Officials Attempt to Pin Down Mysterious Respiratory Bug

R. A. Hettinga
Mon, 17 Mar 2003 23:10:28 -0500


The Wall Street Journal

March 18, 2003 

Officials Attempt to Pin Down 
Mysterious Respiratory Bug 


The number of reported cases of a mysterious respiratory infection is likely to fluctuate up and down until health officials around the world get a better handle on the disease. 

The Geneva-based World Health Organization, which is heading the international probe, Monday reported 167 cases and four deaths from what is being called Severe Acute Respiratory Syndrome, or SARS. Those figures don't include hundreds of illnesses and five reported deaths from what could be a related outbreak in China. 

For now, the WHO's criteria for evaluating the disease remain general. They include fever greater than 100.4 degrees; cough, difficulty breathing, or pneumonia; and a history of travel to areas such as Hong Kong, Hanoi and the Guangdong province in southern China. 

The broadness of that description, however, means cases initially listed as suspicious might be dropped from official case counts upon further investigation. At the same time, earlier cases not deemed suspicious might be added to the count as new information becomes available. Indeed, Hong Kong health authorities said they were reclassifying 45 people as suffering from the unknown illness, nearly doubling the figure announced a day earlier. 

A person suspected of having Severe Acute Respiratory Syndrome will show a recent history of: 

€ High fever : greater than 100.4 degrees Fahrenheit 
€ At least one respiratory symptom, including cough, shortness of breath and difficulty breathing 
€ Close contact* with someone who has been diagnosed with SARS or recent travel to areas that are reporting cases 
€ In addition to the fever and respiratory symptoms above, SARS may be associated with: headache, muscular stiffness, loss of appetite, malaise, confusion, rash and diarrhea. 
*Close contact means having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS. 

Source: World Health Organization 

"You may see some wobbles in the numbers," Julie Gerberding, director of the Centers for Disease Control and Prevention in Atlanta, said at a news conference. 

The CDC is one of several international agencies collaborating with the WHO on the investigation. 

The CDC is investigating 14 reports in the U.S. of possible SARS cases. Ten "almost certainly" aren't the syndrome, Dr. Gerberding said, while four others are under more scrutiny, although it is doubtful any of them will turn out to be the syndrome. 

She declined to specify what states the reports originated from, or to provide other details. She added, however, that "It will not be surprising to us if we identify cases in the U.S." 

Officials believe the disease is spread person to person by respiratory or nasal droplets, but only through close contact, such as that among household members or health-care workers. 

There is no indication so far that casual contact can result in infection. In fact, Dr. Gerberding said she was encouraged that an ill patient who had visited Atlanta on business earlier this month doesn't appear to have spread the infection to anyone else. 

Still, concern over the disease has quickly gone global, due to international air travel. In Europe, suspected cases of the illness emerged in the U.K., Slovenia and France. And in Frankfurt, the pregnant wife of a Singapore doctor suspected of having the illness developed a slight fever and sore throat. 

Britain has identified a "probable" case in a man who traveled on Sunday from Hong Kong to Manchester, England, via Amsterdam, and developed a "severe form of pneumonia," a spokeswoman for the National Health Service said. 

In France, health authorities said some 40 patients had been hospitalized and were being evaluated for the disease, but none appear yet to clearly have the Asian bug. 

Scientists still can't say for sure what is causing the illness, even whether it is a bacterium or a virus. That suggests, Dr. Gerberding said, that the organism isn't a common one, "or we would have found it by now." 

Dr. Gerberding also said the CDC's inquiries had been slowed initially by a lack of fresh clinical and tissue samples, as a result of multiple international laboratories participating and the time required to obtain patient and family consents internationally. 

But the CDC and Tommy Thompson, secretary of health and human services, have been working with the WHO to "open doors" and more specimens are expected soon, she said. 

Officials also said they hope that new cooperation from China could boost their efforts to identify the disease. The WHO and CDC said Monday that China, which had initially declined requests to have outside experts investigate a recent outbreak of pneumonia that may be linked to the current outbreak, had requested international help. The WHO is assembling a team that will go to China as soon as possible. 

The earlier outbreak in China sickened about 300 people and killed five between November 2002 and February 2003. Chinese officials had previously identified the cause as a bacterium called Chlamydia pneumoniae, but that diagnosis is now in doubt, said Iain Simpson, a WHO spokesman. 

If the two outbreaks are linked, Mr. Simpson said, it would result in a larger epidemic, but a slower-moving and less lethal one. Instead of 167 cases over two weeks, it would be nearly 500 cases over three to four months, he said. 

In that case, "It's certainly less explosive and less virulent, because instead of seeing a sharply increasing curve, you'd see a slower outbreak and a smaller average" case fatality rate, he said. In the past two weeks, almost 2.4% of SARS patients have died, while the earlier pneumonia outbreak in China had a lower fatality rate, of about 1.6%, diluting the overall mortality. 

R. A. Hettinga <mailto:>
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