The latest estimates for the SARS mortality rate is even higher than the last revision upwards.
The mortality rate for those younger than 60 is between 6.8 percent and 13.2 percent, but jumps to between 43.3 percent and 55 percent for those 60 and older, the study found.
This work is being published in The Lancet.
The research, led by Dr. Roy M. Anderson and Dr. Christl A. Donnelly, both of Imperial College in London, is to be reported in Saturday's issue of The Lancet, the British-based medical journal.
The current 10 day quarantine period used for those suspected of exposure to SARS may not be long enough.
The Lancet study, based on 1,425 SARS cases in Hong Kong up to April 28, also found that the maximum incubation period -- the time it takes between getting infected and becoming ill -- may be as long as 14 days.
Here is my advice for the day: Do Not Get SARS! Also, stay the heck away from China.
If China becomes a reservoir for Sars, other countries, particularly its neighbours, will have to maintain constant vigilance for cases arriving from the Far East.
Professor Tedder said it was possible that stringent surveillance precautions would be in place in the UK and Europe for the foreseeble future - and perhaps for years to come.
He said: "What it may prove to be is a very effective dry run - one wonders what will happen next time."
Given its mortality rate we really are lucky that SARS is not more easily transmittable. If the latest crossover of a virus from another species into humans had been an influenza with a lower mortality rate than SARS but still fairly high (say 2% like the 1918 Spanish Flu) it would not have been controlled in Western countries as easily. SARS ought to serve as a wake-up call for a future lethal virus that is more easily transmittable.
Then there is the continuing problem posed by SARS. It may become permanently established in China. If that is what is happening then it seems inevitable that sooner or later it will become established in the Indian subcontinent and Africa as well.
The World Health Organization has recently published a summary table of results of tests on how long the SARS virus can survive outside the body. The ability of the SARS virus to survive on a plastic surface at room temperature for at least 2 days provides key evidence for how SARS has been able to spread thru apartment buildings and hospitals.
Another experiment in Germany suggests that killing the SARS virus on surfaces is not a trivial matter.
German scientists found a common detergent failed to kill the virus, indicating that some efforts to sterilize contaminated areas may be ineffective. An experiment conducted in Japan concluded that the virus could live for extended periods in the cold, suggesting it could survive the winter.
On the bright side, the vast bulk of new SARS cases are happening in China and Hong Kong. But given the primitiveness of the health care system in much of China and the attempts of some probable SARS sufferers in China to avoid contact with authorities (poor Chinese people do not trust the government to care for them) it is likely that even if the Chinese government is honestly reporting all known SARS cases (by no means a certainty) there are probably cases in China that are going undetected. One should really take the WHO case numbers with a grain of salt for other reasons as well. The WHO's definition of what constititues a SARS case is narrower than the definition used by some national health authorities (notably the US CDC). India is reporting 20 SARS cases which India claims are confirmed by lab tests and yet WHO has no SARS cases listed for India. The number of SARS cases reported by WHO for the United States includes only the cases that the CDC lists as probable (and perhaps not even all of those? Or is WHO slow about updating counts?). The problem is that most people who have had a milder case of SARS do get listed as probable. Until reliable lab tests are widely used and accepted as definitive I expect WHO SARS case figures will continue to represent only a subset of all people infected by the virus.
On another brighter note, reports of relapsed SARS cases turn out to be unfounded.
HONG KONG -- A dozen former SARS patients here who were initially thought to have suffered relapses actually had other medical problems, health officials said Sunday, as the rate of new SARS cases being reported around the world slowed somewhat.
It is very unlikely that SARS will become established in Western industrial countries. Quarantines other public health measures can contain any new outbreaks that occur in large part because SARS is not too easily transmissible. However, as long as SARS is being passed around in China it threatens to make it into other less developed parts of the world.
A widespread lack of trust in their government is causing many Chinese people who suspect they are sick to avoid contact with doctors and hospitals.
"The government has said the people are panicking because they don't understand SARS, but that's wrong," said Kang, the social scientist. "They are panicking because they don't know who to rely on. The migrant workers in Beijing are afraid that if they are quarantined they won't get treated, just left there to get sick and die. Their flight is actually a rational response."
The previous report is more important than the fact that the WHO reports that SARS is declining in many of its major sites of infection.
BEIJING -As the World Health Organization announced that SARS had peaked and is declining in Hong Kong, Singapore and Canada, Chinese officials continue to withhold information crucial to combating the spread of the deadly virus, the U.N. agency's chief representative in Beijing charged Monday.
While some stock markets are rallying in reaction to WHO statements that SARS has peaked in many locations and a lot of people are breathing sighs of relief that perhaps the worst is behind us these optimistic reactions seem premature. SARS is being controlled in highly industrialized countries and also in Vietnam. But it is spreading deeper into China and there are worrying signs that it is getting a hold in India. With a 10th SARS case reported India has been reporting at least one SARS case a day for the last 4 to 5 days.
Medical experts warned that health authorities needed to do more to tackle the disease as SARS had entered the "local transmission" phase in which Indians who had returned to the country carrying the virus were now infecting fellow citizens.
If SARS becomes well established in rural India and rural China then there is no way it is going to be eradicated in the foreseeable future. There will then be a continuing risk that it will spread to still other less developed countries. An increasing portion of the world will come to be seen as made up of high risk destinations to visit. This will cut economic growth in those areas and in the world as a whole.
Individual Westerners who do not travel to regions which have SARS infection are going to continue to be at very low risk of getting the disease. In any locale where SARS shows up in the West the Western governments will conduct fairly aggressive programs to hospitalize sufferers and quarantine those who have been exposed (my guess is that other Western governments are learnng from Toronto to move quickly). The skilled personnel, supplies, and infrastructure are available to stop a local outbreak from getting out of control. Realistically a typical Westerner or resident of other industrialized countries such as Japan will be at greater risk of death from a car accident.
However, the economic impact of SARS is going to be great for the West in part because risk avoidance behaviors in the infected regions and among those who might otherwise travel to the infected regions will be so great. China is going to shut down its stock markets for at least a week. The economic effects of SARS are extending far beyond the infected countries and the global economy is slowing.
There are two big unknowns at this point:
Obviously, the answer to the first question greatly affects the size of the needed economic restructuring. But there are already many signs that computer and communications technologies are being used to reduce the economic impact of SARS. For instance, home banking use is surging in Hong Kong. Also, Video conferencing is enjoying a boom. Teleconferencing, telecommuting, email, mail order shopping, and other means of reducing one's exposure to other people are all helping to reduce the impact of SARS on the world economy.
On the bright side SARS is very mild in children and children who have SARS appear to be much less infectious than adults.
The researchers discovered the two distinct patterns of disease. The five teenage patients had symptoms similar to SARS in adults - muscle pains, malaise, chill and rigour. However, the younger children had mainly coughs and runny noses with no muscle pains or chills.
Update: A measure of the economic impact of SARS on Beijing.
And there is another more ironic proof of the seriousness of the situation — It is dusk here right now, and it is a clear, blue, glorious evening. The quality of this sky you do not see except when someone is in town that the government wants to impress, such as the International Olympic Committee, and the government shuts down the main thoroughfares and any industry that is going to pollute.
Air flights are not a huge source of risk for SARS infections. Aircraft use high-efficiency particulate air (HEPA) filters and take all bacteria and viruses out of the air at a very fast rate. Airplanes have better air filtering than commercial buildings.
Plane air is completely replaced with air from outside the aircraft 20 to 30 times every hour. This compares favourably against one to three times an hour in a typical building and five to seven times in a hospital operating theatre.
Granted, one could be seated on an aircraft right next to someone who has Severe Acute Respiratory Syndrome (SARS) and that person could cough on you. But consider the odds. The vast majority of those who have SARS are on the ground at any given time. Most do not fly from one place to another before being diagnosed and hospitalized. Few SARS cases to date have been traced back to exposures that happened on aircraft.
The biggest single kind of location for passing SARS on has been in hospitals. But most hospitals do not have SARS cases and so hospitals outside of areas which have a high level of SARS cases do not pose a risk as a source of SARS infections either.
The biggest danger from air flight comes from flying to a place that has a lot of SARS cases. Well, anyone who is worried about catching SARS should avoid visiting those (primarily East Asian) locations. The biggest danger to the rest of the world for SARS comes from the fact that people can fly from SARS-infected areas while still at early undiagnosed stages of infection. The greater danger from infected air passengers comes from the possibility that they will pass SARS along while staying for days at their destinations.
Public health experts are becoming increasingly pessimistic about the prospects for stopping the spread of SARS.
With infections now confirmed in two-thirds of China's provinces and mounting daily, ''hope dwindles'' for wiping out the disease, WHO virologist Wolfgang Preiser said from Shanghai. Even in ''Singapore and Hong Kong, very rich places, they still have problems. We are worried about the spread to poor provinces, maybe countries such as India and Bangladesh,'' where ''we don't think they have the capacity to stem the tide once it's introduced.''
''It may have happened already,'' he said.
Within the past day 3 new cases of SARS have been identified in India.
The Health Ministry has confirmed three more cases of SARS in India, which takes the total number in the country to seven. Of the three freshly confirmed cases, one is being treated in Kasturba Hospital, Mumbai, the second in Apollo Hospital, Kolkata and the third in Naidu Hospital, Pune.
If it was my decision to make I'd order the cessation of all commercial passenger flights between East Asia and the countries of the Indian subcontinent and Africa. Those countries do not have the capacity to contain SARS. They are too poor and most of their populations have little or no access to modern health care facilities.
Poor countries in the Indian subcontinent such India are unwilling to take sufficiently drastic steps to stop SARS in advance of a major SARS outbreak in their region. This is foolish. They lack the infrastructure needed to control SARS. As a result, the industrialized countries will have to adopt very rigorous measures at borders and ports of entry to detect SARS carriers because SARS is going to become endemic in much of the world. Thermal imaging and testing for SARS in all arriving and departing passengers will have to become routine at all ports of entry.
Reliable, accurate, and cheap DNA-based Real-Time Polymerase Chain Reaction (RT-PCR) SARS tests are the greatest hope the industrialized countries have for controlling SARS in a way that minimizes the economic impact. An ideal test would be able to use sputum so that a nurse would not be needed to draw blood. To allow testing of large volumes of business travellers an ideal testing device would need to be automated and have a high thru-put rate.
If all SARS carriers could be identified among international travellers even before they boarded aircraft to fly to a SARS-free country then regular business and holiday travel between SARS-free countries could proceed as normal. Also, anyone willing to risk going to an area where SARS is present would not need to be quarantined on return. Patterns of business meetings could be shifted to allow people from SARS-infected areas to travel to SARS-free areas to facilitate customer-supplier meetings. Then people in low risk areas would not have to travel to high risk areas to do business with the high risk areas.
If Taiwan could develop large-scale DNA-based SARS testing systems and use them to make Taiwan SARS-free then Taiwan could gain an advantage by making Taiwan as a place where mainland Chinese businessmen could travel to meet with businessmen from other parts of the world to do deals. Everyone coming to Taiwan could be tested before and on arrival for SARS virus. That way SARS carriers could be kept out. Business could be done in a safe environment fairly close to China. This would reduce the economic disruption that SARS is causing.
There are countries that are willing to take drastic steps. For instance, in order to keep out new cases of SARS Vietnam may close the 800-mile border it has with China.
Vietnam's northern Quang Ninh province, home of the Halong Bay tourist attraction, began barring Chinese tourists at its land border gates and waterways. Hanoi's health ministry has recommended the country seal all its borders with China indefinitely.
Countries that lack the capacity to fight SARS should be willing to close their borders to visitors from countries which have SARS cases.
The New York Times has an excellent long article that traces the spread of SARS. While China made huge mistakes in its handling of the crisis Singapore shines as a textbook example of how to aggressively quarantine and isolate potential SARS carriers.
But even in a small country, placing thousands on quarantine has been a strain. Last Monday, after a case of SARS was discovered in a vendor at Singapore's largest vegetable market, the Ministry of Health ordered all 2,400 food sellers to report for quarantine, up from a total of 467 quarantined before. Since 80 percent of the country's vegetables pass through the Pasir Panjang Market, restaurants were bracing for a shortage of greens.
Hong Kong has done a much worse job than Singapore in protecting health care workers.
In Singapore, with its aggressive system of identifying and isolating SARS patients, no health care worker has been infected for over three weeks. But in Hong Kong, 2 to 10 doctors and nurses are falling ill each day, in part, health officials there say, because doctors are still not identifying them as SARS victims early enough and are admitting them to ordinary wards.
Only recently -- weeks, if not months, after SARS hit -- have officials in China and Canada begun cordoning off entire buildings containing infected patients. Physicians such as Abraham Verghese say that slow response permitted the deadly virus to infect many others in their own countries and beyond. "The lesson of Hong Kong, China and, to some degree, Singapore is if you don't aggressively isolate, this thing can get out of hand," said Verghese, director of the Center for Medical Humanities and Ethics at the University of Texas Health Sciences Center at San Antonio.
The long incubation period helps SARS to spread around the world.
Its apparent incubation period of two to 10 days is long enough for infected people who are asymptomatic to travel "from one city in the world to any other city having an international airport".
SARS is most likely a coronavirus. Other known coronaviruses can survive on surfaces for 24 to 48 hours.
Research done decades ago showed that the type of coronaviruses that cause many colds can remain viable on surfaces for 24 to 48 hours, depending on air temperature and humidity.
The US CDC reports that there is a preliminary study done in Hong Kong that shows SARS can survive on an exposed surface for at least 24 hours.
How long do coronaviruses survive in the environment?
In general, enveloped viruses such as coronaviruses do not last a long time in the environment. In earlier studies, a different coronavirus was shown to survive for up to 3 hours on surfaces. At this time, it is uncertain how long the newly discovered coronavirus associated with SARS can survive in the environment. In one preliminary study, researchers in Hong Kong found that both dried and liquid samples of the new coronavirus survived as long as 24 hours in the environment. Additional studies are under way to examine this important question.
People who live in areas where SARS is present should wash their hands frequently, avoid touching their faces or other parts of their bodies with their hands, and minimize the number of surfaces they touch in public areas. There are lots of ways to reduce one's need to touch surfaces. Do not use hand rails. Keep your hands on your lap when sitting in a public place. Use a stick or other object to press elevator buttons. Become more aware of where you are going and what you will have to touch in order to get there.
Update: If SARS does make it to the less developed countries the number of peope killed could be enormous.
With many cases still unresolved, a better current estimate of the deadliness of SARS may be the number of deaths as a proportion of resolved cases. Those numbers for Hong Kong, Canada and Singapore are 15.8, 18.3 and 13.7 per cent. But these too could be misleading if, for example, it takes longer to recover from a disease than to die from it.
There are other indications that the SARS death rate may be higher than expected. Mortality among infected SARS patients might end up being in the range of 8% to 15% of infected patients. Keep in mind that the death rate varies as a function of age and the death rate is higher in the elderly. Still, overall it is lookiing like the death rate from SARS is going to turn out to be at least 10%.
"If one looks carefully at the WHO figures on mortality and recovery rates, it is running, unfortunately, at 10 per cent," Professor Roy Anderson of Imperial College said.
Update II: Chinese infectious disease experts see a coming third bigger wave of SARS infections in China.
Bi and other experts have said that Beijing officials did not take adequate measures last week to stop Beijing's huge migrant labor population from returning home, and thereby possibly spreading the disease across China.
"The government held meetings for hours with no decision and meanwhile, everybody left town," Bi said. "Beijing is the second peak of the disease. The third one, in the countryside, will be much, much higher."
My fear about the coming third wave is that it will spread SARS into areas adjacent to China. Granted, most land borders of China are in pretty sparsely populated and harsh environments. But SARS could spread across Central Asia and eventually into more densely populated Asian countries.
Update III: Two more cases of SARS reported in Calcutta and Bombay.
Two more cases of Severe Acute Respiratory Syndrome (Sars) have been reported in India, taking the total number of people infected with the pneumonia-like virus there to nine.
SARS cases seem to be popping up in India daily. This is not good. All it would take is for one of these cases to be a "super-infecter" (also called "super-carriers", "super-spreaders" or "hyper-infecters" in some reports) for the disease to start spreading rapidly there.
Keep in mind that SARS cases in India are orders of magnitude more significant than SARS cases in more developed countries because India is far less able to control the spread of a disease. Places like Canada, the United States, Taiwan, and Singapore have the ability to identify cases, isolate them, trace those who might have been exposed, and generally take the steps that will eventually put a halt to the chain of spread. But if SARS makes it into areas where there are large numbers of poor people and primitive health care the disease will become a greater threat to the entire world. Pay especial attention to reports of SARS cases in the Indian subcontinent and Africa. The battle to prevent a global SARS pandemic will be won or lost in the poorest countries.
Growing fear of Severe Acute Respiratory Syndrome (SARS - also called atypical pneumonia in the Chinese media) has caused 1 million people to flee Beijing for other parts of China.
There was a continued exodus from Beijing today as thousands of people attempted to flee the epidemic and return to their home towns all over China. At the Beijing airport, travelers wearing face masks boarded planes out of the city. Local journalists estimated that almost 1 million people, about 10 percent of the population, had already left the capital.
This is an astounding figure. When is the last time that so many people took such drastic action in such a short period of time in response to a natural biological threat? Imagine how people would respond today to an even bigger infection threat. SARS does not spread as easily as influenza. Some day a new influenza strain that is more lethal than the typical influenza strains will arise. It could cause panic around the world.
The rush to flee Beijing has been fueled by the fear that the government would declare martial law and close off the city from the rest of China. The government has had to announce that it would not impose martial law but it is unlikely that the Beijing public believes it.
This is guaranteed to spread SARS further and faster. Infected people riding on airplanes, trains, and buses will pass the disease along to other passengers. They will also pass it on to people they have contact with at their destinations.
The treatment of those suspected of being exposed to SARS in Beijing is considered to be so harsh that people may be hiding their SARS symptoms from the authorities.
Sars suspects are being victimised in Beijing, where thousands have now been put in compulsory quarantine, a World Health Organisation specialist, Dr Wolfgang Preiser, said yesterday.
"If you make it hell for them, they go into hiding," Dr Preiser, a German virologist, told reporters in Shanghai.
While some might cheer the prospects of the Chinese government coming under intense criticism from its own population for the government's handling of SARS keep in mind that a revolution in China would by itself kill millions and that the chaos of a revolution would cause SARS to spread even faster.
Supermarkets reported a roaring trade in staples such as rice and cooking oil as rumors swirled the city would be isolated, while many other shops simply closed up as scared residents stayed at home.
At least this is a rational response. To reduce the risk of exposure in a high infection area it makes sense to buy a lot of food at a time and shop less often. It also makes sense to shop during the off-hours to reduce the number of people one is exposed to. If there was a big outbreak it would make sense to have open air markets so that the air would be dispersed quickly.
There is lots of bad news about Severe Acute Respiratory Syndrome (SARS). SARS is continuing to spread and to establish itself in more locales. The death rate has risen. It appears to mutate rapidly. There appears to be a more lethal strain that also infects the intestines and SARS is causing kidney failure in some patients. Tens of thousands of people (if not more) are fleeing Beijing and in the process helping to accelerate the spread of SARS to more parts of China. Effective drug therapies and vaccines are both distant prospects.
Different SARS coronavirus isolates have been sequenced and compared and many DNA sequence differences have been found.
The mutations were seen in all five of the viruses' known functional genes, with most of them occurring in the gene that carries the instructions for the distinctive spikes that jut from the outside of the virus, according to Siqi Liu, associate director at the Beijing Genomics Institute, part of the Chinese Academy of Sciences.
Those mutations on the outer coating are important because they can create new strains of the virus that are immunologically distinct. A person who has already been infected by SARS and recovered from it would be at risk of reinfection if exposed to a different strain of SARS that had undergone a lot of mutations in genes that code for outer layer proteins. Also, rapid mutation that generates immunologically different strains makes the job of development of vaccines more difficult and makes the period of protection from a vaccine version shorter.
"The ability of the virus to mutate has been a real problem in poultry vaccines. "The virus has the ability to change quite quickly - a vaccine might be suitable for a while, but not forever."
As I've previously posted, vaccine development time for SARS is measured in years. Well, this news that SARS is mutating rapidly will most likely lengthen the amount of time it will take to develop a vaccine. This is not good.
Rapid mutation can lead to more virulent strains. A more deadly SARS strain that attacks the intestinal tract may have already arisen.
The Amoy Gardens patients are three times as likely to suffer early diarrhoea, twice as likely to need intensive care and less likely to respond to a cocktail of anti-viral drugs and steroids. Even medical staff who caught the infection from Amoy Gardens patients are more seriously ill, Yuen said.
SARS is attacking the kidneys in some patients
Tom Buckley, the head of the intensive care unit at Hong Kong's Princess Margaret Hospital, said organ failure was also now becoming more common.
"Initially patients were presenting with just respiratory failure," Dr Buckley said. "Now we're seeing renal failure and other organ failure."
The death rate for older folks is high.
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.
The death rate from SARS in Hong Kong has increased to 7.2 per cent of reported cases - up from about 5 per cent earlier in the crisis - and officials fear it may go higher.
There are a number of possible reasons why the death rate is increasing. It could be that many of the initially infected tended to be healthy business travellers and health care workers. Now SARS is spreading from them to their families including older folks who are more at risk of dying from infections. Or the virus could be becoming more deadly as it mutates. Or some people may have been sick for weeks before finally succumbing. The real explanation may turn out to be a combination of factors.
The schools are closing in Beijing China.
CHINA: Beijing closed schools for two weeks and sent 1.7 million pupils home yesterday as the country struggled to contain a Sars outbreak thought to have originated in its south.
A major Beijing hospital has been quarantined.
The 1,200 bed Beijing University People's Hospital was sealed off because of SARS today and police were posted to stop people going in or out, hospital staff said.
People are fleeing Beijing by the thousands.
BEIJING, April 23 -- Thousands of people mobbed Beijing's West railroad terminal today in desperate attempts to flee the city as the capital reported another triple-digit increase in the numbers of people infected with SARS and nine more deaths.
Flight of people from infected areas is helping to spread SARS further.
But the relative safety of many of the provinces could prove shortlived if the infection is spread by the railway system.
If the infection is spread by the railway system? Why wouldn't it be spread that way? The infection is already being spread to many provinces of China. Surely some of that spread is happening via rail travel. But cars, airplanes, and other means of transportation are surely contributing as well.
When people start trying to get rail tickets for any place they can get a ticket for then real panic has set in.
Laden with burlap bags and potato sacks, they boarded trains for whichever destination they could get a ticket as the death toll jumped by 25 per cent in the Chinese capital.
Think about it. People are fleeing in panic from the capital of the world's most populated country. Most of the country has health care facilities that are primitive compared to Beijing's. People are spreading out to those more primitive places. My guess is that SARS will achieve pandemic status in China. The Chinese government's honesty (or lack thereof) in reporting SARS cases is becoming irrelevant as SARS spreads into the poorest areas of China. We will not know how many people in China have SARS because most of the future Chinese sufferers will be in areas too primitive for them to be seen by qualified medical professionals.
At least the people fleeing Beijing are trying to avoid enclosed areas where the risk of breathing airborne virus particles is greater.
A sea of faces in white cotton masks scanned coveted train tickets, waiting for hours outside in the chilly air rather than linger in crowded, enclosed waiting rooms.
The WHO says do not travel to Beijing or Toronto.
BEIJING/TORONTO (Reuters) - Saying SARS was still spreading out of control, the World Health Organization tightened travel advisories on Wednesday, adding Beijing and Toronto to the list, while authorities in Beijing started quarantines.
Canadian authorities are upset by this advice.
Canada has responded angrily after the World Heath Organization (WHO) listed Toronto with Beijing and China's Shanxi province as places travellers should avoid because of the danger of Sars.
The Canadian government is being parochial. Steps to stop the spread of SARS need to be taken before it becomes an even bigger threat. The WHO should have gone much farther and told people to avoid China entirely. Plus, it should have asked that people in infected areas not travel from those areas.
China's government waited too long before acting. The spread of SARS to the poorer provinces of China makes it unlikely that the Chinese government will succeed now in stomping out SARS entirely. That, in turn, increases the odds that SARS will spread from China to even less developed countries. If SARS becomes established in India or, even worse, in Africa then it seems likely to achieve pandemic status.
The problem is that the more places SARS becomes established the greater the chance that on any given day there will be someone bringing SARS into areas where it hasn't become established. Plus, the greater the panic becomes the more people will flee infected areas and infected countries and carry SARS with them in the process.
The economic costs of trying to prevent the spread of SARS need to be weighed against the economic costs of what happens when it becomes established. In countries where SARS has taken root the economic costs of people becoming afraid to travel, go to jobs, meetings, and to go shopping in markets is becoming enormous. The Western industrialized countries need to work hard to prevent SARS from becoming big enough to start changing the behavior of a substantial portion of the population of each country. The economic costs would become staggering if SARS did come to be viewed as a threat to the population of the Western nations.
Countries should reduce the issuance of visas for people from infected areas. Some countries already are doing so. Saudi Arabia has stopped issuing visas to visitors from several East Asian countries. So has Israel. Belize has banned visitors from several countries including Canada. Singapore, Hong Kong, Tokyo-Narita, Beijing and other cities with international airports are installing thermal imaging systems to scan passengers for fevers. These are certainly steps in the right direction. More international airports should institute thermal imaging screening and other methods of screening incoming passengers. Unfortunately, it is the countries that are least able to afford to handle a SARS outbreak that will also be least able to afford extensive screening measures at their international airports.
Fast DNA-based SARS tests are essential for stopping the spread of SARS. As soon as fast DNA-based SARS tests become reliable the industrialized countries should use the tests extensively. At the very minimum, all suspected SARS cases and all their contacts should be tested and tested again. However, even more extensive testing regimes could be imagined. For instance, all people coming from infected areas could be tested or, for even more protection, all people coming into a country from any origin could be tested.
Infected areas that are relatively affluent and capable of carrying out fairly sophisticated measures to control SARS ought to consider testing their entire populations. For instance, Singapore's economic losses from SARS are so large and the benefits of being SARS-free are so large that once cheap and fast SARS tests become available city-state of Singapore ought to consider testing its entire population. Also, if a DNA-based test is not reliable within the first day or two of infection Singapore could consider putting people into quarantine for a day or two upon entrance into Singapore in order to test them again before letting them out into their general population. One way to make such a system workable would be to set aside hotels to use for quarantine and then to make each hotel receive only people who arrive on the same day with a rotating list of hotels looping thru the quarantine cycle.
The Eurasian land mass faces a more difficult task to contain SARS than do places that are geographically isolated with smaller populations. Countries like Taiwan, Australia, or New Zealand ought to be able to totally stamp out SARS and keep it out once fast DNA tests are available. But if SARS becomes established in Central Asia it will be able to jump across borders of impoverished countries and maintain its presence far more easily.
If SARS becomes established in countries that are significant sources of illegal immigrants then attempts to control SARS spread at borders of industrialized countries will become considerably more difficult. A SARS epidemic in Mexico would make SARS control in the United States much more difficult while a SARS epidemic in the Middle East or Africa would pose similar problems for Europe.
See the SARS web sites of the World Health Organization and the US CDC for their latest information.
Update: The more industrialized countries ought to start taking more drastic measures now to help the poorer countries detect SARS sufferers entering their countries. For instance, an effort by the United States to help Mexico and Central American and Caribbean countries to screen international visitors for SARS infection (e.g. by training airport workers, providing thermal imaging machines, and eventually supplying help in testing passengers) will help the to prevent the spread of SARS into the United States. Either that or the United States had better be prepared to deploy troops on a massive scale to keep out illegal aliens coming up from Mexico potentially carrying SARS. That troop deployment may become necessary anyhow. SARS could be spreading in Mexico right now without our even being aware of it.
If the Asian Times staff are right China is already doing triage to decide in what parts of its country it will try the hardest to control SARS. The Chinese government may have already resigned itself to the wide spread of SARS into poor interior provinces and may be focusing its attention on Shanghai and other key trading and commerce cities. The industrialized countries need to start planning how they are going to keep a world SARS pandemic from reaching into their populations and disrupting the industrialized economies.
Update II: Time Magazine has an excellent article that confirms the widely suspected continued cover-up of SARS cases in Shanghai.
A doctor at the Shanghai Contagious Diseases Hospital told TIME that there are more than 30 suspected cases have been admitted to their hospital's facilities, nearly double the official suspected caseload for the whole city.
Basically, local authorities in China still are hiding the truth about SARS. Plus, in the poorer sections of China where SARS is spreading the local authorities will not even have the ability to know for themselves how many SARS sufferers there are. It sure looks like SARS is going to continue to spread thru China and therefore its chances of spreading to other parts of the world are probably increasing. The industrialized countries need to start scaling up to try to halt the spread of SARS into regions ill-equipped to handle it.
Once cheap fast SARS tests become available one great way to slow the spread of SARS would be to require the testing of all passengers on flights everywhere in the world. Also, all people crossing borders by other means should be tested as well.
Update III: The SARS death rate is now thought to be between 8% and 15%.
The research by Professor Roy Anderson, due to be published in a medical journal next week, is expected to say the virus could kill between 8% and 15% - or one in seven - of those infected.
Keep in mind that SARS has a much higher death rate in the elderly. If you are young your own odds of dying from SAR woul be lower than this latest estimate and if you are old your odds would be much higher.
The fear of Severe Acute Respiratory Syndrome is causing an increasingly panicked response in Beijing China.
At Bank of China branches, there were no lines. The traffic at Western Station, the city's main rail terminal, has dropped 75 percent, to 80,000 passengers a day.
Beijing universities are closing.
More than half of universities in Beijing said they would close indefinitely as the highly infectious disease spreads there.
It is important to remember that the coronavirus that is the probable cause of SARS is nowhere near as easily spread as influenza. Yet, as previous history demonstrates (most notably the 1918 Spanish Flu), very deadly influenza strains can infect the human population. Given that SARS can cause this degree of fear and panic and economic disruption then just imagine the effects on human behavior of an especially deadly influenza epidemic. Countries would close their borders. Cities around the world would become ghost towns. Natural biological phenomena still have the capacity to cause huge changes in the behavior of literally billions of people.
What I'd like to see come out of the SARS epidemic is a wider appreciation of the need to develop better capabilities to respond to natural disease outbreaks in the human population. Much of what needs to be done to prepare for natural disease outbreaks is also is helpful for handling bioterrorism attacks. Better monitoring systems are needed for both natural and man-made disease outbreak scenarios. Faster methods of identification and isolation and characterization of pathogens and faster methods for developing and manufacturing vaccines are all helpful for both types of scenarios. Advances in biotechnology are needed to speed up all the steps of response to a new disease.
Another area that needs to be looked at is how to allow people to carry out more of the normal activities of business and commerce with less exposure to other humans. What simple cheap things can be developed to allow people to move around and do things without coming into as much contact with surfaces other humans have touched or air that other humans have coughed particles into.
I can imagine all sorts of simple and cheap ways to reduce exposures. For instance, how about short sticks to use to press elevator buttons? Or how about more foot operated devices such as restroom soap squirters and water faucet operators so that people don't have to touch surfaces that other people touched?
Another important area that needs work is the development of better facial masks. This is an area that cries out for nanotechnological developments to create material that will filter air more efficiently and last longer. Masks should not become less efficient as they build up moisture from a person's exhalations of breath. Masks should be able to take more particles out of the air with less resistance so that breathing with them is easier.
Singapore is installing thermal imagers to detect elevated body temperatures in arriving passengers.
Airline passengers arriving in Singapore from certain Sars-stricken areas are now being scanned for the disease by a military-grade thermal imaging camera, which will detect any increase in temperature, officials said.
8 units are being installed in Changi airport.
One of the units is currently in use and another eight will be installed by the end of the week, Ong told The Associated Press.
People with hot skin will be looked at more closely by health officials.
Those who show up on the camera screen as “hot bodies,” or with a temperature greater than 37.5 C (99.5 F), will be pulled aside to have their temperature taken by a nurse, said government spokeswoman Evelyn Ong.
Singapore will also deploy thermal imagers to its border checkpoints with Malayasia. Other countries are following Singapore's lead as has been the case throughout the SARS crisis. Hong Kong's airport is also being equipped with thermal imaging to scan passengers.
In Singapore and Hong Kong, airports are being equipped with thermal imaging systems that can pinpoint feverish passengers
Thermal imaging is just one of the technologies being deployed in novel ways to fight the spread of SARS. The Ontario Province of Canada may join Singapore in placing electronic tracking bracelets on people exposed to SARS in order to monitor compliance with quarantine restrictions.
Dr. Young acknowledged the province is giving some consideration to putting electronic bracelets on people reluctant to stay in quarantine, as has been done in Singapore. "We're thinking about that and looking at that," he said. "There may be some legal issues involved."
Thermal imaging and electronic quarantine enforcement are just two of the ways that modern technology is changing how disease outbreaks are fought. The potentially most powerful tool in the modern epidemic fighting arsenal is DNA detection technology placed on DNA chips using low cost mass production. There are promising signs on that front.
Artus Biotech has announced a 2 hour SARS detection assay that detects SARS coronavirus DNA.
Based on the discovered genetic sequence, the BNI has established a real-time PCR (Polymerase Chain Reaction) diagnostic test from which results can be obtained within two hours. From that test, artus developed a ready-to-use system (RealArtTM HPA-Coronavirus RT PCR Reagents) produced under GMP conditions (Good Manufacturing Practice). It will be available from artus and its subsidiaries in the USA and Malaysia from Monday, April 14th, on. Thomas Laue, project manager at artus says: "By providing this assay quickly, we hope to contribute to the standardization of SARS diagnostic worldwide. The early and rapid detection of the virus will be our small share in controlling this epidemic plague." The PCR assay directly detects parts of the new Corona virus in throat swabs, sputum and faecal samples. The RealArtTM HPA-Coronavirus RT PCR Reagents assay delivers results very quickly. The real-time PCR technique improves specificity, allows interpretation of results during the test and provides data about the quantity of the viruses in the sample material. Classical tests like antibody assays in blood allow detection of an infection normally much later, i.e. ten to twenty days after infection. The prompt results of the RealArtTM HPA-Coronavirus RT PCR Reagents assay allows immediate countermeasures by fast diagnosis, e.g. of travellers. By this, the rapid spread of the disease can be prevented.
Hot on the heels of the Artus announcement Singapore's Genome Institute has announced a 3 hour SARS coronavirus detection assay.
The state-run Genome Institute of Singapore said its new test would take three hours and may be sensitive enough to detect the virus in its early stages before a person develops Sars symptoms such as high fever and a dry cough.
How might the SARS outbreak be ended? Picture cheap, fast, and easy-to-use SARS virus detection tests that can detect SARS at a very early stage of infection. Such a test could be employed far more widely than quarantines. Everyone flying from an area where SARS has spread could be tested either before they get on the airplane or shortly after arrival at their destination airport and not released until their test shows a negative result. The same practice could be used at high risk ground border crossings as well. Plus, anyone found by either conventional thermometers or thermal imaging to be running a temperature could be tested and held until the result of the test is known.
If SARS testing could be made incredibly cheap then a more radical approach will become possible: test everyone for SARS. One could just test everyone in countries where SARS is spreading. Or one could, in the extreme, test the whole planet's population. If the testing was done in a relatively short period of time in a geographic area before non-tested people could pass along the virus to tested people then the disease could be eradicated from the human population in the area tested. Then in that area all people who entered could be tested.
Massive testing as a method to control the spread of a disease is easier to do for areas that are geographically isolated. For instance, it would be far easier to do this for Australia or Hawaii than it would be for a country on the Eurasian landmass. It would also be easier to do for areas that, for whatever reason, have little in the way of cross-border traffic.
The speed, cost, and ease of use of a test are not the only elements needed to make massive testing a feasible way to stop a dangerous disease outbreak. Another crucial element is the speed with which the test can be developed in the first place. SARS does not spread as rapidly as influenza and so it has not reached epidemic status in many locations. But the approximately 2 months that it has taken to develop fast tests for SARS (China knew about SARS 5 months ago but kept it secret and so the Western scientists have had only 2 months to identify the cause of the disease and to make tests for it) would be too long of a time for, say, a new and highly deadly influenza strain. However, it seems reasonable to expect that advances in nanopore technology, microfluidics, and other areas of biotechnology and nanotechnology will gradually shrink the amount of time it takes to identify a new pathogen and to sequence it. Once it is sequenced the creation of a new test for it can be done very rapidly.
What we are seeing in the response to the SARS outbreak is the development of elements of the future high tech public health disease fighting arsenal. Automated systems to detect disease and track human movement will only become cheaper and more powerful. Also, many other areas of relevant technology will surely see improvement. The current generation of facial masks will almost certainly be supplanted by greatly improved materials manufactured using nanotechology. The ability to protect a person from exposure will advance in a large variety of other ways including more advanced air filtration systems (again designed using nanotechnology), fancy personal instruments for monitoring individual health, and detection systems for airborne pathogens located in crowded public places. We may some day witness public health officials dispatched rather like police and emergency workers to quarantine an area and its occupants because a detector in some restaurant, airport, or hotel has signalled the presence of a dangerous pathogen.
Ultimately, just as technological advances have accelerated the rate at which diseases can spread other technological advances promise to entirely stop future epidemics at their very start. We may some day live in a future in which natural disease pandemics no longer happen.
You can read more about SARS from a more biological and public health perspective in my FuturePundit Natural Dangers Archive. For economic impacts see the ParaPundit Political Economics Archive. For what the response to SARS says about open versus closed societies see the ParaPundit Open Versus Closed Societies Archive.
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.
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.
Lots of new strains of influenza first show up in China. The reason is that tens of millions of humans live in close contact with a large variety of farm animals in conditions which encourage viruses to jump between species.
Dongxing is just one example of how Guangdong's 80 million people live close to the animals, poultry and fish they eat. At another piggery close to Mrs Yang's, a farmer keeps young chickens next to his pigs. All the piggeries empty their waste into the ponds where shrimp and grass-carp are raised for the table.
In other places, battery chickens are kept above the pig pens, feeding their waste into the pigs' food troughs. The close proximity and cross pollution adds to the risk of animal viruses infecting humans, either directly or via pigs
Of course it would be great if Chinese farming practices were changed in ways that would reduce the chances of viruses jumping between species. But the farmers who engage in the dangerous livestock raising practices are poor and do not have a lot of alternatives. As China industrializes one can expect conditions to improve as agriculture industrializes, becomes more capital intensive and less labor intensive. With fewer people down on the farm fewer people will come into contact with pigs, ducks, chickens, and other farm animals.
Given that China is such a threat as an origin of new pathogen strains and of pathogen species that jump between mammalian species it would also be great if the Chinese government was really eager to pursue proper public health policies for controlling epidemic disease outbreaks. However, as I explained in my ParaPundit blog posting Repressive Governments Make Fight Against SARS More Difficult the Chinese government, being a repressive regime that has lots of motives to cover up the truth, has plenty of reasons to mishandle an epidemic disease outbreak.
In spite of my previous readings and writings on why the Chinese government does what it does I was still floored to read that the Chinese government is currently trying to encourage domestic tourism as a way to assure international travellers that China is a safe destination.
Despite the risk of spreading the disease across this country, the government thinks that a successful May 1st holiday will help convince international travelers that China is safe, Chinese officials said.
Hong Kong is less an open society than it used to be but it is sufficiently open that scientists there are openly discussing the possibility that SARS will not be stopped.
Samson Wong, a microbiologist from Hong Kong University, said that Sars might infect 80 per cent of the population within two years and eventually everyone could be infected. A Health Department spokeswoman said that the possibility could not be ruled out but declined further comment.
What is making infectious disease experts less optimistic that SARS will be contained is the inability to trace some SARS cases to person-to-person contacts. This has led scientists to speculate that SARS may in some cases be spreading by cockroaches, sewage, contaminated surfaces such as door knobs, and by other means.
But in recent days, epidemiologists have been unable to trace a number of SARS outbreaks in hotels, hospitals and apartment complexes in Hong Kong, Singapore and China to such person-to-person spread.
In the face of such scientific uncertainty the Chinese government continues to be irresponsible in its handling of the SARS outbreak. It may become necessary for more governments to follow the example of Malaysia and start restricting travellers from Hong Kong and China.
Very few SARS cases have been reported in India so far. However, if SARS becomes established in India it will be very hard to stop.
"Our health system is very inadequate and it will be extremely tough to control the disease if it arrives," Anil Bansal, president of the Delhi Medical Association, told Reuters.
The very limited health case system in India makes the news about SARS coming from India very important. Therefore every suspected SARS case in India is watched very closely.
Not all suspected SARS cases in India have turned out to be SARS. For instance, Maria, the first suspected SARS case in New Dehli, may have a different kind of infection.
"She has been provisionally detected of having acute pharyngotonsilitis,’’ said Dr R.N. Salhan, the hospital medical superintendent.
Also, a 23 year old American woman suspected of having SARS in Bombay turned out to have a less dangerous illness. However there are at least two other suspected SARS cases in India including a 48 year old Indian national recently arrived via Singapore.
A 48-year-old software worker was admitted to hospital in Hyderabad on Tuesday after he arrived from Australia via Singapore with high fever, a cough and cold -- symptoms of the virus that has killed more than 100 people worldwide.
Surely the government of India can afford to quarantine and treat a few thousand sufferers. India is making efforts to be prepared to do so.
Facilities have been created for treatment of SARS cases in isolation in the Central Government hospitals as also in other Infectious Disease Hospitals. Health care facilities at International Airports and Ports have been strengthened by deploying additional doctors and evolving a standard operating protocol.
But the problem for India is that there are hundreds of millions of poor people who have little or no access to medical doctors and medical tests. If a single SARS sufferer reaches India and if that sufferer happens to be very infectious the results could be disastrous.
A single SARS sufferer is all it would take to rapidly cause a large SARS outbreak in a primitive country. "Hyper-infectors" (a.k.a. "super-carriers") of SARS may have been responsible for the big SARS outbreak in the Toronto Canada area.
Canada's SARS outbreak has been fuelled by three "hyperinfectors" who each passed on the disease to 20 or more other people -- a phenomenon never before seen with a virus, experts said yesterday
It is noteworthy that all three of the hyper-infectors in Canada died. Could it be that the more severe form of the disease is more infectious? Perhaps the people who have the severe form cough more and therefore generate more airborne particles which contain active virus.
It is unusual for a virus to be highly infectious.
Individuals who are inordinately infectious have been seen with certain types of bacteria, but not viruses, said Dr. Low.
Africa has the same vulnerability to SARS that India has. Therefore SARS cases in Africa are incredibly important to watch for. A Pretoria South African man who travelled from Hong Kong to South Africa on March 27 is hospitalized and suspected of being a SARS case.
A 62-year-old South African man is being treated at a Pretoria hospital as a "probable SARS" case, according to officials.
One factor that is doing a lot to reduce the chances of SARS spread is the great reduction in air travel. Given India's greater vulnerability to SARS Air India's 60% reduction in flights between Hong Kong and Bombay (Mumbai) is good news.
It further curtailed its services to Hong Kong, and will now operate only two flights a week (on Mondays and Fridays) as against the scheduled five flights a week.
While voluntary decisions to not travel are playing a role in efforts to reduce the risk of further spread of SARS government decisions can block off means of spread by more dramatic means. In order to reduce its risk of getting SARS cases from China the government of Malaysia is no longer granting tourist visas at its diplomatic facilities in China.
Malaysia has taken the draconian step of banning all tourists from mainland China to try to stop the spread of the deadly Sars virus.
India and Africa have greater need to take such a dramatic action than Malaysia does. If tourist travel was cut off other types of travel could still be allowed but under much more stringent rules. In the extreme, countries could allow passengers to travel from other countries but then force them into quarantine for 7 to 14 days upon arrival. This would provide a way for people who plan longer term changes in residence to still move around to take different jobs.
Update: On April 17, 2003 a confirmed case of SARS was found in Goa India.
Goa's chief minister, Manohar Parrikar said that a 32-year-old marine engineer had tested positive for the virus and was being treated at the Goa Medical College. The man is said to have arrived in Goa earlier this month after travelling in Singapore.
The worry has to be that this fellow may have already passed on SARS to other people after he returned to India. SARS may now be on the loose in India. If that is the case the odds of containing it there are low. If SARS becomes pandemic in less developed countries the effect on the world economy would be to cause world recession.
Update: India reports 2 new cases of Sars on Saturday April 26.
CALCUTTA, April 26 (Reuters) - A 42-year-old Indian man has tested positive for SARS, authorities said on Saturday, the country's sixth case of the virus that has killed at least 289 people and infected about 5,000 worldwide.
The search for the cause of Severe Acute Respiratory Syndrome (SARS) has been greatly sped up by the use of DNA microarray gene chip technology. UCSF Assistant Professor Joseph DeRisi built a gene microarray containing all known completely sequenced viruses and used it to classify a pathogen isolated from SARS patients as a coronavirus.
DeRisi placed his computer's cursor over one lit dot and it read "bovine coronavirus." Another dot outputted "avian coronavirus." By the time he got to the turkey and human coronavirus dots, he knew he was dealing with something the world's scientists had never seen before.
If it had been a known virus — say the human coronavirus, a cause of the common cold — then only human coronavirus dots would have lit up.
DeRisi discovered that SARS is genetically most similar to a virus that infects birds.
Its genetic sequences so far seem to have the most in common with Avian Infectious Bronchitis Virus, according to preliminary molecular data obtained by Joseph DeRisi at the University of California at San Francisco and circulated among virologists.
Working with MIT post-doc David Wang and one other colleague (whose name I haven't been able to locate) DeRisi built a DNA gene microarray chip with the DNA of 12,000 different viruses. This allowed DeRisi to classify the suspected pathogen within 24 hours of the time he received a sample from scientists at the CDC. Let's put that in perspective. It took months to identify the pathogen that caused Legionnaire's Disease back in the 1970s. While DeRisi's assay was only one step of the process of isolation (it had already been tentatively identified as a coronavirus by viewing it with an electron microscope) it was a step that enormously accelerated the overall process.
DeRisi's development of a robot to place DNA samples onto the DNA gene microarray chip was helped along by advances made to do silicon semiconductor chip manufacture.
In fact, the robots that "pick and place" each sample from a small reservoir onto its spot on the slide are descendants of the machines used to build electronic chips.
This demonstrates a recurring FuturePundit theme: advances in electronic technologies are accelerating the rate of advance of biotechnologies.
The role that DeRisi and his colleagues played in identifying a coronavirus as a suspected cause of SARS came to the attention of the national media when CDC Director Dr. Julie Gerberding mentioned the work in a March 24, 2003 press conference.
But in addition, we're collaborating with academic partners. Earlier this week, we sent DNA out to a laboratory at the University of California, San Francisco, so that they could do the absolute state-of-the-art probe for virus genes and help us identify the cause.
Dr. DeRisi has made a more general contribution to the acceleration of the use of gene array technology. He built and released to the world the design of a robot that automates the process of putting DNA samples into gene arrays.
The technology behind the hope works by hybridization, the affinity for complimentary strands of DNA (cDNA) to form double helix structures. More than 40,000 unique DNA samples can be printed on glass slides in pre-determined locations.
DeRisi designed a robot that, at top speed, prints 14,400 elements per minute. These slides are then used to assay fluorescently labeled cDNA from tumors or organisms, like malaria, which are then stored on computers. Comparing these profiles can reveal the unique molecular signature carried by each type of cancer and give clues as to the original defect.
Despite the central role he played in revolutionizing genomics, it was DeRisi's populist approach to science that made him the buzz among academic and industry scientists. DeRisi never pursued a patent for the robot, instead he posted instructions on how to make it on the Internet.
"Joe could be a very rich man if he kept things to himself," says David Wang, a postdoctoral fellow in DeRisi's lab.
The lab maintains a website that disseminates protocols for the use of microarray technology while his UCSF site includes the instructions on building the robot.
What we still need are advances that will accelerate the rate at which vaccines can be developed. Vaccine development time for a disease like SARS is still measured in years. West Nile virus, for which vaccine development was begun in 1999, killed 277 Americans last year while leaving many others with central nervous system damage. Yet a vaccine for West Nile virus will begin undergoing preliminary testing on humans in June 2003, it is still three to five years away from general availability.
There's still a way that an infectious pathogen which is passed human-to-human like SARS can be defended against using biotechnology: be able to quickly and cheaply identify who is infected so that the infected people can be isolated. This can break the chain of infection and prevent a disease from developing into a pandemic. Without a test to identify exactly who is infected all people who have contact with an infected person must be put into quarantine regardless of whether they really are infected. Singapore has used this aggressive standard technique for epidemic control with considerable success. However, because an infected person can come into contact with a great many people who do not themselves become infected public health authorities are reluctant to quarantine them all. A test to identify people who are infected could make quarantine regimes far more acceptable and effective.
What is needed is a test that can identify infected people at a fairly early stage of the infection. Most of the SARS tests currently under development can not detect the infection at an early enough stage.
The development of a diagnostic test, which is being pursued around the clock by the WHO collaborating network of 11 laboratories, has proved more problematic than hoped. Three diagnostic tests are now available and all have limitations as tools for bringing the SARS outbreak quickly under control.
The ELISA detects antibodies reliably but only from about day 20 after the onset of clinical symptoms. It therefore cannot be used to detect cases at an early stage before they have a chance to spread the infection to others. The second test, an immunofluorescence assay (IFA), detects antibodies reliably as of day 10 of infection, but is a demanding and comparatively slow test that requires the growth of virus in cell culture. The presently available PCR molecular test for detection of SARS virus genetic material is useful in the early stages of infection but produces many false-negatives, meaning that many persons who actually carry the virus may not be detected – creating a dangerous sense of false security for a virus that is known to spread easily in close person-to-person contact.
What is needed is an advance in biotechnology that will provide a test for SARS with high sensitivity at a very early stage of infection.
(thanks to Hylton Jolliffe for the first link)
Experts in public health and infectious disease are beginning to say that they believe SARS is more likely to spread to pandemic levels than to be contained.
"Most people are hesitant to say it will just go away," said Dr. Ruth Berkelman, head of Emory University's Center for Public Health Preparedness and Research. "Too many people are infected to think we won't see it for a long time to come."
In an editorial in The New England Journal of Medicine US CDC Director Dr. Julie Gerberding thinks it would require extreme luck for SARS to be controlled.
"If we are extremely lucky, the epidemic will be curtailed, develop a seasonal pattern that will improve prospects for regional containment, or evolve more slowly than it has at this early stage," Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, wrote in an article this week.
"If the virus moves faster than our scientific, communications and control capacities, we could be in for a long, difficult race."
Note that her extreme luck scenario is for SARS to be controlled, not eliminated.
Dr. Donald Low (who is currently in isolation having himself been exposed to SARS) thinks SARS will become pandemic (i.e. widely spread).
"Unfortunately, it's an epidemic now that will become a pandemic," predicted Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital.
Dr. David Heymann of the World Health Organization thinks we won't know whether we can contain SARS until we have a reliable test for infection.
"I think we've got to keep going at this speed until we get that diagnostic kit in use and figure out what's going on," Heymann said. "Then we'll know if we've lost or not."
One reason for the increased pessimism is the growing belief that some SARS sufferers are high infectious "super spreaders".
The four-member team is most interested in "the phenomenon of 'super spreaders' -- people who seem to spread their disease to a lot of other people," said the WHO team leader, Dr. Robert Breiman.
It is possible that co-infection with another pathogen makes a person into a "super spreader".
"It raises the question of, if you have one pathogen and you get hit with, say, coronavirus . . . are you more likely to transmit? Do you become what we call a 'super spreader?' " Breiman said.
Chinese scientists see evidence in some SARS sufferers of a rare airborne chlamydia bacteria that may be turning people into super spreaders.
Dr Robert Breiman, also of the WHO, said he feared people who already had chlamydia might be vulnerable to the flu-like bug and become highly contagious "super-spreaders".
Governments are moving to increase their quarantine powers. George W. Bush has signed an executive order giving public health officials the legal power to quarantine SARS victims. The Australian government has also moved to grant public health authorities power to force people into quarantine and even to close borders.
It seems likely at this point that decreased travel levels, use of facial surgical masks, and other responses to SARS will be longer lasting and spread to more locales. The economic cost of SARS then seems likely to increase substantially. If containment turns out to be impossible other defenses become more important.
Vaccines would be the ideal next line of defense but the very earliest we could expect help from a vaccine is a year from now. Since SARS is most likely a virus and anti-viral drugs are very difficult to develop the prospects on that front are not hopeful either. The best potential treatment is gamma globulin taken from the blood of people who have recovered from SARS. That may lower the fatality rate of SARS though likely only in industrialized countries and among elites in less developed countries. SARS could become pandemic in less developed countries and travel from those countries to industrialized countries could continually reintroduce it into the countries whose public health infrastructures allow them to stop its spread. Think of a series of fire alarms continually going off all across the industrialized countries as small outbreaks cause a series of small scale quarantines. That might turn out to be our future until a SARS vaccine is developed.
Another possible avenue of treatment is to find a way to suppress the most deadly symptom of SARS: the accumulation of fluids in the lungs which caused SARS to initially be called atypical pneumonia. The key to prevention of the fatal accumulation of fluids may be to find a way to suppress the production or sensing of the natural inflammation signalling compounds called cytokines. It is too early to tell whether steroids (which also suppress immune response) can suppress cytokines enough without suppressing the immune system too much.
With containment looking less likely, the availability of vaccines too distant in the future, and the development of drug regimens that prevent fatal consequences still in doubt the best response to SARS may turn out to be widespread changes in lifestyles and work habits to decrease the chances of spread. The widespread wearing of surgical masks as now seen publically in Hong Kong may spread to other areas where SARS takes hold. Health checks on airline passengers and the wearing of surgical masks on air flights might also become commonplace. The air filtration systems in many commercial and residential buildings may be quickly upgraded to prevent airborne virus spread.
Here's where the effect of SARS may become counter-intuitive: Because it kills only 3 or 4 percent of its victims a widespread public reaction that seeks to reduce the risk of exposure will have the added benefit of reducing the spread of influenza. This could lead to a net reduction in total deaths caused by infectious diseases because estimates of the yearly death toll in the United States from influenza run from 20,000 to 36,000 on average. The yearly death toll estimated as due to influenza in Canada runs from 1,500 to 4,500. Other industrialized countries have similar yearly death tolls from influenza proportionate to their populations. However, since influenza is more likely to kill the elderly the numbers also vary depending on the age distribution of the population and on the rate of yearly immunization. Also, death from influenza does not take as many total years of life away as a disease that strikes people down at a younger age. Still, if the populations of industrialized societies take drastic measures to reduce their risk of getting SARS one likely side effect should be a reduction of the death toll from influenza and possibly from other infectious diseases as well. Even those who are not at risk of dying from influenza will enjoy the benefit of being sick less often and employers will suffer lower amounts of lost work days and reduced productivity days due to sickness.
Update: A doctor in Hong Kong says Westerners fleeing Hong Kong are helping to spread the SARS virus more widely.
Dr David Stirling, told The Telegraph that families trying to escape the outbreak of the incurable illness - which has killed 80 people worldwide - were now the most likely reason for the spread of Severe Acute Respiratory Syndrome.
Update II: Time Magazine has an excellent article that compares the approaches used by Singapore and Hong Kong to respond to the outbreak of SARS. The far more aggressive measures pursued by Singapore resulted in the control of the outbreak.
When new cases were discovered, a team of 100 "contact tracers" tracked down not only patients' immediate families, friends and neighbors but also their office colleagues and favorite food hawkers, and placed them in quarantine, too. Anyone suspected of having SARS is transported to the hospital in an ambulance.
Singapore's far more aggressive approach toward identifying patient contacts and quarantining them has led to a decline in the number of new SARS cases in Singapore. It still may be possible to contain SARS if that aggressive approach is applied in other areas of SARS outbreak.
Update III: SARS may have gotten spread thru the Amoy Garden apartment complex in Hong Kong via cockroaches. If this turns out to be true then it will make SARS harder to contain.
WHO deputy director Alan Hampson estimates SARS vaccine development time in years.
WHO deputy director Alan Hampson, said the disease could be like AIDS with treatments taking years to develop. "It would take years to develop an anti-viral drug," he said. "The earliest you can expect a vaccine is in a small number of years."
German scientist Reinhard Kurth estimates 3 to 5 years for SARS vaccine development.
Reinhard Kurth, the head of the German government's Robert Koch Institute, was not exactly encouraging on Friday night. A vaccine for Sars could be developed, he said – but it would take three to five years.
US National Institutes of Health NIAID director Anthony Fauci offers the best case timeline for SARS vaccine development of at least a year.
If it turns out that some other virus is at work, those researchers will have to start again, cautioned Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease. Even under the best-case scenario, he said, a vaccine is at least a year away.
Clearly, for the foreseeable future the only real option for the halt of the spread of SARS is to identify and isolate its victims quickly and to minimize the chances of exposure in locations where SARS is known to be present.
If you think SARS is bad just keep in mind that it does not spread as easily as influenza does. If SARS was caused by influenza tens of thousands would already be dead.
"If SARS were an influenza pandemic," says Melbourne University professor of virology, Ian Gust, "and the mortality rate was similar to what it is now (about 3.5per cent), we would have tens of thousands of people dead, rather than less than 100." And that is not because the virus would be any more potent, but because it would be much more contagious.
An extremely virulent form of influenza, the kind that only comes once every several decades, could end up infecting almost half of the population of industrialized countries. With a fatality rate similar to that of SARS it could easily kill one percent of the total population. The 1918-1918 so-called Spanish flu (which really didn't originate in Spain) With a world population at the time of 1.8 billion and with a low end estimate of the number killed by Spanish flu as 20 million the low end of the percentage of the population killed by the Spanish flu was at least 1 percent.
Although the history of flu epidemics is non-mathematical, in this case, as Voltaire might say, the superfluous is very necessary. In 1918, when the world population was 1.8 billion, an influenza epidemic incapacitated 1 billion and killed 20 million, all within the space of 8 weeks.
With a world population of 6.3 billion and a current annual growth rate of 1.16 percent a flu pandemic comparable to the 1918 Spanish Flu would kill somewhere in the range of 60 to 150 million people. This would be approximately equal to about one to two years of world population growth at current growth rates.The most intense, to date, occurred in the last year of World War 1: the so-called "Spanish Lady" or "Spanish Flu" pandemic of 1918-19 which infected one billion people, half the world’s population at that time, and killed between forty and fifty million. This makes it the most devastating disease of man known, surpassing even the bubonic plague of the fourteenth century, smallpox in the sixteenth century and the human immunodeficiency virus/AIDS pandemic that is happening now.
Given the fatality rate of SARS infections we are lucky that SARS is not as easily spread as influenza. Still, there is reason to be concerned about the spread of SARS because there are cases of SARS which do not fit the more optimistic model of a requirement of close contact for SARS to spread.
Five of the 24 cases of Sars (Severe Acute Respiratory Syndrome) in the southern Chinese city of Foshan examined so far by a newly-arrived World Health Organization (WHO) team were caught despite the patient having no obvious contact with an infected person.
The biggest defense we have against a highly deadly influenza pandemic is the speed with which influenza vaccines can be developed against threatening new influenza strain.
(MEMPHIS, TENN.--April 2, 2003) Scientists at St. Jude Children's Research Hospital announced today the development of a vaccine against H5N1, a new lethal influenza virus that triggered the World Health Organization (WHO) to declare a pandemic alert in February 2003.
The virus appeared in birds in Hong Kong late last year and subsequently killed one of two infected people with rapidly progressive pneumonia in the past month. St. Jude developed the vaccine in only four weeks from the time it received the H5N1 sample from colleagues in Hong Kong.
The announcement comes at a time when a second, as-yet-unidentified virus, has taken several lives around the world. The unknown virus, which causes severe acute respiratory syndrome (SARS), appears to have originated at the same time and in the same place as the new "flu."
The development of the initial ("seed") batch of H5N1 vaccine is significant because humans do not have a natural immunity to the virus, according to Robert Webster, Ph.D., a member of the Department of Infectious Diseases at St. Jude. Rather, humans appear to become infected through contact with chickens and other birds. In the past the virus killed only the chickens it infected. But the new variant of H5N1 also killed many kinds of wild birds, which is unusual.
Even if a new vaccine could be developed rapidly to counter a killer influenza outbreak the problem today is that there would not be enough production capacity to make influenza vaccine for everyone. However, as demonstrated in US Health and Human Services Cabinet Secretary Tommy Thompson's March 27, 2003 testimony to the US Congress House Committee on Energy and Commerce & House Select Committee on Homeland Security the United States government is funding research to develop vaccine production technologies that are more easily scalable than current vaccine production techniques.
For example, the President's budget foresaw and prepared for an influenza outbreak. It proposes to spend $100 million to ensure the nation has an adequate supply of influenza vaccine in the event of a pandemic. Due to the constant changes in the circulating influenza strains, we cannot stockpile influenza vaccine, and the current manufacturing methods might not meet the Nation's needs in the event of a pandemic.
Funds will be used for activities to ensure a year-round influenza vaccine production capacity and the development and implementation of rapidly expandable production technologies. We will work closely with industry to accomplish these goals.
More scalable vaccine production techniques also have obvious anti-bioterrorism applications. Therefore the development of better vaccine production capabilities have been given an added spur by the rising awareness of the threat of bioterrorism.
Three months after SARS first appeared in China but almost a month before it started causing deaths in Hong Kong a Loudon County Virginia woman recently returned from Guangdong province China came down with what appears to have been the first American case of SARS (Severe Acute Respiratory Syndrome). On February 17 2003 after showing up in the emergency ward of Loudoun Hospital Center she was placed in a sealed room and the health care workers who treated her work protective gear in order to avoid infection.
In the emergency room, she had a high fever and a cough and was having trouble breathing. She and a relative mentioned that she had been in Guangdong and that a flu seemed to be going around there. A triage nurse put the woman in a sealed room that had a dedicated ventilation system to prevent her from passing along the infection.
The details of how she was handled read like a textbook approach for how to handle an unknown and potentially dangerous infectious illness. The Loudoun Hospital Center folks had the assets needed and made the right call.
The Washington Post has a good report laying out the events inside the Chinese government as it covered up the outbreak of SARS.
The outbreak of the illness is a revealing case study in how China's authoritarian government, which seeks to maintain a monopoly on power and control information, concealed vital data about a life-threatening disease from the Chinese people, according to doctors, health officials and journalists familiar with the events.
China is the place where the holding back of information on epidemic outbreaks promises to be most threatening to the world as a whole. Because of the millions of people (tens of millions? hundreds of millions?) in Southern China who live in close proximity with pigs, ducks, and other fowl China is like a big experiment for the mixing of DNA across different virus strains that normally infect different species. In the case of SARS it is likely that a human coronavirus coinfected a cell (probably in a human) at the same time a coronavirus from another species did as well. Genes were exchanged and the result was a coronavirus that is more lethal to humans. This also happens with influenza viruses. The most lethal influenza viruses are either viruses that jumped over from other species or which exchanged DNA with viruses from other species.
Because China has such ideal conditions for gene swapping between virus strains from different species it is more likely than any place on Earth to be the source of the next killer virus whose lethality would rank up there with the 1918-1919 Influenza pandemic that killed 20 to 40 million people. The authoritarian impulses of the Chinese authorities to control and hush up bad news, as they have done with the SARS pathogen, put the rest of the world at much greater risk to every new disease that first shows up in China. This impulse on the part of the Chinese government deserves to be widely and loudly criticised. The rest of the world needs to make it clear to China that this kind of "hush it up" reaction to disease outbreaks will not be tolerated because it creates an unacceptable risk to the health of all of humanity.
While the Chinese government prevented Chinese newspapers from reporting on SARS Dan Gillmor reports that text messaging using mobile phones helped spread the knowledge that SARS was a threat.
I found the Dan Gillmor link in a SARS link collection by Ian Mckenzie.
Update: Health care workers in Beijing are reporting 50 cases of SARS in spite of the fact that the last report from China to the WHO reported only 12 in Beijing. China is still being slow about admitting the extent of its SARS cases.
The additional cases have not been reported to the World Health Organization, even though Chinese health officials promised to begin daily reporting of such statistics this week.
Update II: The Globe and Mail has an excellent story on how the Chinese government tried to keep secret the spread of SARS.
But information was not shared with other health departments in this province of 80 million people. Instead, the Heyuan paper printed this statement on Jan. 3 from the local health bureau: "No epidemic disease is being spread in Heyuan. . . . Symptoms like cough and fever appear due to relatively colder weather." That was apparently the first report on SARS in the Chinese media.
Update III: In a move that is extremely rare for China the director of the Chinese CDC apologized for the Chinese government's handing of SARS.
"Today, we apologize to everyone," said Li Liming, director of the Chinese Center for Disease Control. "Our medical departments and our mass media suffered poor coordination," he said. "We weren't able to muster our forces in helping to provide everyone with scientific publicity and allowing the masses to get hold of this sort of knowledge."
While this apology has been broadcast in Hong Kong it is not clear whether people in mainland China heard it.
Li's statement was not immediately reported by Chinese media. It was not known whether his remarks were authorized by senior officials or whether Li, highly regarded in his field, had taken the unusual step of articulating the widespread view on his own. Other officials who have released unauthorized material about SARS have lost their jobs
In an encouraging sign that the Chinese leaders have perhaps learned that they can't go keeping major disease outbreaks secret the Chinese Deputy Prime Minister made noises about being a lot more open the next time around.
Deputy Prime Minister Wu Yi called for "the immediate establishment of a national medical emergency mechanism, with emphasis placed on a public health information and an early warning reporting mechanism".