New Illness Kills Doc. WHO's Urbani was first physician to identify 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.