SARS: The global spread
By Christopher Horton
BANGKOK - This weekend was a bad one for those
who are trying to battle the mysterious disease known as
severe acute respiratory syndrome (SARS). A flurry of
new cases in Hong Kong, new fatalities in Canada and the
death in Thailand of the first doctor to identify SARS,
rumors that the virus is airborne, and fears that the
epidemic is still in its infancy have shaken both the
affected areas and health officials worldwide.
Because of the nature of SARS, which can
resemble common illnesses such as colds or the flu and
is believed to take up to two weeks before manifesting
symptoms, the available statistics from every region hit
by SARS may severely overestimate or, more dangerously,
underestimat the number of people infected. According
to information released by the World Health Organization
last Thursday, combined with non-WHO updates from around
the world, more than 1,048 people had been infected and
56 people had died since the disease emerged in China
Carlo Urbani, the Italian doctor who first identified
SARS died in Bangkok from SARS symptoms. Public Health
Minister Sudarat Keyuraphan said that despite its first
death related to SARS, Thailand is still safe from the
disease. Health officials at Bangkok's Don Muang
International Airport are screening incoming passengers
for the disease, Sudarat said. Since the inception of
the screenings, about a dozen people have been
quarantined. Most were released within a few hours of
being quarantined, but some were kept more than a day,
she added. The airport screenings are a reaction to the
spread of SARS outside of Thailand rather than within
the country, Sudarat said.
Geneva-based WHO doctor, was receiving treatment for
symptoms he developed after he became the first person
to identify SARS while in Vietnam. The Chinese-American
businessman who later became the first confirmed
SARS-related death was treated by Urbani in Hanoi, where
the virus quickly infected 46 people, including several
health workers, such as fatality No 7 in the SARS
outbreak, a Vietnamese nurse who had been working with
Urbani in caring for the American patient.
for those who treated Urbani in Bangkok before his
death, Charal Trinvuthipong, director general of
Thailand's Department of Communicable Disease Control,
said 33 medical personnel took care of Urbani.
Comprising both Thais and foreigners, the medical
personnel have been screened for the disease and are
still under close watch, Charal said.
the Thai government urged its citizens not to visit
Canada, Hong Kong, mainland China, Taiwan, Singapore or
Vietnam, the countries worst hit. Thailand, which has a
thriving tourism sector, would not only suffer a major
economic blow to the industry were it to develop new
cases of SARS, but it would also likely become a new
global hub for the virus via Don Muang International
Airport, one of Asia's major air hubs. WHO has
attributed at least three confirmed SARS cases to
In Kowloon, a
portion of Hong Kong contiguous with mainland China, an
upscale residential complex witnessed the fastest
localized outbreak of the global epidemic. In the
four-day period ending on Sunday, confirmed SARS cases
in the Amoy Gardens residences shot up from seven to
121. The chilling speed at which the disease spread
prompted numerous health officials to surmise that SARS
was spread through the air. Like most aspects of the
disease, however, the current information about how the
disease spreads is still no more than educated guesses.
As previously reported in Asia Times Online on
March 18 (HK plays down pneumonia fears), it
took more than two weeks for Hong Kong Secretary for
Health, Welfare and Food Dr Yeoh Eng-kiong finally to
admit that the SARS virus has spread throughout the
community. During the two weeks when Yeoh and his
associates repeatedly urged Hong Kong residents not to
worry as the virus was spreading only within isolated
hospital wards, the number of non-medical people
infected by SARS quietly rocketed.
spread of SARS through Amoy Gardens led the US Centers
for Disease Control and Prevention (CDC) to say over the
weekend that SARS may still be an epidemic in its
"What we know about respiratory viruses
suggests that the potential for infection of a large
number of people is very great," CDC director Julie
Gerberding said. "We may be at the very early stages of
what could be a much larger problem."
Mainland China is considered to
be the origin of SARS, specifically Guangdong province,
an economically vibrant province adjacent to Hong Kong.
There is a growing feeling of resentment among residents
and doctors of both Guangdong and Hong Kong toward the
mainland Chinese government regarding the conspicuous
lack of information that has been offered to the public.
Indeed, to this day Chinese officials maintained their
tight-lipped posture vis-a-vis a major health epidemic
in the world's most populous country.
time in the spread of the disease in March may have been
the two weeks during which the National People's
Conference (NPC), China's legislative assembly, was held
in Beijing. During the NPC, Beijing enforced a strict
media blackout regarding SARS. Other than a brief
mention in Chinese newspapers in February, SARS has had
next to no presence in Chinese media.
Wednesday the Chinese government revised its SARS
statistics for the first time since admitting that five
people had died since November. According to the updated
official statistics, 34 Chinese have died from SARS,
including three in Beijing, and 792 have become
Last November, an outbreak of a
mysterious illness widely believed to be SARS affected
Guangdong province, prompting panic-stricken residents
to clear store shelves of face masks and vinegar, which
Chinese boil as a disinfectant.
Due to Beijing's
previous silence about and denial of the epidemic
coupled with its massive population, there are also
widespread concerns that SARS is spreading at a rapid
rate that is unreflected in the updated statistics.
According WHO, SARS has also spread inland to central
China's Shanxi province.
Taiwan, which is not officially a sovereign country,
has become a victim of the politics of China in the face
of a global health epidemic. It has complained
repeatedly that it is receiving the cold shoulder from
the WHO and Beijing on an issue that should not be
tainted by politics. All of Taiwan's SARS cases that
came from outside of the island are believed to have
come directly from the mainland.
During the four
months that SARS was spreading within China, Beijing
made no mention of the phenomenon to the WHO, which is
now attempting to work with the Chinese government. In
contrast, The WHO did little more than pass Taiwan on to
the US CDC, a move which baffled and insulted Taiwan's
government and people.
severe steps are being taken as both the Singaporean
government and its people become increasingly concerned
about SARS, which had killed three people there and made
89 ill as of late Sunday (Singapore time).
Wednesday the Singaporean government ordered the closure
of schools until April 6, affecting some 600,000
students in the city-state of 4 million people. There is
already talk of extending the school closures.
Over the weekend, a sign at a pharmacy in the
normally bustling Parco Bugis Junction shopping center
said it all: "Face masks out of stock". Outside the same
center, a line of taxis stretched halfway round the
block, waiting for patrons.
"Few people are
going out," said taxi driver Lim Teck Hua. "They are
afraid of the virus." He added that drivers had seen
their earnings fall over the weekend as there are so few
But then again, he said, he and other
drivers are themselves nervous. "If a passenger starts
coughing, we quickly open the windows," he pointed out.
But the abundance of taxis may also be due to
another factor. The Health Ministry announced last week
that it was seeking a taxi driver who transported an
infected person to a hospital on Wednesday. The driver
was finally found on Sunday and put in quarantine.
The initial SARS cases in Singapore involved
three women who had traveled to Hong Kong. The most
recent cases concern a designer who returned to
Singapore last Wednesday after visiting Hong Kong and
Beijing and the fifth person to import the virus: a
17-year-old Indonesian boy studying in Singapore. With
his parents and brother, 15, he left Singapore for
Guangdong and Hong Kong on March 15, a day after the
Singaporean government advised against traveling to
SARS-hit areas. They returned on March 23, and on March
24, the boy was back in school. The following day, he
and his mother came down with fevers. They went to a
hospital, where his mother remained and he was sent
home. On Thursday, health officials who checked on him
at home found that his condition had worsened. He was
quarantined and diagnosed as having SARS this past
While some locals have been debating
whether the government can do more to combat the
disease, Singaporean authorities have generally been
praised by international observers for their measures.
Vietnam has proved to be the
luckiest of the countries significantly affected by
SARS. Although it has had SARS cases for a month now,
only four people have died and 58 have been infected.
Considering that Vietnam lacks the funds and technology
of Hong Kong and Singapore, which are faring poorly in
their battles against SARS, it is a small miracle that
SARS has done such little damage to this Southeast Asian
The containment of SARS in Hanoi is
attributed to the close-knit community within the
hospital that received the first patient identified as
infected with SARS. "The French hospital is quite an
enclosed community with people working close together,"
said Aileen Plant, coordinator of the WHO team sent to
help Hanoi with the outbreak.
"It may be that
rather than spreading the virus externally they infected
each other," Plant added. "In the end we're guessing and
we won't really know until the outbreak pans out in Hong
Kong and Singapore."
The hospital's prompt
reporting of the illness to WHO is also credited with
what has so far been a relatively successful containment
Canada is the
hardest-hit country outside of Asia so far, with Toronto
in particular showing a disturbing increase in confirmed
cases at 28, with three fatalities. The Ontario
provincial government has declared a health emergency.
Two of the three patients who succumbed to SARS were
treated at Scarborough Grace Hospital. Anyone who has
been to the hospital in the last two weeks has been
asked by provincial health authorities to quarantine
themselves at home. There have also been SARS cases
confirmed in the west-coast province of British Columbia
and in Ottawa, the national capital. More than 40
Toronto-area homes have been quarantined by authorities.
The United States,
unlike other countries, reports its suspected cases and
confirmed cases in one lump total, so it is difficult to
interpret the 45 cases attributed to the US by WHO. What
is known is that there are believed to be five cases in
New York City.
According to the Bureau of
Communicable Disease of the New York City Department of
Health and Mental Hygiene (DOHMH), there are at least
five suspected cases of SARS in New York, ranging from a
seven-year-old girl to a 67-year-old man. This does not
include the Singaporean doctor who passed through the
city en route to Frankfurt, Germany, where he was
quarantined. Three of the New York cases, including the
young girl, were not hospitalized. The older man was
discharged from the hospital, and another man was still
hospitalized as of Sunday night, New York time.
The DOHMH announced in a news release that it
"is working closely with hospitals and medical providers
to increase their awareness of SARS and to help them
rapidly identify any cases that arrive in the city. As a
precautionary measure, DOHMH issued an alert this past
weekend to hospitals asking them to immediately report
any illnesses suspected of being SARS. Persons who may
have recently traveled to Southeast Asia destinations
within the last 10 days should be aware of these main
signs and symptoms of SARS. Anyone who traveled recently
to Southeast Asia and experiences symptoms of SARS
should seek medical attention."
additional reporting by Inter Press Service)
From February 1 to March 27,
Source: World Health
||Cumulative number of case(s)
||Number of deaths
|China, Hong Kong
|Republic of Ireland
|| To be determined
|| 45 §
|| To be determined
Cumulative number of cases includes number of deaths.
As SARS is a diagnosis of exclusion, the status of a reported case may change
over time. This means that previously reported cases may be discarded after
further investigation and follow-up.
*National public health authorities report to WHO on the areas in which local
chain(s) of transmission is/are occurring. These areas are provided on the list
of Affected Areas.
+ 792 cases, including 31 deaths, reported from Guangdong province cover the
period November 16, 2002, to February 28, 2003. These cases were compiled from
investigations as well as hospital reports and may include suspect as well as
probable cases of SARS.
Due to differences in the case definitions being used at a national level,
probable cases are reported by all countries except the United States of
America, which is reporting suspect cases under investigation.
**One death attributed to Hong Kong
Special Administrative Region of China occurred in a
case medically transferred from Vietnam.
(©2003 Asia Times Online Co, Ltd.
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