the daily thread started yet, so here goes.

I was just watching the local news, and they said that China has quarantined 4,000 people today, and quarantined a second hospital. It was the lead story.

They also talked about the incident at SFO with the sick passenger.

The Times Of India

Air-India cancels 5 flights from Mumbai

PTI[ FRIDAY, APRIL 25, 2003 11:30:40 AM ]

MUMBAI: Air-India on Friday cancelled five flights from here following an agitation by the pilots' union. The flights cancelled are to Dubai (AI 713), Delhi-London (AI 129), Delhi-Hong Kong (AI 310), Chennai-Singapore (AI 472) and Kuwait (AI 859), according to an A-I official.

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The airline is working out a contingency plan following the agitation by Indian Pilots Guild (IPG), which is demanding a certificate from the airlines that the accompanying crew have not flown into SARS affected region for the past 10 days.

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An A-I spokesman said that flights to the US via London and Paris by Boeing 747-400 were being operated behind schedule. A few A310 flights had been affected because of non-availability of executive crew, he added.

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Civil Aviation Minister Shahnawaaz Hussein on Friday said that Indian Pilots Guild (IPG) had not given a strike notice so far. Indian Pilots Guild would meet Civil Aviation Secretary K Roy Paul, who was also the chairman of Air-India, Hussein said.

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Air-India spokesman Jitendra Bhargava said that the meeting could take place on Saturday.

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Bhargava described as "untrue the reports that all Air-India flights are being disrupted due to the pilots agitation."

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He said, "only three to four flights could be affected and there was a possibility that nearly half of the A301 flights operated by Air-India could be cancelled following the strike."

http://www.indiatimes.com/it/news/news9.htm

http://straitstimes.asia1.com.sg/singapore/story/0,4386,185183,00.html?


Hospitals coping despite strain on resources

THE six public hospitals here are coping fairly well with the Sars outbreak even though some are feeling a strain on resources.

Alexandra Hospital, which has not seen any Sars cases and is a 'very small hospital', has to bear the load passed on from Tan Tock Seng Hospital (TTSH) and Singapore General Hospital (SGH), Health Minister Lim Hng Khiang told Parliament yesterday.


KK Women's and Children's Hospital has been free of Sars cases and is 'managing very well', while Changi General Hospital has not had any cases since the end of last month.

Mr Lim said SGH was 'doing okay until the recent episode with Dr Alex Chao'.

Dr Chao, a cardiovascular surgeon at SGH, died on Tuesday night after being treated at the hospital for dengue fever.

The cause of his death is still being investigated.

The National University Hospital is still trying to keep under control a new cluster of cases that are linked to a 64-year-old patient whose brother sparked an earlier cluster at SGH.

Morale has been high at TTSH because none of the health-care workers there have contracted Sars in the last six weeks, the minister said.

The 40 rooms for intensive care have been sufficient so far, with only about 20 being used at a time.

But the same cannot be said for the isolation rooms, which are 'now very stretched'.

This has been especially so since the authorities appealed to those who had been to the Pasir Panjang Wholesale Centre to come forward for screening.

Mr Lim said: 'Because we don't have a diagnostic kit, we have to keep them in individual isolation suites to watch them for some time. So they are filling up very quickly.'

http://www.bernama.com/misc/sars/index.html


A snip from article:

SARS: Care for Probable SARS Cases

· Probable SARS cases should be isolated and accommodated as follows in descending order of preference:
1. negative pressure rooms with the door closed
2. single rooms with their own bathroom facilities
3. cohort placement in an area with an independent air supply, exhaust system and bathroom facilities
· Turning off air conditioning and opening windows for good ventilation is recommended if an independent air supply is unfeasible.
Please ensure that if windows are opened they are away from public places
· WHO advises strict adherence to the barrier nursing of patients with SARS, using precautions for airborne, droplet and contact
transmission
· All staff, including ancilliary staff should be trained in the infection control measures required for the care of such a patient
· If possible, identify a member of the staff who will have the sole role of observing the practice of others and provide feedback on
infection control
· Disposable equipment should be used wherever possible in the treatment and care of patients with SARS and disposed of
appropriately. If devices are to be reused, they should be sterilized in accordance with manufacturers' instructions. Surfaces should
be cleaned with broad spectrum disinfectants of proven antiviral activity
· Movement of patients outside of the isolation unit should be avoided. If moved the patients should wear a N 95 mask
· Visitors, if allowed by the health care facility should be kept to a minimum. They should be issued with personal protective
equipment
(PPE) and supervised
· All non-essential staff (including students) should not be allowed on the unit/ward
· Handwashing is crucial: therefore access to clean water is essential. Hands should be washed before and after contact with any patient, after activities likely to cause contamination and after removing gloves
· Alcohol-based skin disinfectants could be used if there is no obvious organic material contamination
· Particular attention should be paid to interventions such as the use of nebulisers, chest physiotherapy, bronchoscopy or
gastroscopy; any intervention which may disrupt the respiratory tract
· PPE should be worn by all staff and visitors accessing the isolation unit
· The PPE worn in this situation should be:
N95 mask as a minimum
Single pair of gloves
Goggles
Disposable gown
Apron
Footwear that can be decontaminated
· All sharps should be dealt with promptly and safely
· Linen from the patients should be prepared on site for the laundry staff. Appropriate PPE should be worn in this preparation and the linen should be put into biohazard bags
· The room should be cleaned by staff wearing PPE using a broad spectrum disinfectant of proven antiviral activity
· Specific advice concerning air conditioning units will be available soon


Links

1- Ministry of Health : www.moh.gov.my
2- Information about SARS by MOH : http://webjka.dph.gov.my/sars/
3- WHO : www.who.int/csr/sars/guidelines/en/

The Standard

Mum killed by virus worked for HSBC
Staff reporter

The 34-year-old mother who died of coronavirus pneumonia was an employee of HSBC, the bank said.

The bank also said five other staff who had been infected were recovering.

Eva Hui, who was employed on the fifth floor of the bank's headquarters in Central, died on Tuesday night of the disease, said Gareth Hewett, spokesman for HSBC.

She was a resident of the Amoy Gardens housing complex that has accounted for a fifth of Hong Kong's 1,488 infections.

Hui was one of six HSBC employees to contract the disease. The others are believed to have contracted the illness outside of work.

``As far as I am aware, there was no infection at work,'' Hewett said.

Hui was admitted to Princess Margaret Hospital on April 3 and gave birth on the same day.

She was one of three SARS-infected women whose babies had been delivered by Caesarean section, and the second to have died. The first was also a 34-year-old woman who died on April 14.

Hui's baby remained in a stable condition, a Hospital Authority spokesman said. The other two babies were in a serious condition.


All three mothers were taking the anti-viral drug ribavirin.

25 April 2003 / 02:05 AM



http://www.thestandard.com.hk/thestandard/news_detail_frame.cfm?articleid=38475&intcatid=1

The Standard

Primary Six test scrapped

Michael Ng and Matthew Lee

Primary Six students will not have to sit for an assessment test at the end of the current school year.

According to Deputy Secretary for Education and Manpower Cheng Yan-chee, the bureau would not be asking schools to submit final year assessments as primary classes remained suspended indefinitely.

He said the banding of individual Primary Six students in their respective school nets would now be determined by the internal assessment results obtained in the second half of Primary Five and the first half of Primary Six.

The announcement came as Secretary for Education and Manpower Arthur Li announced that all junior secondary students would return to their classes on Monday.

He said classes at primary schools and kindergartens would remain suspended indefinitely.


Li dismissed fears that there would be a recurrence of the chaotic conditions that occurred in several schools on Tuesday as form three and above students queued to have their temperatures checked.

In some cases, classes were delayed by up to an hour.

``When classes resumed [on Tuesday], some parents did not check their children before they left, resulting in queues at school,'' he said. ``The situation has improved since then.''

Li said his bureau had already dispatched two more ear thermometers to each secondary school.


Li said the bureau would study the results of Monday's return to school and the viral pneumonia situation before deciding on when to recall primary, kindergarten and special school children. He said that, up to yesterday, 70 students had contracted viral pneumonia, compared with eight cases before the bureau suspended all classes late last month. But he stressed that none of them had contracted the disease at their respective schools.

Meanwhile, the Jockey Club has donated HK$100 million to help secondary and primary schools to hire additional cleaning staff and to purchase disinfection supplies.

25 April 2003 / 02:05 AM

http://www.thestandard.com.hk/thestandard/news_detail_frame.cfm?articleid=38474&intcatid=1

HEALTH DEPT.- NYC - COMMUNITY TRANSMISSION OF SARS EXPECTED!

Fair use for discussion purposes:



http://www.newsday.com/news/health/ny-nybox253253427apr25,0,6344227.story?coll=ny-health-headlines

18 'Possible' Cases in NYC
The Associated Press

April 25, 2003

The city now has 18 "possible" cases of severe acute respiratory syndrome, two of which are also classified as "probable" cases under new federal guidelines, the Health Department said yesterday.

All of those involved had traveled to areas of the world where transmission of the disease has been documented. They are all improving and only two are currently hospitalized, said Health Department spokeswoman Sandra Mullin.

"Without a definitive test for SARS, it is still not certain whether any of these individuals have SARS or a routine respiratory infection," the department said in a statement.

There have been no secondary cases of SARS spread to household members or health care workers in the city. And no one has tested positive for the coronavirus believed to cause SARS.

Despite the upbeat news, the department said that because of the persistence of the illness, combined with the large number of travelers to New York City, "it would not be unexpected if community transmission of SARS occurred in New York City in the future."

The U.S. Centers for Disease Control and Prevention in Atlanta recently revised the case definition of SARS, distinguishing between "suspect" and "probable" to conform with the World Health Organization's definitions.
Copyright © 2003, Newsday, Inc.

THIS ARTICLE ILLUSTRATES HOW DIFFICULT IT IS TO MANAGE AN EPIDEMIC WITH CITIZENS OF DIFFERENT LEVELS OF EDUCATION AND INTELLIGENCE.

Fair use for discussion purposes:



http://www.newsday.com/news/health/ny-hssars253253434apr25,0,3692922.story?coll=ny-health-headlines

SARS Panic Growing
Beijing closes off a major hospital
By Laurie Garrett
STAFF CORRESPONDENT; This story was supplemented with wire service reports.

April 25, 2003

Beijing - China shut down a major hospital here yesterday - one with more than 2,000 employees and 1,200 beds - ringing the block with police tape and masked, armed guards to prevent anyone from entering or exiting.

The closing of People's Hospital, the prestigious teaching facility of Beijing University, was another attempt to contain the spread of SARS - severe acute respiratory syndrome - in a city sent reeling in the past few days as the reality of the mystery disease has set in. The city's official tally continues to grow, reaching almost 775 cases and 39 deaths.

Government signs posted outside the hospital said the people and buildings were under quarantine, and "when the disease situation is effectively controlled the quarantine measure will be cleared." A university official told The Associated Press the hospital was being disinfected and an unknown number of patients and 2,262 employees were moved for observation to another hospital.

Another Beijing hospital was sealed off today with no visitors allowed in, said a hospital official who declined to be named. Throughout the city anxious residents, fearing stores may be closed or a quarantine imposed as preventive measures, emptied grocery stores of rice, oil and frozen food in a bout of panic-buying.

And about 4,000 people who have had "intimate contact" with others showing SARS symptoms have been ordered to stay at home under quarantine, a Beijing health official said today.

The announcement by Guo Jiyong, deputy director general of the Beijing Health Bureau, came two days after the capital said it was invoking emergency powers to quarantine people exposed to the virus that causes severe acute respiratory syndrome. Guo didn't say who the people 4,000 people were or how long they had been ordered to stay home.

The dramatic steps followed the illness last week of a university student who developed pneumonia and was treated at People's Hospital. After a few days, the hospital released the student, according to other students, saying she was cured, and she returned to her dormitory and to classes. A few days later her symptoms returned and she spread SARS to 22 other students, Dr. He Xiong, chief epidemiologist of the Beijing Center for Disease Prevention and Control, acknowledged at a news conference yesterday.

The girl became so ill that she could not move. When ambulance drivers saw her condition, they refused to handle her, and students pooled their resources to hire "floating people" - migrant workers - to haul her back to People's Hospital. SARS then quickly spread inside People's Hospital, and the Beijing CDC feared the virus might be spread in the ventilation system.

Now the multistory, city block-sized building is being inspected in an effort to learn how the infection spread, He said.

Normally, People's Hospital houses the bulk of China's AIDS patients. Yesterday authorities declined to address whether rapid spread may have been due to the presence of a large population of patients with immune deficiency.

Such closings and other disease prevention policies - some of dubious benefit - have been enacted across SARS-impacted regions of Asia. Governments and the public are responding with scrubbing, hygiene campaigns, disinfection, masks, gloves and quarantines. Restrictions have been placed on businesses and travel, and bleaching of surfaces has been promoted in efforts to rid the virus from the environment.

But it is not at all clear that the virus is, in fact, an environmental agent - at least, not one found floating in the air. Nevertheless, many measures appear to reflect the ancient miasma theory of disease, in which pathogens seemed to be part of "bad air" or dirty environs. Last weekend, for example, Hong Kong executed a citywide cleanup day, bleaching every public space. Beijing authorities now require all cabbies to disinfect their taxis four times a day. And yesterday the municipal government shut down the largest library in the city to prevent large numbers of people from congregating.

But Dr. Jeff McFarland, the World Health Organization's Beijing-assigned epidemiologist, said the answers to this outbreak aren't yet understood.

"The role of public health officials is to answer these very important questions and give that data to politicians so they can make rational decisions," he said in an interview. "The difficulty is, not all the answers are in. And in the face of uncertainty, of unknown risk, people seem to become paralyzed, terrified.

"Our public health response has to be to get these answers as fast as possible."

City officials here have been handing out masks and bleach kits to promote cleanliness - a 70-year-old illiterate man died on Wednesday, apparently because he thought he was supposed to drink the bleach to stay free of SARS.

Beijing has become a city rife with rumors: One insists that 10 "floating people" had become infected and passed the virus to 300 others - and, as a result all of the estimated 750,000 migrant workers, whom most permanent residents of Beijing consider dirty, will be rounded up and sent back to their agrarian homes.

Another posits that the military will take control of the city, forcing the populace to remain indoors until the epidemic passes. In response, residents are stocking up from supermarkets in anticipation of a long homebound siege.

The CDC's Dr. Tang Yaowu said yesterday the agency is trying to find and monitor every close associate, family member and neighbor of individuals under quarantine.

Dr. He said there may be other outbreaks across Beijing related to ambulance drivers' refusals to handle potential SARS cases. Authorities have introduced a squad of 30 ambulances to handle only SARS cases, and created a 24-hour hotline for reporting suspected cases. There's also evidence, He said, that the illness has not been contained to large hospitals, that the virus is in "secondary and even lower hospitals. Even the lower hospitals cannot satisfy the demand of so many patients in Beijing."

Given the experience in Hong Kong of the Amoy Gardens apartments, in which more than 300 people became infected after the visit of a single SARS patient, Beijing authorities are hard-pressed to ensure the virus will not spread inside apartment complexes, dormitories and workers' housing facilities in which individual cases have been found.

Given such uncertainties it is perhaps not surprising that Beijing authorities and citizens are nervous, and "nowadays society is a little bit over-reacting," He said. "It's not necessary to wear a mask outdoors, for example. There is little bit of panic out there."

This story was supplemented with wire service reports.

Understanding SARS

Severe acute respiratory syndrome (SARS) appeared in China last fall and quickly

spread to other nations. A few thousand cases have been reported and most infected people recover fully.

What It Is

SARS is a type of coronavirus, germs that cause colds in humans and serious diseases in animals.

Symptoms appear 2 to 7 days after infection

Person with symptoms can spread virus through saliva, mucus,other body fluids

Requires immediate medical treatment

Symptoms

100.4-degree fever, chills, headaches, body aches.

Dry cough

Difficulty in breathing in some cases as fluid fills lungs.

Treatment:

Antivirus drugs oseltamivir, ribavirin

Antibiotics can't kill SARS virus, but keep bacteria from infecting.

In First Cases Reported:

4% death rate

10% to 20% required mechanical breathing assistance

Source: U.S. Centers for Disease Control and Prevention *Not yet known exactly how long

How It Spreads:

In general, by close contact with infected person.

Infected person coughs or sneezes.

Droplets and virus spray into air.

Virus can survive for hours.*

Enters through nose, infects sinuses, reproduces.

Moves to lungs, into bloodstream.
Copyright © 2003, Newsday, Inc.

Death Rate for Global Outbreak Rising

http://www.washingtonpost.com/wp-dyn/articles/A35146-2003Apr24.html
Death Rate for Global Outbreak Rising


By Shankar Vedantam and Rob Stein
Washington Post Staff Writers
Friday, April 25, 2003; Page A01


The death rate for the worldwide outbreak of severe acute respiratory syndrome, which has fluctuated for months, has recently begun what looks like an ominous rise.

As of yesterday, 263 people have died of SARS worldwide. Although the rate of deaths from the strange new illness initially hovered as low as 3 percent, it has soared to twice as much in recent days, prompting questions about whether the virus is growing more lethal, spreading faster or striking more vulnerable people.

The questions are easier to ask than answer, because the epidemic is still in its early stages: The virus could indeed be killing more people than it did a few weeks ago, researchers say, possibly because of some unknown mutation that has made it more deadly. Equally likely, however, the virus's lethality may not be changing at all -- and the changing numbers may simply reflect statistical aberrations or even changed definitions of what constitutes a case of the disease.

The death rate "has gone from 3.5 and 4 percent, and is now between 5.9 and 6 percent," said Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, yesterday. "The fact that it is changing is not at all surprising, given that the case definition is changing. . . . Different countries are using different definitions."

Still, the rising numbers are cause for concern for three reasons. First, the current -- higher -- death rate is statistically more reliable than the previous -- lower -- estimates.

Second, as hospitals learn to cope with the outbreak and doctors find ways to treat or stabilize patients, the death rate ought to head down, not up.

Finally, large numbers of cases so far, especially in places such as Hong Kong and Singapore, have involved hospital workers, who tend to be younger and healthier. As the SARS virus has spread to the general population in some places, it may strike more vulnerable elderly people and increase in lethality.

Statistics in Hong Kong show that the death rate among people younger than 55 is 3.6 percent. For patients between 65 and 75, it is 18.9 percent. For those older than 75, the death rate is 28.6 percent.

In Canada, the death rate yesterday as reported by the World Health Organization was 10.71 percent, one of the highest in the world, with most of the cases in the Toronto area. The number was based on WHO's count of 15 deaths and 140 cases.

"In Canada, the death rate seems to be very high," said David Brandling-Bennett, deputy director of the Pan American Health Organization in Washington, WHO's regional office. "One wouldn't expect to see higher death rates in Canada -- it may depend on the intensity of the exposure. The more viral particles you get, the more severe the disease."

However, Andrew Simor, who has been treating SARS cases in Toronto, argued that the death rate in Canada is no higher than elsewhere. He said that communication lags meant that the WHO statistics are not always based on the latest figures: "We have 16 deaths out of 270 cases," he said, for a death rate of about 5.93 percent.

Still, Simor acknowledged, "We do have a sicker population," in part because a larger number of elderly people have been exposed. "Fifteen percent end up on a ventilator. . . . The older you are, the more likely you are to run into serious disease."

Such confusion and uncertainty is common in the early days of a worldwide epidemic such as SARS. Doctors do not yet have a practical laboratory test for the virus, meaning that some people with garden-variety influenza are probably being counted as SARS patients, while others, who really have the illness, are being left out of the calculations, said Marc Lipsitch, an epidemiologist at Harvard's School of Public Health.

Additionally, countries such as China, with the largest number of cases in the world, started out trying to mislead WHO about the true extent of SARS, placing national prestige and economic concerns over public health.

Finally, epidemiologists say that the overall number of SARS cases in the world has only recently soared to the size necessary to draw meaningful statistical conclusions about the death rate, which is calculated by dividing the number of deaths by the number of people infected.

Yesterday's statistics, for example, counted 4,439 cases of SARS and 263 deaths worldwide, for a death rate of 5.92 percent.

Lipsitch said a larger number of cases yields a more reliable rate because it reduces the possibility of chance variations. With 40 SARS deaths among any 1,000 cases, the calculated death rate would be 4 percent, but statistically, it is equally likely that in the next 1,000 cases, the number of deaths will be anywhere from 29 to 54 -- yielding rates of 2.9 percent to 5.4 percent, he said. By contrast, with 4 deaths in just 100 cases, the rate for the next 100 cases is statistically likely to be anywhere from 1.1 percent to 9.9 percent.

Only two places, mainland China and Hong Kong, have enough cases to calculate meaningful local death rates: China's stands at 4.54 percent, while Hong Kong is at 7.32 percent.

One thing that worries health officials about SARS is that so far, it seems to be considerably more deadly than influenza, another major respiratory disease that has long afflicted humanity. SARS is the first life-threatening new disease to emerge in decades that can be spread from one person to another by casual contact.

Reliable death rates are available for the flu. In a typical year, it is usually below 1 percent. The Spanish flu pandemic of 1918-19 had a death rate estimated to have been 2 percent. It, however, killed perhaps 25 million people worldwide because it quickly swept the globe and infected millions.

"What made it such a big killer was that so many people were infected," said Stephen S. Morse, director of the Center for Public Health Preparedness at the Mailman School of Public Health of Columbia University. "When you have such a large numerator, then you can still have a tremendous impact."

The actual mortality rate from SARS is likely to be higher or lower than the 6 percent rate that is currently estimated. It may turn out that there are a large number of people who become infected but never fall ill. If that is the case, then the mortality rate will be much lower.

"We don't know what the true denominator is. We don't know the true number of actual SARS cases. So I think it's a safe assumption that it's going to change," Morse said.

The transmissibility of a disease is another key factor in determining how much of a threat it poses. Some diseases have high mortality rates but are not easily spread, so the overall number of people who die is low. That is the case with Ebola, for example, which has a mortality rate of 70 percent to 95 percent but does not spread easily.



© 2003 The Washington Post Company

Robert Lee has a new hypothesis....

http://www.bhc.edu/eastcampus/leeb/aids/goframe.htm

© 2003, Robert E. Lee, M.S., M.S.W., L.C.S.W., abdPhD
Further discussion of SARS Treatment hypothesis in context of FcgammaR inhibition:

Activation of monocytic cells through Fc gamma receptors induces the expression of macrophage-inflammatory protein (MIP)-1 alpha, MIP-1 beta, and RANTES [1]. Exposure of T cells to IFN-beta-1a selectively inhibited mRNA expression for RANTES and MIP-1alpha and their receptor CCR5. T cell surface expression of CCR5 was significantly reduced in MS patients treated with IFN-beta, correlating with decreased T cell transmigration toward RANTES and MIP-1alpha [2]. Synthesis of the CC-chemokines MIP-1alpha, MIP-1beta, and RANTES is associated with a type 1 immune response [3]. A definitive role exists for FcgammaRI and FcgammaRIII in microglial chemokine induction and implicate ERK and NF-kappaB as the signaling components leading to MIP-1alpha expression [4].

The NF-kappaB family of transcription factors forms one of the first lines of defense against infectious disease by inducing the expression of genes involved in inflammatory and immune responses [4a]. The transcription factor NF-kappaB is the central regulator for the expression of various genes involved in inflammation, infection and immune response including the genes for IL-1beta, TNF-alpha, IL-6 and leukocyte adhesion molecules [4b]. In vivo inhibition of nuclear factor (NF)-kappaB activation, a transcription factor regulating expression of many proinflammatory genes, could provide a useful strategy for the treatment of septic shock [4c]. TNF-alpha, IL-1beta, and TII induce expression of proinflammatory cytokines and ICAM-1 in hRPE cells through an NF-kappaB-dependent signal transduction pathway. This effect is blocked by MG-132, a proteasome inhibitor that prevents I kappaB degradation. Inhibition of NF-kappaB may be a useful strategy to treat proliferative vitreoretinopathy and uveitis, ocular diseases initiated and perpetuated by cytokine activation [4d].

Surfactant protein A (SP-A), the major lung surfactant-associated protein, mediates local defense against pathogens and modulates inflammation in the alveolus. Tumor necrosis factor (TNF)-alpha, a proinflammatory cytokine, inhibits SP-A gene expression in lung epithelial cells. TNF-alpha downregulates SP-A gene expression in lung epithelial cells via the p38 MAPK signal transduction pathway. [4e]. The p38 mitogen-activated protein (MAP) kinase is activated in various cells by proinflammatory cytokines and environmental stresses.

Pulmonary surfactant protein C (SP-C) is a 3.7-kDa, hydrophobic peptide secreted by alveolar type II epithelial cells. SP-C enhances surface tension lowering activity of surfactant phospholipids that is critical to the maintenance of alveolar volume at end expiration. The proinflammatory cytokine, tumor necrosis factor alpha (TNF-alpha), decreases SP-C mRNA within 24 h of intratracheal administration to mice. Inhibition of surfactant protein C gene transcription by TNF-alpha may contribute to the abnormalities of surfactant homeostasis associated with pulmonary injury and infection. [4f]. Macrophage-derived cytokines may control surfactant protein expression [4g].

Otsubu (2002) characterized a synthetic lung surfactant activity against proinflammatory cytokines in human monocytes. Their examination of the synthetic lung surfactant revealed the synthetic (SLS) to significantly and dose dependently inhibited the secretion of TNF-alpha [4h]. It would therefore appear that inhibiting TNF-a and action through of a surfactant would serve a bi-fold purpose as treatment in SARS.

Surfactant protein insufficiency contributes to the pathogenesis of pulmonary diseases associated with increased TNF-alpha, such as adult respiratory distress syndrome and pneumonia. TNF-alpha-mediated decrease in SP gene expression may contribute to the surfactant dysfunction and atelectasis observed in inflammatory lung diseases [4i].

The cascade detailed above, leading to hypoxia, there is some evidence that the hypoxia, itself, can further degrade surfactant [4j]. Hypoxia is a symptom of SARS infection [4k]. The SARS coronavirus, like other of the related coronaviruses, is likely to initiate the FcgammaReceptor cascade indicated above leading to hypoxia as a result of TNF-a degradation of lung surfactant.

Therefore, given that the above is true, it would appear that further methods of treatment of SARS would involve interventions in any of the following:

a) FcgammaReceptor inhibition
b) NF-kappaB inhibition
c) p38 MAP kinase inhibition
d) TNF-a inhibition
e) Provision of ancillary surfactant

NF-kappaB inhibition

Luteolin inhibits protein tyrosine phosphorylation, nuclear factor-kappaB-mediated gene expression and proinflammatory cytokine production in murine macrophages. Luteolin, a naturally occurring flavonoid, is abundant in our daily dietary intake. It exhibits a wide spectrum of pharmacological properties and is a leading anti-cancer natural flavinoid [6].
Luteolin is a flavonoid that has been shown to reduce proinflammatory molecule expression in vitro [7]. Luteolin is a normal secondary plant metabolite found throughout the plant kingdom [8].

Nitric oxide may be an important endogenous inhibitor of hyperoxia + tumor necrosis factor-alpha-induced leukocyte recruitment and subsequently tumor necrosis factor-alpha, and interleukin-1 beta [9]. This needs further study, however.

Studies are ongoing concerning development of other NF-kappaB inhibitors. For example, Possadas et al. (2003) [10] as well as research involving the NF-kappaB inhibitors phenylarsine oxide and lactacystin [11].

P38 MAP kinase inhibition

The MAP kinase p38 plays a key role in the biosynthesis of the inflammatory cytokines TNF-alpha and IL-1. p38 MAP kinase is a member of the family of kinases which mediate intracellular transduction pathways. The activation of this particular MAP kinase pathway is in response to a broad variety of extracellular stimuli. Subsequent downstream events triggered by p38 activation result in the production of IL-1 and TNF-a, suggesting that inhibition of this enzyme may provide a useful therapeutic target for intervention in various diseases mediated by these cytokines [11a]. Various working is ongoing concerning development of p38 MAP kinase inhibitors [11b].

TNF-a inhibition

Melatonin, a strong antioxidant, may offer some assistance in inhibition NF-kappaB and subsequent TNF-a induction [12]. Natural antioxidants may serve as potent NF-kappaB inhibitors in vascular endothelial cells, yet act through unique and divergent pathways. N-acetyl cysteine (NAC) has been shown to inhibit TNF-a activity[13].

Surfactants

Surfactants appear to be disturbed by the TNF-a activity of the FcgammaR disease-related conditions. Various efforts to use surfactants and other drugs and regimes have been employed [14] with varying success. It would appear that the hyperimmune feedback loop that is possibly seen in SARS may be causing surfactant damage via TNF-alpha. The hypoxia, itself, will further disturb surfactant ability to assist in oxygen uptake.

Taken all together, the above data suggest that it is a reasonable intervention to consider immune-suppression in some SARS cases as a means of intervening to stop surfactant deregulation. Caution is advised.

Much work needs to be done. However, there is some evidence that FcgammaReceptor activation may have some influence on HIV permissibility. FcgammaR-mediated activation of monocyte-derived macrophages is a potent mechanism of HIV-1 suppression [15]. FcgammaReceptor disorders including not only autoimmune diseases like systemic lupus erythematosus, rheumatoid arthritis, multiple myeloma, but also acquired immunodeficiency syndrome (AIDS), may now, perhaps, include SARS [16].

The sequelae of SARS remain to be seen. There is some evidence in the literature that there will be neurological sequelae. Analysis of the genome of SARS suggests it may have delayed neurotropic potentialities as do some of the other coronaviruses.


References

SARS ACTUAL DEATH RATE AROUND 20 PERCENT! NON-STANDARD CALCULATION METHOD USED DISGUISES REAL NUMBERS.

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Home » Asia » Counting victims: Discounting the SARS reassurance syndrome


Counting victims: Discounting the SARS reassurance syndrome
francis till
When New Zealand's director of public health, Colin Tukuitonga, said at the beginning of the month that 96 out of every 100 people who contracted SARS would recover, his prognostic powers may have been occluded by his second message: don't panic.

According to official figures, the mortality risk associated with SARS, first stated at 2 per cent and until recently at 4 per cent, now appears to be at about 6 per cent in the general population -- and much higher in some locations and among some demographic groups.

But those official figures may be massively understating the actual risk because they are based on a counting model that includes thousands of patients still in the throes of infection, says Dr Henry Niman, a surgery instructor at the Harvard Massachusetts General Hospital.

According to Dr Niman, the actual mortality rate is much closer to 20 per cent in the general population.

"Mortality rates are usually calculated on patients whose outcome is known," Dr. Henry Niman says. "(The CDC's number) would be accurate only if all patients hospitalized survived, which has not been the history of the disease in the more heavily affected areas."

Instead, Dr Niman contends the proper measure of mortality risk is the one used in other epidemics: the number of fatalities is divided by the sum of the number of recovered patients and the number of fatal outcomes.

Currently, official figures are developed by dividing the total numbers of deaths by the total number of infections, including those who have died, recovered and are ill. If 100 people are infected and 5 die, the mortality risk would be 5 per cent under this procedure. On the other hand, if 20 people in that population had recovered, the measurement pool would be 25: the number of recoveries plus the number of deaths. In that scenario, the mortality risk would be 20 per cent (5/25).

The model still in use developed primarily because the disease has a long cycle, it now appears, and health authorities were forced by public pressure to develop some method of estimating risk before there were enough recoveries to make meaningful the more traditional method of mortality projection.

Now that there are a substantial pool of recovered patients, Dr Niman says the CDCs of the world -- and the World Health Organisation itself -- should change their counting methods.

Dr Niman's call for a revision to the mortality risk assessment procedure has fallen on deaf ears in the US Centers for Disease Control and Prevention (CDC) and at the World Health Organisation (WHO), but has been a hot topic on SARS-related internet sites and discussion groups for much of the past two weeks.

Posting on 19 April to the influential discussion list run by Declan McCullagh through his Politechbot.com website, Dr Niman gave mortality figures for a range of locations that should shake many health officials like Mr Tukuitonga to the complacent core.

On 19 April, based on country-supplied data, Dr Niman says the actual death toll was:


Hong Kong 18.2 per cent

Canada 18.2 per cent

Singapore 13.8 per cent

Viet Nam 9.8 per cent

China, on 19 April, had a mortality rate of only 5.4 per cent, the lowest in the world.

By 22 April, the Chinese Ministry of Health reported a total caseload of 2158, a recovered population of 1213 (discharged from hospital), and 97 deaths. Under present WHO/CDC counting procedures, the mortality risk in China on that date was an astonishing 4.5 per cent (fatalities/total cases) -- but under Dr Niman's counting procedure stood at 7.4 per cent. Still low, but closer to the numbers being produced by other outbreaks.

China's figures are influenced deeply, some say skewed, by data from Guangdong Province, where the disease was first reported and which has consistently accounted for the bulk of infections in the country. According to health ministry data for 19 April, the total number of infections stood at 1330 with 1137 discharges and 48 deaths -- presenting a remarkably low mortality risk, the lowest in the world, under any method of counting.

In Beijing, where numbers of discharged patients are very low, the 19 April numbers point to a potential catastrophe: 588 cases, 46 discharges, 28 deaths. In other words, of the 74 patients with known outcomes for the disease, 38 per cent had died.

On 23 April, the health ministry reported 39 deaths and 64 hospital discharges in Beijing, meaning of the 103 cases with known outcomes there, 38 per cent had died -- and indicating the mortality pattern was holding and not merely the result of a reporting spike. In Shanxi Province, where a new outbreak appears underway, the health ministry reported on 23 April a cumulative total of 162 SARS cases including 45 among medical workers, 108 suspected cases, 7 deaths and 14 hospital discharges -- a 33 per cent mortality rate by Dr Niman's method of calculation, but an almost reassuring 6.5 per cent mortality risk by the WHO/CDC counting procedure.

Doctors recently asked by Wired Magazine about the mortality projections noted several factors that could be influencing the WHO/CDC in choosing to maintain their method of assessing risk.

One possibily is that the known SARS universe is extremely variable -- so the most general form of counting may be the best.

“We do not have an infection-specific death rate," Dr. John Zaia, chair and professor of virology at the City of Hope Beckman Research Institute in Duarte, California, told Wired. "That would be very valuable, because it could be that hundreds are getting infected but only small percentage are getting sick. That was the case for polio."

Also, according to Wired, the population of recovered persons may be under-reported because diagnostic procedures failed to identify them as SARS victims -- meaning that until patients can be definitively identified as suffering from SARS, all discussion about mortality risk is speculative.

Also, the population of recovered patients is still very small, allowing for anomolies to creep into tallies.

"Only a small proportion at present have a clear enough outcome that we can declare them recovered," said Dr. David Freedman, a professor of medicine and epidemiology at the University of Alabama at Birmingham, told Wired..

But there is another possibility -- fear of an even more virulent epidemic: panic.

If that is the case, and pronouncements from many political figures in SARS hotspots indicates it may be, it may be time to stop downplaying risk.

Panic is already a reality in China and other places where the disease has taken root, and much of it appears to stem from the belief that governments are not telling the truth -- which, in several high-profile cases, has clearly been the case.

Add to that the unfortunate fact that many well-intentioned medical authorities have followed the leads of the WHO/CDC on a wide range of SARS-related issues and issued ”definitive” guidance -- only to find out later that the advice was incomplete, if not wrong -- and an increasingly suspicious general public is left to react without a medical rudder.

Over the past several weeks it has become clear that the truth about SARS is a shifting chimera, revealing itself incrementally, often only after the epidemic has taken a new turn.

Infection, for example, is possible by a wide range of vectors, not merely the extensive, close personal contact with symptomatic patients that was the first claim of the WHO/CDC. The disease is not purely a respiratory infection, as has been long claimed -- indeed, doctors performing autopsies in Hong Kong have noted major organ failures as well. Nor is the disease source understood very well. In spite of claims that a new member of the family of common-cold spawing Coronaviruses was responsible, new research in Canada shows that virus present in only 40 per cent of probable and suspect cases.

Now, public health officials in New Zealand are suggesting that only symptomatic sufferers can be the source of contagion, even while other medical professionals are suggesting that some victims may not have symptoms -- but could still be carriers.

Uncertainties about the disease mean public health authorities cannot afford to ignore Dr Niman's statistics, especially not if they are doing so simply in the interests of preventing panic. They point to a much more virulent disease than previously thought, especially since they tend to bear out over a relatively long term.

Dr Niman wrote in Politichbot.com on April 20, for example, that “[t]he WHO data has been broken out into deaths and discharged for about 11 days and the numbers have been pretty consistent. The number discharged daily in Hong Kong has gone up quite a bit recently, but so have the fatalities, so the death rate hasn't changed much in the past 11 days:


April 20 17.5 per cent

April 19 18.2 per cent

April 18 17.6 per cent

April 17 19.3 per cent

April 16 19.2 per cent

April 15 18.7 per cent

April 14 17.0 per cent

April 12 14.0 per cent

April 11 15.9 per cent

April 10 16.3 per cent

“[t]he range is pretty wide for country to country, but has been pretty steady for the past 11 days:

Date Hong Kong Canada Singapore China

April 19 18.2 per cent 18.2 per cent 13.8 per cent 5.4 per cent
April 18 17.6 per cent 20.7 per cent 15.0 per cent 5.5 per cent
April 17 19.3 per cent 20.7 per cent 14.2 per cent 5.5 per cent
April 16 19.2 per cent 26.0 per cent 13.3 per cent 5.5 per cent
April 15 18.7 per cent 32.5 per cent 13.3 per cent 6.1 per cent
April 14 17.0 per cent 32.5 per cent 12.5 per cent 5.6 per cent
April 12 14.0 per cent 27.8 per cent 10.5 per cent 5.3 per cent
April 11 15.9 per cent 28.6 per cent 10.5 per cent 5.3 per cent
April 10 16.3 per cent 31.3 per cent 10.7 per cent 5.1 per cent

"The current motality rate in the teens for major sites isn't an upper limit, and the numbers could go higher," he wrote.

Unfortunately, officials in many locations with economies dependent on tourism and service appear to have been influenced by the potential for economic disaster and often seem to have raced to reassure anxious populations only to later discover they should have been far more aggressive in their warnings.

China, where medical authorities actually hid SARS victims and issued falsified reports about the extent of the epidemic is only the worst case in the reassurance syndrome -- and Beijing is almost certainly not the only or the last city to be found hiding SARS under the public health rug.

Recent reports indicate that the Shanghai government may be engaged in active suppression of medical news about the reach of SARS and the weblogging community is describing many instances of quarantine there, related to individual cases the government has not made public.

The weblog of Shanghai resident, Jian Shuo Wang, contains several such reports.

In one, dated 25 April, a Shanghai woman commented:

“My daughter's kindergarten claimed New Century Kindergarten is quarrantined. One parent of a child attending the school is in hospital for SARS treatment. Another kindergarten in Pudong closed yesterday also. Unknown situation out there.

“My health insurance sales guy called yesterday and told me to be extra careful, he claimed that there are over 200 cases in Shanghai.

“Sun Daily in HK reports that one doctor in Shanghai claimed he saw over 37 patients with full blown SARS in one hospital!”

Another commentator wrote:

“We're expats currently living on the island of Hainan, but the situation here is getting pretty grim. The government isn't admitting SARS is here, but everyone is restricted to their own village or town -- no traveling about the island. We're not even permitted to go into Haikou, which is the closest city (1 hour away). Anyone who leaves our village has to be quarantined upon returning. We're really not even supposed to leave our work unit except for necessary stuff. And we're not supposed to have ANY personal contact with mainlanders. Yesterday, I got in trouble for going out to get a massage and riding home with a guy from Beijing (even tho he's been here for 2 months). No more massages, no more socializing with folks from Beijing, Guangzhou, etc. Anyway, our contract isn't over til end of June, but we're thinking we'd better get out now -- at least one of us with the kids. They're starting to cancel flights in and out of Hainan -- yesterday all international flights and flights to Hong Kong were shut down.”

While the government maintains that there are only two known cases in the city, Time magazine is the latest external news agency to find those figures deeply flawed. In an article titled, “Shanghai SARS Cases a State Secret”, the magazine counts dozens of known cases in several hospitals, quotes a doctor as saying the WHO delegation visiting the city is being deceived, and said party officials told local ”official media” that they were “not to report any SARS statistics higher than the government-sanctioned figures” and that they were not “allowed to interview any SARS patients or their families. “

The reason? Time says central government figures, worried that foreign investors would back out of Shanghai the way they have in Hong Kong recently, told city officials to continue to promote the city as a SARS-free zone.

But few governments are that cynical. By most reports, governments appear to be erring out of a misplaced belief that reassurance is the lesser of two evils, with economic ruin the alternative.

New Zealand may be among the group of countries infected by that reassurance syndrome, as demonstrated by Colin Tukuitonga's appeal to the press early this month:

"Yes, there are risks and understandably people are anxious.
"But I'm appealing for people to put that in perspective.
"Be aware, know what to look out for but don't over-react," Mr Tukuitonga told reporters early in the month.

But even as Mr Tukuitonga was telling reporters that direct contact with an infected person was how the disease was transmitted, making the risk of infection very low in the general population, the WHO was issuing statements of concern that other vectors were possible, including sharing an airplane with an infected person, thus changing the advice it had earlier given and on which Mr Tukuitonga appeared to be relying.

Health officials in economies being staggered by SARS -- such as Toronto -- are quick to point out that the actual risk of infection is miniscule, whatever the mortality risk may be, and that deaths from pneumonia -- which are symptomatically related to SARS -- amount to much larger total numbers than anything so far seen from SARS.

Still, it is the risk to the public health system itself that has many worried, and it is a risk that is very real for under-resourced areas like much of New Zealand.

The demands made by SARS for specialist care in negative pressure isolation can stretch even advanced care facilities. Wellington Hospital infectious diseases physician Tim Blackmore was recently quoted as saying that while Wellington Hospital could easily cope with three or four Sars cases at once, any more would start to stretch resources.

And having hundreds of cases appear almost simultaneously, as has been the case in Beijing and other hotspots, may be one reason, unstated by health officials, why some mortality rates are so high.

The biggest challenge in care: as highest-risk health care professionals themselves become infected, the available treatment diminishes -- even as the demand for it grows.


25-Apr-2003



© 2001 NBR Ltd

4,000 in Beijing Sent Home Due to SARS

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Models of a foreign phone maker wear protective masks at China International Communication Technology Exhibition 2003 Friday April 25, 2003 in Shanghai. Even as WHO officials get set Friday to brief municipal government, consulates, and the media that Shanghai has more SARS cases than reported, it's not expected to have hidden cases as Beijing did. WHO investigator Wolfgang Preiser said late Thursday Shanghai's numbers will rise. (AP Photo/STR)

http://www.wtop.com/index.php?nid=106&sid=63339

4,000 in Beijing Sent Home Due to SARS
Updated: Friday, Apr. 25, 2003 - 6:27 AM EST.

By WILLIAM FOREMAN
Associated Press Writer

BEIJING (AP) - Beijing city officials told 4,000 people suspected of being exposed to SARS to stay home Friday as quarantined medical workers in Taiwan held a rowdy protest and Hong Kong hospitals were accused of not properly protecting frontline doctors from the deadly bug.

Countries worldwide were struggling to contain varying outbreaks of the flu-like illness that has already killed more than 260 and infected more than 4,300.

The former head of the U.S. Centers for Disease Control and Prevention said Friday in Hong Kong that doctors probably will never be able to eradicate SARS, but they should be able to bring down the numbers of infections and deaths.

"What we can hope for is a suppression and minimization," said Dr. Jeffrey P. Koplan, a former director of the CDC and now vice president of health affairs at Emory University in Atlanta.

"To think that magically this government or any government or any scientist in the world could stop this, like you stop a car at a stop sign, is very unrealistic," said Koplan, a consultant to SARS researchers at the University of Hong Kong.

In Toronto, tourism businesses braced for disaster after the World Health Organization added the city to a list of countries that people should avoid visiting. Sixteen people have died in Canada, most of them in Toronto.

In Beijing, officials sealed off Ditan Hospital _ the third medical center to be closed this month in the Chinese capital. Earlier this month, foreign reporters were allowed to tour the 500-bed Ditan, which officials considered a showcase of the government's efforts to battle SARS. The hospital specializes in infectious diseases.

So far, officials have reported 42 SARS deaths in Beijing and a total death toll of 115 nationwide. The country has reported a total of 2,422 cases, with more than 750 in Beijing.

Two days after invoking emergency powers to quarantine people, Beijing health officials ordered 4,000 people to stay at home because they had "intimate contact" with others showing symptoms.

Guo Jiyong, deputy director general of the Beijing Health Bureau, didn't say who the people were or how long they had been ordered to stay home.

China also said it would spend $420 million to set up a nationwide health network to fight SARS and other medical emergencies.

It has also earmarked $240 million to pay for emergency medical services for people with SARS who can't pay for their own care, Vice Premier Wu Yi said in a report to the national legislature.

In the Taiwanese capital of Taipei, about 30 nurses and workers were fed up with being quarantined for two weeks at the Hoping Hospital, which reported 10 probable SARS cases earlier this week. They complained that confining people could expose healthy staffers to the disease.

Some protested by tossing bottles and paper out of windows and displaying banners saying "Wrong Policy" and "Long, Long 14 days."

"This is ridiculous. Why can't I go home?" yelled a woman with a gauze mask tightly strapped to her mouth.

Taiwan has reported 41 probable cases, but no deaths.

Canadian officials said they would appeal the WHO travel advisory against travel to Toronto, noting that Canada's more than 300 probable and suspected SARS victims falls far below China and Hong Kong and they have aggressively tracked and isolated all cases.

"They don't know what they're talking about," Mayor Mel Lastman told CNN, referring to the WHO. "Who did they talk to? They've never even been to Toronto. They're located somewhere in Geneva."

In Hong Kong, local media accused the Hospital Authority of not providing enough protective gear for frontline workers _ hundreds of whom have been sickened by SARS on the job.

Many staff working in the 14 hospitals treating SARS patients have been wearing paper gowns that don't offer enough protection when workers come into close contact with SARS patients, the South China Morning Post reported.

The Hospital Authority's acting chief executive, Dr. Ko Wing-man, admitted to problems in dealing with the crisis that has infected about 1,500 people in Hong Kong and killed 109.

"I must admit the performance of the whole management, especially under my guidance, does not reach many people's expectations," Ko said in a radio interview.

In the Philippines, officials said Friday that two people have died of SARS and two others are infected. Previously, the government said the country was free of the illness.

Vietnam was counting down to Monday, when the World Health Organization is prepared to announce that it is the first country to have a local outbreak and then rid itself of the deadly bug.

Five people died in Hanoi after an outbreak at a hospital stemming from an infected patient from Hong Kong, but no new cases of the disease have been reported in Vietnam since April 8.

One WHO official said Friday he believes measures introduced to control the spread of SARS will eventually succeed.

"I think it is some way to go before we can say it is under control, but it is getting there," said Dr. Mark Slater, a medical officer from the WHO's Department of Communicable Diseases, Surveillance and Control. He spoke to reporters on the sidelines of a health conference in Malaysia.


(Copyright 2003 The Associated Press. All rights reserved.)

Toronto Struggles Under Siege From SARS

<IMG src="http://media.bonnint.net/apimage/NY109042423.jpg">

A woman wearing a mask shops on Spadina Ave. in Toronto Thursday, April 24, 2003. The World Health Organization issued an international travel advisory Wednesday for Toronto because of the SARS scare. (AP Photo/CP, Toronto Sun Photo-David Lucas)

http://www.wtop.com/index.php?nid=106&sid=66095

Toronto Struggles Under Siege From SARS
Updated: Friday, Apr. 25, 2003 - 3:49 AM EST.

By EMMA TINKLER
Associated Press Writer

TORONTO (AP) - A day after the World Health Organization warned people against traveling to Canada's largest city, Hillie Schmiedhammer sat with rows of untouched necklaces and rings at a shop in trendy Eaton Center mall.

"Usually by now, with the warmer weather, we have people from everywhere shopping here," Schmiedhammer said. "Even McDonald's is empty."

For the last month, severe acute respiratory syndrome has been spreading slowly through this city on the shore of Lake Ontario. Sixteen people have died nationwide. But Wednesday's travel advisory from the Geneva-based WHO came as a shock, and Toronto businesses are preparing for the worst.

Health authorities condemned the advisory as unwarranted, and Ontario Premier Ernie Eves demanded that the U.N. agency reverse itself.

"The actions of the WHO are wrong and they are irresponsible," Eves said. "The decision is not based on scientific fact."

Toronto has now joined Hong Kong, Beijing, and the Chinese provinces of Guangdong and Shanxi on the list of SARS hot zones _ much to the dismay of the city's outspoken mayor.

"They don't know what they're talking about," Mayor Mel Lastman told CNN, referring to the WHO. "Who did they talk to? They've never even been to Toronto. They're located somewhere in Geneva."

Canadian officials say they shouldn't be on the list, noting that the more than 300 probable and suspected cases is far below China and Hong Kong and they have aggressively tracked and isolated all cases of SARS.

Dr. James Young, the Ontario commissioner of public safety, said WHO officials failed to adequately explain the decision and seemed unaware of its consequences.

"They talked about it in rather cavalier terms," he said. "They talked about it like, well it's just a travel advisory, and it's a lot more than that."

Dr. Paul Gully, a federal health official, indicated Canada would tighten airport screening of passengers to detect possible SARS cases. WHO officials cited possible cases of people from Canada spreading the illness abroad as a reason for the advisory.

Britain, France, Ireland, Australia and Jamaica have also issued warnings about Canada similar to the WHO advisory.

In Canada, SARS was first felt in Toronto's 400,000-strong Chinese community _ the largest in North America.

The hardship is spreading to other parts of the city of 3 million, which accounts for a fifth of the country's total economic activity. Merchants are reporting business down _ particularly among American tourists.

"Slowly but surely as the threat has gotten worse I've noticed a definite decrease," said Charles McLachlan, manager of a computer store in the Eaton Center. "The city has basically emptied out."

No one wears masks on downtown streets, but McLachlan said customers _ the few he sees _ want change placed on the counter instead of in their hands.

Toronto's convention industry has also been hurt. The Independent Educational Consultants Association of Fairfax, Va., with 600 participants, moved its annual meeting from Toronto to Orlando, Fla.

Jim Flaherty, the Ontario enterprise minister, predicted "serious economic harm in the hotel and convention business," a mainstay of the Toronto economy.

"There's concern with respect to the summer season," he said.

The Toronto City Council held an emergency meeting on the situation Thursday, with Lastman depicting a grim situation.

"The businesses are hurting, they're hurting bad," he said. "People's lives are being adversely affected by both the disease and public perception of this crisis."

The mayor said he intended to ask banks to allow deferred payments on loans and mortgages, after previously asking businesses to try to keep employees on their payrolls.

"I don't want to see SARS cost anyone their jobs, their homes, or their businesses," he said.

It's too late for some in the tourism industry, said Paul Clifford, president of a local hotel and restaurant union. Hundreds of bell boys, cleaning staff, and waiters have been laid off.

At Eaton Center, shopper Christy Cummings said she was aware of SARS but not overly concerned as she strolled with her 3-year-old son.

"I've been washing my hands more, and my son's," she said, "but we're still taking the subways and doing what we normally do."


(Copyright 2003 The Associated Press. All rights reserved.)

China seals off second big hospital, denies martial law imminent

China seals off second big hospital, denies martial law imminent

BEIJING (AFP) - A second major Chinese hospital was sealed off and the government was forced to deny martial law was imminent as roadblocks were thrown up around Beijing to combat SARS.

The Ditan Hospital, treating more than 100 SARS patients including foreigners, was quarantined with some 600 medical staff told they cannot go home, hospital officials said.

"Before we were isolating the infectious disease ward within the hospital compound. Now the whole hospital is cordoned off," said a hospital official surnamed Zhao.

It follows the quarantining of the People's Hospital Thursday where more than 1,000 workers and patients were spending their second day in isolation after up to 55 Severe Acute Respiratory Syndrome cases were found.

The Beijing Youth Daily said the 1,000 included doctors, nurses, other staff members, patients and anyone else who happened to be in the hospital when it was ordered shut.

Nineteen confirmed or suspected cases of Severe Acute Respiratory Syndrome had been found in the hospital, the paper said but medical sources told AFP the number of cases was as many as 55.

The Ditan was one of several hospitals designated to take SARS patients and specializes in infectious diseases.

Most of the doctors in the hospital are living in a hotel nearby, but it was not immediately clear whether they were forced to stay there or if they were living there by choice to avoid infecting their families.

Earlier this month, the hospital said it had treated several foreigners, including a Finnish man who died, a Canadian and two Taiwanese.

Its isolation came as new quarantine measures took effect for all those who had come in contact with the deadly SARS virus as the government struggles to combat a virus that has killed 39 in the capital and infected more than 1,600.

Nationwide the death toll stands at 110, with 2,422 confirmed cases.

The quarantine applies to hospitals, factories, construction sites, hotels, restaurants, office buildings, residential buildings, villages, schools and other designated places where the virus has been found.

Roadblocks have also been thrown up around the city of 13 million, reinforcing residents fears that the Chinese capital is to be isolated.

Police officers manning the roadblocks said their purpose was to stop people from heading into neighbouring Hebei province where just six SARS cases have been reported so far.

"If they don't have medical proof from the proper disease control centre that they don't have SARS symptoms, then we won't let them through," one mask-clad policeman on the border told AFP.

An official circular from the Beijing municipal government meanwhile said all college students and teachers were "prohibited from leaving" the capital for the May Day holidays, which have been cut back from seven days to five.

It said any students who insist on leaving must have written documents proving they are healthy, the Xinhua news agency reported.

Students who have poor health and are from rural areas, western parts of the country or areas with SARS are prohibited from leaving altogether.

As panic over the galloping epidemic intensified, the Beijing government was forced to issue a denial that martial law was imminent to control the spread of SARS.

"The government will not close expressways and the airport for this purpose," Cai Fuchao said at a press conference, Xinhua reported.

story.news.yahoo.com/news...0425062004

SARS outbreak in UK 'inevitable'

SARS outbreak in UK 'inevitable'

FRANK URQUHART AND PAUL GALLAGHER

AN OUTBREAK of severe acute respiratory syndrome (SARS) is inevitable in Britain and will stretch NHS resources to breaking point, the country’s leading microbiology expert warned yesterday.

Professor Hugh Pennington, of Aberdeen University, said health officials would be forced to implement emergency plans drawn up to deal with a bio-terrorism attack to tackle the impending crisis.

"It will get about and will be with us for the foreseeable future," Prof Pennington told The Scotsman. "We have to prepare for it to come."

He added that even a small outbreak of the disease would cause "mayhem" in the National Health Service, as entire intensive care units would be devoted to treating SARS sufferers.

As China began implementing draconian quarantine measures to contain the spread of the disease yesterday, Dr Liam Fox, the shadow health secretary, described the UK government’s response to the threat of an outbreak as "feeble, complacent and irresponsible".

Dr Fox called for SARS to be classified a notifiable disease under the Public Health Act, giving officials the power to force patients to receive treatment and ensure others were not exposed to the virus.

He said: "All around the world, SARS is causing immense alarm. Here, on the other hand, ministers’ conduct would make people think that nothing serious is going on.

"The only sensible way for the government to proceed is to make SARS a notifiable disease."

One of the world’s leading experts warned yesterday that unless the virus is dealt with quickly, a second - and larger - wave of cases could emerge.

Dr Donald S Burke, writing in The Scotsman today, said: "Epidemic-control efforts should not simply be maintained, but doubled, and redoubled again."

Four more SARS deaths were reported in the Chinese capital of Beijing yesterday, and authorities have sealed off entire villages, along with the People’s Hospital of Beijing University, where more than 100 infected patients are being treated.

According to the World Health Organisation (WHO), the flu-like virus has killed more than 260 people and infected more than 4,500 worldwide after being spread from Asia by airline passengers. The organisation has advised travellers to avoid visiting Toronto, in Canada, Hong Kong, Beijing and the Guangdong and Shanxi provinces of China.

Economists at the World Bank said the impact of the SARS virus, along with the aftermath of war in Iraq, could knock almost one-sixth of a per cent off economic growth in Asia this year.

The Canadian government strongly protested to the World Health Organisation yesterday for advising travellers to avoid Toronto, the scene of the worst SARS outbreak outside Asia, with 16 fatalities.

"There is no evidence of casual transmission of the disease in Toronto," said Dr Paul Gully, a Canadian government health officer. "We challenge the WHO’s assertion that Toronto is an unsafe place to visit."

So far, only six suspected cases have been found in Britain, none of which has been fatal. All of the cases involved patients who contracted the virus overseas, but it emerged yesterday that a Thai woman in hospital in Bangkok with suspected SARS may have contracted the virus in London.

During a recent visit to Britain, She was in contact with a Chinese businessman who may have passed on the virus.

Health officials said 140 children from Hong Kong and China, quarantined on the Isle of Wight a week ago, have so far shown no sign of the illness.

Prof Pennington, Scotland’s leading microbiologist, who led the investigation into the E coli 0157 outbreak in Wishaw, said the quarantine measures in China and elsewhere were not sufficient to prevent SARS spreading around the globe, and he expected a significant outbreak in Britain within months.

"When it does come - even though the number of cases are small - it might well create mayhem because it will mean that a large chunk of a hospital will have to dedicate itself to SARS at the expense of ordinary run-of-the-mill activity," he said.

SARS was first detected in southern China and has spread to more than 20 countries.

Symptoms are similar to pneumonia, with sufferers complaining of coughing, raging temperatures and sore throats. There is no cure and the mortality rate is between 5 and 6 per cent.

www.thescotsman.co.uk/ind...=471622003

SARS may be impossible to contain: health experts

www.cbc.ca/stories/2003/0...tain030425

SARS may be impossible to contain: health experts

TORONTO - Toronto is reporting a decrease in the number of SARS cases, but some health experts say the virus may never be fully contained and Canadians may just have to live with it.

Officials in Toronto say there are now 257 cases of severe acute respiratory syndrome in Ontario, 10 fewer than the day before.

But even as Toronto tries to stop the spread of SARS, health experts in B.C. say it may be impossible to fully contain the virus.

"I think we have to have a very big respect for Mother Nature. She's the ultimate bio-terrorist," says Dr. Richard Stanwick, medical officer of health for Vancouver Island.

Stanwick says Ontario health officials are doing all they can to hold back SARS, but says it may not be enough and the virus may eventually spread to the general population.

But an expert in viruses says SARS must be put into perspective compared to other infectious diseases, such as influenza, which affects one in five Canadians every year.

"It's important to try to be sensible and recognize that flu does kill 2,000 people a year in B.C. and we tend to ignore it," says Dr. Mel Krajden, head of virology at the B.C. Centre for Disease Control.

Experts say SARS is highly contagious, but its mortality rate is no different than that of influenza.

And the chief medical health officer in B.C. says the cost of trying to contain SARS – with hospitals closing and public health officials doing nothing else – may not be worth it.

"It might be more cost-effective to let the disease run its course," says Dr. Perry Kendall.

Experts say whatever happens to SARS in the coming months, it will change forever the way hospitals treat people who are even suspected of having a contagious disease.

The Discomfort of Home

http://www.washingtonpost.com/ac2/wp-dyn/A34863-2003Apr24?language=printer
The Discomfort of Home
MLB Teams Deal With SARS Fears as Blue Jays Head to Toronto After Road Trip

By Amy Shipley
Washington Post Staff Writer
Friday, April 25, 2003; Page D01


ST. PETERSBURG, Fla., April 24 -- Just hours before the Toronto Blue Jays boarded a charter flight home late tonight after 11 games on the road, designated hitter Frank Catalanotto canceled two other flights to Toronto: those planned for his wife and 4-year-old daughter.

Catalanotto, whose family lives on Long Island, N.Y., made the decision soon after learning Wednesday that the World Health Organization recommended that travelers avoid Toronto because of the spread of the deadly respiratory disease known as SARS, which has claimed the lives of 16 Toronto residents.

Twelve days ago, when Catalanotto and his teammates left town, severe acute respiratory syndrome represented a seemingly distant threat, not a blaring siren of alarm. But in recent days, as the team has prepared to return to SkyDome for a nine-game homestand to a city that has become a focal point of the mysterious illness, players have felt a mix of apprehension, confusion and frustration.

Catalanotto wasn't alone in taking action to address a problem that, on a much grander scale, baseball officials likely will wrestle with for weeks. The wives of infielder Mike Bordick, the former Baltimore Oriole, and pitcher Cory Lidle also called off plans to return to Toronto at the urging of their nervous husbands and with the blessing of Blue Jays medical officials.

"It seems like the last couple of days, it's become something serious," Catalanotto said before the Blue Jays' 5-3 victory over the Devil Rays. "It concerns all of us. It definitely worries us."

Major League Baseball officials say there are no plans at the moment to cancel games in Toronto or move them to other sites.

"We have a lot of concern," Commissioner Bud Selig said today in New York, "but we don't want to overreact."

During an afternoon conference call between baseball's medical adviser, Elliot Pellman, and the head trainers of the teams heading to Toronto in the coming weeks, Pellman urged appropriate precautions while trying to allay irrational fears, baseball spokesman Rich Levin said.

Pellman suggested that players wash their hands frequently, avoid crowds and use their own pens for autograph-signing -- if they sign autographs at all. He also reminded the trainers that players' chances of contracting SARS, which has struck 140 people in Toronto, are extremely remote.

Baseball officials will meet Friday with Gene Orza, associate general counsel for the Major League Players Association, and union medical adviser Joel Solomon to consider further action. Union officials believe moving games out of Toronto is a last resort, but intend to respond to the will of the players. At least one player, California Angels pitcher Kevin Appier, proposed moving the Angels' series in Toronto in the coming weeks to California. Later in the summer, the Angels would swap venues with Toronto for the teams' second series of the season.

"As institutions, Major League Baseball and the Players Association are staying on top of the matter as much as can be done," Orza said. "We are following all of the updates, doing all the research and considering the desires of all of the parties involved."

The Kansas City Royals, who flew tonight to Toronto for a three-game series beginning Friday, have organized a players' dinner in the team hotel for after Saturday's game and plan to set up a recreation room at the hotel so players won't be tempted to go out. Trainer Nick Swartz also passed out brochures with information in Spanish and English on SARS to all of the players.

Meantime, Toronto health and civic officials have expressed vehement opposition to the WHO's travel warning. Blue Jays President Paul Godfrey has echoed that view, repeatedly playing down the severity of the threat to visitors to Toronto and bemoaning the economic impact of the hysteria. He estimated that the team had lost 5,000 to 10,000 in group sales because of SARS and 500-1,000 walk-ups nightly.

"Rest assured if there was a risk to the good health of those individuals, I would be the first to contact Commissioner Selig to have a game rescheduled," Godfrey wrote in a statement to fans on the team's Web site. "You'll recall, two years ago when there was a complication with the roof at SkyDome we canceled a game even though, at the time, engineers assured us there was only a remote threat to the safety of our ballplayers and guests."

Several Toronto players said they weren't certain whether to be panicked or dismissive.

"It's like getting two different stories," reliever Doug Creek said. "I was watching the news last night, and the World Health Organization was saying it's almost dire straights in Toronto. The health board in Toronto was saying it has accounted for every single person that has SARS and that it's not a clear and present threat. . . . We're just trying to get the best information we can get."

Several players said they would cut back on signing autographs and hoped the team would cancel the mandatory signing sessions that precede home games.

"I live right next to the SkyDome," Catalanotto said. "I'm just going to walk to the ballpark and go straight back home until they say this thing has been cleaned up. . . . I like to go out before games and sign autographs and meet the fans, but I'm not taking that chance anymore."

Catalanotto said he first started getting nervous about SARS when he took his son to the emergency room for an ear infection before the team left town. Check-in, he said, took place outside the hospital. Doctors allowed only one parent to go inside and forced everyone entering the building to wear face masks.

Bordick said he wasn't anxious until the WHO issued its report. Then, he said, he began to worry.

"This is a situation where it's obviously reached epidemic proportions," said Bordick, a father of five. "It's a little scary. I have a couple of young kids. My biggest concern is their health."

Staff writer George Solomon contributed to this report from New York.



© 2003 The Washington Post Company

Fair use for discussion purposes:

(Manila Phillippines paper)






Friday, April 25, 2003


Hold that sneeze!

By Maricel Cruz, Reporter

Capitalizing on fears of a SARS outbreak, an overzealous lawmaker on Thursday proposed that malicious sneezing in public be considered an act of terrorism.

At a discussion on provisions of the proposed Anti-Terrorism Act, the House Committee on Justice chairman, Rep. Marcelino Libanan of Eastern Samar, asserted that “intentional sneezing” in public is a crime.

“If you sneeze with the intent of creating common danger, terror, panic or chaos to the public or a segment thereof, then you can be charged as a terrorist,” Libanan said during the floor debates.

“But if you just sneeze for the sake of sneezing, then it is not terrorism.”

Libanan was referring to individuals infected with SARS.

He said the act of a SARS victim who sneezes openly could be considered a terrorist act.

Libanan’s colleagues took his argument seriously enough to shoot it down.

Rep. Teodoro Locsin Jr. of Makati City pointed out that sneezing is an uncontrollable act and cannot be prohibited by law.

“Sneezing is a reflexive act. People cannot control it,” Locsin said.

Meantime Rep. Juan Miguel Zubiri of Bukidnon, said the public should be as worried over air quality as much as SARS.

Zubiri said the government is already spending P20 billion annually for the treatment and health-care services of respiratory ailments caused by air pollution.

Citing a World Bank report released in 2002, Zubiri said that 2,000 deaths are reported annually from respiratory ailments in Metro Manila and the cities of Cebu, Davao and Baguio.

Some 9,000 more get sick from chronic bronchitis caused by carbon monoxide and other poisons whose levels exceed acceptable standards, he added.

“The government should treat other diseases with the same attention it is lavishing on SARS,” Zubiri said.



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Hmmm... may NOT take the day off...lol

Weather picture is mixed & it seems every morning I'm waking up to loads to read from YESTERDAY'S thread & today's well started. Okay I read fast so that part isn't a problem, but thinking fast isn't always advisable. But if it warms up, I can just as easily think outside.

Going through yesterday evenings posts now. There seems to be a couple of common themes so far - some late identification of cases & people breaking quarantine, then breaking with symptoms. So by next Wednesday, the 'second wave' should be building nicely - albeit I hate to use the term 'nicely'. And the warnings about the effects on buisness get stronger by the day.

About Toronto - loads of reaction yesterday from government, the press, the public to the WHO travel advisory. Few think it was a good idea & our federal/provincial government want it liftedd. I think even if it IS lifted - & the WHO would be ignoring their own criteria to do so - it's already been frront page news throughout much of the world - the damage has been done. On the positive side; no new cases yesterday.

News from China just gets more & more 'interesting' doesn't it? A third Beijing hospital now quarantined & although I've not read it yet, the People's Daily has an article denying rumors of impending martial law. Ain't the articles you posted by Laurie Garrett made me cringe. That hospital has housed primarily HIV/AIDS patients - here we go. I'm not too sure the miasma concept, (bad air), & reaction result from lower level of education. I think it's more an attempt to be seen to be 'doing something' & an attempt to give people some feeling of control. I can only hope that stirring up all that filth doesn't result in faster spread - if it's in the environment or stir up OTHER infectious disease pathogens. Darned shame about that poor man drinking bleach. Correct information in simple terms MUST be put out there. Those numbers given for migrant workers are scary - they'rer likely to contribute to faster spread if any/many do contract SARS.

As several articles mention - it's too early to truly determine the true death rate. You never really get that until AFTER an outbreak is over, although you can be pretty close. Determining whether there are mild cases or asymptomatic cases may change the rate dramatically. And of course until a case is resolved as recovered or dead, numbers don't mean much.I'm using 5% right now - if only to have SOMETHING to work with. Right now, HK's cfr is roughly15.7% & China is at 8.26%. Once this outbreak is deemed 'over' we'll see case fatality rates covering sexes, age groups, pre-existing conditions & all kinds of combinations. I guess which is important to anyone depends what group they fit into.

The US numbers of suspect cases seem to be growing pretty fast now. Are any suspect/probables there seriously ill?

About 'downplaying' the risk. The risk of death seems higher than originally thought, but the morbidity rate is still low. So... not a high risk of catching it but a far higher risk of a poor outcome. Uncertainties are the real dark horse right now & conflicting info from different jurisdictions is even more confusing. When you consider how many people can get news reports online from different areas - no wonder people become confused.

Just adding new cases in different areas reported in these articles - comparing new probable totals with the official dailies from yesterday, right now I make it 4645 cases & other countries may have more. As it is that's close to a 5% increase today alone, albeit China makes up the bulk of the increase again. Be curious to see dailies today.

Off to drug store - weekly prescription run.

I've been battling a monstrous sore throat, and the rest of the typical symptoms for the last 4 days.
I've been using a nebulizer with CS, and this knocks it down, but not out, unless I do the neb. continually.
Which, I will do today because last night was kinda rough.
http://drugstore.com is the place to get the neb. but they are back ordered 2 weeks, so........
I ordered one for my wife in China, but when I asked her if she wanted one, she said there was no need. She is in Guangdong- the place I visited last summer.
She said she avoids the crowds, and that is about all at this point.
Last summer, I broached about selling colloidal silver, but I got the same reaction we often get here.

Uh, Moe?

Did you get anything in the mail from her in the last couple of weeks?

PETA and SARS....

it had to happen! LOLOL
I wont waste bandwidth on the article, but ya gotta see this- they have developed a "Say No To Pigs FaceMask" So that when they start wearing them it will make people ask about the link between SARS and pigs and give them an oppotrunity to preach the vegan lifestyle!
http://www.peta.org/feat/sars/
I can't stand it....we've fallen down the rabbit hole and the Queen is coming...and she looks like Miss Piggy....this whole thing has its moments of feeling surreal, but I tell ya, if I see one of those masks come through the hospital doors, I may loose it big time!!!!
Oh, well, it gave me a really good belly laugh, and thats always a good thing on a dark and dreary day when you're reading about SARS.
Laura

Mineymoe,

For a monstrous sore throat, besides seeing the doctor, try getting some fresh lemons and sucking on them. the acid in them seems to cure sore throats pretty quick.

Hope this might help! Best wishes...

A couple of days out of date but gives a good idea of where cases may be in the near future

http://www.cdc.gov/od/oc/media/sars.htm

State Total Suspect Probable Cases Alabama 1 1 0
Arizona 1 1 0
Arkansas 1 1 0
California 49 35 14
Colorado 9 7 2 Connecticut 5 4 1
Florida 15 14 1
Georgia 3 3 0
Hawaii 5 3 2
Illinois 13 12 1
Indiana 1 1 0
Kansas 2 1 1
Kentucky 2 1 1
Maine 2 2 0
Mass 12 11 1
Michigan 3 3 0
Minnesota 7 7 0
Mississippi 2 1 1
Missouri 2 2 0
Nevada 2 2 0
N H 1 1 0
N J 3 2 1
N M 1 0 1
N Y 28 23 5
N C 6 6 0
Ohio 11 10 1
Oregon 1 1 0
Pen 8 7 1
R I 1 1 0
S C 2 2 0
Texas 7 7 0
Utah 7 6 1
Vermont 2 2 0
Virginia 7 4 3
Wash 23 22 1
Wisconsin 1 1 0
Total 247 208 39


Just a couple if things I've picked up in the local papers.

The NH case was a man from Exeter. He was on a plane from China and became ill. They landed the plane in Michigan and took him to a hospital there. This was around the 2nd of April and he is doing well. Sofar no cases actually in NH.

One of the cases in Massachusetts is a baby girl that was just adopted from China. This may put a crimp in the chances of anyone adopting from there.

Please forgive formatting. How it shows is NOT how I spaced things.

"My non-PC summary of the current SARS situation"

There are 20+ hyperlinks in this article at the VDARE.COM site.

VDARE.COM - http://www.vdare.com/misc/pringle_sars_2.htm

April 24, 2003

SARS: The Immigration Dimension II
By Walter Pringle

Recently, I received an email from a New York Times reporter with the unusual name of Jennifer .8 Lee about my April 2 VDARE.COM article SARS: The Immigration Dimension. In that article, I dared to make this politically incorrect observation: “The brutal truth is that SARS is, currently, a predominantly Chinese disease…”

I was not terribly surprised that Ms. Lee wanted to ask only about my credentials and my alleged belief that SARS was an “Asian Disease.” Subsequently, she published a superficial SARS article about anxious residents in Chinese communities on the West Coast.

Here’s an example:

“Now only non-Asian customers are coming, Mr. Hong [owner of a Chinese restaurant] said, not the white-collar, immigrant Asian workers who used to fill the restaurant after work.”

In U.S., Fear Is Spreading Faster Than SARS, By Dean E. Murphy The New York Times, Apr 17, 2003

This article was reported by Jennifer 8. Lee, Dean E. Murphy and Yilu Zhao and written by Mr. Murphy.

So judging by the behavior she describes—avoiding Chinese businesses, to the point of business dropping by 70-90% in North American Chinatowns - the Chinese certainly think it’s a Chinese disease, if not an Asian one!

They may be right—but we’ll never know based on the PC “reporting” of SARS in the major media and the racially null data put out by US and Canadian health authorities. We do get the odd name when the SARS victim is white (cf. current crime reporting) but not when the victims are non-white, in this case Asian.

Toronto officials and media especially, to no one’s surprise, have been disgorging a steady effluvia of PC drivel in their silly attempt to maintain PC uber alles in their “highly diverse” metropolis.

The result of this censorship: everyone, especially the Chinese here in North America, assume that all risk of infection is from Chinese.

Again, we don’t know if this is true. However, the health authorities most certainly know it and record it. The information is an essential variable of epidemiology—which is defined as “the study of populations in order to determine the frequency and distribution of disease and measure risks.” Yet the best we get from the authorities is that SARS “is milder” here than in Hong Kong and China.

In fact, SARS does seem to be milder in the U.S.—as of now. But, since it’s the same virus, mustn’t the “mildness” be due to lower susceptibility among Americans? And if not, then why?

And what will happen next?

The history of our world significantly resulted from racial differences in immunity to disease. Examples: In 1500s Mexico and Peru, the decimation of the Aztecs and Incas by smallpox and measles infections carried by Spanish invaders. In 1800s Haiti, the virtual annihilation of Napoleon’s invading army by Yellow Fever infection—which barely affected the defending African blacks. That led directly to the collapse of French colonial power in the Caribbean and America and the fire sale of the French-owned Louisiana territory to America, thus doubling the size of our county.

A more recent example: the recent spread of TB in the US by immigrants. Donald G. McNeil Jr. and Lawrence K. Altman noted this recently in the New York Times while describing the important concept of disease “super spreaders:”

“A famous tuberculosis 'super spreader', described in The New England Journal of Medicine in November 1999, was a nine-year-old boy in rural North Dakota, an immigrant from the Marshall Islands, who in 1997 and 1998 infected his family and 56 schoolmates. The boy had deep cavities in his lungs, while his twin brother, who was 5 cm taller and 5 kg heavier, had a mild case and was not infectious.

“Some populations are genetically more susceptible, so the first carrier to get it often becomes a 'super spreader'. For example, [Dr. James] Plorde [an infectious disease expert with the University of Washington] said, 'people of European descent handle TB much better than American Indians - presumably because their genetic stock survived more epidemics of TB.’” [italics added].

Also, chronic diseases differ in their incidence among groups for many reasons. These chronic diseases in turn can cause differences in resistance to new infections.

TB is very wide-spread in China. And Hepatitis B has been estimated as infecting up to 65% of the population of China. (In fact, the vast majority of Hepatitis B in the U.S. right now is due to Chinese immigration and lax border control.)

Could the existence of a chronic disease among Chinese explain their apparent higher rates of infection and death from SARS? Could some unknown lung tissue characteristic render them more susceptible to SARS, like the boy who brought TB from the Marshall Islands?

Or could the apparent relative immunity among Americans be due to prior exposure to some form of coronavirus, the suspected SARS virus?

Regardless of the reason, this should be a subject for open discussion - not only among for the scientific elite, but for the rest of us who are among the potential victims of a SARS epidemic.

My non-PC summary of the current SARS situation:
SARS totals continue to rise in Toronto, Hong Kong, China and Singapore. Some experts feel containment in these hotspots may be impossible.

China has finally fessed up to an astounding 20x under-report of SARS cases in Beijing alone—700 now - thus pretty much blowing any remaining credibility for their numbers. SARS has now spread to the hinterlands, where medical care is extremely limited and hygiene is terrible. The odds of containing it there are nil if it continues spreading for the next few weeks. Unfortunately for containment, panicked residents are fleeing Beijing. China also contains about 1.5M AIDS cases who will have little defense against SARS. China currently claims a preposterously low 2300 SARS cases and 106 deaths, 4.5% death rate.

Canada/Toronto WHO now advises travelers to avoid Toronto, though Canadian officials are protesting. Toronto, where all of the SARS fatalities in Canada have occurred, now has 140 cases with 16 deaths, an 11.5% death rate. And the disease is “out in the community”, including 30 members of a religious group and some people in a condo complex. SARS may not be containable in Toronto.

Singapore has instituted a severe new SARS control regime, possibly a little late. They have 192 cases and 19 deaths, a 10% death rate.

Hong Kong now has 1458 cases and 105 deaths, about a 7% death rate (n.b. and that in a hospital setting.) A Hong Kong doctor feels that the newer cases, with more severe symptoms and deaths among the young and healthy, may have become more virulent through mutation.

Africa has reported only one SARS cases as yet, in South Africa. This will likely not last. With limited to non-existent health care in Africa, 300M crammed into urban areas and 30M+ AIDS cases, the African situation may ultimately be the worst of all.

India has 3 cases and has a worse public health environment than China. It is expected to be imported there by travelers.


And now the good news (for us):

The U.S. is remarkably free of SARS at this time. Having revised their SARS reporting criteria, the American authorities now list only 39 cases and no deaths.

But this may just be luck—the “super-spreaders” from China just didn’t happen to traveling here. It gives us no excuse whatsoever for allowing SARS to spread here. Some feel that a respiratory disease, ultimately, cannot be contained without a vaccine. The more time we have to develop one, the better.

Other points to note:

SARS death rates appear to be rising, partly due to the greater virulence of a newly-mutated SARS virus. Some feel that current global SARS death rates of about 6% are closer to 10%. Either number is alarmingly high - yet it would be far higher without the immediate, modern medical care that most current patients enjoy. Of course, the death rate in immunosupressed patients - such as those with HIV or Measles—is expected to be far higher.

The origin of SARS was thought to have been the transfer of a coronavirus from poultry to man in South China in November 2002. This is a common route for new flus and colds originating in that area. However, the gene sequencing revealed that this particular coronavirus was previously unknown and had gene sequences common with not only the chicken, but the cow! This has led to speculation among Russian microbiologists that it could be a bioweapon and, by others, that it could have been created in a genetics lab, accidentally or otherwise. Amazingly, WHO did not immediately discount this speculation.


My conclusion: Unlike some people, I do not believe that the SARS threat is overblown. The fact that we are in the early stages of this epidemic is the only reason for hope—nobody can predict the outcome, but we can make some good guesses.

When the Spanish Flu of 1918-1919 started in April 1918, in Fort Riley, Kansas, among young army recruits, people thought it was just a bad flu. A bit later, it was a bad flu with pneumonia. But after it traveled with the troops across the seas, the virus found a huge new incubation source in the millions of soldiers over there. Then it mutated and ultimately killed 30M (650,000 in the U.S.) in less than 2 years. And this was before massive immigration bloated this country’s population—then it was only 100M and international travel was by boat and train.

The SARS virus is expected to mutate—and for the worse—but it may not. It could mutate to a benign form, and leave us alone. Or it could fade away over the summer, like the 1918-19 flu, then resurge in a more virulent form.

SARS is also expected to spread—particularly in the Third World. This will create an enormous incubation source for the disease.

In the end, we cannot eliminate the risk of SARS for sure without strict border control - and much-reduced immigration.

Walter Pringle (email him) studied biomedicine at a major university.

From The Asia Times, Hong Kong:

http://www.atimes.com/atimes/China/ED26Ad02.html

<h3>SARS could doom China's leadership role</h3>
By Phar Kim Beng HONG KONG - At the height of the Asian financial crisis in 1997, two stories surrounded the role of China. One attested to China's positive role as a stabilizer, while the other pointed to China's unsavory economic practices.

According to the latter, China had intentionally devalued its currency in 1994 to strengthen its comparative advantage versus Southeast Asia. The Chinese Ministry of Foreign Affairs, sensing the risk of China being singled out for rebuke, hence losing its influence to the United States and Japan in the region, quickly rallied to the aid of Thailand with a loan in 1997. This gesture, followed by Beijing's promise not to devalue its currency again, proved effective. China's faux pas was forgiven and forgotten. In time, China was gradually accepted as a responsible regional actor and leader.

But the competition for regional leadership has once again become complicated with the outbreak of severe acute respiratory syndrome (SARS). The political capital that China has assiduously cultivated with the Association of Southeast Asian Nations (ASEAN) since 1997 is withering away. Throughout the region, accusatory fingers are being pointed at China for not disclosing cases of SARS when they first arose last November.

Recently, ASEAN leaders met in Bangkok to confront the economic impact of SARS head-on. Prime Minister Goh Chok Tong of Singapore was particularly displeased: "SARS may not kill everyone in Singapore. But it can kill the Singapore economy. Therefore, it can kill the livelihood of Singaporeans." Goh's statement was not off the mark.

The hotel occupancy rate in Singapore and other Southeast Asian countries affected by SARS has been hovering around 20 percent. This is a huge economic and commercial disaster, given that 6-7 percent of these countries' gross domestic products rely on tourism. Indeed, three of the region's leading airlines, Cathay Pacific, Singapore Airlines and Malaysia Airlines, have had to reduce their flights by half - with no relief in sight.

But beyond the economic cost of SARS, which some analysts have estimated at US$11 billion this year, the outbreak is also having a geopolitical impact that may well be long-term in its effect.

To begin with, more East Asian countries, having observed the decrepit health system of China, are beginning to understand - finally - that China's internal developments have major consequences in the region. Beyond the issue of China's growing military might, about which some East Asian countries are no less worried, lies China's often partial, half-hearted and incomplete evolution toward becoming a responsible power. Complaints about China's massive fossil-fuel consumption, for instance, have traditionally come from Japan and South Korea, two countries that are concerned about Chinese air pollution being carried to their
skies.

But since the outbreak of SARS, it is Southeast Asia's turn to understand that when Chinese sneezes its citizens too can catch a cold, if not suffer a painful death. Indeed, SARS is causing a seismic shift in political awareness on two fronts: it makes members of ASEAN less deferential to China, and it makes China less acceptable as a regional model.

The longer the SARS crisis lasts, the more China's feet of clay will become prominent. With China unable to influence the decision-making of major multilateral organizations such as World Bank, the International Monetary Fund or even the Asian Development Bank, Beijing cannot be counted upon to produce a regional rescue package.

Instead, such a role would fall on the lap of Japan, hitherto a country that has been too easily described as the "sick man of Asia" due to Tokyo's decade-long struggle with an economic recession. If anything, SARS could prove that Japan has a lot more to offer the region than China does. Moreover, the fact that SARS has affected neither Japan nor South Korea further implies that these countries are more reliable trade partners.

SARS is also affecting what is the most important single relationship in East Asia: the Sino-Taiwan tie. Because of the fear of SARS, Taiwan has become wary of mainland China. President Chen Shui-bian, together with his Democratic Progressive Party colleagues, have time and again emphasized the inappropriateness of allowing Taiwan to be reunified with the mainland along the model provided by Hong Kong.


As demonstrated by SARS, the widely acclaimed "one country, two systems" simply does not work. The health systems of Taiwan and China do not match either in terms of quality or disclosure standards. Nor is the political culture of China appropriate to Taiwan's democratic practice. Indeed, Beijing only came clean with SARS this past Sunday, some seven weeks after Hong Kong had been battered by the problem. When the official announcement was made it was revealed that Beijing alone has had 10 times as many SARS cases than originally reported.

In contemporary international relations, soft power matters. Reputation, transparency and accountability are all important measures to reflect one's standing in the global hierarchy. In its mishandling of SARS, China has squandered precious political capital that it has built up over the past five years. It will be a long time before China can restore its internal and international position, granted that SARS' coronavirus is said to be susceptible to quick mutation, and therefore resistant to an effective cure.

While East Asia is battling SARS with all medical means at its disposal, the geopolitical configuration of the region has undergone a subtle but significant change.

Despite the effort of China to contain SARS, the ripple effect has already hit th shores of Southeast Asia, causing irreparable damage. Unless leaders of Southeast Asia are willing to be forgiving and forgetful again - unlikely - Beijing will stand accused of being in dereliction of its regional responsibility.

While the SARS problem remains unsolved, the reins of leadership will swing, slowly but surely, toward Tokyo. This is a bonanza that the Japanese government of Prime Minister Junichiro Koizumi did not expect, nor for that matter relish, since SARS is above all a human tragedy. But the proverbial passing of batons would have come around anyway. This is because China has caused great consternation and despair to the region that only Japan can redeem, being in alignment with other developed countries in control of various multilateral trade agencies.


<HR size="2" color="#cccccc">

From The Reuters Foundation, BEIJING:

http://www.alertnet.org/thenews/newsdesk/PEK33304.htm
<H3>NEWSMAKER-China's "Iron Lady" Wu, now SARS commander-in-chief</h3>
25 Apr 2003 10:31:17 GMT

By John Ruwitch --
BEIJING, April 25 (Reuters) - Chinese Vice Premier Wu Yi has little experience in health care, but the oil executive turned trade guru has been appointed "commander in chief" of the war on SARS in the country worst hit by the disease.<P></P> The official Xinhua news agency reported this week the establishment of a SARS Control and Prevention Headquarters, a national task force to lead the fight on the growing outbreak in China which has killed over 100 people and infected some 2,600.<P></P> Wu, China's most senior woman politician, a one-time trade minister and member of the powerful 24-member Communist Party Politburo, was named its "commander in chief".<P></P> Analysts say the move says much about how the administration of President Hu Jintao and Premier Wen Jiabao, which took the reins of power in March and got off to a rocky start with its handling of SARS, is approaching the thorny issue.<P></P> Wu, 64, is viewed as perhaps the most competent troubleshooter in the Chinese leadership, which has been criticised abroad for the secretive early handling of the SARS epidemic after it erupted in the southern province of Guangdong.<P></P> She was appointed after the health minister and Beijing mayor were fired over the cover-up of the epidemic.<P></P> It "shows that the government is serious about the issue and is attaching great importance to it. The Health Ministry did not do a good job of handling the SARS issue at the begining," said Zhao Xijun, vice director of the Finance and Securities Institute at People's University.<P></P> Wu has earned a reputation as a hard-nosed, businesslike operator who puts work above all else, including her personal life -- she has never married.<P></P> Former Premier Zhu Rongji appointed Wu to coordinate China's adoption of the conditions of which it joined the World Trade Organisation in December, 2001.<P></P> And as a State Councillor form 1998-2002, a job one rung down from Vice Premier, Wu handled the sensitive issues of state-owned industry reform, intellectual property rights and development of China's backward hinterland.<P></P> She has handled crises, too. Wu is said to have handled a major smuggling case in the coastal city of Xiamen, which the government alleges was masterminded by Lai Changxing, the country's most wanted fugitive.<P></P> FOREIGN TRADE EXPERIENCE KEY<P></P> But Wu's experience in foreign trade -- she was vice trade minister from 1991-93, minister from 1993-98 and then oversaw China's trade relations as State Councillor -- may have clinched the SARS appointment, some analysts say.<P></P> Wu's appointment was seen as having been been made with business in mind, not health, with an eye on maintaining international confidence in the world's only fast-growing major economy and keeping up the inflow of foreign investment.<P></P> Qu Hongbin, an economist at HSBC in Hong Kong, said: "Using someone well-known by the outside will help boost external confidence."<P></P> "Her focus has been on international trade and investor relations types of things, so at that point their focus was, and to a certain extent still is, is in reassuring the international community," said one Western diplomat.<P></P> "Their concern was for the economic impact on China," the diplomat said. "I think putting her into that lead spot, to me, at that time, was indicating that their priority was viewing this through an economic prism rather than a public health prism."<P></P> In addition to health, Wu is in charge of education and, more important, foreign trade.<P></P> But with schools closed and a string of travel advisories from various countries and the World Health Organisation keeping investors away, Wu will have plenty of time to focus on health.<P></P> "There aren't a lot of foreign investors coming over for look-sees these days," the diplomat said. "People aren't making billion dollar investments without coming and having a look at them."

From Canada:

http://canada.com/national/story.asp?id=20344F01-64C8-408C-85B0-B67EF638868E


<IMG valign="top" src="http://media.canada.com/scripts/locate.asp?id=21304f70-6c8c-439d-9b54-788c70b2a3a5" width="150" height="198">
Ian Lindsay, Vancouver Sun / FIGHTING SARS WITH THE LAYERED LOOK: Occupational hygienist Quinn Danyluk and Liz Jones demonstrate the latest defence against SARS: the N95 particulate mask fit-tested with a hood and aerosol spray.

<h3>Seven new suspect cases reported in B.C.</h3>
Amy O'Brian and Lori CulbertVancouver Sun, with files from Nicholas Read, Vancouver Sun, and Mark Hume, CanWest News Service.
Friday, April 25, 2003

Provincial health officials announced seven new suspected cases of SARS Thursday but said it is rare for suspected cases to develop into probable cases.

Patricia Daly, director of communicable disease control for the Vancouver Coastal Health Authority, said she is concerned that the public misunderstands the meaning of "suspect SARS."

"I think it is important to remember that people who fall into that category do not have SARS and in fact, of those suspect cases that we've reported from our region, all of them turned out to have other diagnoses," she said.

"We really should be looking at the probable cases, because those are the people we feel have SARS."

Several health officials are questioning the need to even keep track of the suspected cases, saying such a practice is unusual and would not be done with other diseases.

"[Suspect cases] are so nebulous," said Helen Carkner of the Fraser Health Authority.

"What the suspect means is that somebody has a sneeze."

But while some provincial authorities might like to see the term "suspect case" abolished, they must wait for Health Canada to initiate the move.

Although the World Health Organization decided recently to stop reporting suspected cases, Health Canada is still keeping track, which means British Columbia must follow suit.

Because the illness does not yet have an accurate diagnostic test, health authorities want to continue monitoring people with symptoms that could possibly be SARS related, said Tara Wilson, a public affairs officer with the health services ministry.

She added it is possible Health Canada will soon follow the WHO's example and stop reporting suspected cases.

For now though, there are 54 suspected cases of severe acute respiratory syndrome listed in B.C. and four probable cases.

Although two of the probable cases are now at home and considered by the Vancouver Coastal Health Authority to be "completely recovered," they remain counted on the list of probable cases because the lists are cumulative, Wilson said. Even if someone were to die of the illness, their case would remain listed as probable.

The two other probable cases of SARS in this province are said to be in stable to good condition, but remain in hospital.

Meanwhile, the B.C. Centre for Disease Control was in the process Thursday of contacting 250 B.C. residents who flew to Vancouver April 19 on a flight that originated in New Delhi, India and had a brief stop-over in Taipei, Taiwan.

Ten passengers on the China Airlines flight, all from the Abbotsford area, have since developed a fever and cough, and are now classified as having suspected cases of SARS.

After contacting the bulk of the other B.C. residents on the flight, the CDC has identified three other people with SARS-like symptoms. The three people were still being assessed and had not been classified as additional suspect cases by late Thursday.

"The [three] people identified with a fever and a cough aren't seriously ill.... They are in isolation and they are being monitored by public health," CDC spokeswoman Sally Greenwood said.

Of the 10 suspected SARS cases, two people -- an adult and a two-year-old girl -- are hospitalized in Abbotsford and Surrey, and the other eight are recovering at home. None of the patients, who come from eight different families, is seriously ill.

The CDC is acting cautiously, as the 10 people were not displaying symptoms while on the flight, so the chance of them being contagious while on the plane is slim.

"India is not considered a SARS-affected area by the World Health Organization and there was only a brief stopover in Taipei. The risk may be low that these [10] individuals have SARS, but we don't want to take any chances," the CDC's Dr. Monika Naus added Thursday.

That sentiment is echoed by several other groups and agencies, who say they are simply being extra cautious.

Vancouver-based Placer Dome Inc. announced Thursday its senior executives would not go to Toronto to attend an annual general meeting because of concerns about SARS.

Instead, the mining giant's executives, responding to an advisory by the WHO that Toronto is a destination to avoid, will attend, and participate in, the meeting by video-conference.

Placer Dome was one of a number of B.C. companies that advised their employees this week not to travel to Toronto unless it was absolutely necessary.

Although travel isn't a primary concern for the College of Dental Surgeons of B.C., it is erring on the side of caution and has sent a bulletin to all its dentists, recommending they screen patients with a series of SARS-related questions before they visit the office.

"We have recommended it is a precaution that they take," said John Henry, registrar at the College.

However, Henry said he and his colleagues are growing less concerned with the illness as they learn more about it.

"I think we were all pretty frightened, at least to begin with," he said.

"But I think everyone's getting more and more education now."

Richard Mathias, a professor of public health at the University of British Columbia, said the fear and misinformation that has been spreading about SARS reminds him of the early days of AIDS, when people used to worry they could get infected by shaking hands with someone.

"The risk communication that is being done on SARS is not terribly helpful to people at present," he said.

"What I see is a lot of information going out to the public that is not specific enough. People are uncertain who to trust [as experts on the disease], and so they are drawing their own conclusions."

He said when the WHO issued a travel warning about going to Toronto, it was reasonable for people to conclude there must be a high risk of infection in the city, even though local health officials were insisting the situation was safe.

Mathias said he didn't want to criticize the health officials who have been struggling to contain the SARS outbreak, but he urged them to reassess the way they are getting the message out to the public.

"Let's rethink what we know, reassess how we tell that to the public -- and then be consistent with our message," he said.

Mathias said because of the conflicting views and images, fear of SARS has grown far out of proportion to the risk.

"Going to Toronto is not a risk," he said.

"Transmission in Toronto is occurring only in tight pockets and as long as you stay out of those pockets the chances of getting infected are extremely low."

Steven Taylor, a professor of psychology at UBC and an expert on health anxieties, said when an issue like SARS dominates news coverage, it feeds into the fears of those who are worried about their health.

"They hear reports on the number of deaths, and that fuels their anxieties.... They see people in masks, and they overestimate how likely it is that they'll get it."

Fair use for discussion purposes:


C B C . C A N e w s - F u l l S t o r y :
--------------------------------------------------------------------------------
Canadian Forces can spare only three health workers for SARS
Last Updated Fri Apr 25 07:51:30 2003
OTTAWA-- The Canadian Forces can only send three medical staff to Toronto to help relieve front-line health workers dealing with the SARS outbreak, officials said.

The Ontario government requested the military send doctors and nurses to relieve medical staff at Toronto hospitals.


FROM APRIL 24, 2003: Military could relieve Ontario doctors in SARS outbreak

The deputy chief of staff for Canadian Forces Medical Operations says the military can send just two doctors and one nurse to help with SARS.

"They'd like to have 30, and we'd give them to them if we had them. But we just don't have them," said Capt. Margaret Kavanagh.

"Hopefully, the three will at least help," she said.

Like the rest of the military, the Canadian Forces medical staff is stretched to the limit, with only about 100 doctors, far fewer than are needed.

As the Forces prepare for a major deployment to Afghanistan and Ottawa considers sending military personnel to Iraq, there are few medical personnel to spare.

Col. David Solsbury, one of the doctors who could go to Toronto, says he's not sure whether his services will be needed.

Solsbury specializes in public health, but he says Toronto hasn't asked for help in that area.

"They're looking for infectious disease and respiratory disease expertise and that's not an area that we would have a tremendous amount of capability in," said Col. David Solsbury.

Solsbury says the military doctors in the Canadian Forces are more skilled at treating injured soldiers than they are in controlling infectious disease.



Written by CBC News Online staff


Copyright © 2003 Canadian Broadcasting Corporation - All Rights Reserved

From Australia, AP Report:

http://www.smh.com.au/articles/2003/04/25/1050777391317.html

<h3><HEADLINE>Doctors fear three newborns may have SARS</h3>
April 25 2003</DATE>
<p>Hong Kong: Three babies have been delivered prematurely in Hong Kong to women infected with the SARS virus. And doctors fear the babies themselves may be infected.</p><p>Doctors performed the Caesarean-section births because the expectant mothers were getting sicker, and there were fears the foetuses could be deformed if the women received a cocktail treatment of antiviral drugs and steroids being given to SARS patients here. </p><p>Two of the mothers died within days of giving birth, both at age 34. The surviving mother was listed yesterday as stable, said Dr Liu Shao-haei, senior executive manager of the Hospital Authority. </p><p>The babies are all in intensive care. </p><p>Two were on ventilators yesterday but stable, said a pediatrician who has been following those two cases, Dr Hon Kam-lun. Hon had no information on the third baby's condition. </p><p>Although the babies all have tested negative for SARS, they are acting in some ways like SARS patients, for example with difficulty breathing, doctors have said. Since the diagnosis for SARS is not 100 per cent reliable, the doctors are closely monitoring them under the premise they could well have it. </p><p>Their outlook remains uncertain. </p><p>"They might be the only cases in the world, so it's very difficult to tell," said Dr Lo Wing-lok, an infectious disease expert and president of the Hong Kong Medical Association. </p><p>"It's of course a big concern," said Lo, who also serves as a lawmaker representing Hong Kong's health care industry. "If pregnant women get the infection, it's not only the woman - if the baby is old enough to be viable, it has to be delivered." </p><p>The babies have had trouble breathing, which can be a symptom of SARS. Lo said it's also possible they are suffering from respiratory disease syndrome, which occurs in premmies, and the uncertainty leaves experts in a quandary. </p><p>"We have been monitoring their cases with great suspicion, and treating them as if they might have been infected," Liu said earlier. </p><p>Little information has been made available about the babies. It has not been confirmed how premature they were and no identities have been made public. A newspaper reported that one of the fathers, the husband of the first mother to die, had recently recovered from SARS. </p><p>The disease has infected more than 4,000 people globally and killed more than 250, but it is unclear whether pregnant SARS victims elsewhere have had to give birth as they were dying or deteriorating. </p><p>A World Health Organisation spokesman, Peter Cordingley, said yesterday from the agency's regional headquarters in Manila he was not immediately aware of other such cases being tracked. </p><p>Liu said the Hong Kong babies' lungs and other organs were being monitored daily for SARS symptoms or other problems. </p><p>Doctors have held out the possibility that the babies could get the same SARS treatment as adults - a combination of the antiviral drug ribavirin and steroids. But Liu has said that won't happen unless they are confirmed to have the disease. </p><p>Hong Kong Health Director Dr Margaret Chan noted that doctors caring for the babies are hindered by a lack of case histories, since no-one has yet dealt with infants sickened by a new disease that is still so poorly understood.

From Australia:

http://www.smh.com.au/articles/2003/04/25/1050777405349.html

<h3><HEADLINE>SARS timebombs: fatal threat of the super-carriers</HEADLINE></h3>
April 26 2003

The spread of SARS may be due to people who are vastly more infectious than most sufferers, Julie Robotham writes.

<p>They are the wild cards in the epidemic. So-called "super-spreaders", who apparently infect others with the SARS virus much more readily than most patients, seem to be responsible for several regional outbreaks of the pneumonia-causing illness.

If it is true that some SARS carriers are hyper-infectious, that would be grim for the prospect of containing the disease. Just one super-spreader could ignite a whole new outbreak, and demolish all the good work done by isolating dozens of other patients.

What specialists must now do is figure out how real the phenomenon is. Is there something fundamentally different about how the coronavirus implicated in SARS is carried or shed by the super-spreaders, or did they just cough in the wrong place at the wrong time?

Esther Mok, a flight attendant, has been dubbed a super-spreader by the health minister of Singapore, which traces almost all cases in its epidemic back to 26-year-old Ms Mok's shopping trip to Hong Kong.

"Esther Mok infected the whole lot of us," the minister, Lim Hng Kiang, tactlessly told a press conference earlier this month. Ms Mok has survived, but her parents are both dead from severe acute respiratory syndrome.

The idea that one individual, who appears no different from any other patient, could be the touchpaper for an incendiary outbreak sounds like an urban myth. It sounds like a benighted explanation for something scary and not understood, justifying people's feelings of mistrust.

But other apparent super-spreaders have been identified. <br>A Chinese doctor, who visited Hong Kong and spread SARS through a hotel there, is linked to multiple infections, including at least two who took the disease out of the territory and introduced it to other regions of the world. Experts are far from dismissing the possibility that some patients may be off the scale in their capacity to pass on the virus.

Julie Gerberding, director of America's Centres for Disease Control, this week nominated the relative infectiousness of different individuals at the top of her wish-list of questions requiring answers. "Why are some patients more infectious or more capable of serving as a source of infection to others than most patients are?" she asked. "How long does a person remain infectious after they acquire the illness?"

Scientists have to entertain a range of possibilities. It could be that some individuals are somehow - possibly genetically - extremely susceptible to becoming ill from or spreading SARS. Perhaps some people are capable of sending the virus into the air around them, while most transmit it only directly through nasal or throat secretions.

Alternatively, it could be that the super-spreaders are carrying a mutated form of the virus that makes it easier to contract.

Associate Professor Bill Rawlinson, a senior medical virologist at Sydney's Prince of Wales Hospital, says a basic test to determine that someone has SARS will offer no information about their infectiousness. But other viral illnesses may provide some clues.

"To get a viral infection you don't just have to be in contact with the virus, you have to contact enough of it," Professor Rawlinson says. Just one viral particle in a thousand "droplets" in a cough or sneeze probably will not be enough to infect another person, he says. But increase the concentration and you reach a threshold, after which the chance of passing on the bug jumps rapidly.

There are other general rules. "If you're a child you tend to have more virus and be more infectious," he says. The same goes for people whose immune systems are suppressed by HIV infection or drugs.

The "viral load" - the number of live copies of the virus a person carries - also changes during the course of an illness. "If you're incubating or early in the virus, there often is large amounts present. There are even people who are asymptomatic carriers. You can find influenza in people's throats who have no symptoms. They can be asymptomatic of genital herpes [virus] without lesions," Professor Rawlinson says.

To date, that does not seem to be the case with SARS. "The epidemiology suggests SARS is most infectious when people are symptomatic," he says.

The question of whether there are more and less infectious SARS strains will not be answered until many more specimens have been analysed and compared. But this is the case with some other viruses. Influenza A, for example, is more infectious that influenza B.

The news on SARS infectiousness is both very good and very bad, Professor Rawlinson says. Where stringent control measures are in place, containment seems possible. Singapore and Canada appear close to reining in their outbreaks. But when procedures slip, SARS spreads like wildfire.

Dominic Dwyer, a medical virologist at Westmead Hospital, says: "Certainly it does appear there have been people who are 'super-spreaders' in the sense that they have infected lots of people around them."

What is hard to know, he says, is whether they are genuinely more infectious, or whether they just happened to come into contact with more people.

His gut feeling is that the truth may fall in the middle, with individual variations in the degree of infectiousness at least partly responsible. Dr Dwyer does not dismiss the concept of the super-spreader. In other illnesses, he says, "some people have a lot of virus on-board; others don't".

SARS may be a more extreme example of that.

In blood-borne viral diseases, like HIV, it is possible to test for the concentration of virus. That in turn is assumed to be linked to the amount of virus shed through other body secretions and to the likelihood the infected individual will pass it on.

In viral respiratory infections, such as flu - and presumably SARS - the picture is much hazier.

A test on the products of one cough might yield nothing, but a slightly more energetic one a minute later could be saturated with virus. "We don't have a good handle on viral load and shedding in respiratory illnesses," Dr Dwyer says.

That fact is going to make the SARS puzzle all the more difficult to solve.

VIOLATION OF ISOLATION ORDER NOW A MISDEMEANOR IN CALIFORNIA

Fair use for discussion purposes:


Oakland Tribune


Six victims of SARS must stay in isolation
Agreement to remain home is form of 'quarantine', say county officials
By Jean Whitney
STAFF WRITER


Friday, April 25, 2003 - SAN MATEO -- The "voluntary" isolation program for suspected SARS victims in the county is now a little less voluntary.

County health officials are asking suspected victims of the virus -- there are six now, with a new case reported Thursday -- to sign a written agreement that they will stay isolated at home during the illness and for 10 days after the disappearance of symptoms.

Officials referred to the voluntary isolation by victims as "a form of quarantine" and said violation of the agreement will be considered a misdemeanor.

Violation a misdemeanor

Violation of a medical isolation is a criminal misdemeanor under both state and federal law, punishable by fine and/or imprisonment.

County public health staff will call suspected SARS victims twice a day to confirm they are staying home, according to public health officials.

Under the isolation program, homebound residents also agree to follow sanitary procedures to avoid spreading the virus, such as wearing a mask in the company of non-infected individuals, and washing their hands.

None of the county's six suspected cases have required hospitalization, officials said, and only one has been classified as "probable" under the new standards issued by the Centers for Disease Control and Prevention.

The sixth suspected case of SARS here within three weeks is a 3-year-old girl who recently traveled through the Singapore airport. So far, the girl's traveling companion has not been identified as a SARS victim, officials said.

None of the names or hometowns of the county residents suspected of having SARS was made public.

The 3-year-old likely exhibited some of the typical symptoms of SARS such as coughing, fever of at least 100.4 degrees, and shortness of breath.

The previously unknown virus of the coronavirus family is believed to have erupted in Guangdong province in of China and spread to Singapore, Hanoi and Toronto.

49 cases in state

In California, 49 cases have been reported as of Thursday, with 14 of those designated "probable" and 35 "suspected," according to the CDC.

Only one case of SARS in California -- in Santa Clara County -- has so far been definitively diagnosed as SARS.

Worldwide, there have been 263 deaths counted from SARS, out of 4,439 suspected cases, according to the World Health Organization.

There have been no deaths in the U.S. so far out of 247 cases, according to the CDC.

From The New York Times:

http://www.nytimes.com/2003/04/25/i...tml?ex=1051934400&en=d56b6b798d4838ec&ei=5062

<H3>4,000 Quarantined in Beijing as Suspected SARS Cases Climb</H3>
By ERIK ECKHOLM

<IMG SRC="http://graphics7.nytimes.com/images/dropcap/b.gif" BORDER="0" ALIGN="left" ALT="B">EIJING, April 25 — At least 4,000 Beijing residents with exposure to a contagious respiratory disease are being kept in isolation, often in their own homes, health authorities said today, and a second major hospital was put under total quarantine, with virtually no one allowed to enter or leave.</P><P> City education officials also revealed that 300 college students who had contact with infected people suffering the dangerous new disease, known as SARS, have been sequestered in a military training camp for two weeks' observation. </P><P> As Beijing began a stringent new quarantine program to try to halt the spread of severe acute respiratory syndrome, pledging to isolate virus-exposed people and contaminated buildings, reported SARS cases in the capital continued to surge for the fifth straight day.</P><P> One hundred and three more patients were confirmed as of Thursday evening, taking the city's reported total to 877. </P><P> Equally ominous, experts said, was the relentless climb in suspected SARS cases in the city, to 954 as of Thursday night compared with fewer than 700 a few days back. Officials have not said what portion of suspected cases turn out to be SARS. </P><P> But the parallel rise in numbers indicates that the epidemic is still worsening in Beijing and also spells an overwhelming load for hospitals and medical workers, who must treat all the cases with the same extraordinary precautions. </P><P> In the huge southern city of Shanghai, which has reported only two confirmed and 18 suspected cases of SARS, a team from the World Health Organization said today that the statistics appeared to be generally reliable, unlike the finding last week in Beijing of major undercounting. Why Shanghai, which is far closer to the SARS epicenter of Guangdong, has had such a light burden is something of a mystery.</P><P> This morning Beijing officials held the first of what they promised would be frequent press briefings on an epidemic that has suddenly become a consuming threat and popular obsession.</P><P> Cai Fuchao, Beijing's propaganda chief, condemned as pernicious rumors the widely repeated claim that air and road links to the city will be cut or that martial law will be imposed.</P><P> "Beijing has ample food," he also declared, vowing to punish vendors caught increasing prices as worried residents buy up rice, noodles and other groceries. </P><P> Mr. Cai said that hundreds of inspectors are visiting 147 city hospitals to insure that disease reports are accurate. But international health officials complain that Beijing has still not provided details about where the virus has appeared within the city and among what groups — information that is vital for defeating the disease and assessing risks to the general public. </P><P> Only after he was cornered by frustrated reporters did a city health official provide a sketchy picture of quarantines so far. Some 4,000 residents with exposure to SARS patients are in isolation, many of them in their own homes, said Guo Jiyong, deputy director of the Beijing health bureau. It was not clear whether that number included the staff and patients now sequestered in two hospitals and officials did not reveal how many apartment blocks, factories or other buildings had been quarantined.</P><P> Beijing's train stations were crowded again today, mainly with well-dressed college students carrying knapsacks and less-polished migrants from rural areas carrying their belongings in grain sacks. </P><P> Despite an order that college students should not leave the city without permission, many were boarding trains for their home provinces, in the belief that dormitories in Beijing might be more dangerous. Migrant workers in protective masks said they were going home either out of fear or because work, especially in hotels and restaurants, was drying up.</P><P> "I think the disease is a little less bad back home in Henan," one departing plumber said. </P><P> On Thursday the city essentially closed down the People's Hospital of Beijing University after dozens of doctors and nurses inside reportedly showed possible signs of SARS. More than 2,000 employees of the hospital and an unknown number of patients are forbidden to leave as the facilities are decontaminated and those inside observed for telltale symptoms.</P><P> Today the hospital was still ringed by tape and the police, while trucks delivered boxes of fruit and other foods and some people tried to talk through the fence with healthy relatives stuck inside.</P><P> A second facility, Ditan Hospital, which is one of the prime hospitals treating SARS patients, was also closed off today, for reasons that were not disclosed. </P><P> But at You'an Hospital, another prime SARS treatment center, only the medical staff in the infectious disease wing were being sequestered and the atmosphere outside, and in adjacent compounds housing hospital staff, seemed relaxed. </P><P> "If anyone here gets a fever they'll be isolated, but it hasn't happened yet," said a woman from the residents' committee of one apartment block. </P><P> Since Monday, Beijing education authorities have been sending college students with possible SARS exposure to a military training camp, normally used to train students each fall, in Daxing County, just south of the city. About 300 students are held there right now, said a Mr. Zhang of the Beijing Education Commission, in a telephone interview. </P><P> Another 50 students sent to the camp from People's University bolted after complaining of poor living conditions. They are now living in a building on the People's University campus.</P><P> Cases in universities and schools have not been publicized, but the Web page of the Beijing Northern Transportation University said today that of 52 teachers, other staff members and students sent ill to hospitals, 14 had been confirmed to have SARS and another 9 are suspected of it.</P><P> Nationwide, according to data released this evening by the Ministry of Health, China has recorded 2,601 SARS cases, including 115 deaths, with the disease now appearing in 21 provinces and municipalities. </P>

ROLF - only PETA, Laura...

I'm curious how they've reactedd in the past to the slaughter of millions of poulty when they've been found to contain avian flu which may be transmissible to humans?

The 'Chinese Dimension' - I'm not sure it's a "Chinese Disease" so much as it originated there. Toronto has an Asian population of 400,000 with frequent travel back & forth- business, students & folks visiting family. Although Toronto officials aren't 'profiling', some of the deaths & many of the seriously ill have been non-Asian. The US is pretty ethnically diverse - I don't think the lower case load/milder symptoms is due to that. Mind you, WHY you're not being hit as hard is something I can't figure out yet. If some ethnic groups or some immigrating are from areas with higher endemic rates of infectious disease - do better screening.I know Canada's leaves much to be desired & the fcat that we don't import more illness is at times, sheer luck.,

SARS totals are currently DROPPING in Toronto - a number of cases were removed from the lists when they tested as having other causes for their symptoms. Containment in many Asian nations may be difficult if not impossible more for the reasons these are high density populations, have different sanitation stamndards & different lifestyles - humans & animals closely intermingling, as an example. It's easy to say Ebola has an thnic tendency to affect blacks, but that would be false - the disease in endemic in Africa, not white Europe or North America. Marburg - the first filovirus identified struck whites in Germany & Belgium - all depends where the disease first manifests.

Mutations causing more serious disease? I'd still like to see more specimens sequenced with significant differences before I'll agree that's what's happening. There's also this possibility. The illness has struck less that 5,000 people world wide. It hasn't affeected the full range of ages, lifestyles & pre-existing conditions with enough frequency to determine whether "new" manifestations are due to mutating virus or differences in patinets. More time needed.

I'm not yet ready to say it will be as bad as pandemic flu yet either. Flu was more contagious. It took 2 years to travel. SARS has been with us 6 months & the world is "smaller". The fact that it's not established in more nations, the fact that it's affecting relatively large numbers in only a few countries & the fact that these days 6 months gives an infectious illness plenty of time to go 'run away pandemic' - yet it hasn't, gives us room for some optimism. Much hinges on the real numbers in China & what other nations do in temrs of screening of travellers.

HK & Canada are wrestling the daily numbers of new cases downwards. If that continues then the potential for damage will rest on imported cases. Better screening for sure - & I don't care how 'intrusive' some questions may appear. If I fly to Toronto from Macau & am sick - they'd better be asking a lot of questions.

And yeah, today & tomorrow's numbers will tell us a lot about the true transmissibility of SARS amng more casualcontacts - we should be getting new case reports as a result of the Easter long weekend.

Fair use for discussion purposes:


Local Woman Hospitalized For SARS Symptoms
Michigan Takes Action To Prevent Spread Of Disease
Posted: 8:43 a.m. EDT April 25, 2003
Updated: 9:20 a.m. EDT April 25, 2003

A woman who was a patient at the Henry Ford Clinic in Troy is reportedly being evaluated for symptoms of the SARS virus.

An employee of the clinic told Local 4 that a female patient came to the clinic Thursday afternoon. The woman had recently been in Canada and did show signs of SARS symptoms, the station reported

The patient has reportedly been moved to Henry Ford Hospital in downtown Detroit. Officials would not comment on precautions being taken inside the facility or the Troy clinic to prevent the spread of the potential illness.

Another local woman was also being checked for SARS. Her fiancé, a 40-year-old Baltimore physician, flew into Detroit Metropolitan Airport last week to pick up the woman. He reportedly became ill but then continued to fly on flights through Baltimore, Toronto, Detroit and Cleveland. The man reportedly began showing signs of the virus and is currently hospitalized at Johns Hopkins Medical Center. The woman was treated at a Detroit area hospital.

The Centers for Disease Control is currently trying to contact passengers aboard the flights in which the man traveled.

Detroit Metropolitan Airport is trying to increase their efforts to contain the SARS virus. Ticket counters are supposed to be wiped down every three hours, and airplanes will be thoroughly disinfected if a passenger appears to be ill, the station reported.

Wayne County officials are calling on U.S. Congress and the CDC to stop the 130 trucks hauling Toronto trash across the border to a Michigan landfill. Wayne County Executive Robert Ficano said there is no proof that SARS can be transmitted that way, but they are being proactive and cautious.

A mandate is also expected to go into effect at the Michigan border crossing in which all officers will wear masks and hand out SARS information cards.


Copyright 2003 by ClickOnDetroit.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Singapore toughens Infectious Diseases Act to deal with SARS outbreak

Singapore toughens Infectious Diseases Act to deal with SARS outbreak

Singapore's Infectious Diseases Act has been expanded and toughened, to better tackle the SARS outbreak.
Using a Certificate of Urgency, the changes were tabled, debated and approved in a single Parliament sitting on Friday.

The main thrust of the changes to the Infectious Diseases law is to give health authorities more teeth to deal with irresponsible and recalcitrant people who breach quarantine orders, and disregard the advice of doctors.

People who break home quarantine will be tagged or even arrested and detained at a hospital or some other place.

They can be fined up to $5,000, and repeat offenders will be referred to court.

To deal with an Amoy Garden-type situation, the law now also allows for contaminated areas to be quarantined.

Any suspected sources of infection like the water supply, sewage system or goods can also be destroyed.

Despite calls not to be irresponsible and endanger the health of others, some have turned a deaf ear.

So, now the law says anyone who knows or suspects he has an infectious disease is not allowed to go to public places, except for treatment.

And if there's a designated treatment centre, like Tan Tock Seng for SARS, he must go there or face stiff fines and even jail.

"In our battle against SARS, we need a higher level of social discipline and social responsibility. Singaporeans must have the confidence that fellow Singaporeans will not commit irresponsible acts that expose others to the risk of infection," said Health Minister Lim Hng Kiang.

People who refuse to cooperate with disease control measures or provide false or misleading information face a $10,000 fine and jail up to 6 months.

Repeat offenders can be fined up to $20,000 and jailed up to a year.

Because SARS may be masked by other medical conditions, health authorities can in some suspect deaths order a post-mortem, insist on special precautions in handling the body, and also not allow for a funeral wake.

asia.news.yahoo.com/03042...38336.html

"...Experts say whatever happens to SARS in the coming months, it will change forever the way hospitals treat people who are even suspected of having a contagious disease...."

Costs of emergancy care from EMT to ER just went into orbit.

And the secondary treaters will be right behind.

Anybody for Hillary/GephartCare?

It's coming.

Wow Broth Rat!

That article REALLY makes for some BIG CHANGES in business as usual and affects EVERYONE sick with SARS or not . WOW.

IF SUCH MEASURES WERE EVEN CONTEMPLATED HERE IN AMERICA YOU WOULD SEE SUCH A RUN ON GROCERIES ETC.
WOW.

http://story.news.yahoo.com/news?tmpl=story&ncid=578&e=2&u=/nm/20030425/bs_nm/sars_dc


SARS Deaths Mount, Hospitals Quarantined
37 minutes ago Add Business - Reuters to My Yahoo!


By Benjamin Kang Lim

BEIJING (Reuters) - The Philippines reported its first deaths from SARS (news - web sites) on Friday and authorities in Taiwan quarantined over 1,000 doctors, nurses and patients in a hospital to halt the spread of the deadly flu-like disease.


A World Health Organization (news - web sites) official said SARS could become a horrifying epidemic if it spread in China's provinces or in nations like India and Bangladesh, where people live cheek by jowl and medical facilities are poor.


"There will be various countries in the world where we would be really concerned because we don't think they have the capacity to stem the tide once it is introduced," WHO official Wolfgang Preiser told reporters in Shanghai.


"It may have happened already. We don't know."


SARS, a respiratory infection for which there is no known cure and which has a mortality rate of about six percent, has killed at least 276 people and infected about 4,800 in 25 nations.


It has caused widespread alarm in mainland China and in Hong Kong, each of which has reported 115 deaths.


The Philippines reported its first two deaths from the virus on Friday, joining China, Hong Kong, Singapore, Canada, Vietnam, Malaysia and Thailand as countries with SARS fatalities.


Health Secretary Manuel Dayrit said the Philippine dead were a nursing assistant visiting home from Toronto and her father.


The disease is spread by droplets from sneezing and coughing but may also be transmitted by touching contaminated objects such as elevator buttons.


Taiwan authorities sealed the Taipei Municipal Ho Ping Hospital on Thursday after more than 25 suspected SARS cases were discovered and more than 1,100 doctors, nurses, patients and visitors will have to stay there for up to two weeks.


WHY ME?


Many of those caught in the hospital were furious. "I am not sick. Why should I be quarantined?" a nurse in an apple green uniform shouted at reporters.


Patients pasted signs and raised placards to the windows of the downtown hospital in protest. "Quarantining healthy people is against the law. Do not treat us like birds with bird flu or pigs with foot-and-mouth (news - web sites) disease," wrote one patient.


Taiwan has strong business and ethnic ties with China and Hong Kong, but has reported only 49 probable cases of SARS with strict measures at airports and broad use of quarantine orders.


In its latest step to curb the spread of SARS, Taiwan said it would suspend issuing landing visas for Hong Kong residents for one month, effective at midnight on Friday.


In Hong Kong the acting head of the Hospital Authority, Ko Wing-man, offered to resign for not doing enough to stop the spread of SARS, but a U.S. health expert advising the government said that any health authority "will be hard pressed to deal with something like this."


Senior Canadian officials challenged a travel warning from WHO to avoid Toronto, as well as Hong Kong, Beijing and China's Guangdong and Shanxi provinces, as the city won support from the U.S. Centers for Disease Control (CDC) in Atlanta for its handling of the outbreak.





The CDC said the risk of contracting SARS was no greater in Canada than in any other nation with cases of the disease, but recommended precautions such as staying away from hospitals.

WHO Director General Gro Harlem Brundtland telephoned Canadian Health Minister Anne Mclellan to reaffirm the travel warning and say it would stay in place, a WHO spokeswoman said in Geneva.

In the United States, the virus was found in six more patients, bringing the U.S. total to 245 suspected cases, but only 39 were probable cases, meaning they had pneumonia as well as fever and cough or other symptoms, CDC head Dr. Julie Gerberding said. All but two had traveled to Asia or Toronto, suggesting, the CDC said, that it was not spreading freely.

The WHO said Vietnam, with 63 cases and five deaths, had managed to control SARS through aggressive measures. Some other countries with outbreaks had managed to stop the spread.

ECONOMIC IMPACT

The economic impact of SARS appears to be spreading faster than the virus, threatening to turn a short-term hit on Asian demand into a shock that could disrupt global output and trade.

Shares in European airlines and travel groups fell on Friday and luxury goods were under scrutiny. "We think the market has clearly underestimated the impact of SARS," said one luxury goods analyst. SARS fears also weighed on shares across Asia.

"Investors are no longer focusing on countries with high counts of infections and deaths," said Philip Wee, treasury markets strategist at DBS in Singapore. "Attention is starting to shift to economic fallout on countries dependent on affected countries for growth."

So far the impact has been mainly on Asian consumer spending -- people staying away from shops and entertainment venues and curtailing travel and holiday plans -- but quarantine measures and fears of the disease spreading could hit production.

Commodity traders are worried that if SARS disrupted trade and slowed growth it would weaken Chinese demand for industrial imports, such as metals and rubber. Imports such as cotton and grains were also at risk as people avoid shops and restaurants.

The World Trade Organization (news - web sites) has said global commerce would be shaken if trading giant China were badly hurt by the crisis.

The World Bank (news - web sites) said East Asian economies should be able to weather SARS, but warned of a severe short-term effect. (With additional reporting by Lee Chyen Yee in Shanghai and John Mair in Singapore)

From New York Newsday (AP):

http://www.newsday.com/news/health/ny-sarswire0425,0,6306373.story?coll=ny-health-headlines

<h3>Countries Struggle to Contain SARS</h3>
April 25, 2003, 9:44 AM EDT

Countries worldwide were struggling to contain varying outbreaks of the flu-like illness that has already killed more than 260 and infected more than 4,300.

In the Philippines, officials announced the country's first confirmed cases, saying two people have died of SARS. Philippines President Gloria Macapagal Arroyo authorized the health secretary to mobilize police to impose quarantines and take other measures against SARS.

The former head of the U.S. Centers for Disease Control and Prevention said Friday in Hong Kong that doctors probably will never be able to eradicate SARS, but they should be able to bring down the numbers of infections and deaths.

"What we can hope for is a suppression and minimization," said Dr. Jeffrey P. Koplan, a former director of the CDC and now vice president of health affairs at Emory University in Atlanta.

"To think that magically this government or any government or any scientist in the world could stop this, like you stop a car at a stop sign, is very unrealistic," said Koplan, a consultant to SARS researchers at the University of Hong Kong.

In Toronto, tourism businesses braced for disaster after the World Health Organization added the city to a list of countries that people should avoid visiting. Sixteen people have died in Canada, most of them in Toronto.

In the Taiwanese capital of Taipei, about 30 nurses and workers were fed up with being quarantined for two weeks at the Hoping Hospital, which reported 10 probable SARS cases earlier this week. They complained that confining people could expose healthy staffers to the disease.

Some protested by tossing bottles and paper out of windows and displaying banners saying "Wrong Policy" and "Long, Long 14 days."

"This is ridiculous. Why can't I go home?" yelled a woman with a gauze mask tightly strapped to her mouth.

Taiwan has reported 41 probable cases, but no deaths.

Canadian officials said they would appeal the WHO travel advisory against travel to Toronto, noting that Canada's more than 300 probable and suspected SARS victims falls far below China and Hong Kong and they have aggressively tracked and isolated all cases.

"They don't know what they're talking about," Mayor Mel Lastman told CNN, referring to the WHO. "Who did they talk to? They've never even been to Toronto. They're located somewhere in Geneva."

In Hong Kong, local media accused the Hospital Authority of not providing enough protective gear for frontline workers -- hundreds of whom have been sickened by SARS on the job.

Many staff working in the 14 hospitals treating SARS patients have been wearing paper gowns that don't offer enough protection when workers come into close contact with SARS patients, the South China Morning Post reported.

The Hospital Authority's acting chief executive, Dr. Ko Wing-man, admitted to problems in dealing with the crisis that has infected about 1,500 people in Hong Kong and killed 109.

"I must admit the performance of the whole management, especially under my guidance, does not reach many people's expectations," Ko said in a radio interview.

In South Korea, health officials checking for SARS poked a thermometer in James Kelly's ear Friday as the U.S. assistant secretary of state arrived to the country following talks in Beijing.

South Korea has had no confirmed SARS cases but takes the temperature of all arriving travelers as a precaution. Officials said Kelly's temperature was normal.

Vietnam, meanwhile, was counting down to Monday, when the World Health Organization is prepared to announce that it is the first country to have a local outbreak and then rid itself of the deadly bug.

Five people died in Hanoi after an outbreak at a hospital stemming from an infected patient from Hong Kong, but no new cases of the disease have been reported in Vietnam since April 8.

One WHO official said Friday he believes measures introduced to control the spread of SARS will eventually succeed.

"I think it is some way to go before we can say it is under control, but it is getting there," said Dr. Mark Slater, a medical officer from the WHO's Department of Communicable Diseases, Surveillance and Control. He spoke to reporters on the sidelines of a health conference in Malaysia.

A dozen Asian countries, including China, are considering a joint plan to strengthen their defenses against SARS. The plan, outlined by senior health officials at a conference in Malaysia, calls for mandatory health declarations for all passengers and travel bans on anyone with symptoms.

Purple prose from China...

You've GOT to read this frrom the People's Daily.Talk about pure Communist - yeah for the couragous people stuff. URL:

http://english.peopledaily.com.cn/200304/25/eng20030425_115776.shtml

Here's the article & warning - no you didn't double up on your prescriptions accidently this morning. DO NOT eat or drink while reading this. Apparently, 'love is all we need':


True Love Knot - Most Effective Weapon for Fighting SARS
Love and warmth are quickly disseminating and spreading. With warmth and love, a true love knot woven with one heart and one mind by the people of the whole country, the day of victory is drawing near.

Up to 20:00 pm April 23, the virus of SARS (Severe Acute Respiratory Syndrome) had taken away the lives of 110 Chinese. Altogether 2,422 people were infected, with 1,278 suspected cases. In Beijing, 774 cases (143 cases related to medical workers) had been discovered, with 39 cases of death and 863 cases of suspected disease.

This is a war without the smoke and sound of guns. When Chinese President Hu Jintao and Premier Wen Jiabao, without wearing any guauze masks, appeared on the frontline of countering virus, when head nurse Ye Xin with the Guangdong Hospital of Traditional Chinese Medicine fell at the work post to which she had dedicated half of her life, when scientific research workers were weeping together in order to find out the culprit of SARS, when Guangdong's photographer Wang Xiaoming was infected as he tried to find out the truth, and when the first patient infected with SARS was discharged from the Beijing You'an Hospital, people were shedding tears-the virus was shocking to the people for its ferocity and cruelty. Human beings continue to forge ahead with their tenacious efforts.

Science can beat back the serious disease, while unity is the strongest force that thoroughly defeats the disease.


Party and government leadership: Personal presence in the frontline, squarely facing SARS
On April 14, in the Guangdong Provincial Disease Prevention and Control Center, Hu Jintao, general secretary of the Central Committee of the Communist Party of China (CPC) and Chinese president, stood up and made a deep bow to the medical workers fighting on the frontline. "We feel heartrending when we see that the health and safety of the lives of some masses are facing serious threat", said President Hu.

At around 10:30 am, on the commercial street of Beijing Road in Guangzhou, someone suddenly shouted "President Hu Jintao", then people saw a familiar image standing before them, and the president kept waving greetings to the people around. It is said that Hu Jintao, after investigating the Guangdong Provincial Disease Prevention and Control Center, without giving any notice in advance, came directly to observe the busiest commercial street of Beijing Road in Guangzhou.

Prof. Zhang Tongxin with the Party History Department of Renmin University of China, said: under the present circumstance wherein the epidemic situation has not been removed and many people are still wearing gauze masks, Hu as the highest State leader, who personally went to Guangdong to inspect the downtown area under the circumstance without taking any protective and security measures, has set an example featuring the style of "cordiality and affection" for the people.

Earlier on the afternoon of April 12, Premier Wen Jiabao who had left his footprints in "1,800 counties and districts nationwide" appeared in the Beijing You'an Hospital, a hospital specially accepting and treating SARS patients. On April 18, Premier Wen again went in succession to the Beijing June 1 Kindergarten, the Beijing 101 Middle School, a primary school attached to Peking University and the Beijing Aerospace University to express his best regards for the teachers and students there. "A responsible government must always put the interests of the people in the first place," said Wen Jiabao. A media organization published a report entitled "Facing SARS Squarely" on Premier Wen's personal presence in the Beijing You'an Hospital.

Beijing is a severely SARS-affected area, the Beijing municipal Party committee and the municipal government have the health and safety of the Beijing people at heart. On the morning of April 21, Liu Qi, a member of the Political Bureau of the CPC Central Committee and secretary of the Beijing municipal Party committee, and deputy secretary of the Beijing municipal Party committee Wang Qishan went to the Beijing First-aid Center, the Chaoyang District Disease Prevention and Control Center and the Beijing Disease Prevention and Control Center to check up on the situation regarding implementation of SARS prevention and treatment work.

Over the past few days, other leaders of the Beijing municipal Party committee and other related departments have also checked up on the situation regarding implementation of SARS prevention and treatment work. "With the solicitude of the leaders, we'll certainly be able to defeat the virus!" said Beijing residents with excitement.

Beijing is allocating one thousand beds used for SARS patients, patients of suspected disease and patients kept for observation; hospitals concerned have set up makeshift establishments equipped with several hundred beds and tried everything possible to ensure sufficient reserved hospital beds, the city has specially assigned 152 personnel to coordinate and inspect work in 147 hospitals, and it has purchased additional necessary medical equipment.


Doctors and nurses: They are entrusted with care for people's health and lives
Before they entered the medical realm, each medical worker had made the solemn pledge: Entrusted with the care for the health and lives of the people, I am determined to do my best to deliver humankind out of painful diseases, help people get perfect health and safeguard the sacredness and honor of skilled medical personnel.. Rescuing the dying and healing the wounded, I will not shrink from toil and hardships but I will persist in my pursuit.

At the time of the occurrence of the September 11 attack when every one was rushing downstairs to flee for their lives, there was only a group of people who went upstairs-they were the fire fighters; when the war against SARS, a war without the smoke and sound of gun, broke out, it was the medical workers who are entrusted with care for the safety of lives were the first to charge to the frontline. Head nurse Ye Xin of the Guangdong Hospital of Traditional Chinese Medicine, affected with SARS virus, fell on the frontline of battle against SARS, when other doctors and nurses got close to her to check her lung and phlegm, she wrote on a paper with difficulty these words: "Don't get close to me, my disease is infectious."

After the Changxindian Hospital in Fengtai District, Beijing city, was designated as a hospital specially for accepting and treating SARS patients, nurse Hao Yanmei, in her "request for a battle assignment" written to the hospital Party branch committee, she resolutely demanded to plunge herself into the frontline of fighting against SARS.

Dr. Jiang Rongmeng of Ditan Hospital, after working hard continuously for 24 hours in rescuing patients, he lacked the physical strength even to open the cover of the spring water bottle.

The wife of reporter Li Keyong with the Xinhua News Agency is a doctor of People's Hospital under Peking University, she formally became one of five doctors of this hospital to specially treat SARS patients, she was so busy and so tired that sometimes she couldn't help weeping, but she had to keep her tears off. Li Keyong thought: As long as there is a group of people like her battling on the frontline, there is hope for us to defeat the SARS disease.

Seeing the medical workers' fearless and selfless spirit of dedication, people express their deep respects for them.

Scientific research workers: Working day in and day out, making concerted efforts to tackle difficult problems

In compliance with the requirements of the Party Central Committee, the State Council and the Central Military Commission, the Microbial Epidemic Disease Research Institute under the Military Academy of Medical Sciences and the Beijing Genome Research Institute under the Chinese Academy of Sciences have launched the work of research on SARS and tackling difficult technical problems. On February 12, the Military Academy of Medical Sciences sent out assistants to directors of institute, epidemiologists and virologists to Guangdong's epidemic areas to collect samples. Because several institutions simultaneously launched studies on etiology, while the samples collected were limited, whether or not the collection of samples can be completed bears on the success or failure of the research on etiology and all the more on the health of the masses of people.

While sending out people to take samples, the academy of medical sciences also stepped up the formulation of a research action program: It set up a special leading group and an experts group composed of 13 authoritative scholars; it organized a research contingent based mainly on the microbial detecting center and with the participation of several departments which carries out multi-faceted research.

In an effort to produce results as soon as possible, researchers sometimes work for as long as over 16 hours a day. Finally, researchers on the frontline scored major achievements after working hard days and nights; they separated etiology from SARS-a new coronavirus, completing the whole genome detecting procedure of coronavirus. And developing a quick detecting technology for SARS-a new reagent. These achievements have provided a relatively accurate, reliable, quick and economical diagnostic means for the prevention and treatment of SARS, thus laying a foundation for the production of vaccine and medicine.

While inspecting the Military Academy of Medical Sciences and the Chinese Academy of Sciences on April 20, President Hu Jintao said, "At such a crucial moment, the numerous scientific research workers thought of what was on the minds of the Party Central Committee and were anxious about the needs of fighting the disease and did things to meet the needs of the masses; with a high sense of responsibility for the people and a rigorous scientific attitude, they have been working days and nights, engaged in stubborn struggle, made concerted efforts to tackle difficult problems, had done huge amounts of painstaking and meticulous research work, and reaped valuable fruits, all this is of important significance to defeating atypical pneumonia. The Party and government thank you, the people are grateful to you."


Masses of the people: Helping one another to tide over the difficulties
Artist Zhao Bandi, at the crucial moment when people of the whole country are fighting against SARS, presented his latest work of art-a plane advertisement with "fighting SARS and defending our homeland" as the theme. The advertising picture shows Zhao Bandi and his closest partner "Panda" wearing large gauze masks, an indicator of the "SARS period". In an environmental setting similar to street fighting, arms in hands, they meet the "invisible "enemy" head-on.

Zhao said, "I choose a battle scene, because I feel that the current resistance to SARS is like a war with the participation of the whole nation. I am an artist, but I am all the more a special social worker, in my own way I express my sense of responsibility to the society.

In the face of the serious disease, people, with one heart and one mind, have begun a war involving the whole nation.

The Beijing Mobile Co. Ltd. has donated 1 million yuan for research on the prevention and treatment of SARS, the Beijing medicine supply department and medicine Co. Ltd. have stepped up purchase and production of various kinds of medical equipment and drugs.

In addition, Beijing has opened a special network for direct report on the SARS epidemic situation; established a rescue and aid mechanism for SARS patients; set ceiling prices for commodities and services related to the prevention of SARS; power supply companies guarantee stable and reliable electricity for six hospitals designated for accepting and treating SARS patients; the Beijing leading group in charge of the prevention and treatment of SARS recently opened a telephone consulting system, which answer related questions round the clock.

Beijing also conducted sterilization of some public utilities and public traffic departments

Love and warmth are quickly disseminating and spreading. With warmth and love, a true love knot woven with one heart and one mind by the people of the whole country, the day of victory is drawing near.

By People's Daily Online