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Last Updated

20 Jun 2003

Source: Newsday, June 20, 2003

Uncertainty Plagues SARS Fight

China's cover-up, questions about virus concern WHO


Beijing - The World Health Organization and the Chinese government are locked in debate about when China can be declared SARS-free or, at a minimum, when travel advisories against Beijing can be lifted.

The debate stems largely from China's original cover-up of the severe acute respiratory syndrome epidemic, but also involves fundamental questions about the virus for which there are no clear answers and its likelihood of making a comeback.

Complicating matters, tensions between WHO and Chinese authorities have deteriorated, with WHO's Manila chief, Dr. Hitoshi Oshitani, decrying China's recent lack of cooperation in supplying sufficient new data about the epidemic. Oshitani charged that China won't cooperate in global scientific inquiries and even has kept its biologists out of the international cooperative research network created by WHO.

Last week, Dr. David Heymann, head of WHO's epidemic response effort, held a joint news conference with Gao Qiang, deputy chief of the nation's anti-SARS efforts, declaring, "China has made huge strides in its effort to contain the outbreak of SARS. The key thing now is to maintain vigilance and build up China's disease surveillance."

China has recorded more than 5,300 SARS cases, 347 of them fatal. No new cases have been reported since June 11. Nevertheless, WHO hasn't yet lifted travel advisories against Beijing.

Dr. Henk Bekedam, head of WHO operations in Beijing, said recently that China first must meet certain criteria: A sustained period in which the number of cases and people in hospitals remains below 60 and the daily number of new cases is below five; no evidence of SARS moving from one province to another; and explanation of how local transmissions are occurring. In those terms, "Beijing is not doing well - not yet," Bekedam said. "Our concern is that there are too many cases in the 'suspected' mode in China."

Authorities said in late April they were unable to explain how the majority of Beijing's SARS cases occurred. Most confirmed cases reported in recent weeks are individuals who have long been on the list of suspect cases. Last week, China's health authorities said the cause of more than 70 percent of infections remains mysterious. Yet in other SARS-afflicted locales - Hong Kong, Vietnam, Singapore and Toronto - nearly all chains of transmission have been identified.

Bekedam worries that China's "background noise" is partly to blame: So many infectious diseases rage across the country, many causing atypical pneumonias, that the diagnosis is clouded. And the arrival of flu season means simple fever checks - the hallmark of SARS control efforts - are inadequate. "If you look at Shanghai, for example, on an annual basis they have 14,000 atypical pneumonia cases," Bekedam said. "They will nearly all fit SARS diagnosis. That's a very heavy background noise level."

Authorities may have over-diagnosed SARS at the outbreak's peak in the spring, he said, having lumped all cases with high fevers and cloudy lung X-rays together. Now the tendency is to shift the other way, under-diagnosing SARS in favor of assumed flu and other seasonal outbreaks.

Many scientists worry the virus may surface again in the fall, citing findings that it seems to survive for long periods on surfaces when temperatures are below 70 degrees; animals harboring the virus may have a cycle that brings it into contact with hunters, butchers, chefs and would-be diners during certain seasons; and that consumption of mammals is more common here from November to February.