37 In United States May Have SARS

Dr. Koop ^ | 03-24-03

[Mother Abigail]

The United States now has 37 suspected cases of severe acute respiratory syndrome (SARS). The latest list from the U.S. Centers for Disease Control and Prevention shows 17 states with suspected cases, including New York with five, California with eight, and Texas and Hawaii with three each.

There were no immediate details of the new U.S. totals, which have increased by 15 since Friday. But the global toll of suspected and confirmed cases of the deadly respiratory illness also continued to rise.

In Hong Kong, the top hospital health official was hospitalized Sunday night with pneumonia symptoms, as health officials there announced two more deaths and another 38 people infected, the Associated Press reports.

Hong Kong Hospital Authority chief executive, Dr. William Ho, was reported in stable condition Monday, according to the AP, but it is not yet clear whether he has SARS. Officials say Ho had been going through hospitals lately to offer moral support to medical workers and patients.

In Singapore, meanwhile, the government reported 14 new cases Monday and ordered 740 people who may have been exposed to SARS to stay home for 10 days in a bid to contain the illness, the Washington Post reports.

Health Minister Lim Hng Kiang said he was invoking the Infectious Diseases Act for what could be the first time since Singapore gained independence in 1965, the Post said.

Singapore's total number of SARS cases is now 65, including 12 in intensive care. That puts it second to Hong Kong, which has 240, and ahead of Vietnam, which has 63.

The new deaths and illnesses in Singapore and Hong Kong are not yet included in the official World Health Organization tally, which now lists 15 countries, 386 cases, and 11 deaths. In addition, there are more than 300 illnesses and 5 deaths in China's Guangdong province that have yet to be officially counted.

[Mother Abigail]

 Scott StinsonNational Post, with files from The Canadian Press and CanWest News Service

Monday, March 24, 2003

TORONTO - Two additional people in Ontario are suspected of having severe acute respiratory syndrome (SARS), bringing to 17 the number of Canadians with the deadly pneumonia strain, amid new fears 12 more people may have it.

Dr. Colin D'Cunha, Ontario's Public Health Commissioner, yesterday said one of the two new cases is categorized as probable and the other is listed as suspected.

Announcing the latest cases at a news conference yesterday, Dr. D'Cunha said the emergency ward at a Toronto hospital has been closed to allow medical staff to provide an "appropriate level of care to their patients."

A number of patients suspected of having the mysterious disease remain at Scarborough Hospital's Grace division. The first people in Ontario to be diagnosed with SARS were treated at the hospital, and most of those who contracted the illness are their relatives.

Dr. Allison McGeer, head of infection control for Toronto's Mount Sinai Hospital, said the initial patient at the Scarborough hospital was "not managed in appropriate isolation precautions," since medical staff did not know SARS was involved. She said the clampdown at the hospital is necessary to prevent its further spread.

"All of the rest of us in the city are depending on them to get us the data on how transmissible this is, who is at risk, what the problems are," Dr. McGeer said.
Health officials also disclosed that public health staff are monitoring a cluster of 12 people who are showing systems of the disease. A spokesman at the Ministry of Health and Long-Term Care would not confirm yesterday if the 12 are at the Scarborough hospital, citing patient confidentiality.

Dr. McGeer said hospitals throughout the city are holding several people in voluntary isolation, since the disease is highly contagious.

"The physicians who are seeing them are triaging them carefully to determine whether there is any risk that they might have SARS because we know that SARS is contagious," she said.

Yesterday's developments came after health officials confirmed on Saturday that a third Toronto resident died from the pneumonia strain. The man, believed to be in his 70s, died on Friday night. Officials said he contracted the disease after sharing a hospital room with the city's initial SARS patient.

Sui-Chu Kwan, 78, died on March 5, and her son, Chi Kwai Tse, 44, died on March 13.

Officials believe Ms. Kwan and her husband contracted the disease while staying at a hotel in Hong Kong in February. A professor from mainland China -- where an outbreak of an unidentified illness occurred in February -- was staying on their floor and likely passed the disease onto them and other hotel guests.

In addition to the 10 probable cases and four suspected cases in Ontario, a Vancouver man remains in critical condition due to the illness and two Alberta residents are considered suspected cases.

Probable cases are people showing symptoms who have recently travelled to Asia or have been in close contact with other SARS patients. Suspect cases show symptoms, but have no travel or contact history.

[Goodlife]

Does anyone have any info on the Michigan cases? Why can't we find out where these people are, even if we don't have to know who?

Getting tired of the "To be determined" local transmission box at WHO, too...

[Conservative Me]

My guess is that they are trying to stop people from panicing and flooding the local hospitals. I tried a Google search with SARS and Michigan and got only generic information, nothing with specific Michigan locations.

[Mother Abigail]

At the same time, scientists in Geneva and the United States said they believe the cause of the flu-like ailment that has stymied them for weeks could be one of the viruses that causes the common cold.

The U.S. Centers for Disease Control and Prevention said Monday that evidence is mounting the cause is a coronavirus, a bug that can cause colds.

CDC director Dr. Julie Gerberding in Atlanta said a form of the virus unlike any seen in humans before has been found in the lungs and other tissue of some victims.
Furthermore, patients seem to develop antibodies to the virus as they get sicker with the pneumonia, Gerberding said.
T
here is no known treatment, although the World Health Organization said last week it had developed a reasonable test for diagnosing the disease. CDC scientists are skeptical of its accuracy.

[Mother Abigail]

Good point, it is a little late in the game to deny local transmission

[Goodlife]

I did the same thing, and also, nothing.

Wondered if any Freepers had any connections, could maybe squeak a little more information out than we're "allowed" to have.

I figure it *has* to be either Detroit or Ann Arbor. My in-laws live in Detroit, and the wife and I just went to Ann Arbor and had dinner at a Chinese restaurant.

I'd like to know whether I should now be watching myself ever-so-carefully.

[Conservative Me]

From WHO website:

Q : How contagious is SARS ?

A : Based on currently available evidence, close contact with an infected person is needed for the infective agent to spread from one person to another. Contact with aerosolized (exhaled) droplets and bodily secretions from an infected person appears to be important. To date, the majority of cases have occurred in hospital workers who have cared for SARS patients and the close family members of these patients. However, the amount of the infective agent needed to cause an infection has not yet been determined.

---

Sounds almost like it is as contageous as the common cold. If that is the case, there is not much you can do. On the plus side, we have far superior doctors here than in other countries, IMHO, not that I wish anyone sickness. Hopefully this can be contained or a treatment found as soon as possible.

[uncitizen]

All those states are border states, thru which people enter our country from other countries.

[aristeides]

Worldwide cases have been doubling every three days or so since I first noticed this over a week ago.

[uncitizen]

Nix that last reply. I only skimmed the article. The usual.

[aristeides]

Sounds almost like it is as contageous as the common cold.

A current thread says it is a strain of the Coronavirus, which also causes colds.

[Mother Abigail]

SECTION I - INFECTIOUS AGENT
NAME: Human coronavirus

SYNONYM OR CROSS REFERENCE: Viral respiratory disease, viral gastroenteritis

CHARACTERISTICS: Coronaviridae; first isolated in 1965, spherical enveloped virion, 80-160 nm in diameter, crown-like in appearance, club-shaped peplomars, single-stranded, linear, non-segmented, positive-sense RNA genome;

SECTION II - HEALTH HAZARD

PATHOGENICITY: Usually produce an afebrile cold in adults, characterized by nasal discharge, and malaise; may exacerbate respiratory symptoms in asthmatic and chronic pulmonary disease patients; implicated in gastroenteritis; greater occurrence in children; maybe associated with pneumonia and pleural reactions, rarely manifests in neurological complications; immunity is serotype specific; antigenic heterogeneity allows for multiple symptomatic reinfections

EPIDEMIOLOGY: Worldwide; major cause of respiratory disease between late fall and early winter; accounts for 10-30% of all colds

HOST RANGE: Humans

INFECTIOUS DOSE: Not known

MODE OF TRANSMISSION: By inhalation of aerosols; respiratory transmission from person-to-person; indirectly through fomites

INCUBATION PERIOD: From 2 to 5 days

COMMUNICABILITY: Communicable during the acute and convalescent stages of the disease

SECTION III - DISSEMINATION

RESERVOIR: Humans

ZOONOSIS: None

VECTORS: None

SECTION IV - VIABILITY

DRUG SUSCEPTIBILITY: No specific antivirals

SUSCEPTIBILITY TO DISINFECTANTS: Susceptible to 1% sodium hypochlorite, 2% glutaraldehyde

PHYSICAL INACTIVATION: Sensitive to heat

SURVIVAL OUTSIDE HOST: Survives up to 24 hours on metal surfaces at ambient conditions

SECTION V - MEDICAL

SURVEILLANCE: Monitor for symptoms; confirm by serological testing and viral isolation
FIRST AID/TREATMENT: No specific therapy

IMMUNIZATION: None available

PROPHYLAXIS: None available

SECTION VI - LABORATORY HAZARDS
LABORATORY-ACQUIRED INFECTIONS: None reported to date

SOURCES/SPECIMENS: Nasal discharges, respiratory
secretions; stools

PRIMARY HAZARDS: Droplet exposure of the mucous membranes of the eye, nose and/or mouth; inhalation of infectious aerosols; ingestion

SECTION VII - RECOMMENDED PRECAUTIONS

CONTAINMENT REQUIREMENTS: Biosafety level 2 practices, equipment and containment facilities for activities involving virus, infectious body tissues and fluids

[riri]

hmmm...I'm pretty clean. Shower a couple of times a day, wash my hands frequently...Still managed to get the flu this winter.

Dropping your sick kids off at a daycare facility because you are "out" of sick days has nothing to do with work ethic, IMO. A good friend of mine runs a facility, according to her it happens all the time.

I love the American work ethic however in a situation such as this it is not an advantage. (Except in the case of scientists working to solve this problem, ofcourse)

[CathyRyan]

And by the time you know you are sick you may have already spread it. :(

[Conservative Me]

The problem with a sickness such as this, where the disease is contracted through mucus membranes, is that no matter where you are you are at risk.

My youngest sucks her thumb (2 years old). Imagine you go to the grocery store. You get a cart, and put your toddler in it. The kid sitting in the cart before her was contagious. Now your toddler is at risk of getting sick without you even knowing about it because she touched the cart where the sick child sneezed. She then put her hand in her mouth or rubbed her eyes.

Generally speaking, anyway, in regards to sick kids at daycare, you are contagious before you show symptoms so anyone at daycare would probably have already been exposed, not that I condone such things.

[Mother Abigail]

Attention Health/News Editors:

Public Health Commissioner Updates Ontarians On SARS


TORONTO, March 24 /CNW/ - Today Dr. Colin D'Cunha, Ontario's Commissioner of Public Health, informed Ontarians that one additional suspect case of Severe Acute Respiratory Syndrome (SARS) has been identified in Toronto.

In addition, Public Health officials are monitoring one cluster of approximately 14 people who appear to be showing symptoms. The majority of these cases are being monitored at West Park Healthcare Centre, which has the expertise to treat respiratory disorders. West Park is following infection control procedures mandated by the World Health Organization and Health Canada.

"The cases we are monitoring now are the result of unprotected contact with initial cases before we were aware of SARS. Now, health care staff across the province are alert to the virus and are able to protect themselves and their patients to prevent further infection," said Dr. D'Cunha.

[Mother Abigail]

March 24, 2003

Contact: CDC Media Relations

CDC Lab Analysis Suggests New Coronavirus
May Cause SARS

The Centers for Disease Control and Prevention (CDC) announced today that a previously unrecognized virus from the coronavirus family is the leading hypothesis for the cause of severe acute respiratory syndrome (SARS). Two coronaviruses that are known to infect humans cause one third of common colds and are also a common cause of health care-associated upper respiratory infections in premature infants.

"This is encouraging news from our laboratories at CDC," said Tommy G. Thompson, Secretary of Health and Humans Services. "These and other excellent scientists all over the world have been working around the clock for days and their hard work is paying off. They continue to look at other possible causes of SARS, but this is a key finding in our efforts to identify the cause of this global outbreak."

Additional steps needed to confirm this hypothesis include further culturing of the virus from appropriate specimens, sequencing the viral genome, and examining specimens from patients at different stages of their illness.

"This collaboration among scientists led by the World Health Organization (WHO) is unprecedented," said CDC Director Dr. Julie Gerberding. "We certainly have more work to do, but we think we are on the right track. And our systems to identify cases and investigate them are working too, thanks to all the frontline clinicians and state and local health departments around the country."

As of Monday, March 24, CDC is reporting 39 suspected SARS cases in 18 states. WHO is reporting 456 cases and 17 deaths.

[theFIRMbss]

>...new U.S. totals, which have increased by 15 since Friday.
>>the growth rate seems to be 'blooming.'

In a week or two,
people with graphing programs
can start posting trends.

Fifteen new cases
over a weekend sounds bad.
But nothing's as clear

as a simple chart
built from solild numbers, or
firm speculation.

Fifteen new cases
over a weekend. Let's pray
this can't hold steady...

[CathyRyan]

Heard any more on the 7/10 split out of HK? I an not having a good day.

[Goodlife]

I dunno if I agree.

Consider that this germ has been "out of the box" and really has never been quarantined, no matter what anyone has said. It's turned up on Hong Kong schools, hits hospitals pretty hard, etc.

That was the revelation on March 15th. Now it's March 24th, and we're look at 4x cases. In ten days if it was as wildly virulent and some people think, I'd expect to be EVERYWHERE. Every person infecting everyone else... there'd be no end of cases. It wouldn't be 400 probably cases, it'd be 400,000.

So I think I buy the "close contact" theory...