Spread of SARS slowsBMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7401.1232 (Published 05 June 2003) Cite this as: BMJ 2003;326:1232
The outbreak of severe acute respiratory syndrome (SARS) has slowed considerably, with only 182 new cases worldwide in the week to 2 June, taking the total to 8384. However, the disease claimed another 45 lives during the week, and the death toll stood at 770 people.
The World Health Organization is cautiously optimistic that the outbreak in China is now under control and that the disease is on the decline in Taiwan, but Canada is experiencing a fresh outbreak linked to four Toronto hospitals.
“As we approach the three month mark since the global alert was issued on 12 March, we are confident that the SARS outbreak is well on its way to being contained globally,” said Peter Cordingley, WHO's spokesman in Manila.
“However, there are still pockets of anxiety, particularly in the more remote provinces of China and possibly Taiwan, and what has happened in Toronto should be a lesson to health authorities everywhere that nobody can afford to let their guard down,” he added.
By 2 June Canada had reported 198 probable cases, and the new outbreak has put Canada back on WHO's list of areas with local transmission, 12 days after it was taken off. The death toll has risen to 31, and autopsies are being conducted on four people suspected of having had SARS, even though they died in a hospital that was not listed as being affected by the virus.
The number of probable cases in Canada jumped sharply on 30 May after the Canadian health department amended its case definition to bring it into line with that used by WHO. Hundreds of people have been put into quarantine in Toronto.
The number of reported cases in China has gone into steep decline, and while WHO accepts that the drop in numbers indicates a greatly improved situation, there are still frustrating gaps in the information provided by the Chinese authorities.
On 31 May Singapore was removed from the WHO's list of areas with recent local transmission of SARS, 20 days having elapsed since the last locally acquired case was diagnosed. WHO hailed Singapore's experience as a victory that should encourage efforts to contain the SARS virus.
“From the start Singapore's handling of its SARS outbreak has been exemplary,” said Dr David Heymann, WHO's executive director for communicable diseases.
While the drop in the number of cases of SARS in China is encouraging, cooperation from the authorities there is still inadequate, according to WHO's team leader in the western Pacific region in the fight against SARS. In an interview with the International Herald Tribune, Dr Hitoshi Oshitani complained that although there had been change on a policy level, this was not reflected at an operational level. The Chinese authorities were still disclosing far too little information on the number and background of cases, as well as findings about treatments and possible sources of the disease, he said.
This stood in sharp contrast to the efforts made by the governments of Singapore, Hong Kong, Canada, and Vietnam, he added.
By 2 June China reported 5328 probable cases, 334 deaths, and 1499 people still being treated in hospital. Although WHO is cautiously optimistic that provinces with good surveillance and reporting infrastructure can bring SARS under control, this is not the case in much of China.
“For much of the more remote regions of the country we still have very little idea about what's going on. The reporting lines are not yet in place,” said Mr Cordingley.
In response to research by scientists in China and Hong Kong that the coronavirus that causes SARS had been found in civet cats, one of a range of wild animals that are a delicacy in southern China, the Guangdong provincial government banned the sale of wild animals.
However, this move has elicited a sceptical response from one of the microbiologists responsible for the identification of the virus in wild animals. “Eating this kind of game animal has been part of Chinese culture for the last 5000 years, and it's not going to be turned around in a few days,” said Professor K Y Yuen, head of the department of microbiology at the University of Hong Kong. “It's more important to observe good hygiene when eating these animals,” he said.
The situation in Taiwan is improving, but by 2 June there had been 684 cases and 81 deaths. In a bid to galvanise public cooperation in the fight against SARS, the Taiwan government launched an island-wide campaign to encourage citizens to check their own temperature twice a day and to attend a clinic if they had suspicious symptoms. However, the 10 day campaign descended into chaos when it was launched on 1 June and looks unlikely to take off. Nevertheless, WHO is encouraged by other measures taken by the government.
“We are confident that the measures being taken in Taiwan are bringing the numbers down,” said Mr Cordingley, “but the outbreak spiked so quickly and spread so rapidly that we worry the situation may still not be fully contained. However, we are delighted that measures such as fever clinics, better procedures in emergency rooms, and better screening and detection have been put in place. This shows the seriousness with which the Taiwanese authorities are now facing the situation.”
Hong Kong is still experiencing a handful of new cases on an almost daily basis, including infections of health workers, but by 2 June there were only 86 patients with the disease in hospital, of whom 25 were in intensive care. The disease had claimed the lives of eight medical workers by 2 June.
As public hospitals attempt to resume normal service, they are grappling with a backlog of an estimated 16 000 postponed operations because of the suspension of 30% of medical services during the SARS crisis.
Since the lifting of the WHO travel warning on Hong Kong, the government has launched a massive publicity campaign to reassure overseas business travellers and tourists that Hong Kong is now safe.
“We are now in the recovery phase … and our city is once again a safe place to visit and conduct business,” said Andrew Leung, director general of the Hong Kong Economic and Trade Office in London.