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SARS: What Is It and How Can You Deal with It?
Author: Robert Haru Fisher
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, "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
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.
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