April 4, 2003--In less than six weeks since Severe Acute Respiratory Syndrome (SARS) was first noticed in one man visiting Hanoi from Shanghai and Hong Kong, the travel industry has suffered its own severe blow, with bookings to the most seriously affected parts of Asia dropping precipitously. Nobody contacted would give figures or percentages, but sources in Hong Kong and elsewhere acknowledged "many" cancellations. The brightest note was uttered by Lillibeth Bishop, publicity manager of the Hong Kong Tourism Board in Los Angeles, who said that "some hotels and operators report cancellations, but the majority are saying customers are simply postponing their trips to this summer and fall." More gloomily, KLM executive Leo van Wijk said, "SARS will have a bigger impact than Iraq" by making people afraid to fly altogether.
Since mid February when the outbreak began in Hanoi, the World Health Organization (WHO) has been tracking the disease, issuing its first report on March 12, 2003. By March 15, the Centers for Disease Control (CDC) in the United States had issued its own warning, advising potential travelers to China (including Hong Kong), Singapore and Hanoi to postpone their trips at least until June 26, 2003. Finally, on April 2, the WHO's Geneva headquarters advised travelers heading for Hong Kong and the Chinese province of Guandong to postpone nonessential travel there. "This is the first time in recent years that WHO has made such a recommendation," said David Heymann, head of the communicable diseases section of WHO. The organization took action after discovering that at least nine foreign businessmen contracted the disease in Hong Kong and returned with it to their home countries.
By now, SARS has killed at least 78 persons and infected more than 2,200 in 15 countries, most of them in China (1,167 cases, 43 dead) and Hong Kong (685 cases, 16 dead), but with at least 69 cases (no deaths) reported in the USA and 151 in Canada (six dead, all in the Toronto area). In late March, the Government of Ontario declared SARS to be a provincial emergency and passengers arriving at Pearson Airport in Toronto and at Vancouver airport from affected areas in Asia are being screened carefully. Some hospitals in Ontario have been closed briefly or restricted, with limited access in and out.
The American government has ordered non-essential employees of its consulates or embassies in Hong Kong, Guangzhou (formerly Canton), Hanoi and Ho Chi Minh City (formerly Saigon) to leave those places. The Australian government advised its citizens not to travel to Canada or affected Asian countries. Singapore has closed its schools and quarantined hundreds of its residents. Nearly 100 persons have been infected there, with four deaths reported already. At the Taipei International Airport, officials handed out 100,000 free surgical masks to travelers and workers. In Hong Kong, thousands of citizens are wearing masks while in public, some schools have closed, and the Rolling Stones cancelled their appearances there and in mainland China.
Outside the most highly infected areas, neighboring countries are running scared. Thailand, with six reported cases and two deaths, reports that it will refuse entry to foreigners suspected of suffering from SARS and will force anyone allowed in from the affected countries to wear masks in public. In addition to the countries already mentioned, these nations have reported cases of SARS: Australia (1), France (1), Germany (5), Italy (3), Ireland (2), Romania (3), Switzerland (3), Taiwan (13), Vietnam (58, four dead).
With pessimists evoking memories of the horrific Spanish Flu Epidemic of 1918, which killed at least half a million in the USA and an estimated 20 to 40 million around the world, and others mentioning a pandemic as bad as AIDS, just what are the symptoms and what is the probability of catching this disease?
Symptoms
Look for initial flu-like illness (rapid onset of high fever, followed by muscle aches, headache and sore throat). In some, but not all cases, this is followed by bilateral pneumonia, and a possible progression to acute respiratory distress requiring assisted breathing on a respirator.
There is no apparent link between SARS and "bird flu" reported earlier in Hong Kong, by the way. American researchers at the CDC in Atlanta say they are "90 percent sure" that a new species of corona virus is responsible for SARS. If this is true, a quick antidote could be coming along soon, since this kind of virus usually responds quickly to medication. At least 90% of the 685 victims in Hong Kong have recovered, after being treated with the antiviral drug, ribavirin, originally developed for use against hepatitis C.
Three factors determine the likelihood of having the disease: (1) recent travel to Asia, (2) a temperature of 100.4° Fahrenheit (38° Celsius) or higher, and (3) signs of respiratory illness, including cough, shortness of breath, difficulty breathing, hypoxia (deficiency of oxygen reaching tissues or organs) or radiographic findings of either pneumonia or acute respiratory distress syndrome. Alternatively, if you have had close contact within ten days of onset of symptoms with either a person with a respiratory illness who traveled to a SARS area or a person known to be a suspect SARS case. (Close contact is defined as having cared for, having lived with, or having direct contact with respiratory secretions and/or body fluids of a patient known to be a suspect SARS case.) The death rate from SARS is fairly low, at about 3.5%, with "most patients recovering within about seven days," according to CDC Director Julie Gerberding.
The virus appears to be spread casually, including airborne transmission, even without face-to-face contact. The virus may also survive on objects such as tabletops, elevator panels and other spots frequently touched by humans. On the other hand, researchers note that that SARS is spread mostly through droplets emitted from coughing and sneezing. The aim of the medical profession and such organizations as CDC and WHO now is to contain the outbreak before it spreads to the general population.
What to Do
Staying away from China (including Hong Kong), Hanoi and Singapore makes sense, which is why many Wall Street firms such Lehman Brothers, Merrill Lynch and Goldman Sachs have ordered their employees to cancel or defer trips to the region. Also, take care when you're around persons who have traveled there recently. The incubation period is currently believed to be approximately 2 to 7 or 10 days.
Wearing a mask while on the plane probably won't help, as viruses can easily penetrate the filters they create short of those on a bio suit or perhaps a gas mask. An infected person, on the other hand, should wear a mask, as doing so will reduce the number of droplets the person expels when coughing, thus helping others around him or her to avoid catching the disease.
If you do travel to affected areas, wash your hands frequently and refrain from touching your face, especially nose, eyes and mouth. Avoid unnecessary physical contact with strangers such as shaking hands or hugging. If someone on an escalator or in an elevator coughs, move away whenever possible, even if just a short distance, and cover your own mouth and nose with a handkerchief or mask.
If someone on your plane appears to be suffering from SARS (see Symptoms, above), inform the crew immediately. The captain is required by law to report such illness, in the case of an American-bound flight to the nearest US Quarantine Station, which will send officials to arrange appropriate medical assistance when the plane lands. On returning home, monitor your health closely for ten days thereafter. If you become ill with fever accompanied by cough or difficulty in breathing, consult a physician immediately.
Treatment
The only treatment, except for the so-far unproved effectiveness of ribavirin in Hong Kong, is isolation, observation and supportive care (meaning rest, liquids and sympathy).
Summing Up
If you are not traveling to the affected areas, you need not worry as yet. And, there is a little good news. An American Airlines flight from Tokyo to San Jose (with passengers from Hong Kong who had transferred in Japan) was delayed for several hours on landing in California on April 1, but local health officials cleared everyone aboard after three were taken to a hospital for a more complete exam, saying the passengers and crew on Flight 128 were not exposes to SARS.
Most important, remember that the "regular" flu and related respiratory illnesses killed about 65,00 persons in 1999 (latest year data available) in the USA, though that is up sharply from about 23,000 deaths just nine years earlier. To date, SARS has yet to cause a single death here, though that, of course, could change.
Websites & Phone Numbers for Updated Information
For more information, consider these spots:
CDC, dial toll free 888/246-2675 (in English) for the public information hotline. The Spanish-language toll free-phone is 888/246-2857, TTY hearing impaired line 866/874-2646. Hotline hours are weekdays 5 AM to 8 PM, weekends 7 AM to 5 PM, all times PST. The SARS-specific website is www.cdc.gov/ncidod/sars.
The World Health Organization deals only with governments, but you can visit their website at www.who.int/csr/sars/en.
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