SARS Is Here to Stay, Hong Kong and Singapore Tell Citizens

HONG KONG, April 8 — Health officials in Hong Kong and Singapore warned their citizens today that the SARS virus had spread so far that it would be hard to bring under control any time soon, if ever.

"Singaporeans must be psychologically prepared for the problem to stay with us for some time," said Lee Hsien Loong, Singapore's deputy prime minister.

Hong Kong and Singapore began emphasizing measures to slow the spread of the disease and reduce its severity, but backed away from suggestions that the disease could be eradicated.

Dr. Leung Pak-yin, Hong Kong's deputy director of health, said residents should be concerned about possible environmental contamination if many cases developed in their apartment buildings.

"We believe that every citizen could become a carrier of the virus," he said, especially if people do not take preventive measures like washing their hands and wearing face masks. Hong Kong University researchers have found evidence suggesting that many people come in contact with the virus without actually falling seriously ill.

Mr. Lee and Tung Chee-hwa, Hong Kong's chief executive, both warned of serious harm to their cities' economies because of the outbreak, which has particularly hurt the airline, hotel, retailing and restaurant industries. "This SARS has now a profound long-term impact on our economy and it is a very serious matter," Mr. Tung said at a news conference this evening.

Hong Kong reported 45 new cases today, including the infections of 18 health care workers, as well as the deaths of two elderly men who were infected with SARS but had other health problems as well. Figures for new cases over the last several days have included 30 cases at the Ngau Tau Kok apartment complex, which had not previously been affected, Dr. Leung said.

The disease has already infected close to 300 people in the nearby Amoy Gardens apartment complex, and it appears that people from the Ngau Tau Kok complex had been visiting Amoy Gardens, Dr. Leung added.

Until today, Hong Kong health officials had discouraged the everyday use of face masks, saying that regular hand washing was more important. But Dr. Leung endorsed the use of face masks tonight.

He did not draw a distinction between cloth surgical masks of the sort that doctors have worn for decades and the newer, cupped respirators that doctors wear in some of the most hazardous rooms.

Some doctors here have expressed concern that while the respirators filter more out of the air, they may be less effective for the lay user than a surgical mask because the respirators are so uncomfortable that they prompt wearers to touch their faces to adjust them. This can spread the virus to the eyes, nose or mouth and then into the body, causing an infection.

In one of the more unusual health tips here lately, government officials also said it might help if people were to close toilet lids when flushing, and to clean the underside of the lid and the toilet seat with a bleach solution later. Preliminary analyses of the outbreak at Amoy Gardens suggest that it was spread by sewage, partly from toilets that backed up into neighbors' apartments and partly from cockroaches that tracked tiny amounts of virus-tainted sewage through homes, they added.

SARS will inevitably spread to the Middle east, and ultimately to Iraq. In the wake of war, its effects will be as devastating for poorly nourished Iraqi children as for the elderly with compromised immune systems. It is not unlikely we shall see a humanitarian catastrophe of the sort that the Spanish Flu epidemic caused in the wake of WWI when, after 10 million died in combat, another 20 million died of the flu -- at least partly because of the weakened condition of the troops who fought in WWI.

Let's hope CDC is working on this one 24 hr per day to learn why SARS is so highly infectious, and to decide, with certainty, what the causative agent is -- in the hope that a vaccine can be prepared, something that, alas, has never been especially effective against coronaviruses such as the one that causes the common cold.

WHO Guangdong China team to issue its report
8 April 2003

Disease Outbreak Reported

The WHO expert team in Guangdong Province, China will be issuing its official interim report and recommendations on the local SARS situation early tomorrow. The four-person team, headed by John MacKenzie of Australia, has been in Guangdong since Thursday 3 April. The team was charged to assess the local situation and to support the strengthening of surveillance, clinical management, infection control, and laboratory evaluation of SARS cases.

The team has visited Foshan City, where the earliest case is thought to have occurred in mid-November 2002, and Guangzhou City, the provincial capital. In a wide ranging collaborative investigation, the team has met with authorities, health and veterinary professionals, and technical experts in the provincial Centers for Disease Control laboratories and the virology laboratories of Zongshan Medical University. The team has conferred with staff at all levels and been granted full access to all sites, institutes, and hospitals requested.

The team will be reporting on the provincial surveillance system, measures for community infection control, patient management and hospital infection control. It will also give a detailed review of microbiological findings.

The SARS outbreak in Guangdong Province is presently the largest and oldest known outbreak of SARS and may hold important clues about both the origins or the virus and measures for clinical management. In one of its earliest reports about cases of atypical pneumonia to WHO, the Chinese Ministry of Health reported 305 cases and 5 deaths, from mid-November to 9 February, in 6 municipalities: Foshan, Guangzhou, Heyuan, Jiangmen, Shenzhen, and Zhongshan.

Guangzhou was the home of a 64-year old professor of nephrology, at Zhongshan University, who is thought to be the index case who sparked the outbreak in Hong Kong. During late February, he stayed in room 911 on the ninth floor of the Metropole Hotel. Guests staying on the hotel’s ninth floor sparked outbreaks in other countries when they returned to their homes in Toronto and Singapore. A 48-year-old American businessman, who also stayed on the 9th floor, is believed to have originated the outbreaks in Hanoi and in Hong Kong’s Princess Margaret Hotel, where he was transferred. One local Hong Kong resident, who visited an acquaintance on the ninth floor, subsequently sparked an outbreak in a second Hong Kong hospital.

Elsewhere in China, Shanghai, which has reported its first SARS case, has requested a visit from the WHO team to discuss SARS and be advised on how best to deal with the disease.

In Beijing, the death on Sunday of a 53-year-old staff member of the International Labour Organization continued to cause considerable anxiety, particularly at embassies and among staff of international organizations. Epidemiologists at the WHO Office in Beijing have conducted contact tracing and other investigations to determine the source of the staff member’s exposure and to assess whether close contacts may have been exposed. To date, no SARS cases or suspicious symptoms related to this death have been observed. The investigations are continuing.

Update on cases and countries

As of today, 2671 SARS cases with 103 deaths have been reported from 17 countries. This represents an increase of 70 cases and 5 deaths when compared with yesterday. The new deaths were reported in Canada (1), Hong Kong SAR (2), and Singapore (2). The additional cases were reported in Canada (1), China (11), Hong Kong SAR (45), France (1), Singapore (7), and the United States (7). Taiwan, China removed 2 cases from the list.

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