The Strait Times APRIL 1, 2003 TUE

HONGKONG -- Struggling to contain the worldwide spread of the deadly flu-like illness that has killed at least 62 people, worried Asian governments on Tuesday ordered tougher infection screening of air travellers and imposed other emergency measures.

Badly-hit Hongkong said it might open rural camps to quarantine people who have been possibly exposed.

Taiwanese nationals arriving in Taiwan's Kinmen Island from mainland China are greeted by a quarantine official, who distributes questionnaire forms and surgical masks. -- AP

Authorities in China meanwhile urged physicians treating cases of severe acute respiratory syndrome, or Sars, to disinfect everything they touch and wear 12-layer surgical masks.

Thailand's government invoked an emergency regulation to give health officials the authority to quarantine arriving travellers, suspected of having the illness, for up to 14 days.

Scientists have yet to identify the disease that has sickened more than 1,600 on three continents and they are working hard to find a cure.

Its initial symptoms include fever, dry cough and shortness of breath. Most victims have been in Asia. Hongkong doctors say some have responded well to antibodies from others who recovered from the disease.

Also on Tuesday, Australia announced its first case -- a man who had been to Singapore where tough quarantine measures are now in place. He had recovered and the illness has not spread, health authorities said.

Taiwan banned boats from sailing between an outlying island chain and mainland China, where the disease was first detected in November.

Four recreational activity camps in rural Hongkong areas could be turned into quarantine centres if the Health Department decides it's necessary, said Mr Gordon Tam, a spokesman for the Leisure and Cultural Services Department.

Meanwhile, hundreds of people remained confined inside a badly-hit Hongkong apartment building. Health officials on Monday sealed off the building in the 19-tower apartment complex, Amoy Gardens.

Authorities said 213 residents of the entire complex remained hospitalised, though by Tuesday, just 185 had shown Sars symptoms.

More than 600 people have been infected In Hongkong and 15 have died.

In Canada, where a health emergency has been declared in Ontario province, Toronto authorities reported that at least two children had been hospitalised with the disease, and three others had symptoms.

Taiwan temporarily banned shipping traffic between the Chinese mainland and the Matsu Islands, 9 km off China's southern coast -- because the islands' clinics wouldn't be able to cope with a major outbreak, the government said on Monday.

Taiwan's known Sars cases remained at 13 on Tuesday, while authorities issued more than 800 quarantine orders to people who had come into contact with patients.

Also, the Olympic Council of Asia decided to shift the site of its April 22-23 meeting from Vietnam, where four people have died from Sars, to Thailand, an official of the Thai National Olympic Council said.

The World Health Organization said on Monday that experts hope to pinpoint the cause soon, and signs continue to point to the coronavirus, which causes about one-fifth of all colds.

In a new and perplexing twist, the germ inside the Hongkong apartment building seemed to be spreading vertically, a WHO official said on Monday.

'They are finding that the infections are in people living in apartments on top of each other, only in one area of this apartment block,' virologist Klaus Stohr said at WHO headquarters in Geneva.

That differs from the pattern seen earlier at the Metropole Hotel in Hongkong, where the disease spread when people who spent time on the ninth floor in late February were infected by a sick mainland Chinese medical professor.

'That was horizontal, and now you have a vertical connection,' Mr Stohr said. 'You can talk about water pipes and sewage pipes, about drafts which move up and down - that's pure speculation. These are hypotheses that are being looked into.'

Before the quarantine was imposed, many residents of the apartment building had fled in fear as dozens of people became sick, raising the possibility that Sars could spread further. The other 18 buildings in the complex were not sealed off despite having multiple Sars cases, but Hongkong's health secretary, Dr Yeoh Eng Kiong, said no other buildings were hit as badly.

'If isolation is effective to control the spread of the disease, we can say that this decision came too late,' said Professor Leung Ping Chung, an orthopedic and traumatology professor who has been monitoring the Prince of Wales Hospital in Hongkong, where dozens of staff have been sickened. -- AP

The Strait Times APRIL 1, 2003 TUE

SINGAPORE -- Singapore's Education Minister said on Tuesday he would close a technical education college at least until the end of the week to help stop the spread of a mystery illness that has killed four so far.

Education Minister Teo Chee Hean told a news conference late on Tuesday that he had decided to shut down Ngee Ann Polytechnic for at least a week starting on Wednesday. Advertisement

He said the closure would be reviewed and could be extended longer.

The Health Ministry reported three new cases of severe acute respiratory syndrome, or Sars, on Tuesday -- bringing the country's total to 95. Four people have died of it in Singapore.

Rear-Adm (NS) Teo said he would consider extending previously announced school closures and he could call other post secondary schools to be temporarily shut down in the next few days.

He announced the closure of all schools from day care centres to junior colleges on March 26, but at the time stressed that the decision was made to calm parents -- not on medical grounds.

Shutting down Ngee Ann will affect some 13,000 to 14,000 students, he noted.

Also at the news conference, health authorities said the number of people under home quarantine currently was 977. As many as 1,500 people have been under quarantine in recent days. -- AP

Singapore Undergrads asked to reveal trips to hotspots 7 suspected Sars cases identified at Changi airport

The news observer Tuesday, April 1, 2003 9:55PM EST By KIM CURTIS, ASSOCIATED PRESS

SAN JOSE, Calif. (AP) - Five passengers on a flight from Tokyo were cleared of a mystery illness from Asia after the jetliner was stopped on the tarmac in what first looked like a public health emergency.

American Airlines Flight 128 from Tokyo to San Jose stopped short of the gate and was flanked by ambulances after the airline alerted the San Jose airport about the scare, said Todd Burke, a spokesman for the airline. After 10 hours in the air, the 125 passengers and 14 crew members waited as health officials in surgical masks came on board.

But when doctors had cleared all five people hours later, the situation turned into a testament to fears surrounding little-understood severe acute respiratory syndrome, or SARS, which has killed more than 60 people worldwide.

"It took a tremendous amount of resources to do this," said Dr. Karen Smith, the Santa Clara County health officer who boarded the plane. "If every flight from Asia has someone coughing on it and has to go through the same procedure, I just don't see how that's feasible."

Doctors cleared two passengers on board and sent three others to a hospital. Those three did not appear particularly ill and were quickly discharged, said Tad Hurst, an emergency room doctor at Santa Clara Valley Medical Center.

Of primary concern was whether they had spent time in areas where SARS outbreaks have occurred - in mainland China, Hong Kong, Singapore and Hanoi, Vietnam. Initial reports were that four of the five who reported feeling sick may have boarded in Tokyo after flying from Hong Kong, said Joy Alexiou, a spokeswoman for the Santa Clara County Public Health Department.

More than 1,600 cases of the illness have been reported so far worldwide, including 69 cases in the United States. None of the U.S. cases have been fatal.

Last week, evidence surfaced that SARS can be caught on airplanes. Hong Kong authorities said several tourists on a China Air flight caught the disease after flying with another SARS-infected passenger.

related  WHO discourages travel to Hong Kong, Chinese province suffering SARS outbreak  Spread of SARS provokes worry in U.S.  Chinese province Guangdong reports 9 SARS deaths  SARS illness curbs travel to Asia  SARS kills 2 more in Canada  Hong Kong sends SARS victims to quarantine camps

CHICAGO, April 1, 2003 (AP/CBS)

"It can look like another disease but if it's summer months, they need to think about West Nile." Neurologist Dr. Nidhi Watson

(AP) Vision loss, muscle tremors and numbness may be symptoms of the West Nile virus, according to researchers who are warning doctors and patients to be on the lookout as warmer weather and mosquito season approach.

The neurological symptoms seem to mimic those of such ailments as strokes, Parkinson's disease and polio.

"It can look like another disease but if it's summer months, they need to think about West Nile," said Dr. Nidhi Watson, a neurologist at Rush-Presbyterian-St. Luke's Medical Center.

Watson and doctors from two other Chicago-area hospitals reached that conclusion after pooling information on 28 patients seen from August through October last year. More than half had unusual neurological symptoms.

The 28 contributed to Illinois' nation-leading West Nile toll last year: 884 reported human cases and 62 West Nile deaths. Nationwide, there were 4,161 cases and 277 deaths as the virus spread toward the West Coast.

The doctors prepared a report on the 28 cases for presentation Monday at the American Academy of Neurology's annual meeting in Honolulu.

A high occurrence of neurological symptoms was found in West Nile patients hospitalized in Louisiana last summer. The federal Centers for Disease Control and Prevention is working to get the word out to doctors to be alert for those signs, said Dr. Jim Sejvar, a CDC neuroepidemiologist.

Most people bitten by an infected mosquito don't become ill. About 20 percent will develop West Nile fever, which includes mild symptoms such as headache, swollen lymph nodes and a rash.

The CDC estimates that less than 1 percent will develop a more severe illness characterized by encephalitis or meningitis, both neurological ailments. Encephalitis may involve headaches and confusion. Meningitis may also include severe headache, but also stiff neck, vomiting and sensitivity to light.

The researchers found that neurological problems other than encephalitis and meningitis may also occur. Of the 28 Illinois patients, 15 - 54 percent - had symptoms such as vision loss, tremors similar to those seen in Parkinson's patients, muscle weakness or numbness.

While nine of the 15 were diagnosed with meningitis or encephalitis, six never developed those ailments, said co-author Dr. Sidney Houff, neurology chairman at Loyola University Medical Center.

Most patients had milder symptoms including fever about a week or so before neurological symptoms developed, but it was the more severe symptoms that prompted them to seek help. Houff said the study suggests such symptoms occur in a large number of patients, though the true incidence requires more research.

Older people and those with weakened conditions are thought to be most susceptible to ill effects from the virus, and the 28 Chicago-area patients were age 58 on average. Some had underlying ailments that may have made them more vulnerable to West Nile, Watson said.

Mass Live The Associated Press 4/1/03 12:29 PM

BOSTON (AP) -- A baby girl adopted in China was identified Tuesday as the third Massachusetts resident who may have contracted a mysterious respiratory illness that has killed at least 63 people worldwide.

The 1-year-old is the niece of a Springfield woman who was treated last week for severe acute respiratory syndrome, or SARS. The 40-year-old woman had traveled with her sister, the adoptive mother, and re-entered the United States on March 21.

The child was being treated at Baystate Medical Center in Springfield for symptoms including fever, cough, and difficulty breathing, according to the state Department of Public Health.

"She's been in very good condition," DPH spokeswoman Roseanne Pawelec said. "She's recovering and is expected to be released soon."

The mother is not ill, she added. The 40-year-old woman, whose name was not released, was treated by her doctor in Connecticut and is recovering, Pawelec said. She traveled to Hong Kong and parts of China between March 7 and March 21. She did not require hospitalization.

"Both this 1-year-old child and the aunt had some symptoms while they were in China," Pawelec said. "It was not a matter of the child becoming ill from the aunt."

Hospital staff are treating the child in an isolation room. Attending staff are wearing gloves, gowns, eye protection and face masks, Pawelec said. She said the child was admitted to the hospital either late Friday or Saturday after DPH officials interviewed the mother as a precaution when the aunt reported symptoms.

Several other Massachusetts residents who recently traveled to Southeast Asia have reported respiratory symptoms and are being evaluated to determine if they meet the case definition for SARS, Pawelec said.

"We've been talking to dozens of people," she said. "People are being ruled out or ruled in depending upon their symptoms and their history of travel. There will be additional suspect cases in the days and weeks to come."

Massachusetts two weeks ago became one of the first states to mandate the reporting of SARS to public health officials.

The first suspected Massachusetts case was a Cambridge man who had just returned from a trip to Hong Kong and Singapore. He also is recovering.

Blood samples from the suspected cases are being tested to see if the symptoms can be attributed to any other kind of illness.

There have been no deaths from SARS in the United States.

Some of the most severe measures were being taken in Hong Kong, which has recorded 16 deaths from SARS. Out of more than 1,600 SARS cases globally, 685 have been in Hong Kong.

Hong Kong on Tuesday invoked a colonial-era law to quarantine more than 240 people in countryside vacation camps, part of redoubled efforts to halt the spread of the illness.

Nations across Asia implemented new measures to contain the spread of SARS. It first was reported in China and its initial symptoms include fever, dry cough and shortness of breath. There still is no cure.

Singapore shut down one of its largest colleges for a week, Taiwan banned boats from sailing from mainland China to an outlying island chain, and the World Economic Forum postponed a meeting of economic and government leaders in Beijing until autumn.