Containment of SARS depends on how it is handled in China

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Containment of SARS depends on how it is handled in China

Hong Kong Jane Parry

The outbreak of severe acute respiratory syndrome (SARS) has yet to peak in China, according to the World Health Organization, which has said that worldwide containment of the disease depends on how it is handled there.

"We are looking at this as a medium term disease. China could seed the rest of the world with SARS," said Peter Cordingley, WHO’s spokesman in Manila. By 5 May, of the global total of 6583 reported probable cases, 65% were in China, as were 44% of the deaths.

In Guangdong province less than 150 of the total 1441 reported cases were still in hospital by 5 May, but in Beijing over 80% of cases are current and nearly 20% of the 1897 cases have occurred among health workers. The quarantine orders on over 16 000 people include staff and patients at 27 SARS designated hospitals as well as two building sites and three university apartment buildings.

Villages outside Beijing are barricading roads, and other provinces are forcing visitors who arrive from provinces and countries affected with SARS into 14 day quarantine, but still the disease continues to spread across the country. "Every day a couple of new areas are affected," said Mr Cordingley. Among the worst affected areas are the Shanxi provincial capital Taiyuan, where 360 cases have been reported, and Inner Mongolia where there are at least 190 cases.

Although China is now supplying infection figures on a daily basis, much information is still being withheld, including the specific location of infections, and WHO is pressing the authorities to give more details. "The public needs to have more information on when and where infection is happening. We don’t know that right now," said Dr Henk Bekedam, WHO’s representative in China.

In Hong Kong, SARS seems to have peaked, with only 80 new cases in the week to 5 May compared with 165 the previous week. With 10 days of declining cases, the government is looking at what other milestones that WHO would need to see before lifting its travel warning, in place since 2 April.

The situation in Taiwan is causing concern, according to WHO, which has learned that three new hospital clusters have emerged there. A two person WHO team arrived in Taiwan on 3 May to investigate the outbreak there after the number of cases tripled in 10 days.

"We got very concerned about Taiwan. The WHO doesn’t normally have anything to do with Taiwan because we have no official contact, but we convinced the Beijing authorities how serious this was," said Mr Cordingley.

The Taiwanese government has stepped up quarantine measures, including a mandatory 14 day quarantine on all incoming travellers from areas affected with SARS, and it has introduced heavy sanctions, including jail terms of up to three years, for those who do not obey quarantine orders. Among those quarantined are the 930 staff and 240 patients of Hoping Hospital in Taipei, which was sealed off on 28 April for two weeks.

Researchers at the Chinese University of Hong Kong have shown that the SARS virus is mutating at a rapid rate. Another team of Hong Kong scientists have published findings on the treatment protocol there, which includes ribavirin and corticosteroids. A summary of findings, due for publication in the Lancet this week, has been posted on WHO’s website (www.who.int/csr/sars/prospectivestudy/en/index.html). Although patients respond well in the first week, over 85% have recurrent fever and other symptoms in the second week, leading to damage to lung tissue, the report said.

Research by the WHO network of laboratories (see www.who.int/csr/sars/survival_2003_05_04/en/index.html) has also shown that in laboratory conditions the virus can survive in urine for at least 24 hours, in stools for at least two days and in diarrhoeal stools, which has a higher pH, for up to four days. It can also survive on plastic surfaces for up to 48 hours, but it is not yet known how big a dose of the virus is required to cause infection.

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