U.S. WARNING ON RESPIRATORY DISEASE
30 Mar 2003
Source: New York Times, March 30, 2003
U.S. Warning on Respiratory Disease
By LAWRENCE K. ALTMAN with KEITH BRADSHER
The director of the Centers for Disease Control and Prevention warned yesterday that a mysterious respiratory disease, which has infected hundreds of people worldwide, could be spread very efficiently through close contact and expressed deep concern that it might also be spread through the air or on contaminated objects.
"The potential for infecting large numbers of people is very great," said the director, Dr. Julie L. Gerberding. "We may be in the very early stages of a much larger" epidemic of a disease for which there is no specific treatment beyond standard supportive nursing and respiratory care, Dr. Gerberding added.
Her warning came as the World Health Organization announced in Geneva that the doctor who first identified the fast-spreading disease has himself died of it. The doctor, Carlo Urbani, 46, identified the disease, known as SARS — for severe acute respiratory syndrome — in an American businessman admitted to a hospital in Hanoi, Vietnam, where Dr. Urbani was based.
Officials continue to monitor developments in Hong Kong, where SARS may have sickened 78 people in one apartment complex over the last three days.
The development suggests that the disease may be more easily transmitted than previously believed, Hong Kong officials said.
One person from the apartment block became ill a week ago after visiting a hospitalized brother who was being treated for SARS.
Since then, dozens of other people from the same apartment complex have fallen ill with the disease. And health officials raised the possibility that for so many people to be infected, the virus might be capable of staying suspended in the air in fairly small droplets.
"With such a major concentration in one place, we're extremely concerned," Dr. Thomas Tsang, the Hong Kong Health Department's medical consultant, said at a news conference.
How one person could infect so many people was a mystery. But Dr. Tsang said that "anything is possible and we're not ruling anything out."
In a conference call from Atlanta with reporters yesterday, Dr. Gerberding said there were many unanswered questions about the spread of SARS and the possibility of airborne transmission.
As of yesterday, 15 countries have reported a total of 1,550 SARS cases, including 54 deaths, to the World Health Organization. Many of the survivors are recovering, but very slowly, after long hospitalizations, including the need for support from mechanical respirators.
The United States is investigating 62 of the cases, 55 of which involve people who traveled to affected areas. Five are household members or friends of suspected cases, and two are health workers, Dr. Gerberding said.
C.D.C. and W.H.O. officials continue to say that it takes close, sustained contact with an infected individual to transmit SARS through droplets expelled through coughs.
Epidemiologic evidence exists that, for unknown reasons, some patients can transmit SARS to other people much more efficiently than other SARS patients can. Dr. Gerberding cited one patient in Hanoi who spread SARS to 56 percent of the health workers with whom the patient came in contact. That occurred before hospital workers began using measures like gloves, masks, gowns and goggles.
Such barrier nursing methods have stopped transmission of SARS in hospitals, though Dr. Gerberding said scientists did not know whether they were 100 percent effective.
Asked about the risk of spread from brief encounters with an infected person in public places like elevators, Dr. Gerberding said: "We don't know."
But, she emphasized, "so far there is no evidence in the United States that those activities are posing any risk."
W.H.O. and C.D.C. officials are increasingly suspicious that a previously unknown virus belonging to the coronavirus family causes SARS, though the evidence is far from conclusive.
Because known coronaviruses can survive in the environment for up to three hours, health officials are also concerned about the possibility that SARS could be transmitted through contaminated objects.
New information has led health officials to extend to 10 days from 7 the longest period from exposure to the SARS to the onset of symptoms.
As the disease continued to spread, the Hong Kong Health Department appealed today for anyone who had visited hospitalized SARS patients in the last month to contact health officials immediately. One problem is that hospitals there have virtually no security, so it is difficult to identify visitors.
The disease apparently first appeared in Guangdong Province, adjacent to Hong Kong, over the winter, and has infected about 800 people there. But it spread to Hong Kong through just one patient, a Chinese medical professor who had been treating patients in Guangdong and who went to the Metropole Hotel in Hong Kong on Feb. 21 and then fell ill.
The professor infected six tourists from other countries and one local resident, a 26-year-old Hong Kong airport worker, Hong Kong health officials said.
The professor went to the Prince of Wales Hospital, told the staff that he was highly infectious and demanded that he be given a mask and put in an isolation ward behind double-sealed doors and with reduced air pressure to prevent any viral particles from leaking out. He then gave doctors a brief history of the illness before he became extremely sick and died, a Hong Kong official said.
The C.D.C. issued new guidelines yesterday for caring for suspected SARS patients in their homes.
In the 10 days after respiratory symptoms and fever are gone, patients are advised to limit interactions outside the home and not to go to work, school, out-of-home day care or other public areas. The agency also advised people recovering from the disease to wear a surgical mask during close contact with uninfected persons. If the patient is unable to wear a surgical mask, other persons in the home should wear masks when in close contact with the patient.