Businessman Becomes First To Contract SARS In Britain

The first case of a potentially lethal virus caught in Britain was announced last night as health officials tried to trace anyone who had been in contact with an infected Hong Kong businessman.

The British patient is thought to have been infected with Sars (severe acute respiratory syndrome) during a two-hour business meeting in London. He is being treated in isolation at Northwick Park Hospital in Harrow, north-west London.

Health officials revealed that a 48-year-old Hong Kong businessman who had attended the meeting was already showing symptoms of the highly contagious infection when he arrived in London on 2 April. He stayed in the country for more than 24 hours before returning to Hong Kong, where he was admitted to hospital.

"We are trying to trace people he might have been in contact with him while he was in the UK," said a spokeswoman for the Health Protection Agency. "They will be monitored in case they develop any symptoms of Sars."

The Hong Kong Health Department appealed for passengers and air crews from seven Lufthansa flights used by the businessman to contact doctors. The man left Hong Kong for Munich on 30 March and then flew on to Barcelona, where he developed symptoms of the infection. But he decided to continue his trip, flying to Frankfurt before arriving in London on flight 4520. He left London on flight 4671 to Munich and then went back to Frankfurt before returning to Hong Kong on 5 April.

The case is likely to lead to calls for the introduction of stricter monitoring of passengers from those countries in the Far East where the virus is known to be a severe risk. Five previous cases of Sars in the UK are believed to have been caught abroad.

Yesterday a 47-year-old British businessman was identified as the first probable case of Sars in Indonesia after travelling to the country from Hong Kong and Singapore. The Philippines also reported its first cases yesterday.

Meanwhile, the World Health Organisation (WHO) warned that Sars could threaten a global catastrophe. Twenty countries have now been affected.

Delivering an update on the new disease one month after it issued a global health alert about Sars, the WHO said it remained a particularly serious threat to international health because of the ease with which it had been spread by air travel and because of the way it was concentrated among health workers, disabling hospitals and health systems.

"If the Sars virus maintains its present pathogenicity and transmissibility, Sars could become the first severe new disease of the 21st century with global epidemic potential," said David Heymann, executive director of communicable diseases at the WHO.

Mr Heymann said the "hot zones" of concern remained China, Canada, Hong Kong, Hanoi and Singapore. "One of the most alarming features of Sars in these areas is its rapid spread in hospitals where it has affected a large number of previously healthy healthcare workers," he said.

In contrast to new diseases that have emerged in recent years such as avian flu, variant Creutzfeldt-Jakob disease, Ebola and Marburg disease Sars was more infectious, spread more widely and caused serious illness with "alarming" numbers of victims requiring intensive care.

Hotel staff on alert after sixth Sars scare

Staff at a hotel visited by a man suspected of being Britain's sixth victim of Sars have been urged to be aware of the symptoms of the deadly virus.

The latest possible victim, currently in isolation at London's Northwick Park Hospital, held a meeting at the Marriott Heathrow Hotel with a Hong Kong businessman who has now being treated for Sars in his own country.

The pair met for the one-to-one talks on April 3 and the visitor from Hong Kong, who had stayed at the hotel the previous night, left for Germany later that day.

The Health Protection Agency says it had begun an investigation into the circumstances of the stay at the Marriott on a "precautionary basis".

In a statement, the HPA said: "As a precautionary measure, members of the Hillingdon Health Protection Team and local Primary Care Trust are now working closely with the Marriott Hotel to provide health advice to management and staff and to obtain further details regarding the guest's stay."

The agency said that based on current World Health Organisation advice, the risk to staff and guests at the hotel on April 2 and 3 April was "extremely low" and there should not be any risk to guests who stayed after those dates.

To date, more than 100 people have died as a result of Sars around the world.

Story filed: 17:12 Saturday 12th April 2003

From http://www.ards.org/learnaboutards/whatisards/faq/faq1.html

What is Adult Respiratory Distress Syndrome, commonly called simply: ARDS? What ARDS is not. What are the phases/stages of ARDS?

Adult (or Acute) Respiratory Distress Syndrome (ARDS) is a medical condition which prevents the normal breathing process from taking place. ARDS occurs when there is severe inflammation in both lungs resulting in an inability of the lungs to function properly. ARDS is a devastating, often fatal, inflammatory lung condition that usually occurs in conjunction with catastrophic medical conditions, such as pneumonia, shock, sepsis (or severe infection throughout the body, sometimes also referred to as systemic infection, and may include or also be called a blood or blood-borne infection), and trauma. It is a form of sudden and often severe lung failure. Lung failure means that the lungs can no longer carry out their normal function of getting oxygen into the blood and removing carbon dioxide from the body.

As will be seen, ARDS may result in a relatively short period of battle to recover characterized by what seems to be a remarkably speedy recovery with little if any damage to the lungs. More often, if death does not occur, there is a very protracted period of battle with varying levels of lung damage sometimes but not always leading to the need for extensive physical and pulmonary rehabilitation.

Thousands upon thousands of individuals suffer from ARDS (and the less severe precusor medical condition known as Acute Lung Injury - ALI) each year in the US alone. Worldwide, the cases of ARDS and ALI total in the hundreds of thousands. Patients, family members and friends, survivors, medical personnel and facilities, are severely tested emotionally, morally, financially, and significantly effected by the devastating consequences of ARDS each year.

The pathogenesis of ARDS generally has been characterized into three phases/stages. It is important to remember each individual is different and the path through battling ARDS may vary widely. There may usually are many ups and downs along the way.

1.) Exudative phase/stage. Characterized by accumulation of excessive fluid in the lungs due to exudation (leaking of fluids) and acute injury Characterized by accumulation of excessive fluid in the lungs due to exudation (leaking of fluids) and acute injury (Acute Lung Injury "ALI" often is a precusor injury medical condition to the more severe development of ARDS, although ALI is more prevalent and not all ALI cases develop into ARDS). Arterial oxygention is usually most severe during this phase of actute injury, including injury to the endothelium (lining membrane) and epithelium (surface layer of cells). Some individuals quickly recover from this first phase; many others progress after about a week into the second phase/stage.

2.) Fibroproliferative (or sometimes shortened to proliferative) phase/stage. Connective tissue and other structural elements in the lungs proliferate in response to the initial injury, including development of fibroblasts (cells giving rise to connective tissue). Under a microscope, lung tissue appears densely cellular. Terms "stiff lung" and "shock lung" have been known to characterize this phase/stage. Two to four weeks after the onset of lung injury, abnormally enlarged air spaces and fibrotic tissue (scarring) are increasingly apparent. There is ongoing danger of barotrauma or volutrauma causing a pneumothorax - a rupture allowing leakage of air from the damaged lung into surrounding spaces, driven by the high pressure (barotrauma) or the volume of air used (volutrauma) in mechanically assisted breathing. There is also danger of pneumonia and blood-born infection (sepsis) developing, or difficulty in resolving one or both of these conditions if they were the precipitating conditions leading to the ARDS. Many people die during this phase/stage because of Multiple Organ Failure (MOF) or infectious complications. The second phase/stage typically lasts 3-10 weeks. The first two phases/stages generally are the most critically severe stages from a life or death consequence standpoint.

3.) Fibrosis (or fibrotic) phase/stage-Repair and recovery (or the healing stage). The lung reorganizes and recovers during this phase/stage. Resolution of inflammation, excess cellularity, and fibrosis settles. Oxygenation improves to the point of liberation from mechanical ventilation becomes possible. Lung function may continue to improve for as long as 6 to 12 months after onset of respiratory failure, depending on the precipitating condition and severity of the initial injury. It is important to remember that there may be and often are different levels of pulmonary fibrotic changes between individuals who suffer from ARDS.

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