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

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.

Colombia, Bogotá, domingo 6 de abril de 2003 ELTIEMPO.COM

Es el segundo territorio más afectado por la dolencia pulmonar después de China; su gobierno intenta mantener la calma entre sus más de seis millones de habitantes.

Hong Kong ya cerró sus escuelas y tomó una medida draconiana de aislamiento con respecto a un bloque de viviendas donde la epidemia se propagó a unas 200 personas. 

Algunos extranjeros residentes en el territorio empezaron a evacuar a sus familias ante el temor de que sus países de origen decidan prohibir la entrada de vuelos procedentes de Hong Kong. Entre los que optan por quedarse, muchos no se quitan la mascarilla y algunos llevan incluso guantes de látex.

La mayoría de los restaurantes del territorio, por lo general muy frecuentados, se encuentran, por estos días vacíos, al igual que los cines y otros lugares públicos, ya que una de las recomendaciones es evitar las aglomeraciones.

A pesar de las medidas establecidas por el Gobierno, son muchos los que consideran que las autoridades han tardado demasiado en reaccionar.

"Si hubiesen admitido desde un principio que desconocían por completo a lo que nos enfrentábamos, en lugar de asegurar que lo tenían todo bajo control, no se habrían producido tantos contagios", declaró el arquitecto británico Anthony Hackett, quien optó por permanecer en casa.

El hecho de que los casos se hayan propagado de forma tan rápida suscitó la sospecha de que la enfermedad pueda transmitirse por el aire y no sólo por contacto directo, como apuntaban las primeras investigaciones.

Algunas empresas adoptaron planes de contingencia que les permitan continuar con sus actividades en el caso de que se vean obligados a cerrar si se produce algún caso en sus oficinas.

"Hemos prohibido a cualquier empleado viajar a zonas afectadas y les urgimos a que no vengan a trabajar si tienen síntomas gripales a menos que muestren un certificado médico que garantice que no han contraído el Sars", señaló el directivo de una entidad financiera que prefirió no identificarse.

En Singapur, los equipos masculinos y femeninos de rugby fueron puestos en cuarentena al regresar de un torneo en Hong Kong. Uno de los principales bancos, el DBS Bank, suspendió todos los viajes de su personal para limitar los riesgos y ordenó a todos los empleados que regresaron de las zonas afectadas que permanecieran en sus hogares durante diez días. 

Cantón en China, el núcleo del problema

Fuentes vinculadas a la Organización Mundial de la Salud (OMS) dijeron que sospechaban que la cohabitación de animales de granja y habitantes en el sur de China había desencadenado la epidemia, que surgió en noviembre en la región de Cantón.

China no ha autorizado a la OMS a viajar a la provincia de Cantón, donde se inició la epidemia, y es acusada de mantener toda la información relativa al SRAS en secreto.

El ministerio chino de Salud Pública anunció el martes que no publicará un balance global del país, pero que pronto estarán disponibles las cifras a nivel provincial. 

No obstante, una portavoz no pudo dar una fecha para la publicación de esas cifras, mientras las oficinas de salud provinciales y los hospitales se niegan a dar información al respecto. 

Ante la actitud de China, la OMS manifestó su preocupación. "Durante una epidemia mundial, todos los participantes deben participar. Si uno de los principales participantes decide no hacerlo, eso puede ser muy problemático", destacó el Dr. James Maguire, un especialista de la OMS que se encuentra en Pekín.  Continúa el consejo de no viajar a zonas afectadas

Varios países, entre ellos Estados Unidos, recomendaron no viajar a las zonas afectadas, especialmente a China, Hong Kong y Singapur, donde en los últimos días las infecciones se han multiplicado, a pesar de las medidas de control. Las autoridades sanitarias francesas se unieron el lunes al consejo y advierten que es preferible postergar los viajes a las otras zonas afectadas por el síndrome respiratorio agudo severo (SRAS), que ya cobró 62 vidas. 

Indonesia, que afirma no haber sido afectada por esta epidemia, anunció haber tomado medidas de precaución. 

Malasia también sostiene que no ha registrado ningún caso de SRAS y desaconsejó los viajes a las regiones afectadas. 

En Filipinas, 23 personas fueron colocadas en observación y son atendidas después de presentar síntomas de neumonía atípica.

Hong Kong Con AFP y EFE

The Atlanta Journal-Constitution By M.A.J. McKENNA / Cox News Service

ATLANTA - Georgia reported its first case of severe acute respiratory syndrome on Monday, an elderly Atlanta woman who is recovering in a hospital, as governments in Asia took drastic action to limit spread of the fast-moving disease.

Health authorities in Hong Kong, where 610 people have been hospitalized and 15 have died, sealed residents inside an apartment complex where 213 people already have become sick. Officials said they will set up quarantine camps if cases continue to rise.

The World Health Organization said Monday 1,563 cases of SARS have been identified outside the United States, including 58 deaths. But those numbers were acknowledged to be incomplete: There have been no updates from mainland China, where the outbreak began and is believed to be spreading rapidly.

There were 72 cases of SARS in the United States, a jump of 10 since Saturday, according to the federal Centers for Disease Control and Prevention in Atlanta. There have been no U.S. deaths.

Georgia has been on alert since the outbreak began: A Canadian victim visited Atlanta in early March, but did not pass the disease to anyone here. On Monday, health authorities discovered the first Georgia case.

The Georgia Division of Public Health said the patient, whom they declined to identify by name, is an 83-year-old woman who lives in an Atlanta suburb. She recently traveled with a tour group that visited several locations in China, said Dr. Susan Lance-Parker, an epidemiologist. The woman began experiencing mild symptoms Wednesday, the day she returned, and was hospitalized Friday.

Despite her age, she did not become ill enough to need a respirator and is recovering, Lance-Parker said. A member of her household who also went on the tour became mildly ill, but was not sick enough to be considered a SARS case by the CDC. Another household member, who did not go on the trip, remained well.

The CDC is tracking down passengers on the flight and members of the tour, which was not operated by an Atlanta company. "We don't know of any other patients from that flight," Lance-Parker said.

The woman had no known contact with any SARS patients who have been identified, health officials said. Her case reinforces the likelihood that the disease can no longer be tracked on clear paths from patient to patient, but is spreading through communities in a pattern that could be impossible to trace.

Fear of community outbreaks prompted severe actions Monday in Asia and Canada.

In Hong Kong, authorities placed one block of the Amoy Gardens apartment complex under strict quarantine for 10 days, with orders that residents must disinfect their apartments before they will be allowed outside again.

The complex is a set of 11 33-story towers, designated A through K, that perch on a shared lobby. Each tower holds 240 families. At least 107 patients, of the 213 from the complex, have come from tower block E, which was sealed Monday.

The Hong Kong Health Department said it had identified the person who brought the disease to the apartments: a SARS patient who now is in a hospital but who had visited his brother in Block E three to four times.

"We have reason to believe ... that this is the source of infection. And the other residents in other blocks have been affected as a spillover from this infected block," Dr. Yeoh Eng-kiong, Hong Kong's health secretary, said.

WHO epidemiologists said they were concerned that cases in the tower were occurring vertically, with victims living in apartments directly above or below each other. That is in sharp contrast to the cluster of cases traced to Hong Kong's Metropole Hotel, where the disease spread horizontally: A doctor who had treated patients in mainland China apparently gave the disease to at least nine and possibly 14 guests sharing the same floor.

Both instances have increased concern that the virus can spread through the air, as well as through building systems such as ventilation ducts.

Amid fear that the Amoy Garden quarantine had been ordered after many residents had already fled the building, the Hong Kong government said it might consider isolating SARS patients in four campgrounds.

"With a large number of people infected, the unpredictability becomes larger, so we are planning for all different types of scenarios," Yeoh said.

In Canada, where visitors from Hong Kong brought the infection to Toronto, thousands of health care workers, hospital patients and their families are under quarantine. Authorities announced additional measures Monday: In Toronto, where officials have declared a health emergency, every hospital staff member has been ordered to wear gloves, gown, mask and protective eyewear.

Ontario, which has 81 of Canada's 98 suspected SARS patients, put severe restrictions on its hospitals. The province's Health Ministry has already closed two hospitals and has limited visitor traffic in three others.

On Monday, the Health Ministry broadened the restrictions to all hospitals, nursing homes, prisons and long-term care facilities in the Toronto metro area and suburbs. The order prevents people from entering facilities unless they are relatives of a critically ill patient or a sick child.

Ontario officials announced that at least two children, and possibly five, may have come down with SARS. They are hospitalized in Toronto's Hospital for Sick Children. The hospital has not been put under quarantine.

Hospital doors have been locked, with security guards or police posted in front of them. Visitors are interviewed before being allowed to pass. Once inside, visitors must don masks and dip their hands in disinfectant before being allowed onto the floors where patients are.

Because hundreds of health care workers are among the thousands under quarantine in Ontario, many nonemergency services -- including elective surgeries and outpatient care -- have been canceled.

Canada and the United States have asked residents not to travel to Hong Kong, mainland China, Singapore or Hanoi -- the epidemic's hot spots -- if it can be avoided. In the United States, the CDC is meeting any flights that originated in those areas or passed through them and handing out health alert cards to arriving passengers.

The cards list SARS symptoms and tell passengers to report to a doctor if they become sick within 10 days of arriving.

More than 160,000 cards have been handed out so far -- a sizable portion of them at Atlanta's Hartsfield International Airport, where the CDC maintains one of eight permanent stations that monitor the health of international travelers.

M.A.J. McKenna writes for The Atlanta Journal-Constitution.

The Age April 2 2003 By David Wroe, Amanda Dunn

A mother and her son wear masks on the street to protect against a deadly pneumonia virus in Hong Kong. Photo: AFP

Related links: Avoid travel to Hong Kong: WHO Australians warned as toll mounts More killer bugs to come: expert All the facts: SARS In-depth

Airline pilots entering Australia will have to declare sick passengers under a quarantine clampdown as the killer SARS virus spreads panic around the world.

As the death toll reached 62 and Australia's first confirmed case of the disease emerged, Commonwealth Chief Medical Officer Richard Smallwood announced the tough quarantine rules.

"We'll be making... pilots check with quarantine and get quarantine clearances," Professor Smallwood said.

"If someone is sick and arriving in Sydney, we do not turn them away. We care for them. (But) they would be isolated."

He said Australians should consider deferring non-essential travel to any of the 15 affected countries - Singapore, Hong Kong, Vietnam, China, Germany, Switzerland, Canada, Italy, Ireland, Romania, Thailand, Britain, the United States, Taiwan and France.

But suspending all travel to the worst affected countries would be "an over-reaction".

Under World Health Organisation advice, travellers who show symptoms while in an affected country may not be able to leave that country until they are well.

Authorities notified WHO on Monday of a British tourist who showed symptoms when he arrived in Australia in February after spending two days in Singapore. The man recovered and health authorities are satisfied he did not infect anyone in this country. He has since returned to Britain.

The NSW Health Department traced everyone the man had contacted, Professor Smallwood said. Given the incubation time of a week, anyone infected by the man would have shown symptoms by now, he said.

Doctors did not realise at the time that the man had SARS because it was a month before WHO issued its alert.

Professor Smallwood said three Australians were now being monitored for the illness - two in NSW and one in Canberra. In the past fortnight, there have been about 40 suspected cases. All have been given the all-clear.

A professor of virology at Melbourne University, Ian Gust, said the most likely way in which SARS was spread was through droplets transmitted through coughing or sneezing.

Deputy Chief Medical Officer John Mathews, said a few cases could not be explained by close contact.

Once it has infected the upper respiratory tract, the virus could move into the lungs and cause pneumonia. The body then sends white blood cells to combat the invader, while the lungs fill with liquid.

Professor Gust said that in cases where the patient died from the disease, the lungs became heavy and could not function on their own.

A spokesman for the Victorian Department of Human Services said major hospitals were prepared to deal with suspected or confirmed cases of the disease. Medical staff treating the person would wear full protective clothing, masks and gloves.

While several people have been investigated for SARS in Victoria, there have been no confirmed cases.

Meanwhile, a 14-year-old schoolboy sparked a wild rush on supermarkets in pneumonia-wary Hong Kong with a bogus news report that the port city had been declared an "infected area", police said today.

The message, which was posted on a website yesterday, said Hong Kong would be closed to the rest of the world due to the Severe Acute Respiratory Syndrome (SARS) outbreak gripping the territory.

The false report came as the Hong Kong government was preparing to move some 200 residents of a quarantined housing estate to two holiday camps in an effort to stop the spread of SARS, which has so far claimed 16 lives and infected nearly 700 people in Hong Kong.

The panic buying only abated after the Hong Kong government dismissed the information, but not before fears of a Hong Kong-wide closure affected financial markets, with the Hang Seng index plunging about 100 points.

The student was arrested in his Tai Po home late yesterday on suspicion "of access to computer with dishonest intent," a police spokesman said.

He was released on bail of $HK1,000 ($A210), but must report back to police in three months, the spokesman said.

The unnamed student allegedly stole a page design from the website of the Chinese-language Ming Pao newspaper, copied it on his own web page and added a bogus news item that Hong Kong had been declared an "infected area," border checkpoints had been closed and people had been ordered to stay home. The report coincided with April Fool's Day.

• Agencies

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