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SARS

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WHO reported SARS through 03-Apr-2003
Country Cases Deaths
Australia 1 0
Belgium 1 0
Brazil 1 0
Canada 62 7
China 1190 46
Hong Kong (China) 734 17
Taiwan (China) 14 0
France 3 0
Germany 5 0
Italy 3 0
Ireland 1 0
Romania 1 0
Singapore 98 4
Switzerland 2 0
Thailand 7 2
United Kingdom 3 0
United States (+) 85 0
Vietnam 59 4
Total 2270 80
(+) Due to reporting differences, US figures
reflect suspected instead of probable cases.

Severe Acute Respiratory Syndrome (SARS) is an atypical pneumonia that first appeared in November 2002 in Guangdong Province, China. The first case of infection was speculated to be a farmer in Foshan County. It spread to Hong Kong and Vietnam in late February 2003, and then to other countries via air and land travel of infected persons.

To date, the illness has caused death in about 3.5% of known cases. As of 02-Apr-2003 the World Health Organization (WHO) recognizes 2223 reported cases and 78 fatalities. The WHO reports that local transmission of SARS is taking place in Toronto, Singapore, Taiwan, Hanoi, and the Chinese regions of Guangdong, Hong Kong, and Shanxi. In Hong Kong the first batch of affected people have been discharged from hospital on March 29, 2003. Until today, Apr 3, the number of recovery cases in Hong Kong are 86.

SARS is probably caused by a previously unknown virus. Disease transmission is not well understood at this time. It is suspected to spread via inhalation of droplets expelled by an infected person when coughing or sneezing, or possibly via contact with secretions on objects. Health authorities are also investigating the possibility that it may be airborne, which would increase the pontential contagiousness of the disease.

Symptoms and treatment

On March 12, 2003, the WHO issued a global alert, followed by a health alert by the United States Centers for Disease Control and Prevention (CDC). WHO recommends that suspected cases be treated in isolation, and defined a suspected case as a person presenting after February 1, 2003 with history of:

  • high fever of >38° C (100.4° F) -and-
  • one or more respiratory symptoms including cough, shortness of breath, difficulty breathing; signs of hypoxia; or a confirmed diagnosis of pneumonia -and-
  • one or more of the following:
    • close contact with a person suspected of having SARS -or-
    • recent history of travel to areas with documented transmission of SARS

A probable case is defined as a suspected case with the additional findings of pneumonia or respiratory distress syndrome by chest x-ray or autopsy.

In addition to fever and respiratory symptoms, SARS may be associated with other symptoms including headache, muscular stiffness, loss of appetite, malaise, confusion, rash, and diarrhea. The count of white blood cells and platelets is often low. Symptoms usually appear 2-7 days (in rare cases up to 10 days) after infection. In about 10-20% of the cases, symptoms are so severe that patients have to be put on a ventilator.

Antibiotics are ineffective. The antiviral drugs ribavirin or oseltamivir may have some efficacy, and the role of steroids in treatment remains to be determined. The CDC is testing antiviral drugs against coronaviruses to see if specific recommendations can be formulated.

Current state of etiologic knowledge of SARS

The etiology of SARS is still unknown.

Initially, electron microscopic examination in Hong Kong and Germany found viral particles with structures suggesting paramyxovirus in respiratory secretions of SARS patients; subsequently, in Canada, electron microscopic examination found viral particles with structures suggestive of metapneumovirus (a subtype of paramyxovirus) in respiratory secretions. The Pasteur Institute in Paris identified coronavirus in samples taken from six patients. The CDC, however, noted viral particles in affected tissue (finding a virus in tissue rather than secretions suggests that it is actually pathogenic rather than an incidental finding). On electron microscopy, these tissue viral inclusions resembled coronaviruses, and PCR testing suggested that they were a previously unrecognized coronavirus. Sequencing of the virus genome is ongoing. A test was developed for antibodies to the virus, and it was found that patients did indeed develop such antibodies over the course of the disease, which is very suggestive that the virus does have a causative role. Findings, however, remain preliminary: further work, such as a comparison of the viral strains from all patients, remains to be done, and other etiologic possibilities may be revealed through continued study.

Progress of the outbreak

On November 16, 2002 an outbreak of what is believed to be the same disease began in the Guangdong province of China, which borders on Hong Kong. Of the 806 people reported infected, at least 34 died. China notified WHO about this outbreak on February 10, and the outbreak peaked in mid-February 2003.

China has forbidden its press to report on the disease, and it has generally lagged in reporting the situation to the World Health Organization, delaying the initial report and so far only reporting statistics through the end of February. Initially, it did not provide information for Chinese provinces other than Guangdong, the province where the disease is believed to have originated. [1] A WHO team that travelled to Bejing was not allowed to visit the Guangdong province.

On February 21, a Chinese doctor who had treated cases in Guangdong checked into the Hong Kong hotel Metropole and infected seven other guests. He was admitted to the Hong Kong Prince of Wales Hospital and died on March 4. A large number of hospital workers were infected. About 80% of the Hong Kong cases have been traced back to this doctor.

In late February, an American businessman living in Shanghai travelled via Hong Kong, where he stayed in the Metropole Hotel, to Hanoi, Vietnam. There he fell ill and was admitted to the French Hospital on February 26. After the disease was transmitted to a number of hospital workers there, he was returned to Hong Kong where he died on March 14. WHO doctor Carlo Urbani, who was based in Hanoi, noticed the outbreak among hospital workers there and first identified the disease. He later died of the disease on March 29.

Almost all of those infected to date have been either medical staff or family members of people who have fallen ill. It is believed that all affected medical staff were not using respiratory precautions, a safety protocol that should fully protect medical workers, at the time of exposure. The various cases around the world are directly or indirectly traceable to people who have recently visited Asia.

On March 20, WHO reported that several hospitals in Vietnam and Hong Kong were operating with half the usual staff, because many workers stayed home out of fear of getting infected. WHO raised the concern that substandard care of the infected patients may contribute to the spread of the disease.

On March 25, Hong Kong authorities said nine tourists came down with the disease when a mainland Chinese man infected them on a March 15 Air China flight to Beijing.

The Singaporean Government enforced compulsory quarantine of any inflected person.

On March 27, Arthur K. C. Li, the head of the Hong Kong Education and Manpower Bureau announced class cancellation of all educational institutions.

On March 30, Hong Kong authorities quarantined the estate E of the Amoy Garden Apartment due to a massive (200+ cases) outbreak in the building. The balcony was completely closed of all uses and guarded by the police. The residents of the building were later transferred to the quaratined Lei Yue Mun Holiday Camp and Lady Maclehose Holiday Village on April 1 because the building was deemed a health hazard. Most of the cases were tied to apartment units with a north-western orientation that shared the same sewage pipe. According to government officials, the virus was brought into the estate by an infected kidney patient (type of kidney illness has not been specified) after whom was discharged from Prince of Wales Hospital, visited and thus infected his elder brother living in a flat on the seventh floor. Through excretion the virus spread thorugh plumbings. One speculated theory that supported airborne transmission was that the virus was spread through dried up U-shaped P-traps in the plumbing and was blown by a maritime breeze to the ventilation of the estate's balcony and stairs. It was confirmed that the virus can spread via droplets, but this latest outbreak made the officials question the possiblility of spreading through the air.

(unknown date sometime between March 25 and April 1), an international ice hockey tournament in Beijing was cancelled.

(unknown date sometime between March 25 and April 1), an asian commerce conference was postponed to an undetermined date in autumn.

On April 1, the US government called back non-essential personnel in their consulate office in Hong Kong and Canton. The US government also advised US citizens not to travel to the region.

On April 2, Chinese medical officials began reporting the status of the SARS outbreak. China's southern Guangdong province reported 361 new infections and 9 new deaths, increasing the total China figures previously reported at end-February. The virus was also detected in Beijing and Shanghai. The WHO also advised travelers to avoid Hong Kong and Guangdong during a press briefing. [2]

On April 2, a Hong Kong teenage boy was arrested for spoofing on the internet that the city had been declared a city of infection.

On April 3, A team of international scientists landed in Guangzhou from Beijing to discuss with officials but has yet to inspect any suspected origin or any medical facilities on progress of inflection control.

On April 3, 15 of the quarantined Amoy Garden residents at Lei Yue Mun Holiday Camp have been relocated to the Sai Kung Outdoor Recreation Centre after an overnight protest on washroom sharing.

On April 3, first case of decease among infected medical workers in Hong Kong. The doctor was survived by a daughter and his infected wife who is also among the quarantined medical workers under intensive care.

On April 3, Arthur K C. Li, the head of the Hong Kong Education and Manpower Bureau prolonged class cancellation of all educational institutions by a week.

Action to try to control SARS

WHO set up a network for doctors and researchers dealing with SARS, consisting of a secure web site to study chest x-rays and a teleconference.

Attempts are being made to control further SARS infection through the use of quarantine. Over 1200 are under quarantine in Hong Kong, while in Singapore and Taiwan, 977 and 1147 are quarantined respectively. Canada also put thousands of people under quarantine. [3] In Singapore, schools were closed for 10 days and in Hong Kong they are closed until April 22 to contain the spread of SARS. [4]

On March 27, 2003, the WHO recommended the screening of airline passengers for the symptoms of SARS. [5]

Economic effects by SARS

On April 1, an [Europe]]an airline laid off a batch of employees owing to drop of travellers by the September 11 and SARS.

Severe customer drop of Chinese cuisine restaurants in Guangdong, Hong Kong and Chinatowns in North America, 90% decrease in some cases.

Offical Updates

Medical Mailing Lists

Mainstream News

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