The Denver post Article Published: Tuesday, April 01, 2003 - 12:00:00 AM MST

It's some of the most troubling news Colorado has received in a long time: Three possible cases of a life-threatening disease that is sweeping the globe have apparently turned up in metro Denver.

Severe Acute Respiratory Syndrome has been labeled a world health emergency and prompted warnings against unnecessary travel to parts of China or Vietnam. The three Colorado nurses with suspected SARS all had recently returned from China.

The rapidity and lethality with which SARS is spreading has alarmed medical professionals. There's no cause for public panic, but there is reason to be concerned and alert.

SARS is the first major new infection that can spread directly from person to person to appear in decades. Although SARS may be related to a well-known cold virus, experts still worry that people around the globe may have little or no immunity to it.

Although SARS was identified in Vietnam, it actually cropped up a little more than a month ago in China. In just a few weeks, SARS jetted into an astounding 13 nations, striking both developing and industrialized countries. Unlike some killer diseases, such as malaria, SARS strikes regardless of climate or region. There was no reason for SARS not to come to Colorado.

On Friday, there were 1,550 cases and 54 deaths worldwide. By Monday, there were 1,622 cases and 58 deaths. Officially, the United States reported 69 suspected cases as of Sunday, but that figure doesn't include Colorado's possible cases. At this writing, no Americans have died of SARS.

Ironically, technology helps SARS spread faster than it could have in an earlier era: New cases have been appearing along airline routes. That is, the disease is traveling quickly because its carriers - people - can be anywhere on the globe in less than 24 hours, taking the virus with them.

That's not unlike what happened in 1918-19, when the deadly Spanish Flu spread on trains and troop ships, eventually killing 40 million people worldwide, including 600,000 Americans.

Infectious-disease experts had feared SARS might be a new influenza - which it doesn't seem to be, thank goodness. Experts first thought it might be, though, because several lethal flu strains have erupted out of Asia in recent decades.

Unlike those viruses, which have struck almost anyone in the general public, SARS has been most devastating to doctors and nurses who have cared for SARS patients. It wasn't surprising that Colorado's first suspected cases appeared among medical people.

Sadly, the global death toll includes Dr. Carlo Urbani, the World Health Organization expert who identified SARS and first flagged it as a major world health threat. Without his extraordinary work, SARS would be an even worse menace. Urbani's death is a real loss to humanity because of his dedication and remarkable insight.

SARS seems to be a natural phenomenon. But if an accidental outbreak of a new disease can cause such suffering and confusion, think what might happen if terrorists deliberately spread an unknown, deadly virus or bacteria.

As awful as SARS is, it may give medical professionals a real-life test for containing any future epidemics of deadly contagions - including any let loose by terrorists intent on creating public panic.

<a href=www.japantoday.com>Japan Today Tuesday, April 1, 2003 at 14:00 JST

SYDNEY — Australia notified the World Health Organization (WHO) on Tuesday of its first suspected case of a deadly pneumonia that is sweeping the globe, Commonwealth Chief Medical Officer Richard Smallwood said.

Severe acute respiratory syndrome (SARS) is a mysterious illness first detected in Hanoi on Feb 26, which has claimed 58 lives and infected more than 1,600 people in 13 countries, according to the WHO.

The Australian man has been under investigation in New South Wales for some time, Smallwood said. There was no spread of SARS to any of his contacts.

"While the man had fully recovered, he fitted the WHO criteria for SARS and no other cause for his illness had been identified," he said in a statement.

The man returned to Australia on Feb 12 after spending two days in Singapore and was admitted to a Sydney hospital Feb 23 with a fever, cough, shortness of breath and difficulty breathing, Smallwood said. "He recovered after two weeks and was well when released from hospital. The classification of SARS was made retrospectively as the man had recovered before the health alert was released by the WHO on March 14."

Australian health authorities have investigated more than 30 suspected SARS cases in the past three weeks, but no other people were found to fit the WHO criteria, he said. "We still cannot be sure this person had SARS, but in the absence of other diagnosis, we thought it would be prudent to alert the WHO to this unusual case."

Australia has boosted its surveillance for SARS at its ports of entry and at public hospitals and doctors' surgeries, Smallwood said.

"I am convinced that our excellent public health infrastructure will quickly identify any potential case of SARS and the prompt implementation of infection control procedures will ensure that if a case does come into Australia, it will be isolated and contained," he said. (Kyodo News)

Japan Today Discussion

<a href=iol.co.za>IOL 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.

<a href=www.kron4.com>Kron4.com Posted: March 31, 2003 at 4:38 p.m.

SAN FRANCISCO (BCN) -- The Department of Public Health reports that a suspected case of the Asian flu-like epidemic known as Severe Acute Respiratory Syndrome has been detected in San Francisco.

In a news conference at 1 p.m. today, Dr. Susan Fernyak, the department's director of disease control, said the suspected SARS patient was admitted to a San Francisco hospital over the weekend.

The local patient is being kept in isolation, despite being in stable condition and having an excellent prognosis for recovery, Fernyak said.

To date, the state Department of Health Services has reported a total of 16 possible SARS cases in California, including four in Santa Clara County, one in Alameda County, one in Marin County, and one in Sonoma County.

These local numbers are relatively low, as 1,622 cases of SARS have been reported so far in 13, mostly Asian, countries worldwide. Given the number of people in contact with Asia, and the broad definition of the syndrome's symptoms, Fernyak said she is surprised that more cases have not yet been detected in the Bay Area.

"We are going to have more cases under investigation (in the future)," said Fernyak. "It's inevitable, as people continue to travel abroad."

A suspected case is defined by the health department as someone with fever over 100.4 degrees, respiratory problems developed since Feb. 1 this year, and either close contact with another SARS patient, or recent travel to an Asian country with documented SARS cases.

The list of countries reporting cases to the World Health Organization includes Vietnam, Singapore, Canada, Hong Kong Special Administrative Region of China, and the entire country of China itself.

People with SARS are thought to be infectious from the time their symptoms start, until 10 days after the symptoms subside, and the main mode of infection is believed to be airborne, within close quarters.

Fernyak defined close quarters as being within six feet, and said that immediate family members of SARS patients and healthcare workers are therefore at greatest risk.

Family members of diagnosed patients are advised to wear surgical masks, and not to share eating utensils or towels until after the infectious period has passed.

So far, the illness has claimed around 60 lives, or approximately 4 to 5 percent of those infected.

In the early stages of the illness, Fernyak said healthcare workers weren't taking the illness seriously, and subsequently exposed themselves to infection -- a mistake they aren't making anymore.

Despite the seriousness of the epidemic, Fernyak doesn't want to cause people undue alarm, as the number of local cases is in fact still low.

"We don't want people panicking at this point -- we'll let you know if we want you to panic," she said.

San Francisco International Airport offers the most Bay Area flights to Asia, prompting officials there to take steps to warn the public of the disease.

SFO spokesman Mike McCarron said yellow alert notices are currently being handed out to all passengers on the three daily flights directly to and from Hong Kong, to caution them about the recent outbreaks.

By: Robert A. Wascher, M.D., F.A.C.S. Jewish World Review March 31, 2003

SARS (Severe Acute Respiratory Syndrome) is a viral infection that has recently become a source of concern among public health officials. First identified in Vietnam, cases of SARS have now appeared in China (in Hong Kong and Guangdong province, in particular), Singapore, Indonesia, Canada, Thailand, the Phillipines, and the United States. Approximately another dozen countries have reported possible cases of SARS within the past several days. At the present time, nearly 1600 cases SARS, including 54 deaths, have been reported throughout the world by the WHO and CDC. Although the causative agent of SARS is not fully understood at this time, it appears to be a previously unknown member of the coronavirus family of viruses. Sadly, the Italian physician who first identified SARS in a German businessman under his care in Vietnam has, himself, now died of the disease. According to the US Centers for Disease Control (CDC) and the World Health Organization (WHO), the symptoms of SARS include high fever, sore throat, dry cough, shortness of breath, and decreased white blood cell and platelet counts. Other typical symptoms of viral infection may occur with SARS, including headache, muscular pain and stiffness, loss of appetite, malaise, confusion, rashes and diarrhea. The incubation period for SARS appears to be relatively short, ranging from 2 to 7 days following initial exposure. Based upon the rather high prevalence of infections among healthcare personnel, the WHO has indicated that close and sustained contact with infected persons may be necessary to spread SARS. In particular, contact with respiratory droplets from coughs and sneezes, as well as direct contact with bodily secretions, are thought to be important infection vectors. However, recent reports of SARS spread among tenants within apartment buildings in China, and at least one case involving a flight attendant on a Hong Kong-based airline, suggest that the SARS virus may be passed with more casual contact. The treatment of patients infected with the SARS virus is similar to that recommended for other serious viral respiratory infections, as there are no antibiotics that have any activity against such diseases. The current recommendation is that patients with SARS should be kept in respiratory isolation wards. Supplemental oxygen, inhaled medications to keep the airways clear of secretions and to prevent collapse of small airways, control of excessive fever, intravenous fluids to support blood pressure and vital organs, and, in some cases, mechanical ventilation, are mainstays of supportive treatment. At the present time, public health officials are not advising prospective travelers to cancel their trips overseas. However, some officials are now suggesting that travel to endemic areas be deferred if possible. Some flight attendants and travelers have taken to wearing surgical face masks in an effort to reduce the risk of inhaling respiratory aerosols from potentially infected persons, although the efficacy of this strategy is uncertain at this time. If you-or anyone you know-has recently developed a severe upper respiratory infection, particularly following travel to one of the countries mentioned above, then medical care should be urgently sought. While there are hundreds of other viruses that can cause the same symptoms as SARS, the virulence of the virus causing SARS seems to approach, at least in some cases, that of strains of influenza that have caused pandemics of severe illness and death in the past. Update on Smallpox Vaccine The CDC announced, on March 25th, an advisory regarding the administration of the smallpox vaccine to people with a history of heart disease. More than 30,000 healthcare workers have recently received the smallpox vaccine as part of recent Homeland Defense initiatives. Among these volunteers, seven have developed cardiac-related complications, although it is presently unknown if these complications are directly related to the vaccine. Among these seven stricken healthcare workers, three have experienced heart attacks (one of which was fatal), two cases of angina (chest pain due to blocked coronary arteries) occurred, and two cases of myopericarditis (inflammation of the heart muscle or the fibrous sac that surrounds the heart) occurred. The CDC is currently studying the medical histories of each of these seven patients, and is carefully evaluating their cardiac disease risk profiles (at least one of these patients was reported to have had an extensive history of preexisting heart disease). While cases of heart inflammation were reported during the period when smallpox vaccine was most extensively administered (in the 1960s and 1970s), no epidemiologic studies were carried out at the time in order to ascertain any causative effect by the vaccine. As it is currently unclear whether or not the smallpox vaccine, which consists of a live virus that is related to the smallpox virus, is linked to these few cases of cardiac complications, the CDC is being somewhat circumspect in its advisory. The CDC is now recommending that persons with a history of cardiomyopathy, heart attack or angina, or any other evidence of heart disease be temporarily deferred from receiving the smallpox vaccine. Inflammatory Markers and Risk of Heart Failure There is growing evidence that the progression of coronary artery disease is influenced by mediators of inflammation. Most recently, C-reactive protein has taken center stage as a key inflammatory protein that appears to play a critical role in the development of coronary atherosclerosis. While coronary artery disease has been linked with inflammation and, in turn, directly with the risk of developing a heart attack, another equally life-threatening cardiac ailment has not previously been associated with inflammation. Congestive heart failure (CHF), which most commonly occurs after a heart attack permanently damages heart muscle, is a common cause of disability and death among older Americans. As its name implies, CHF results when the heart becomes sufficiently damaged so that its ability to pump blood to the body becomes seriously impaired. Patients with CHF may have difficulty breathing due to fluid build-up in their lungs, and often experience debilitating weakness and fatigue as a result of inadequate oxygen delivery throughout their bodies. Swelling of the lower extremities may also cause difficulties for patients with CHF. A new study in the journal Circulation looks at the potential role of inflammation in patients with CHF who have never had a heart attack before. This study was conducted within the framework of the highly respected Framingham Heart Study, one of the longest running and largest heart study research programs ever undertaken. In this new study, a total of 732 elderly patients who entered the Framingham Heart Study without any prior evidence of CHF or heart attack were followed for an average of 5.2 years. All study volunteers underwent extensive blood tests upon entry into the study, which included assays for known mediators of inflammation, including C-reactive protein, interleukin-6, and tumor necrosis factor-alpha. Among the 732 volunteers, 56 of them subsequently developed CHF-without experiencing any heart attacks-during the course of this study. The study determined that initially elevated levels of any of these inflammatory mediators were significantly correlated with the subsequent development of CHF among the study volunteers. Among patients who had elevations in the blood levels of all three of these markers upon entering the study, the risk of subsequently developing CHF was more than four time higher when compared to other study volunteers without elevated levels of these inflammatory markers. The study's authors concluded that a single measurement of inflammatory markers in the blood was highly predictive of the risk for subsequently developing CHF, even in the absence of heart attacks. Breast Fibroadenomas and the Risk of Breast Cancer The presence of benign fibrous nodules in the breast, called fibroadenomas, has been linked, in some studies, to a slightly increased risk of developing breast cancer. Other benign breast conditions, including ductal hyperplasia, and even a history of prior breast biopsies for benign lesions, have been statistically associated with small increases in breast cancer risk as well. A new study in the Archives of Surgery looked at 32 patients with fibroadenomas occurring in the breast at the same time as breast cancer. These patients were compared with 26 control patients who had breast fibroadenomas without the concomitant presence of breast cancer in the same breast. The researchers used several highly sensitive tests to assess both the fibroadenoma tumors and the breast cancer tumors for characteristic genetic mutations associated the development of cancer. The study determined that fibroadenomas of the breast, whether or not they co-existed with breast cancers in the same patient, did not contain any of the genetic mutations commonly identified in the breast cancer tumors. From these results, the authors infer that fibroadenomas are not directly associated with the development of breast cancers. This small study should be repeated with larger numbers of patients to validate its findings. However, these results should provide considerable reassurance to women with benign fibroadenomas of the breast. Dr. Robert A. Wascher is a regular columnist/contributor at Jewish World Review and a senior research fellow in molecular and surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here. Visit Dr. Wascher's web site. © 2003, Dr. Robert A. Wascher