X-Message-Number: 21458 Date: Mon, 24 Mar 2003 00:04:22 -0500 (EST) From: Charles Platt <> Subject: Some more informative SARS coverage At last a journalist has asked some obvious questions (but still stopping short of questions such as, how many people who contract SARS require hispitalization? How many must be ventilated? How many have recovered sufficiently to be weaned from oxygen? What is the average hospital stay? How many had been discharged?) This from the Monday NY Times: (No W.H.O figures on Sundays; I guess the bureaucrats take the day off regardless of worldwide epidemics). --- Respiratory Illness Spreads to a Third Wave of Cases By LAWRENCE K. ALTMAN A mysterious respiratory illness has spread into a new, third wave of cases in Singapore and Vietnam in recent days, World Health Organization officials said yesterday. But in both countries, the source of all new cases continues to be close contact with health care workers or family members and other people who themselves had close contact with earlier cases, Dr. David L. Heymann, a W.H.O. official, said. Although the number of new cases is relatively small, officials said, they are a cause for concern because they indicate that control measures have not stopped the spread of the disease in those countries. The W.H.O., a United Nations agency, has declared the illness known as severe acute respiratory syndrome a "worldwide health threat." The cause has not been determined, but most health officials believe that it is a virus. Scientists at the University of Hong Kong, a member of the W.H.O.'s collaborative network, have isolated a virus in recent days that is a prime suspect. Yesterday, the agency reported further progress in identifying the virus and developing a test for it. Scientists seeking to identify the virus are taking the utmost precautions as they work in highly secure laboratories categorized at the "three-plus" level, half a step below the maximum-security level-four labs. They wear masks and gowns, all materials in the room are burned after use, and the room is steam cleaned before it is used again. Dr. Klaus Sthr, who is leading the W.H.O. scientific team investigating the illness, said members of the agency's laboratory network would not distribute the suspect virus to any laboratory without three-plus level capability until it was determined that it was safe to do so. The illness "still looks like a disease you get only after close contact with an ill person," said Dr. Heymann, executive director in charge of communicable diseases for the W.H.O. The new information, he said, "shows a typical epidemic curve of successive waves of transmission of a disease that is transmitted person to person," referring to graphs that epidemiologists construct to plot the progress of outbreaks. The new wave of cases will increase the difficulty of containing the spread of the disease. But health officials said they would be far more concerned if they had not found a link between the latest cases and earlier ones. An inability to trace the new cases would mean that the disease agent had become loose in the general population, raising the specter that it would become an endemic disease. Dr. Heymann said transmission in the general community would be evident in the inability to trace contacts of new cases to older ones. With influenza, for example, such transmission occurs when droplets containing the virus are dispersed widely in the air. The hope is that the latest outbreaks will die out in affected areas as a result of proper precautions, he said. An important aspect of containing the illness remains barrier measures that include wearing masks, gowns, gloves and goggles in caring for patients. What set off alarms at the W.H.O. and other health agencies was the initial explosive nature of the outbreaks among health care workers; its ability to cause death quickly; and the apparent rapidity with which the ailment was spreading. But use of barrier precautions seems to have prevented further spread among hospital workers in many countries. During the past 10 days, reported cases have involved a smaller percentage of health care workers who have had close contact with affected patients and a larger percentage of family members and other people who had contact with cases, Dr. Heymann said. In Hong Kong, about 51 percent of the 222 cases involve health care workers; 10 days ago, the figure was about 90 percent among a smaller number of cases. The remaining 49 percent involved family members and close contacts. In Singapore, about 48 percent of cases now involve health care workers and 52 percent close contacts. The outbreak in Singapore began with three cases imported from elsewhere. In the first generation of cases, those 3 individuals transmitted the disease agent to 21 people (9 health care workers, 9 family members and 3 friends). In the second generation, the 21 individuals spread the illness to 13 others (6 health care workers, 4 family members and 3 friends). Those 21, in turn, spread the disease to 7 others (6 health care workers and a family member) in the third and current generation. A total of 386 cases, including 11 deaths, has been reported to the W.H.O. from 14 countries from Feb. 1 to Saturday. In addition, China has reported 305 cases, including 5 deaths, from November to Feb. 1 in Guangdong Province. The W.H.O. has established a network of doctors who have cared for at least one patient with the illness. After speaking with each other in teleconferences, their initial impression is that about 10 percent of the cases become so-called rapid progressors because the condition of the patients declined so quickly, Dr. Heymann said. About half of the rapid progressors 5 percent of total cases develop such severe difficulty in breathing that they have to be connected to mechanical respirators. Most deaths have occurred among those who needed mechanical respiratory support. Even among the other patients, many experience breathing trouble, one reason that an overwhelming majority remain in hospitals. Hong Kong has reported 222 cases, including seven deaths. Hong Kong officials said 210 patients remained in hospitals, 38 in intensive care. The Hong Kong Hospital Authority announced today that its chief executive, Dr. William Ho, had been hospitalized yesterday evening with pneumonia symptoms and was in stable condition. While his case had not been confirmed as severe acute respiratory syndrome 1,500 to 2,000 people typically fall ill with other types of pneumonia each month in Hong Kong it was nonetheless a further setback for the city's image. Dr. Ho and Dr. Yeoh Eng-kiong, Hong Kong's secretary for health, welfare and food, have been overseeing the response to the outbreak. --- end of excerpt Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=21458