<a href=iol.co.za>Source March 31 2003 at 02:13PM

Hong Kong - A highly contagious respiratory virus spreading across the world has killed 59 people and infected more than 1 600 others, mainly in Asia.

Here are facts about severe acute respiratory syndrome (SARS), an atypical type of pneumonia:

What is it?

Scientists say SARS is caused by a new virus from the family of coronaviruses, which also causes the common cold.

The United States Centre for Disease Control and Prevention has confirmed that the virus is the primary causative agent, but experts say much laboratory work still needs to be done to pinpoint its exact characteristics. Development of a vaccine will take years.

The World Health Organisation says the disease originated in China's southern province of Guangdong, before spreading to Hong Kong, where it was then carried to Vietnam, Singapore and Canada. Other cases later surfaced in the United States, France, Britain, Taiwan and Germany.

Hong Kong and WHO scientists say the strain likely originated from animals.

Health experts in Hong Kong have ruled out any association with influenza A and B viruses, and also the H5N1 bird-flu virus which jumped the species barrier and killed six people in the territory in 1997, and one man in February.

SARS is a type of atypical pneumonia, which is usually caused by viruses, such as influenza viruses, adeno-virus and other respiratory viruses, according to Hong Kong health officials.

Atypical pneumonia can also be caused by organisms such as legionella, although that is rare in Hong Kong.

WHO officials say there is no indication that SARS is linked to bioterrorism.

What are the symptoms?

The WHO says the main symptoms of SARS are high fever (over 38°C), a dry cough, shortness of breath or breathing difficulties. Changes in chest X-rays, which are indicative of pneumonia, also occur. SARS may be associated with other symptoms, including chills, headache, muscular stiffness, loss of appetite, confusion, rash and diarrhoea.

Health experts say the disease has an incubation period of between two and seven days - with three to five days being more common - before victims start showing flu-like symptoms.

How dangerous is it?

The mortality rate appears to be between three to five percent. In Hong Kong, at least, those who are infected invariably develop severe pneumonia, which can cause numerous complications.

Conditions of victims deteriorate very quickly, in as short a period as five days.

How are patients treated?

There is currently no specific cure for the disease. But doctors worldwide have been treating it with ribavirin - an anti-viral drug - and steroids. Doctors say if treated early most patients without other serious illnesses can recover.

How does it spread?

The WHO and Hong Kong experts say the virus spreads through droplets by sneezing or coughing and such direct infection can usually happen within a radius of about one metre.

The virus can also spread indirectly as it can survive outside of the human body for three to six hours. Contact with any object that is tainted by droplets containing the virus could lead to infection if a person then touches their eyes, nose or mouth.

Health experts have not ruled out that it could be airborne, which infinitely raises the contagious nature of the virus and would make it far harder to contain.

How fast does it spread?

The WHO says SARS appears to be less infectious than influenza, and is not highly contagious when protective measures are used. Hong Kong's health chief has said the virus is highly infectious, but can be killed by a solution of common household bleach.

How does the virus travel globally?

The WHO says the speed of international travel creates a risk that cases can rapidly spread around the world.

When an infected person travels, he can spread the virus to other passengers on his flight and also to people at his destination. Authorities around Asia are hunting for passengers who were on about half a dozen flights as they fear that these passengers have been exposed.

Who is most likely to be infected?

Hong Kong experts say the virus is highly concentrated in discharges such as mucous or phlegm when the victim is very sick and in need of urgent medical care. Therefore, the virus has tended to spread primarily to health care professionals treating victims or close family members of victims.

How should infected patients be managed?

The WHO says patients should be placed in an isolation unit. Health care workers and visitors should wear efficient filter masks, goggles, aprons, head covers, and gloves when in close contact with the patient.

Is it safe to travel?

The WHO has not recommended restricting travel to any destination in the world. However, all travellers should be aware of the main symptoms and signs of SARS. People who have these symptoms and have been in close contact with a person who has been diagnosed with SARS, or have a recent history of travel to areas where cases of SARS have been spreading, should seek medical attention and inform health care staff of recent travel.

Travellers who develop these symptoms are advised not to undertake further travel until fully recovered.

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BREATHING UNEASY: Government health officials have quarantined 214 residents for ten days after 92 new cases of the deadly Severe Acute Respiratory Syndrome (Sars) virus were reported in the Amoy Gardens housing estate in Hong Kong. This young resident at the estate wears a protective mask and gloves. Reuters 01 April 2003

HONG KONG: Hong Kong has quarantined more than 200 people in a single apartment block and sealed the building to try to halt the spread of a mystery pneumonia that has killed nearly 60 people worldwide.

But many families had already fled the complex, officials said, sparking fears of multiple new infections in the Chinese territory.

Hong Kong, which like Singapore has closed all schools, reported a staggering 92 new cases in the housing block yesterday, bringing the total number of infections in the former British colony to more than 620.

"We are now examining all possible angles, to see if it is airborne or in the water mains," a government spokeswoman said.

The disease has triggered tighter screenings at many airports and a growing number of countries have advised citizens against unnecessary travel to the worst-affected areas.

Singapore has closed schools and quarantined 945 people, with hundreds of others advised to stay home, as new infections from the flu-like virus showed no sign of letting up.

Yesterday it sent nurses to the airport to check incoming passengers.

Travellers have spread severe acute respiratory syndrome (Sars) in the past few weeks to Hong Kong, Canada, Singapore and Vietnam after the virus first showed up in southern China.

Cases have since surfaced in the United States, Britain, France, Australia, Japan and Taiwan.

More than 1,600 people have been infected worldwide, but many have since recovered.

The high number of cases at the Amoy Gardens housing estate in Kong Kong's crowded Kowloon peninsula has raised fears that the virus could be airborne rather than carried by droplets from sneezing or coughing.

Dozens of health workers in full surgical gear stood guard at the entrance of block E to stop any residents going out. Policemen in masks cordoned off the block.

"It was only when I arrived at work that I knew the building had been sealed off," said a resident returning to the estate, speaking through a mask.

Hong Kong said all residents would be quarantined for 10 days and anyone showing symptoms of the disease – a high fever, chills and breathing difficulties – would be sent to hospital.

During the quarantine period, residents would receive medical checkups and free meals from the government.

But entire families from 154 units in the building have already fled.

"Those who have left must contact us...every infected person has the potential to cause another big outbreak like the one at Amoy Gardens," Health Minister Yeoh Eng-kiong told a news conference.

The US Centers for Disease Control and Prevention warned on Saturday that the virus may wreak havoc.

"The potential for infecting large numbers of people is great," said its director Julie Gerberding. "We may be in the early stages of what could be a larger problem."

Canadian health officials said on Sunday a fourth person had died from the disease, bringing the death toll to 59 people worldwide, including 13 in Hong Kong.

It has been clear in recent weeks that the disease was fast spreading in the community of nearly seven million people but it was not until late last week that Hong Kong admitted it.

Last Thursday, it ordered schools to close and more than 1,000 family and friends of those with the disease to be quarantined, but the quarantine did not go into effect until Monday.

Yeoh said an infected man with kidney disease had visited his brother who lived at Block E and probably tainted the block in the process. In just six days, the number of infections at the estate has jumped from seven to 213.

Up to 70 per cent of those infected in Block E live in one wing, leading experts to wonder if the virus is airborne or even waterborne.

Yeoh said: "Maybe there are factors in the environment that cause the virus to spread quickly, like at Amoy Gardens. There may be another outbreak."

COMBINED WIRE SERVICES March 30, 2003 The World Health Organization doctor who first identified the outbreak of a global mystery illness died of the disease yesterday. Italian Dr. Carlo Urbani, 46, a WHO expert on communicable diseases, died in Thailand, where he was being treated after becoming infected with what has been termed severe acute respiratory syndrome, or SARS, while working in Vietnam, the United Nations agency said. Urbani - who worked in public health programs in Cambodia, Laos and Vietnam - identified the ailment in an American businessman admitted to a Hanoi hospital. The businessman later died. So far, at least 55 people have died from SARS. More than 1,500 cases have been reported, the vast majority in China and Southeast Asia. Federal health officials hoping to insulate the United States yesterday added all of China and Singapore to a growing list of destinations that should be avoided by tourists and business travelers. The national Centers for Disease Control and Prevention had previously recommended that travelers postpone nonessential travel to Hong Kong, Hanoi and China's southern Guangdong province. "We may be in the very early stages of something that could be a much larger problem with time," Dr. Julie Gerberding, director of the CDC, told reporters in a conference call. Prolonged face-to-face exposure seems to be the way that the illness is spread, although briefer contacts might also transmit it, she said. "The bottom line is that we don't know," she said. "If you were in an elevator and an infected person literally coughed on you, it's conceivable that you could acquire a respiratory infection," including the one causing this outbreak. Gerberding noted that there were no signs that the epidemic was spreading in the United States beyond a relatively small number of people who had traveled recently to Asia or the handful of health care workers and relatives who had steady contact with this group. The CDC has identified 62 cases. But fears that the virus, which is marked by high fever, coughing and, in severe cases, pneumonia, may be poised to escalate into a full-blown global epidemic are growing in Asia and other parts of the world. Hong Kong remained gripped by fear as 45 new cases were reported yesterday, for a total of 470; 12 deaths have been reported. Thousands of people donned surgical masks but many more refused to venture outside and activity in the usually bustling city ground to a halt. Taxi stands where people normally line up during rush hour had few customers in sight. Anti-war protesters in Hong Kong canceled a peace rally. For about two years, WHO has been building a new system to tackle the emergence of new global diseases. Just more than two weeks ago came the chance to try it out, when health authorities in Singapore reported that a doctor from their country might be sick with the mysterious Asian bug - and he could be carrying the new disease around the world on a flight home from New York. "We had the name, but not the flight number or even the airline," said Dr. Mike Ryan, whose name was at the top of a 24-hour contact list given to governments dealing with the illness. Ryan heads WHO's Global Outbreak Alert and Response Network. It took a few more calls to determine that the man was headed for Frankfurt. By the time the plane landed there on the morning of March 15, German quarantine services were waiting for him. "We've had killer outbreaks of new diseases before, like Ebola, but they have never spread internationally," said the WHO's infectious diseases chief, Dr. David Heymann. Heymann was part of the scientific team dispatched to what was Zaire in 1976 to investigate the first Ebola outbreak. The case of the Singapore doctor, together with a report the night before from Canada of a suspicious outbreak there, prompted the agency to ratchet up the response. Later that afternoon, WHO issued an unprecedented worldwide emergency travel advisory, declaring SARS a global health threat and alerting the world to the symptoms: fever, cough, breathlessness and breathing problems.

March 31, 2003, 4:27PM Reuters News Service

A family leaves the Amoy Gardens apartment complex today in Hong Kong. The complex was badly hit by a mystery illness that is spreading across Asia.

HONG KONG - More than 100 people in one Hong Kong apartment block were suspected to have been infected by a deadly pneumonia virus, officials said today, triggering fears that the killer disease was being spread through air or water.

At least two more people died from the Severe Acute Respiratoy Syndrome, known as SARS, in Hong Kong during the day, taking the death toll in the city to 15 and to 61 worldwide.

A total of 213 people living in the Amoy Gardens housing estate were confirmed or suspected to be infected with SARS, of whom 107 are from Block E of the complex, Health Secretary Yeoh Eng-kiong told a news conference.

Authorities have quarantined more than 200 other residents in Block E in an effort to contain the virus, which has infected almost 1,700 people across the world, mostly in Asia.

Dozens of health workers in full surgical gear stood guard at the entrance of the apartment block to stop any residents from leaving as policemen in masks cordoned off the area.

But residents said many families had already fled.

The number of those infected in Amoy Gardens, in the heart of the teeming Kowloon district, is almost one-third of the total number in Hong Kong, a city of seven million people.

Two elderly men died of the disease today, bringing the death toll in the city to 15.

Amoy Gardens is in a maze of crowded housing estates and smoke-spewing industrial buildings in one of the most densely-populated areas in the world.

Proliferation of the virus in such an environment is certain to create havoc and put immense pressure on public hospitals, which are already stretched and barely able to cope.

"We are now examining all possible angles, to see if it is airborne or in the (building's) water mains," a government spokeswoman said of the virus.

Health Minister Yeoh said: "We are now detecting the virus in the faecal material (from Amoy Gardens patients). So that would be one possible potential cause of spread to large populations under unusual circumstances."

"There was a suggestion that the sewage system was leaking...we are investigating."

Experts have previously said the virus was carried by droplets from sneezing or coughing, but the high number of cases at Amoy Gardens has raised fears the virus could be water or airborne.

"Up till today, it is spread through droplets. But no one can rule out that it could be airborne, because viruses change all the time," Yeoh said.

Fearful of the disease, some companies have ordered staff to work from homes while others have begun to organise backup, skeletal teams in case their workers get infected.

Hong Kong and Singapore have closed schools in a bid to contain the disease and quarantined those exposed. Besides these two cities, deaths have also been reported from Vietnam, Canada and from China, where the disease originated in November.

A doctor from the World Health Organization, who was infected in Vietnam after he had identified the virus, died in a Bangkok hospital at the weekend.

The disease has triggered tighter screenings at many airports and a growing number of countries have advised citizens against unnecessary travel to the worst-affected areas.

In Singapore, nurses have been deployed at the airport to check incoming passengers.

Apart from scaring away tourists, the epidemic has disrupted business in Hong Kong. A growing list of shops, banks and offices have shut after employees were found infected.

Some expatriates have departed quietly, taking their families with them on home leave.

The U.S. Centers for Disease Control and Prevention warned on Saturday that the virus may wreak more havoc.

"The potential for infecting larger numbers of people is great," said its director Julie Gerberding. "We may be in the early stages of what could be a larger problem."

Cases have also surfaced in the United States, Germany, Britain, France, Japan, Ireland, Italy and Taiwan.

Almost 1,700 people have been infected worldwide, but some have since recovered. About four percent of the people who catch it die from the disease.

Herald Sun By MANDI ZONNEVELDT, health reporter 01apr03

FRESH outbreaks of the deadly SARS virus have led to fears it may be airborne.

Almost 100 more cases of the killer flu were reported in Hong Kong yesterday, with authorities forced to isolate an entire housing block where 213 people had been infected.

Until now, experts have believed the deadly disease could only be spread by droplets expelled by a cough or sneeze.

But United States Centres for Disease Control and Prevention director Dr Julie Gerberding said the rapid spread of the virus suggested it could be airborne.

"We are concerned about the possibility of airborne transmission across broader areas and by objects handled by those who have been infected," she said.

"The potential for infecting large numbers of people is very great.

"So we may be in the very early stages of what could be a much larger problem."

Hong Kong Director of Health Margaret Chan also refused to rule out the possibility of the virus being airborne.

Australian travellers are cancelling trips to Asia as the SARS toll climbs, with at least 59 now dead -- including a fourth Canadian victim -- and more than 1600 infected.

Australians who heed the Health Department's warning to "reconsider" travel to Hong Kong, China, Singapore and Vietnam stand to lose their money.

Insurance Council of Australia spokeswoman Sandie Watson said

most travel insurers would refuse to cover people who cancelled trips to Asia in the absence of an official government travel warning.

"If you just cancel out of concern you may not be covered," she said.

"We always advise people to check with their travel insurer before cancelling any trip."

Taylor's Lakes man Ken Goodwill, who has paid for a trip to Singapore and Thailand in May, yesterday expressed his frustration at the situation.

"If you've pre-paid your flight and accommodation, you're in a lose-lose situation now," he said.

"You lose your money if you cancel and if you go there and get stuck in a situation where you can't travel you also lose.

"I won't be travelling unless things pick up and it's going to cost me thousands of dollars."

Health experts are yet to find a cure for SARS, now believed to be a previously unseen strain of the same virus that causes the common cold.

Queensland University's Dr John Mackenzie and Curtin University of Technology professor Aileen Plant are joining a World Health Organisation team investigating the source of the outbreak.