Posted on 03/17/2003 12:36:40 AM PST by sarcasm
hinese health officials yesterday gave the World Health Organization the first, sketchy details about a mysterious respiratory ailment that is believed to have first broken out in Guangdong province last November and that Chinese officials say has tapered off in recent weeks.
W.H.O. officials were elated to receive the information, because it was the first official communication from China about the outbreak and because it provides a longer-term view of how the illness has behaved since the first cases were detected. Although the new information hints that the outbreak may be ending in Guangdong for unknown reasons, W.H.O. officials say they need more information to be certain.
"If it has burned out, it certainly will give us optimism over its control" elsewhere, Dr. David L. Heymann, executive director in charge of communicable diseases for the W.H.O., said in an interview. "That is why we need more information to know what the natural history of the illness has been since November."
The W.H.O., an agency of the United Nations, on Saturday declared the ailment "a worldwide health threat." The agency calls the ailment severe acute respiratory syndrome, or SARS, and says it has caused at least nine deaths in Canada and five other countries in recent weeks. The spread of the ailment, a form of atypical pneumonia, has been aided by international air travel. New cases, including many hospital workers, are being reported daily in affected countries, according to the W.H.O.
Laboratories in at least five countries have failed to identify any known infectious agent as a cause of the illness. The illness starts with the sudden onset of fever of 101.4 degrees or higher, muscle aches, headache, sore throat, dry cough and shortness of breath. X-rays show pneumonia or respiratory distress syndrome. Laboratory tests show low numbers of white blood cells and platelets, which help blood clot.
There have been no reports of the illness in the United States. But a 32-year-old doctor from Singapore and his 62-year-old mother-in-law are being treated for pneumonia in isolation in a German hospital after having attended a medical conference at the Crowne Plaza Hotel in New York City. Officials believe he may have contracted the illness in treating the first two cases in Singapore, where there are now 20 reported cases.
The doctor has a fever and a slight cough, and his mother-in-law has a high fever, doctors at the Johann Wolfgang Goethe-University Hospital in Frankfurt said at a news conference yesterday. They said that the doctor's 30-year-old wife, who is pregnant, has shown no symptoms.
New York City health officials said it was highly unlikely that the doctor or his family had given the illness to anyone in the city.
When asked about the issue at a St. Patrick's Day parade yesterday, Mayor Michael R. Bloomberg said he had spoken with the health commissioner, Thomas R. Frieden, and said, "Let me stress that the commissioner is reasonably confident that this guy did not infect anybody" in New York.
Health officials say they believe it takes direct and sustained contact to transmit the illness. But health officials have asked doctors to be alert to patients with flu-like symptoms who have recently traveled to Asia.
Coincidentally, infectious diseases were the subject of the meeting that the Singapore doctor attended, and news of the respiratory ailment was a hot topic in the hallways. The doctor attended the conference for two hours, said Dr. Marcelle Layton, New York City's assistant health commissioner for communicable diseases.
Dr. Layton said the Singapore doctor reported that he did not sit near other participants in the meeting and that he had minimal contact with anyone else during his stay in New York City. Dr. Layton said she had interviewed the doctor by telephone from his hospital room in Germany.
"He was very cooperative and helpful," Dr. Layton said in an interview.
Mr. Bloomberg said yesterday that health officials "have interviewed every single person that he had contact with when he was here and we are observing all of them."
Dr. Frieden "is reasonably confident that this guy did not infect anybody," Mr. Bloomberg said.
The doctor, whose name has not been released, had treated Singapore's first two cases of the illness. One patient was a doctor who had traveled to Singapore from Hanoi, Vietnam, where the outbreak has affected 46 people.
Before the Singapore doctor left home for the United States on March 11, he developed a fever, severe muscle aches and a rash, which disappeared within two to three days.
Dr. Barry M. Rosenthal, a physician at Lenox Hill Hospital in New York City, said in an interview that late Thursday night he had received a call from the Singapore doctor, who said he had a rash and fever and wanted to know where he could get a blood test because he suspected he had dengue fever, a mosquito-borne viral infection.
Dr. Rosenthal referred the doctor to another physician. New York City health officials said that X-rays showed pneumonia in one lobe of the doctor's left lung and that he was treated with oral antibiotics.
The Singapore doctor called a colleague in Singapore before leaving for home via Frankfurt. The colleague notified W.H.O. officials, who arranged to have the doctor hospitalized in Germany. Yesterday, hospital officials said his condition had worsened slightly but that he was awake, alert and asking to read newspapers.
Information about the cases was distributed to participants at the New York City conference, which ended yesterday. More information would have been given to the public if the risk of transmission had been considered greater, Dr. Layton said.
The ailment has affected hundreds of patients in China, Hong Kong, the Philippines, Singapore, Thailand and Vietnam, according to the W.H.O. In Canada, where two patients have died, there are eight other suspected cases.
The organization had previously listed Indonesia, but the cases seen there do not meet the working definition of the illness, Dr. Heymann said. Australian officials said they were monitoring a number of cases that did not meet the definition.
According to information gathered by the Chinese government over recent months but released to the W.H.O. only yesterday, SARS has behaved differently from past outbreaks of influenza, which can cause atypical pneumonia, or nonbacterial pneumonia. Chinese scientists at first thought the cases might be avian influenza but could find no evidence of any influenza virus. The current outbreak, in Guangzhou, the capital of Guangdong province, involves clusters of cases, particularly among hospital workers and family members of patients.
Chinese officials reported earlier that there were 305 cases, including five deaths. The cases have involved men and women in all age groups, but most have occurred among young adults.
The outbreak began in November and was at its peak Feb. 3 to Feb. 14. "The number of new cases decreased markedly after Feb. 15, and no new cases were detected in other cities," the Chinese reported.
Because the report appears to conflict with earlier reports from the W.H.O. that the epidemic in Guangdong had ended and the government's statement that the outbreak was confined to Guangzhou, Dr. Heymann said the W.H.O. was asking for clarification.
In Guangdong, the fever was of long duration, but officials did not say for how long. Most patients experience a dry cough, and any sputum is often tinged with blood.
Chest X-rays of many patients showed pneumonia in both lungs. In many patients, the disease progressed rapidly, even if the fever dropped. Some experienced a secondary pneumonia caused by bacteria.
Seven percent of patients experienced such severe difficulty in breathing that tubes had to be inserted in their windpipes and presumably connected to a ventilator.
The X-rays of many patients resembled the pattern of pneumonia produced by a microbe, Pneumocystis carinii pneumoniae, or PCP, that is common in patients with AIDS but rarely seen in people with normal immune systems.
A point of confusion was a statement by the Chinese that some seriously ill patients showed "immune system functions at a low level." There was no mention of whether such patients were infected with H.I.V., the AIDS virus. Dr. Heymann said the W.H.O. was seeking a clarification.
The Chinese report also said that "most of the patients could be cured after treatment, especially the patients who have no bacterial co-infection." The report gave few details of such a cure but said that "antibiotics did not have an obvious effect."
The Chinese provided no numbers, and Dr. Heymann said that W.H.O. was asking for clarification of those statements.
Electron microscopy showed evidence of infection in four patients with one of two microbes, Chlamydia psittaci, or parrot fever, and para-chlamydia. The W.H.O. said chlamydia had not been identified in cases outside of Guangdong.
The Chinese also said that "generally, transmission became weaker and weaker," a hint that if the cause is an infectious agent, it becomes less virulent as it is passed along.
W.H.O. officials have said that they expect to be able to send experts to Guangdong soon to clarify all the points of confusion and that they expect that their work will solve the riddle of the illness.
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