Monday, March 31, 2003 Back The Halifax Herald Limited Vincent Yu / The Associated Press By Chris Morris / <a href=www.herald.ns.ca Canadian Press SARS OUTBREAK

Rugby fans wear masks in an attempt to protect themselves from SARS during a tournament in Hong Kong, where officials said Sunday that 60 more people had fallen ill with the disease.

The principal of a middle school in Miramichi, N.B., has become the first suspect case of the potentially-deadly syndrome in Atlantic Canada.

Dr. Wayne MacDonald, New Brunswick's chief medical health officer, told a hastily called news conference Sunday that the individual has voluntarily quarantined herself in her home where she will stay until she's free of symptoms of the respiratory syndrome which, so far, has killed more than 50 people worldwide.

At least 60 people who have been in contact with the principal since her return last week from a trip to China are also being monitored for signs of SARS.

MacDonald said there are no other suspected cases and no one else is being quarantined. He said the Losier Middle School where the woman works will be cleaned.

"We feel the risk is low," MacDonald said.

Steve Benteau, a spokesman for the New Brunswick Education Department, said the school will be closed until April 8 since officials are having problems contacting about 380 families and staff members from the school.

MacDonald said the woman returned from a week-long trip to China last Monday.

She had been ill during the trip and by the time she came home to the Miramichi, she was starting to feel better.

However, like all people arriving in Canada from places considered high-risk for the mystery illness, including China, she was given a card when she landed and told to watch for symptoms.

She went to the Miramichi hospital Friday, concerned that the symptoms she had experienced during her trip and was still feeling to a lesser extent, might becaused by SARS, notably fever and respiratory difficulties.

"The individual is at home where she's recovering," MacDonald said.

He said he was pleased with the measures taken by the hospital when she arrived to be examined.

He said he is confident proper containment procedures were followed and there should be little or no risk to staff or patients.

As well, MacDonald said Health Canada has been advised of the case. He said it's up to Health Canada to follow up with investigations of the flights she was on and warn her fellow passengers.

More than 100 people across Canada are being watched as suspected or probable cases of SARS, a pneumonia-like illness that causes high fever, coughing and breathing troubles.

Most are in the Toronto area, however suspected cases have been reported in British Columbia, Ottawa, Alberta, Saskatchewan and now New Brunswick.

MacDonald said the incubation period for the illness, believed to be caused by a virus, ranges from two to 10 days with most cases showing up four or five days after exposure.

A fourth Toronto-area resident died of SARS on the weekend, and a 21-month-old child joined the growing list of probable and suspected Canadian cases of the rapidly spreading disease.

Swamped public health officials estimated Ontario has roughly 100 cases of severe acute respiratory syndrome, but admitted they had only been able to analyse data for 81 - 42 probable and 39 suspect cases.

"There are very many more individuals provincewide who are cases that are under investigation," said Dr. Colin D'Cunha, Ontario's chief medical officer of health.

Dr. Jim Young, the province's commissioner of public safety, urged hospitals and health-care workers around the province to be vigilant for potential SARS cases, saying they fear that as time goes on the ripples from the Toronto cases will move further afield.

Vancouver has two probable SARS cases and a number of people under surveillance for the disease. But health officials in Manitoba said Sunday a patient who had been listed as a probable SARS case in Winnipeg does not have the disease.

Health Canada also lists five suspect cases in Alberta and one in Saskatchewan. However, an Alberta health official said Sunday evening the five suspected cases in that province have since been diagnosed as something else.

"There's nothing new in Alberta to report," said Howard May, Alberta Health spokesman.

The Ontario officials confirmed the latest person to die had become infected while receiving treatment in the intensive care unit of Scarborough Grace Hospital - the nexus of Toronto's growing cluster of SARS cases.

One of the original Canadian SARS patients was treated at Scarborough Grace in early March before health-care workers realized they were facing a highly contagious and potentially deadly new disease that required high level infection containment measures: gowns, gloves, goggles and masks at all times. Waves of cases have emanated from that first patient.

The latest person to succumb to SARS was transferred to York Central Hospital on March 16 - long before he began showing signs of SARS. As a result, staff there did not impose the stringent infection control measures needed to contain the disease. The patient died Saturday night.

At least two nurses from York Central have come down with SARS. Both York Central and Scarborough Grace are now closed to new patients. Staff from the two facilities are barred from working elsewhere for the time being.

Anyone who worked at, visited or was a patient of either hospital from March 16 onwards has been asked to go into quarantine for a period of 10 days from the last exposure to the hospitals.

While no one has a good handle on how many people are holed up in their homes, officials have estimated the numbers would reach into the thousands.

March 31, 2003, 12:01AM Experts fear faster spread of SARS By MARGARET WONG Associated Press

HONG KONG -- Dozens more people at a Hong Kong apartment complex contracted a flu-like disease to bring the number there to 213, health officials said Monday, as the mystery illness with no known treatment continued its spread.

Hong Kong's health secretary, Dr. Yeoh Eng-kiong, announced the big rise in severe acute respiratory syndrome, or SARS, cases just hours after authorities imposed a tight quarantine on one section of apartments at the Amoy Gardens complex.

He said 88 new cases were diagnosed at the building complex to add to 125 other cases, bringing the total to 213.

The report came as the World Health Organization said SARS has killed at least 54 people worldwide, with the majority of cases in Hong Kong and China. That figure does not include three more deaths reported Sunday, one each in Hong Kong, Toronto and Singapore. More than 1,600 have been infected worldwide.

Singapore's health minister, Lim Hng Kiang, said the disease may spread more easily than first believed, with some people found to be more infectious than others. Labeled as "super infectors," they can infect as many as 40 others, he said.

"We run the risk of a huge new cluster of infected people, which could start a chain reaction," Lim said.

Singapore said it will station nurses at its airport to examine all travelers arriving from infected areas, while Canada planned to screen those traveling abroad from Toronto.

Yeoh said 107 of the sick people were from one section. He said officials believe the virus was brought to Amoy Gardens by a man infected at the Prince of Wales Hospital, where many of Hong Kong's victims have fallen ill.

Yeoh appeared emotional and initially had trouble speaking as he made a statement on the isolation of the section.

"It's a very exceptional circumstance," Yeoh said. "We haven't done it before, and we hope we won't do it again."

In Canada, meanwhile, another death was reported Sunday to bring the toll there to four. Officials earlier declared a health emergency in Toronto, located 50 miles from the U.S. border. U.S. health officials have reported 62 cases in the United States but no deaths.

About 100 probable or suspect cases have been reported in Canada. Officials have closed two hospitals to new patients, and hundreds of people have been quarantined in their homes.

Another possible case turned up in New Brunswick on Canada's east coast, officials said Sunday, meaning the illness that originated in Asia may now reach across Canada. The New Brunswick case involves a school principal who traveled to China.

Other suspected cases are in Ottawa; Winnipeg, Manitoba; and on the west coast in Vancouver, British Columbia.

The United States and Canada have advised people to avoid travel to afflicted areas in Asia, and the World Health Organization recommended that international travelers from Toronto and several Asian cities get screened for symptoms.

Most of the Toronto-area cases are health care workers at Scarborough Grace Hospital and York Central Hospital who became infected while treating initial victims, all of whom had traveled in Asia or had close contact with other victims.

The disease has caused a run on surgical masks in the city and slowed business by as much as 70 percent at Pacific Mall, a Chinese shopping mall in Toronto's northern suburbs.

Some merchants also were taking precautions, wearing protective masks even though no cases have been linked to the mall.

The International Ice Hockey Federation canceled the women's world championships Thursday in Beijing. The federation said the spread of the illness to Beijing from southern China put the players at risk.

Players for Canada, the defending champion, were disappointed but understood.

"You could lose your life going there and just being in contact with somebody," forward Danielle Goyette said. "Life is more important than hockey right now."

March 31, 2003, 9:39AM By EDWARD HEGSTROM Houston Chronicle

RESOURCES • Q&A on SARS • Facts about virus • CDC information page • World Health Organization information

The sudden global spread of a lethal new disease out of Asia illustrates how little power modern medicine has to prevent deadly germs from moving around the world as fast as an airplane can carry them, experts say.

The disease, known as severe acute respiratory syndrome, or SARS, appears to have spread from China to Hanoi, Hong Kong, Singapore, Taipei, Frankfurt, Toronto and now Houston.

Because health officials in Hong Kong say they believe it has been spread among passengers during a flight, SARS raises particularly serious questions about air travel. And the reports resonate with some in the United States, which has been on heightened alert for bioterrorism the past year and a half.

The United States used to maintain a robust quarantine system to prevent the arrival of dangerous diseases on ships and airplanes, but that system has been severely slashed in recent years. More than 15,000 international travelers arrive at Houston's Intercontinental Airport every day, including some on a direct flight from Tokyo. But the quarantine inspector who ostensibly polices the Houston airport works out of an office in Los Angeles.

SARS is not the first disease to arrive in America from overseas. In an era of globalization, with millions of people crossing borders daily, diseases regularly jump continents, and experts say they have no way to prevent that.

"This is the sort of disease that will spread everywhere because it is carried by people, and people travel," said Dr. Mary E. Wilson, an international health expert at the Harvard School of Medicine. " I think we have to expect that this sort of thing will continue to happen. Borders are porous."

Though none of the 62 suspected SARS cases in United States has proven fatal as of yet, other internationally imported diseases have been more lethal. World Health Organization Director General Gro Harlem Brundtland estimates that in the latter half of the 20th century, five times as many Americans were killed by internationally imported infectious diseases than by war.

Many studies -- including one released earlier this month by the Institute of Medicine -- find that the best way to stop the global spread of infectious disease is by improving surveillance. If countries can cooperate to identify diseases as soon as they emerge, international health authorities can step in and stop them from spreading, the studies conclude.

Good surveillance and early international intervention prevented the spread of a dangerous avian influenza virus that emerged in Hong Kong a few years ago, Wilson noted. And good surveillance may be preventing the secondary spread of the SARS in the United States, she added.

But surveillance only works if officials are willing to disclose outbreaks. Many countries cover up epidemics in an attempt to prevent the damage that may result to their trade and tourism industries, said David Fidler, a University of Indiana law professor who writes extensively on the links between international law and infectious disease.

"History shows that if there is an outbreak in a country, that country does not want to share that information because of the effect it could have on their economy," Fidler said.

WHO officials issued their first warnings about SARS in mid-March. But the organization now reports the disease first emerged in south China in early November. Officials still do not know if that four-month delay in diagnosing the new disease proved crucial in allowing its spread.

Wilson acknowledged that the Chinese government's reluctance to alert the world about the disease may have been related to "economics." Reports of an unknown disease in southern China began circulating as early as mid-February, but Chinese officials initially refused international help in identifying the disease, she said.

The globalization of infectious disease is not new. European explorers brought smallpox to the New World nearly five centuries ago; an influenza pandemic spread around the world in a matter of months in 1918.

But the pace of international trade and travel has accelerated the movement of diseases. After essentially disappearing from Latin America in the 1970s, dengue fever has returned with a vengeance, reaching from Venezuela to northern Mexico, and creeping across into South Texas. As many as 100 million people catch the disease, and jet passengers continue to take it to new areas, including Hawaii.

After first appearing in New York in 1999, West Nile Fever spread south and west, reaching Houston last summer. Despite years of study, officials say they still do not know how the disease reached the Americas.

Quarantine used to be the preferred way of stopping diseases at a country's border, but that approach has lost favor with world health experts. Modern jet travel is so fast and so frequent that quarantine officials cannot possibly stop diseases at an airport, Wilson said.

The emergence of SARS may change that thinking. Health officials in Asia are now using quarantine, and the U.S. Centers for Disease Control and Prevention has set up a screening process in which quarantine officers are being asked to identify sick passengers at some airports.

At Los Angeles and other airports where the CDC has staff, quarantine officers now monitor incoming flights and hold ill passengers to make sure they go straight to a doctor.

But years of neglect and underfunding have left the U.S. quarantine system short-staffed. In the 1960s, the United States had more than 50 quarantine stations; now it has eight. Officers at those quarantine stations are expected to patrol numerous air and land ports of entry.

If a sick passenger shows up on a flight in Houston, airline officials are asked to call the quarantine inspector in Los Angeles.

There are U.S. Customs Service agents at the Houston airport who screen for incoming drugs and contraband. The Department of Agriculture keeps agents there every day to screen for possible disease-carrying fruits, vegetables or pets. But no one at the airport screens for dangerous human diseases such as SARS.

"The CDC doesn't have a presence out here," said Ernest DeSoto, spokesman for the Houston Airport System.

With the CDC so short-staffed, quarantine in this country works essentially on the honor system. Airline crews who identify a sick passenger on an international flight arriving in the United States are expected to call ahead and notify quarantine officials. If the flight attendants fail to notice the disease, customs and immigration agents are supposed to stop it. But the honor system doesn't work.

Interviews and CDC quarantine records obtained by the Chronicle show that airlines have routinely allowed obviously sick passengers to board international flights bound for the United States, and customs officials sometimes let them enter the country.

The CDC quarantine reports tell of passengers flying to the United States while noticeably sick with AIDS, chickenpox, dengue fever, hepatitis, malaria, measles, meningitis, mumps, pneumonia, rabies, rotavirus, rubella, syphilis and typhoid fever, among others. Many were allowed to board planes while showing unmistakable symptoms of disease.

Allowing obviously sick passengers to board jets could open the country to the threat of bioterrorism. Under one frequently postulated scenario, a terrorist could spread smallpox by infecting himself with the disease and then boarding a jet to spread it to the other passengers.

Some experts dismiss the "smallpox martyr" theory. They say that people with infectious smallpox would have a rash and fever and that no airline's ticketing agent would allow them to board a plane.

But the CDC quarantine reports obtained by the Chronicle indicate that -- at least before Sept. 11, 2001 -- passengers were sometimes allowed to board U.S.-bound international jets while seriously ill with fevers and rashes.

In 1999 alone, at least six passengers with chickenpox were pulled aside by quarantine authorities after arriving in the United States on an international flight. To someone who is not an expert, chickenpox is hard to differentiate from smallpox.

Bioterrorism expert Jonathan Tucker, author of Scourge: The Once and Future Threat of Smallpox, said he believes a passenger with chickenpox would have a harder time travelling after 9/11. "I just think people are more alert and more sensitive to passengers getting on planes with rashes now," he said.

Beside the threat of bringing disease into the country, sick passengers also risk infecting others on the plane. Airline passengers have contracted flu, measles and even deadly strains of drug-resistant tuberculosis from breathing the air in a jet cabin, studies have shown.

Hong Kong officials now say they believe SARS has also spread among passengers on a flight. In response, WHO issued guidelines late last week asking airlines to step up their efforts to screen passengers.

CDC officials did not return phone calls seeking comment on the connection between SARS and quarantine. But in an interview last year, James Barrow, chief of field operations for the CDC's Division of Global Migration and Quarantine, acknowledged that globalization has caused the government to question whether quarantine is even feasible anymore.

"If you look at the sheer volume of travelers," he said, "I don't think you could have enough quarantine inspectors to look each of them in the eye and determine if they're carrying an infectious disease."

Sunday, March 30, 2003 From <a href=www2.ocregister.com>OCRegister news services

Two Buffalo Sabres players were under observation Saturday after possibly being exposed to a mysterious and potentially deadly respiratory illness.

Defensemen Rhett Warrener and Brian Campbell, who played in the Sabres' 4-1 victory over Montreal on Friday, did not travel with the team for its game at Carolina on Saturday.

Erie County (N.Y.) Health Commissioner Anthony Billittier recommended the players remain isolated - but not quarantined - for 10 days, effectively ending their season because the Sabres play their last game April 6.

Team spokesman Mike Gilbert said the decision to hold the players back was a precaution, and that neither has shown any signs of being infected with severe acute respiratory syndrome, or SARS. It was determined that there was what Gilbert called "a remote chance" that the players had limited exposure to the virus after a female relative of Campbell's visited them Monday. The players are roommates.

The relative, who lives in Toronto, was exposed at her job as a hospital worker in Ontario and was hospitalized after showing symptoms Friday, Billittier said.

Warrener said he and Campbell were feeling well and were not very concerned.

C B C . C A   N e w s  Written by CBC News Online staff Last Updated Mon Mar 31 14:21:44 2003

HONG KONG-- Health authorities in Hong Kong quarantined a 33-storey apartment building in the Amoy Gardens complex on Monday because of the number of severe acute respiratory syndrome (SARS) cases there.

The decision was denounced as political by Leung Ping-chung, a medical professor who has been monitoring the spread of the atypical pneumonia through the staff of a hospital in Hong Kong.

"If isolation is effective to control the spread of the disease, we can say this decision came too late," he said. "And who can say for sure who should be isolated?"

Over the weekend, 58 of the 105 new SARS cases reported in Hong Kong were found in Block E of the Amoy Gardens complex.

Of the 213 people in the complex with SARS, 107 live in Block E, the World Health Organization said Monday.

Police sealed the building where about 240 people will have to stay for 10 days.

Hong Kong is the location of the second-largest outbreak of the disease, after China, but ahead of Canada, where Health Canada on Sunday reported 98 probable or suspected cases.

• FROM MARCH 30, 2003: Fourth SARS death reported in Toronto

Four people have died in Canada.

Researchers expect to identify the virus that causes SARS in "at most a few weeks," Hitosho Oshitani, the World Health Organization's SARS co-ordinator, said Monday.

He called the disease "the most significant outbreak that has been spread through air travel in history."

WHO said Monday that there are 1,622 known cases, and 58 deaths. That's up by 72 and 4, respectively, since Saturday, when the previous WHO report was released.