Cingles Info

http://www.nytimes.com/2003/04/09/science/sciencespecial/09INFE.html?th
Asian Officials Say SARS May Be Here to Stay
By KEITH BRADSHER with LAWRENCE K. ALTMAN
ONG KONG, April 8 - Health officials in Hong Kong and Singapore warned their
citizens today that the agent that causes a mysterious respiratory disease has
spread so far in their communities and abroad that it will 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 officials began emphasizing new measures to slow the
spread of the disease, but refrained from suggestions that they might be able to
get rid of the disease completely.
The World Health Organization, however, remained cautiously optimistic that the
disease, severe acute respiratory syndrome, or SARS, could be kept in check.
Dr. Leung Pak-yin, Hong Kong's deputy director of health, said that residents
should be concerned that the illness could be spread through contaminated
objects, particularly if their apartment buildings developed large numbers of
cases.
"We believe that every citizen could become a carrier of the virus," especially
if people do not follow practices like hand washing and the wearing of face
masks, he said.
The cause of SARS is unknown, but officials are almost certain that it is a
virus, and they strongly suspect that the culprit is a previously unknown member
of the coronavirus family.
Epidemiologists have traced most SARS cases to close person-to-person contact.
That finding initially led officials to believe that they could break the SARS
chain by isolating patients and their contacts and by requiring health workers
to use standard infection control measures in caring for patients. Such
measures, including frequent hand washing and wearing masks, gloves, gowns and
goggles, have worked in most places.
But in recent days epidemiologists have been unable to trace a number of SARS
outbreaks in hotels, hospitals and apartment complexes in Hong Kong, Singapore
and China to such person-to-person spread. Because of that, many health
officials have become increasingly suspicious that the disease can be spread
through contaminated objects like door knobs, water and sewage, as well as by
person-to-person contact. Hong Kong officials also have theorized that insects
like cockroaches could spread the disease, perhaps by tracking contaminated
sewage from apartment to apartment.
Hong Kong University researchers have found evidence suggesting that many people
may come in contact with the virus and only become mildly ill and not meet the
case definition. Also, officials are now suspicious that some people may be able
to spread the disease even if they are only mildly ill with SARS.
If it can be spread by insects or objects or healthy human carriers, containing
its spread would be much more difficult. The fear is that in a short time SARS
could become another on the long list of diseases that are a fixture in many
areas.
Still, two top W.H.O. officials expressed cautious optimism that SARS could be
stopped before that happens.
Dr. David L. Heymann, executive director in charge of communicable diseases for
W.H.O., said that his United Nations agency "was hopeful that SARS can be
contained, we haven't given up hope."
A W.H.O. team has just concluded a visit to Guangdong Province in China, which
is adjacent to Hong Kong and is where the epidemic apparently began last
November. W.H.O. expects to learn a considerable amount from the team's
research.
The team found that the Chinese kept "really meticulous records," Dr. Heymann
said, adding, "So there's a lot to learn because as the cases went on, the death
rate apparently was lower, meaning either the doctors learned to handle the
disease better or something else happened."
He also said that W.H.O. has two additional teams of scientists on standby to go
to China to help with the epidemiology and infection control.
Dr. Klaus Stöhr, the scientific director of the W.H.O. team investigating SARS,
said, "There is still a good chance we can contain it, provided that there is
nothing ongoing in China that is similar to what is going on in Hong Kong."
Experts think that SARS is largely spread through droplets exhaled by dry
coughs. There are two distinct ways in which coughing can spread viral diseases:
droplet or airborne transmission. In droplet transmission, the infective
material is coughed or sneezed out of a patient's airway surrounded by a bit of
moisture. The particles are too large to travel more than about three feet, and
so relatively close, face-to-face contact is required for transmission to take
place through the air. But the viruses may also persist on inanimate objects,
and people can become infected from touching contaminated surfaces. Masks,
gloves and frequent hand washing can sharply reduce droplet transmission.
By contrast, airborne viruses travel much farther than three feet and can hang
in the air and infect other people for a long time after a coughing or sneezing
patient has left the room. Airborne transmission is far more efficient than
droplet transmission, and it is the way that diseases like influenza and measles
spread. Experts doubt that SARS is airborne, because if it were, there would be
even faster spread and many more cases.
To help determine whether seemingly healthy people can spread the SARS agent,
Hong Kong is conducting a number of studies involving the hundreds of people in
isolation here because they had contact with a SARS patient.
In 10 percent of one study involving 200 people, scientists have found evidence
of the new coronavirus in their feces. But the virus is in an immature form and
is unable to cause infection unless other parts of the virus are present, Dr.
Stöhr said.
"So we do not know what the finding means," Dr. Stöhr said.
He said that similar studies are being conducted in Ontario, where more than 180
SARS cases, including 10 deaths, have occurred.
Mr. Lee and Tung Chee-hwa, Hong Kong's chief executive, each 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 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.
---
Outgoing mail is certified Virus Free.
Checked by AVG anti-virus system (http://www.grisoft.com).
Version: 6.0.455 / Virus Database: 255 - Release Date: 02/14/2003