April 14, 2003
China Leaders Finally Acknowledge Seriousness Of SARS

As the number of SARS cases in China continues to increase and as SARS shows up in additional parts of China the Chinese leadership has begun to publically acknowledge the seriousness the problem.

Chinese President Hu Jintao admits to being worried about SARS.

"Since the discovery of the SARS cases, I feel very worried. I feel anxious for the masses," Chinese President Hu Jintao said today.

The message from President Hu was broadcast using his own voice to underline the point.

It was his first public comment on SARS and, in an unusual step, the national evening news broadcast his own voice instead of having an announcer read his comments.

Chinese Premier Wen Jiabao says the situation remains grave.

``Much progress has been made in combating the disease, with the epidemic brought under control in some areas, but the overall situation remains grave,'' Mr Wen was quoted as telling a national conference.

These statements are being reported by the Xinhua News Agency and major Chinese newspapers. The Chinese population is still being told that the spread of SARS is being controlled. The official message is still that the government has a handle on the situation. But the problem has gotten large enough and so visible internationally that the Chinese leaders have had to come closer to admitting to their own people the full extent of the problem. It is likely that SARS cases known in Chinese hospitals are still going unreported to the World Health Organization. But it is becoming too hard to cover it up.

Previous official statements that China had SARS under control were scaring away foreign visitors who didn't trust the excessively optimistic picture the Chinese authorities were painting.

Foreign diplomats said the main reason for China's slightly more transparent line on Sars appeared to be a realisation that the previous blithe assurances were scaring more potential foreign visitors than they were reassuring. Mr Wen was now trying a different tack to limit damage to the country's economy.

The official acknowledgement of the scope of the problem may signal that the Chinese authorities are going to try harder to fight the spread of the disease. These comments from top leaders were accompanied by the announcement that China will begin screening rail and aircraft passengers for symptoms of SARS and quarantine suspected SARS cases.

The problem is that China has already lost its best opportunity to control the SARS epidemic before it reached pandemic status. China's best chance was to contain SARS where it started at an early stage. One obvious reason to try to stop a disease at its earliest stage of spread is that the smaller an area it exists in and the fewer infected by it the easier it will be to contain it. But the other less obvious reason is that SARS originated in the Chinese province best equipped medically to contain an epidemic.

Due to its proximity to Hong Kong the Guangdong province of China, the origin of the initial SARS infections, has industrialized much more rapidly than the rest of China. Therefore Guangdong is more affluent and this greater affluence has translated into greater wealth flowing into health care facilities in the province with more hospitals equipped with modern medical equipment, test labs, and drugs. The wealthier hospitals and clinics of Guangdong province have a greater capacity to handle SARS than is the case for the rest of China. Public health experts are quite aware of this situation. In their preliminary report of April 9, 2003 the World Health Organization team in China made note that as SARS spreads from Guangdong into the rest of China it is spreading into areas far less able to handle the disease.

However, the team found an urgent need to improve surveillance in the countryside to head off new outbreaks in rural areas. The team was further concerned by an increase in sporadic cases, which could not be linked to a particular transmission chain, as such cases raised questions about the adequacy of contact tracing. In addition, the report noted many remaining concerns about the ability of other provinces, where health systems are not as strong as the one in Guangdong, to respond promptly and effectively to the challenge of SARS. In Beijing, for example, only a minority of hospitals make daily reports of SARS cases. Contact tracing is another problem in Beijing and does not appear to be carried out systematically. Failure to perform careful contact tracing will allow the disease to spread. The team observed that many of China’s poorer provinces may not have adequate resources, facilities, and equipment to cope with outbreaks of SARS, and underscored that Guangdong’s capacity was exceptional among China’s provinces. In Guangdong, the SARS outbreak placed an enormous strain on the health care system. The Guangdong Infectious Disease Hospital (Guangzhou No. 8 People’s Hospital) had 150 of its 400 beds occupied by SARS patients daily during the second week of February. The team noted that the response of the health care system has been exemplary, and commended the dedication and bravery of doctors, nurses, and others working in clinics and hospitals.

Even wealthier Guangdong's handling of SARS is far from perfect. Poor people infected with SARS are being turned away from Guangdong area hospitals.

The man, who was also exhibiting symptoms of SARS, owed the hospital $250, said Chen's daughter, Chen Lili, who was visiting her father at the time. "They made him pack up and go," she said. "Who knows what happened to him? He had no money and he was sick."

These patients are sent home where they can spread the disease to family members and thereby continue the spread of SARS.

The WHO is worried that SARS may be spreading thru other provinces.

"We're very concerned about what may be happening out in the provinces," Henk Bekedan, director of the W.H.O. office here, said in an interview today.

The April 14, 2003 SARS update from the World Health Organization reporting new SARS cases in the Chinese northern province of Shanxi and in Inner Mongolia. This spread from the south to the very north suggests SARS is probably spreading throughout China.

China has today reported 109 new probable cases of SARS and 6 deaths, bringing the cumulative total to 1418 cases and 64 deaths. The largest number of cases occurred in Shanxi Province, where 47 new cases were reported. In addition, two provinces reported SARS cases for the first time – 10 in Inner Mongolia and 3 in Fujian. The reports indicate that the nationwide surveillance system, recently introduced by Chinese authorities, is working to detect and report cases. However, questions remain about the capacity of some provinces to cope with the challenge of SARS.

Shanxi was instructed only last week to start taking SARS seriously.

Today, officials in Shanxi said the province's local Center for Disease Control was instructed only last week to deal with SARS on an urgent basis. Only three hospitals in the province, all in the capital, Taiyuan, are able to handle SARS patients, officials said.

After 4 people travelling from Inner Mongolia showed up in the country of Mongolia to the north of China the Mongolian authorities responded by cutting off air and rail links to Inner Mongolian capital Hohhot.

The government said in a statement it had cut air and rail links to Hohhot for 14 days after four people with symptoms of the disease arrived from the capital of China's Inner Mongolia region, where three people have died of SARS.

Does anyone think there is the slightest chance that Mongolia and Inner Mongolia have the capacity to deal with SARS? This disease looks set to spread throughout the poorest parts of Asia. Now it is time to start looking for reports of SARS in Central Asia. Russia ought to start checking all rail and air passengers coming into Russia from China and Mongolia and ought to start checking those headed westward. But given how far SARS has already spread in China it seems only a matter of time before the disease spreads westward across China and into Tajikistan, Uzbekistan, and other countries in that region.

In spite of all this do you still feel optimistic that the spread of SARS can be halted? Well, South Africa wants rich Chinese tourists so much that it continues to encourage them to visit South African and it will not even screen them as they enter the country for signs of SARS.

Beijing - South Africa wooed Chinese tourists on Monday, saying they will not be barred from the country or subject to screening despite the spread of the deadly severe acute respiratory syndrome, or SARS, virus.

Picture SARS getting established in Africa spreading thru large populations of HIV sufferers with weakened immune systems. The lackadaisical South African government attitude toward SARS is grossly irresponsible.

The April 14, 2003 SARS update from the World Health Organization shows Hong Kong and China have 80 percent of all known SARS cases to date.

As of today, a cumulative total of 3169 cases of SARS, with 144 deaths, have been reported to WHO from 21 countries. This represents an increase of 213 cases and 25 deaths since the last update on Saturday. Indonesia, the Philippines, and Sweden report their first probable cases (1 in each country) today. Japan, which had previously reported four probable cases, was removed from the list as these cases were determined to have other causes. China, with 1418 cases and 64 deaths, remains the most seriously affected area. Hong Kong SAR, with 1190 cases and 47 deaths, is the second most seriously affected area. Three of the deaths in Hong Kong over the weekend occurred in persons under the age of 50, marking a departure from a previously pattern in which SARS caused deaths primarily in the elderly or in persons with pre-existing disease.

My guess is that China's SARS spread will accelerate while Hong Kong might be able to get it under control. The events in China may presage what will eventually happen in India, Africa, and other impoverished locales. If it gains a foothold outside of China in a poor country then SARS is very likely to become a pandemic.

One thing that Chinese health authorities ought to consider doing is to identify all people who have been exposed to and recovered from SARS. Then recruit those people to become health care workers to take care of SARS patients. Many of those who were infected with SARS in the first place were health care workers. So they already possess the needed skills. But the other recovered SARS patients could be trained in simple medical skills and work under the supervision of more skilled people who could tell them what to do.

A German biotech company has released the first SARS test which is based on the assumption that SARS is caused by a coronavirus.

The full coronavirus sequence will allow the development of faster, more accurate tests for SARS, using specific viral DNA fragments to prime PCR reactions. Early sequencing by the Bernhard Nocht Institute in Hamburg, Germany, has already helped the German firm Artus to produce a test that goes on sale on Monday.

The new Artus test takes only 2 hours.

The test can detect the virus from throat swabs, sputum or feces and produces results in two hours, say its makers, who specialize in disease test kits. They said classical tests for antibodies typically took 10 to 20 days after infection.

Because the Artus test uses polymerase chain reaction it is testing for SARS coronavirus DNA sequences.

A HAMBURG BIOTECH company will release a real time PCR (polymerase chain reaction) diagnostic test on Monday which, it is claimed, can diagnose SARS (severe acute respiratory syndrom) in two hours.

What is good about a PCR-based DNA test is that it can detect a SARS infection at a far earlier stage than an antibody-based test. Therefore this Artus test is very good news.

A cheap fast SARS virus DNA detection test has the potential to at least keep SARS from becoming a big presence in the industrialized countries. The SARS virus might achieve pandemic status worldwide and yet the industrialized countries could mount a vigorous long term defense using testing to keep SARS from becoming established in the industrialized countries. Testing could be done to all people entering industrialized countries thru legal ports of entry to identify people who need to be sent into quarantine. People could be held in customs until their tests were completed. Also, anyone showing SARS symptoms or exposed to someone with SARS could be quickly tested. However, illegal immigrants would still serve as carriers of SARS into industrialized countries. Also, there would still be false negative test results among those at the earliest stages of infection. Plus, all tests have error rates. Still, widespread testing could limit the presence of SARS in the industrialized countries until a vaccine becomes available.

Share |      Randall Parker, 2003 April 14 06:05 PM  Dangers Natural Bio

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