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Looks like containment failed.
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FreeRepublic , LLC PO BOX 9771 FRESNO, CA 93794
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It is in the breaking news sidebar! |
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China
The WHO team of experts presented its interim report on the SARS outbreak in Guangdong Province this morning to the Chinese Ministry of Health and Vice Premier Wu Yi in Beijing. The team began its investigations in Guangdong on 3 Apr 2003.
The team concluded that the health system in Guangdong responded well to the outbreak. The province has a health system in which every hospital at every level reports any new cases of SARS. The WHO report therefore concluded that virtually all probable cases of SARS presenting at a hospital in Guangdong Province will be detected and rapidly reported.
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 [2003]. 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.
Microbiological findings
Large banks of stored specimens from suspected and probable SARS cases, from case contacts as well as from “normal controls” exist at the institutions visited and are stored under suitable conditions; detailed information about the numbers and types of these specimens are available and were provided to members of the WHO team. Although the patient data on each of these is very limited, it is sufficient to allow linkage with the very detailed epidemiological and clinical information held elsewhere in Guangdong Provincial Centers for Disease Control and the hospitals.
These specimen banks comprise different types of respiratory specimens from which the detection of agents can be attempted and serum samples, often as paired acute and convalescent sera (i.e., the first sample obtained during the acute phase of the illness and the second during recovery), which will allow determination of seroconversions. The laboratory staff agreed that once a causative agent for SARS was identified, these banks should be tested and will provide very valuable information; they seemed, however, less sure whether this time had come already, i.e. whether there was already sufficient evidence and whether suitable tests had been developed elsewhere that would make such an exercise worthwhile. They requested assistance from the WHO team to obtain relevant information on primer sequences and other matters as well as access to suitable experimental tests such as immunofluorescence antibody assays
. Main recommendations
--------- The interim report made several major recommendations, including the following:
- The SARS reporting system established in Guangdong is an excellent model that all provinces should follow. Team members suggest that the MOH ensures that all provinces are brought up to Guangdong standards by implementing this system nationwide as a matter of the utmost urgency. A programme for evaluating and accrediting surveillance systems through evaluation by technical experts is also suggested in order to ensure that consistent standards are achieved and maintained.
- The Guangdong experience should be used to develop uniform standards throughout all provinces for preventing the spread of SARS in health care facilities.
- Careful contact tracing of SARS cases is vital to bring the outbreak under control. Detailed interviewing of all newly reported SARS cases by trained interviewers including a full review not only of close contacts but potential exposure in other crowded settings, e.g. public transport, needs to be routinely carried out. Contacts of cases should be provided with detailed preventive advice verbally and in writing.
- Much better collaboration between virological laboratories in China is required, particularly to facilitate the exchange of results, specimens, and reagents. The following institutions should form the nucleus of a national SARS laboratory network within China:
- National Institute of Virology, China CDC, Beijing
- Virology Unit, Beijing Provincial CDC, Beijing
- Virology Unit, Guangdong Provincial CDC, Guangzhou
- Department of Virology, Zhongshan University, Guangzhou
Laboratories from other areas with experience of SARS cases should also be included. Adequate funding and human resources need to be urgently provided to ensure the proper functioning and sustainability of SARS surveillance activities, as they are essential to controlling spread of the disease. Chinese institutions should form a national SARS laboratory network within China to speed up the exchange of results, specimens, and reagents.
- Guangdong clinicians have cared for the largest number of patients in the world and their experience should be shared with the international community through publications, meetings, and in drafting guidelines for the management of SARS patients.
Priority actions
Priority actions recommended in the report to contain SARS include:
- early recognition and treatment of cases
- stringent infection control measures in hospitals and clinics
- prompt reporting of suspected cases
- meticulous investigation and contact tracing in the community - public awareness campaigns and education.
[C] Epidemiologic links
A mapping of the cumulative number of SARS cases reported to WHO (and contained in the above table [A]) as of 9 Apr 2003 can be found at:
Epidemic curves of the SARS cases reported to WHO (as of 8 Apr 2003) can be found at: . There are multiple curves, representing the global outbreak, and then outbreaks by country for Hong Kong, Viet Nam, Singapore, Canada, the United States, and the European Region. Reviewing the curves, when looking at the epidemic curve by date of onset, it does appear as though the global outbreak may have already peaked, although this curve represents a small fraction of actual reported probable cases, as dates of onset were not available for 2105 cases. The date of onset of the most recent reported cases was 1 Apr 2003, 6 days preceding the last date of notification. In contrast, the epidemic curve plotting reported cases by date of report appears to be consistent with ongoing transmission at a steady rate, with a marked increase in numbers of cases reported on 1 Apr 2003 (representing the delayed reports from China) and another significant increase in reported cases on 8 Apr 2003.
The epidemic curve by date of report in Hong Kong suggests that there was a large peak during the week of 29 Mar 2003, and a second smaller peak during the week of 5 Apr 2003. The epidemic curve by date of onset for Viet Nam suggests that there was a peak during the week of 8 Mar 2003, and apparent interruption of transmission (or missed cases, or one incubation period pending appearance of new cases) during the week of 29 Mar 2003 and the appearance of a few cases during the week of 5 Apr 2003. The epidemic curve, by date of onset for Singapore shows a clear peak in cases during the period 15-22 Mar 2003 and a significant tapering off of cases by the week 5 Apr 2003. The epidemic curve, by date of onset, for Canada shows a clear peak during the period 15-22 Mar 2003, with continued transmission but at a lower rate. There have not been any cases reported with dates of onset since 4 Apr 2003 in Canada. The epidemic curve, by date of onset (current as of 4 Apr 2003), for the United States shows several peak periods of cases, during the weeks of 15 Mar 2003, 22 Mar 2003, and 29 Mar 2003. The maximum number of cases with dates of onset on a single day was 9 on 17 Mar 2003. (We do not have information on the dates of onset of the few healthcare workers and family members that were contacts of imported cases, but the overwhelming majority of cases reported in the United States were in individuals with a history of travel to affected areas (see section [B] above). There have not been any cases reported with dates of onset since 30 Mar 2003, representing a 5-day period without new cases. In contrast, the epidemic curve by date of onset for the European Region is more consistent with sporadic case reports, with a maximum of one or 2 cases per day. To date there have not been reports of any secondary transmission in the European Region. - Mod.MPP]
By Christopher Bodeen, AP, in Beijing
10 April 2003
Independent (UK)
A prominent Chinese surgeon accused the government yesterday of concealing the full extent of the outbreak of severe acute respiratory syndrome (Sars), saying there had been several more deaths and five times more cases of infection in Beijing than publicly reported.
And in a further indication of the scale of the problem, an employee at a hospital in the Chinese capital said it was shut down after staff contracted the potentially fatal illness.
Even as state media repeated the government's insistence that the outbreak was under control, the Health Ministry said health officials from throughout China had been summoned to Beijing for a meeting about efforts to combat the illness.
The claim of unreported deaths came in a statement by Dr Jiang Yanyong, a retired chief of surgery for a Beijing military hospital. He said two other military-run institutions have suffered at least seven fatalities plus there were 106 cases of the disease. Chinese authorities have reported four fatalities and 19 cases in Beijing, including a Finnish man who died on Sunday.
Doctors and administrators reached by telephone at the hospitals cited by Dr Jiang – the Military 302 and 309 hospitals – refused to comment. Dr Jiang said his information came from staff who work at those hospitals.
At the People's Armed Police General Hospital in Beijing, a receptionist who answered the telephone said the facility was closed five days ago after staff fell ill.