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the time.
- 29 august 2003. Fourteen
United Nations and Chinese experts visited farms and markets in
Guangdong province in quest for an animal carrier of the SARS virus.
As reported in Beijing by the veterinarian François Moutou (president
of the French Association for the study and protection of Mammals), it
is extremely surprizing to have recovered SARS-like virus from such a
broad range of animals, from snakes and birds to mammals. One can
remember that, in addition to the hypothesis of infection of a civet
cat, snakes were proposed very early on
to have been at the origin of the virus. Outbreaks of legionellosis
continue to develop in France, while a patient who had travelled on a
cruise to Greenland died from the disease when returning to his home
land in Germany.
- 24 august 2003. After
the recent heat wave two outbreaks of Leptospirosis affect the
east and south west of France. This revives the interest for
Leptospira interrogans, a plague of rice paddies in China.
- 21 august 2003. A
bitter debate affects medical and political authorities in
France while the funeral undertakers declared 10,000 more deaths than
the previous year. Deaths were usually caused by hyperthermy, not by
microbial infections. This triggers a Europe-wide investigation to
compare the situation in other countries affected by the same heat
wave.
- 5 august 2003. An
epidemic of Legionellosis affects the region of Montpellier in
France. 25 persons have been infected.
- 25 july 2003. The
SARS outbreak is terminating, with a record death toll in Hong
Kong (299 deaths, more than 17% of the cases). A large cholera
outbreak is developing in Liberia where civil war prevents proper
control of the disease. In Mainland China analysis of the situation
demonstrates that Chinese scientists had discovered the coronavirus
cause of SARS well before it was found at the CDC in Atlanta and in
Hong Kong. The old confucean tradition prevented these scientists to
voice out their discovery. This particular cultural feature is
triggering a lively discussion in China.
- 10 july
2003. Philippe Desprès, Jean-Louis
Virelizier and Fernando Arenzana at the Institut Pasteur de Paris
have just discovered in vitro the nature of a receptor on the cell
surface that allows the dengue virus to enter its host and start this
often deadly disease. This has of course to be substantiated by in
vivo studies. If the discovery holds it will open the door for
medication preventing, or at least controlling the dengue infection
after humans are bitten by carrier mosquitoes, Aedes aegypti.
- 8 july 2003. Within
the frame of eradication of poliomyelitis a thorough campaign of
vaccination was launched in Madagascar. No cases were found since
1997, until, during a survey between october 2001 and april 2002 five
new cases were detected. Surprisingly, a study developed at the
Institut Pasteur de Madagascar with the Institut Pasteur in Paris has
demonstrated that these cases are mutants of the vaccine strain (which
is a live vaccine). This shows that the campaign of eradication of the
disease will be more difficult than expected.
- 7 july 2003. While
the WHO removed Taiwan from its list of areas with local
transmission of SARS two suspect cases have been found in GuangDong
awaiting confirmation. There are no left chain of transmission left,
but one should still be extremely cautious, since the diagnostic of
the disease is still difficult. Also, its origin is not well
understood yet, although a general consensus is that it originated
from an animal (presumably feline) host. If this were the case
adaptation to man would have required several steps, and it is not
unlikely that a parent disease, causing only very mild symptoms, is
still present. This might be a reservoir for a resurgence of the
disease when the weather cools down in autumn. Meanwhile a team of
scientists from the Institut Pasteur is working with authorities in
Algeria and the WHO Global
Alert and Response Network, to investigate the recent outbreak
of plague, that caused 10 infections and one fatality, and control its
vectors. In Hong Kong the hot and humid season makes it now important
to monitor the possible come back of dengue fever.
- 29 june 2003. The
World Health Organisation, as medical authorities world-wide,
are investigating the impact of atypical pneumonia on the local health
systems and the response they should propose in case the disease (or a
similar one) appears again. Extreme variations in the number of
fatalities in different places is a remarkable puzzle that is being
actively investigated. The disease also triggered reflection at the
Pugwash workshop “Science, Ethic and Society” (Paris, 27-29 June
2003). The Pugwash Movement is
well-known for the role it has played in promoting recognition of the
social responsability of scientists in the domain of arms control and
involvement of scientists in violence. At the present time it is of
interest to investigate the various reactions of scientific
institutions which often, for the pure sake of fashion or short-term
considerations, lost the view of what should have been their strategic
(i.e. long term) choices. The
origin of the SARS virus is not yet certain, and the disease — which
is as expected very sensitive to heat because the virus is much less
stable at temperatures higher than 30°C — may appear again when the
wether cools down in autumn. However its most severe behaviour was due
to person-to-person contamination, and we can reasonably hope that,
when cooler days will return no human case will still exist. The
disease may then have disappeared from the Earth, at least for some
time. It is therefore urgent to remember that, among the causes of the
havoc were poor hygiene measures (especially in hospitals), and, above
all, lack of pre-existing research on the virus. We know some of our
future diseases (and flu is one of them: H5N1 in Asia, and H7N7 in
Europe, for example, as well as dengue fever in South East Asia), but
we do not know most of them. The family of the Human
Immunodeficiency Virus was not considered as interesting before the
scourge of AIDS appeared, and not many scientists were interested in
Coronaviruses. This means that we need urgently basic academic
research on all kinds of microbes, on their vectors and on microbial
systems that may put them under control, if we wish to be ready for
the next epidemic. Will this lesson of SARS be understood?
- 25 june 2003. Beijing's
population went to celebrate in the street the end of the WHO
warning over travel to the city because of SARS.
- 22 june 2003. On
june 18th an eleven years old child died of plague
in Oran (Algeria) where several cases have been diagnosed. He was
affected as well as several members of his family since the beginning
of the month. This indicates endemy of this disease, in a country that
witnessed the large outbreak fifty years ago, made famous by the novel
of Albert Camus, The Plague.
- 19 june 2003. 100
days elapsed since the WHO warning on SARS was published. Although
SARS is clearly coming under control, the need for continued vigilance
is now greater than ever. The chain of person to person transmission
everywhere is not yet totally interrupted and, as demonstrated
recently in Toronto the disease may suddenly reappear when it was
thought to have been. As stated by WHO at a recent conference there is
a need for at least a full year of surveillance to determine whether
the disease has established endemicity and to ensure that no cases
have spread, undetected, to countries with poor surveillance and
reporting systems. After a peak of the number of cases at the
beginning of May the disease rapidly went under control, most probably
because of the efficiency of means that have been implemented in the
regions at risk. It is most important that these measures remain in
effect.
- 16 june 2003. The
World Health Organization advice against travel to Tianjin,
Hebei, Shanxi and Inner Mongolia was lifted late Friday while SARS is
now rapidly receding in Mainland China. For unknown reasons, the
epidemic is still not contained in Canada and in Taiwan, although the
situation is improving.
- 12 june 2003. As
atypical pneumonia recedes world-wide, and in particular in
China (no new case and no new fatality in Hong Kong), the consequences
of the disease on human habits begin to be visible. In Mainland China,
in particular, this will help the government to implement a strong
policy against spitting (a notoriously difficult task, especially in
the poor parts of Western China). This will also inevitably have
consequences on the dining habits in this country. Chinese use to
share dishes, a very friendly social practice, but which may have a
significant impact in terms of diseases spreading. The government is
starting a reflection in this domain, which will have immense
consequences if the western style dining portions is becoming the
rule.
- 9 june 2003. The
distribution of atypical pneumonia is becoming somewhat erratic.
More questions arise about the possible treatments for the disease as
the death toll in Canada reaches 32 persons. The Chinese government
warns that, because it is not possible to control totally the
movements of person in their huge country, some new cases may appear
here and there. While the total number of cases, and of deaths is very
small as compared to the situation with other diseases such as
tuberculosis, malaria, or AIDS (and even typical pneumonia), the
particular feature of SARS is its remarkable contagiosity, which
forces authorities to implement stringent confinement measures around
patients. If no action had been taken it is clear that the level of
contamination in the world would have been much higher.
- 5 june 2003. As
a sign of hope, for the second time there is no new SARS case in
Hong Kong during the past 24 hours. The experience in Toronto, where
more than 70 new cases have been reported since 26 May 2003,
underscores the risk of a resurgence of cases and reminds us that a
single imported case can reignite an outbreak. The WHO reminds us that
this is a matter of concern for the future if all cases have not
disappeared during the summer.
- 2 june 2003. As
the discrepancies between SARS infections at various places in the
world increase the disease remains more and more of a puzzle.
Some of the data might reflect inaccurate reporting, but that does not
seem to explain everything. In fact several reports from the Mainland
suggest that many people are immunologically seropositive for the
virus but did not show symptoms. Asymptomatic diseases are very
frequent, but this would hardly fit with places where up to 50% of the
local people got infected (this was the unfortunate situation at the
Block E of the Amoy Gardens Estate). One alternative explanation, that
we proposed several weeks ago, is that a double
epidemic might reconcile these observations: a first outbreak of
a mild disease (probably derived from some animal) would have escaped
attention (it might have been the gastro-enteritis witnessed since the
end of 2002 in Guangdong and in Hong Kong), and a mutant virus,
derived from this first one would have acquired a tropism for the
respiratory tract. This would have caused SARS. Those people who had
been infected with the first disease would have been protected, while
the other ones would have the full blown syndrome. This would account
for seropositivity in otherwise healthy people. We are in urgent need
of a highly sensitive and reproducible test for monitoring the
immunological status of the whole population in the regions of
interest.
- 31 may 2003. SARS
remains a nosocomial infection as there are three new confirmed
cases in Hong Kong who are healthcare workers of North District
Hospital. Another sad news is that the number of deaths almost reached
the 16% figure in the city. Fortunately, if figures can be believed,
there was only a single new case in the Mainland. Singapore is removed
from the list of areas with recent local transmission of SARS. The
change in status comes 20 days after the last locally acquired case
was placed in isolation, on 11 May 2003. In Taiwan the disease
recedes, but on may 30th Canada was affected again, since the
suspected cases recently discovered have been identified as SARS
cases.
- 28 may 2003. With
less than 8,500 cases as the total number of SARS patients
world-wide, one can be confident that the disease is now
under control. One should not let one's guard down however
because the disease can reappear where it was thought to have been
eradicated. In addition we need to prepare for a possible surge when
the weather will cool down in autumn. Much will have to be learnt
about protective and proper hygiene measures in hospitals since the
disease can be classified as a nosocomial infection. In addition
handling and eating wild-life animals will have to be severely
controlled. The Chinese governement is considering new measures in
this domain.
- 27 may 2003. After
an alert was sent on may 23d, Toronto is back on the list of
places with recent local transmission of SARS, while a new cluster is
discovered. Taiwan is now the place where the disease is spreading the
fastest.
- 24 may 2003. The
SARS epidemic is being under control in Hong Kong, with no new
cases and only 9 suspected cases left. The local death toll is
unfortunately above the 15% figure. The situation allowed the WHO to
remove Hong Kong from the list of places that should be avoided by
occasional travellers. The situation in Taiwan is unfortunately
growing worse as the number of new patients is steadily on the
increase despite severe control measures at the entry of the region.
The number of new patients in the Mainland is stable, probably on the
decrease. The origin of the virus might be cat since teams
investigating the presence of coronaviruses in Guangdong discovered
that these viruses were ubiquitously present in animals, cats
included, prepared on the local markets for food. Except in Taiwan the
disease seems to be receding fairly rapidly. In addition to confinment
and control measures implemented, this may be due to the warming up of
the climate in this season. It will be extremely important to monitor
the situation when the weather will cool down,
next autumn.
- 20 may 2003. SARS
in the Mainland may have escaped attention for some time, as a WHO
expert team returning from Guangxi province found that 2 separate
clusters of SARS cases, dating from December 2002 and January 2003,
had recently been detected by local health officials following a
review of hospital records. Figures seem to be on the decrease
everywhere in the Mainland, but the speed of the decrease is probably
too fast to reflect reality. On the encouraging side, only four new
patients were identified in Hong Kong, where the number of persons
still in hospital went below the 250 figure.
- 18 may 2003. While
Singapore was about to be declared free of SARS a new case, who became
ill on may 11th, was discovered, showing that one should not be
confident too early that the fight against SARS is won. For unknown
reasons the situation seems to be getting worse in Taiwan, while in
Mainland China and in Hong Kong the number of new patients seems to be
steadily decreasing. At the first global consultation on SARS
epidemiology, held at WHO headquarters in Geneva from 16 to 17 May,
experts declared that the overall case fatality ratio is 14% to 15%
but with wide variations in case fatality related to age, sex, the
presence of other diseases, and treatment protocols.
- 16 may 2003. The
cause of SARS as a Coronavirus is proven, as described in "Koch's
postulates fulfilled for SARS virus. Ron A. M. Fouchier, Thijs Kuiken,
Martin Schutten, Geert Van Amerongen, Gerard J. J. Van Doornum,
Bernadette G. Van Den Hoogen, Malik Peiris, Wilina Lim, Klaus Stohr
& Albert D. M. E. Osterhaus. Nature 423:240 (2003). It is
important to identify as fast as possible patients who carry the
virus. At the date of May 8th, on average the time needed for
identification was still about 4 days, too long to stop the spread of
the disease. If this figure can be lowered to 2 days, the epidemic
will rapidly be totally under control. Misdiagnostic, especially of
the milder forms of SARS is a matter of much concern, since this might
lead to relaxing the confinement of patients who are still contagious.
More than 600 deaths have been attributed to SARS world-wide, a high
figure for a new disease. In Hong Kong the death toll reached 14%,
menacing to be soon the highest recorded death toll for the disease.
There is hope that the fight against the disease will succeed as the
number of new cases in Beijing and Mainland China seems to be steadily
dropping down, suggesting that the methods used to contained the
epidemic are effective. It is interesting to have a view of the official
position of the Chinese government on the origin, tracing, and
management of the epidemic.
- 13 may 2003. The
total number of known SARS patients world-wide has passed the 7,500
figure. Sadly, the death toll passed the 13% figure among patients in
Hong Kong. In an exemplary move to control the disease, contact
tracing has established epidemiological links for the vast majority of
Hong Kong’s patients. Around 9% of SARS patients have no identifiable
exposure source. Detailed investigation is ongoing to understand the
transmission routes. Figures of new SARS cases in the Mainland are
much smaller than the day before, but this may be due to the way
patients are identified (one witnesses strong oscillations in the
daily number of new patients in China). Japan has banned import of
poultry from China after it discovered the H5N1 flu virus in an
imported duck.
- 11 may 2003. Steady
state on the SARS front, with one case in a new country, Finland. The
death toll keeps increasing in Hong Kong while the disease recedes
(less that 10 suspected cases remain). The Chinese government has
formed forums for students abroad, aiming at collecting as much
helpful information as possible to fight the disease immediately and
in the future. A fruitful students meeting was held in Paris on may
10th. Contradictory reports analyse the sequence of the virus, and
suggest that some mutations may have occured during cultivation in
laboratories while others are directly due to the selective pressure
of the immune system of the hosts. It is very important that sequences
are accurate and are obtained totally independently from each other to
begin to get a pedigree of the virus and follow its trail. Features
specific to the isolate started from the patient that spread the
disease from an hotel in Kowloon are now characterized.
- 9 may 2003. The
possibility for a success of the fight agains SARS is illustrated in
Vietnam where no cases have been detected for several weeks, and where
the death toll remained lower than 8%. One likely case in Eastern
Russia, after the disease reached Inner Mongolia, then Mongolia,
triggers a new concern for expansion of the disease. Awareness,
however, allows authorities to stop the creation of an outbreak. The
number of confirmed cases in Beijing dropped sharply (48 cases), while
in Guangdong it persists oscillating between 5 and 20 per day. The
decrease in Hong Kong is confirmed. In order to improve efficiency of
treatment it is absolutely essential that governments totally forbid
that companies pay medical doctors for enticing them to use the drugs
they produce by whatever means they try to use.
- 7 may 2003. An
attempt to use
serum of recovering SARS patients to lower the viral load and
cure patients has apparently meeting success. If this is subtantiated
by further studies this is extremely good news, since this suggests
that a vaccine will be possible. This also particularly important at a
time when the number of deaths passed 12% in Hong Kong, indicating
that existing treatments did not work as well as promised. The
situation in Mainland China remains stationary. One positive outcome
of this epidemic is the reflection triggered in the domain of control
of water quality, pollution, and management of both domestic animals
and wild life. The suspected cases in France are very unlikely to be
SARS, in line with the lack of an outbreak in the Nanjing region.
- 6 may 2003. Two
suspected cases of SARS have been detected in France, from persons
coming after a stay in Nanjing. Awareness of the existence of SARS may
begin to have a positive effect in Mainland China, where the number of
new cases in Beijing (more than 16,000 persons are quarantined)
experience a significant downturn (70 new cases). 2 cases have been
diagnosed in Shanghai, and during the past couple of days the number
of new cases rose again in Hong Kong (this is not statistically
significant, however), unfortunately with a high death toll. The most
surprising observation remains the high number of medical staff
infected despite stringent hygiene control measures.
- 4 may 2003. Shanghai,
which is still almost rid of SARS has
adopted a series of desinfection measures in transportation, and
control measures for travellers. While SARS remains constant in China
but recedes in Hong Kong, it is time to put the disease in
perspective. Many other epidemics are affecting countries in the world
at the same time. In particular, as almost every year, meningitis is
killing thousands in Burkina Faso. A different type of concern exists
in developed countries: a Legionella case in a factory in the centre
of France shows that hot water systems, as well as air conditioning
are ready to spread dangerous infectious diseases. The particular
danger posed by SARS is its contagiosity which forces affected
countries to set up extremely tough controls on travels and drastic
quarantine measures, resulting in catastrophic negative economic
consequences. Any relaxing measure would immediately result in the
spread of the disease. This should be a lesson for the future and
trigger appropriate support for research on infectious diseases: the
cost of research is very small when compared to the huge losses
encountered when the diseases spread.
- 3 may 2003. Steady
state SARS infection level in Mainland China, 114 new cases in
Beijing, and 10 new cases in Hong Kong (where unfortunately the death
toll increased by 9 persons). In Taiwan the cumulated number of cases
passed 100, while the disease seems to be vanishing in Canada and in
Singapore. It is important at this point not only to take this
epidemic seriously — and appropriate quarantine measures, coupled to
monitoring travellers at many major places in China, are certainly
efficient — but to be aware of other diseases that may have similar,
or even worse, consequences. This is the case of most diseases
affecting our livestocks, and in particular of bird's flu, which has
two pending virulent forms, one in Europe
(H7N7) and one in China (H5N1). We are at the mercy of reassortments
of the genomes coupled to mutations, that would allow transmission of
the disease not only from birds to humans, but from humans to humans.
Lessons should be learnt from the scientists and veterinarians dealing
with the spread of those diseases.
- 2 may 2003. Almost
13,000 people are now quarantined in Beijing. In an un precedented
effort the municipality of Beijing put together a work force of 7,000
to build up a 1,000 beds temporary hospital with a number of special
facilities for treating SARS patients. The number of new cases was
today lower than 100. In Hong Kong 11 new cases were detected while
the number of patients dying from SARS has now passed the 10% figure.
Shanghai is enforcing strict SARS preventative measures, including a
14-day quarantine period for travellers arriving from affected areas.
Traffic checkpoints have been set up where travellers are given
temperature checks and asked to fill out health declaration forms.
After Viet Nam, the UK and the USA have been removed from the list of
areas with recent local SARS transmission. In both countries, the last
instance of local transmission occurred more than 20 days ago.
Tianjin, China and Ulaanbaatar City, Mongolia, were added to the list.
A new country (Poland) is affected by SARS (1 case). The cases in
India have been discarded as SARS cases by the WHO.
- 1 may 2003. The
number of SARS cases reached today 1,600 in Hong Kong (fortunately
with "only" 11 new cases), while more than 180 were diagnosed with the
disease in the Mainland (122 in Beijing). 19 cases appeared to have
been identified in India, while the South Korean case might be due to
a different type of pneumonia. Drastic measures of quarantine are now
implemented in Beijing where the authorities organise the local life
for quarantined people.
- 30 april 2003. More
than 100 new SARS
cases identified in Beijing, while Shanghai remains practically
immune and a low level of new cases in Guangdong persists. The
situation in Shanxi is a matter of concern because the number of new
cases seems to be on the rise. In Hong Kong the number of new cases
remains constant now for a few days. Also, in Beijing it appears that
some cases of mass contamination resembling the Amoy Gardens event is
occurring. This might be the case at a dormitory in Northern Jiatong
University. In contrast it seems remarkable, as published by a team at
the Chinese University in Hong Kong, that children get a much milder
form of the disease. It is time to look back at the situation of SARS
in the world. The disease seems to be contained outside Eastern Asia,
and officials from 12 countries met yesterday in Bangkok to set up
rules for controlling health of travellers between their countries. We
are facing a situation similar to that faced when the first acts of
terrorism affected airplanes: appropriate facilities will probably
have to be set up on a stable basis to monitor health parameters of
travellers world-wide. The situation of
SARS is at a turning point: a number of 5,000 affected people at the
end of this month was thought to indicate the turning point where it
might go out of control. Since we are just at this border, we still
have hope, and the next figure of concern would be 10,000 by the end
of may. A feature of great concern is the vast interest shown by
companies for the possible royalties that might come out for the
disease, triggering a dangerous competition between countries,
hospitals and universities, at a time when collaboration is urgently
needed (and remarkably well set up by the World Health Organisation).
- 28 april 2003. The
news are mixed today: for one week the number of new cases in Hong
Kong kept decreasing, raising hope that the measures implemented are
effective and that SARS will be contained within one month.
Unfortunately deaths of patients previously recruited was still high,
rising the local death toll to almost 9%. However the local situation
is certainly less serious than what is generally perceived in the
absence of explicit information. People should not lower their guard
however since a single case started the
present world-wide outbreak. In Beijing the number of new patients is
of the order of 100 per day, indicating
a serious situation in the capital. The World Health
Organisation however says that, learning from the situation elsewhere
in the world, we still can hope that the disease will be contained.
authorities in Beijing are implementing extremely stringent measures
and a general
cleaning program to prevent further spread of the disease.
Patients are discovered throughout the Mainland suggesting that
several causes contribute to the outbreak here or there.
- 27 april 2003. Beijing
is now severely affected by SARS, and all public places such a cinemas
or theaters have been closed for the time being. The People's
University has also closed because SARS cases have been reported
there. One of the most puzzling feature of SARS is the extreme
difference between the situation in Beijing and in Shanghai (where
only a few cases have been reported) despite the strong ties between
Shanghai and Guangdong or Hong Kong. This
is consistent with the double epidemic
hypothesis, suggesting that people at some places might have
been protected by a previous infection by an innocuous or mildly
virulent virus. Another puzzle is the fact that the death toll
appeared to increase at some places as compared to others. This may
also be linked to the same hypothesis, with a variable virus
segregating more virulent mutants. If this were the case, the use of
many antivirals may be dangerous because they might enhance
the mutation rate of the virus
,
as suggested by the rate of evolution witnessed in bacterial viruses.
The Asian health ministers approved a plan to boost screening of
possible SARS patients at international departure points, bar
travelers with SARS symptoms (fever in particular), and require health
declaration forms for visitors from affected countries. "We must use
every weapon at our disposal," the regional director of WHO, Shigeru
Omi, told the health ministers and senior officials from South East
Asia, China, Hong Kong, Japan, and South Korea. A joint symposium on
SARS was held in Hong Kong with scientific representatives of the
region.
- 26 april 2003. While
diagnostic kits for SARS are distributed world-wide, the WHO
warns against inaccuracies inherently associated to these kits
essentially based on the Polymerase Chain Reaction (PCR).
Sensitivity is high but the genetic material of the virus is unstable,
leading to false negatives. In contrast, once the assay has been used
for some time, the rate of false positives may increase because of
contamination of the diagnostic laboratories, unless extreme
precautions are taken. After his official visit to Beijing the French
Prime Minister stressed that panick is the worse reaction to an
epidemic. There were 154 new cases in the Mainland (113 in Beijing)
and 17 in Hong Kong. India has identified three new cases (7 in
total). No new case in Vietnam for 18 days: it is now likely that the
country will be the first one to have contained the disease, setting
an example to other countries in the world.
- 25 april 2003. The
number of new patients affected by SARS in Hong Kong seems to
decrease slowly. Unfortunately the rate of deaths has increased
significantly in the past few days, rising the overall death rate to
7.6%. Scientists are collecting isolates from various places and
compare them. The first observations demonstrate that the virus is
still in a rapidly evolving phase. This is consistent both with the
nature of the virus (in general viruses, that are not real living
organisms but parasites of life, mutate at a high rate because they do
not have the elaborate "proof-reading" system present in most living
organisms) and with the hypothesis that it comes from a non human
host.
- 24 april 2003. The
epidemic has apparently been contained in Vietnam. Figures in Mainland
China, although much more accurate than previously are still difficult
to evaluate since not all hospitals are able to tell SARS from other
diseases with similar symptoms. Some Canadian scientists cast doubt on
cause of SARS, because they do not find the suspected coronavirus in
50% of the cases, while they find it in control patients. It seems of
the utmost importance that the community reaches a consensus since
hundreds of scientists are working round the clock with the hypothesis
that the virus is the cause, and are constructing diagnostic tests,
and vaccine approaches on this hypothesis while the disease is still
progressing. However the experiments with monkeys, showing the very
symptoms of SARS, argue strongly in favour of the new coronavirus
species as being the cause. For some reason, doubts systematically
came from the same place, where some other cause might have altered
the symptoms and/or the samples.
- 23 april 2003. Schools
will be closed for a fortnight in Beijing. 24 cases and 6 deaths in
Hong Kong. Claims about the efficacy of treatments have to be revised
because it is extremely dangerous to extrapolate from textbook
knowledge to a new type of infection. It seems clear that symptomatic
treatment, when delivered early on might be helpful. The difficulty
with any urgent situation as the present one is that one should do
controlled experiments, ie compared the fate of many patients with,
and without treatment, and this is morally difficult, in particular
when some believe that this, or that treatment may be efficient. This
is the only way out, however.
- 22 april 2003. In
Hong Kong a cumulated total of 1,434 cases of SARS have been reported
todate. The public perception of the disease worsens in Beijing while
the Central government takes an entirely new and open attitude towards
the challenges posed by the disease. It is in particular extremely
difficult to be careful with a disease that only affects a minute
portion of the population, to manage its possible extension (which
could be considerable if nothing is done) while controlling the
extremely dangerous economic consequences induced by panick. Involving
the people in the fight, as done during the past few days in Hong Kong
is probably one of the best solutions. There is also an urgent need
for totally open collaboration between scientists throughout the
world, an attitude that is dramatically illustrating the negative
impact of the competition attitude induced by inappropriate
management of successful behaviour in science. Part of the
problem caused by the virus could be due not to contact through air,
but because of an unusual stability on many surfaces. This indicates
that excellent hygiene is most important at places where cases have
happened.
- 21 april 2003. The
situation in Mainland China is somewhat confusing, as authorities in
the provinces are trying to provide accurate figures for cases of
SARS, at a moment when they often do not have appropriate means to
identify cases. In Beijing the population begins to show its concern,
after the two political dismissals of the day before, and one observes
a large number of masks in train stations. The rumor spreads that the
city might be completely closed for travels in and out within two
days. The WHO now counts more than 4,000 cases world-wide, while the
number of new cases in Hong Kong dropped significantly, unfortunately
with still several deaths.
- 20 april 2003. At
this date we may reach a turning point for the spread of SARS. Countries
are resorting to drastic measures to slow down the spread of the
disease. China, using a new method to count patients affected,
recognizes that the disease has now severely reached Beijing, with
more than 300 patients officially identified. In a political move
without equivalent for 25 years, the mayor of the city as well as the
Minister of Health were asked to resign from their position in the
Communist Party, as a sign that they were not able to cope with the
severity of the problem. In addition the Chinese Government has
transformed the first week of May, used normally as a nation-wide
vacation, into only one day vacation, in an attempt to prevent travels
within the country. More than 1400 persons who went to an open market
in Singapore where a patient was identified are confined for 10 days
quarantine. Toronto has identified new cases that do not appear to be
directly connected to previously identified patients, rising fear that
the virus might now spread by air. The authorities are considering
placing buildings, or even whole blocks, in quarantine. In Hong Kong
the disease does not seem to recede. Lessons from the outbreak
or Porcine Respiratory CoronaVirus twenty years ago show that
the virus may even become airborne. The present virus is a totally new
one, from yet unknown origin, but it is of interest to understand how
similar viruses evolved in animal communities in the past. Several
world-reknown scientists are now involved in the fight against SARS in
Hong Kong, in particular David Ho (who devised tritherapy against
AIDS), Jeff Copland, Michael Lai and Monto Ho (who solved an
enterovirus outbreak in Taiwan several years ago).
- 19 april 2003. This
is the worse day in Hong Kong since the beginning of the SARS
outbreak, with 12 people passing away, while the number of new cases
remains stable. Young people coming from Hong Kong have been placed in
quarantine while they arrived from Hong Kong in UK. In a completely
different context, the viral epidemic that plagues chicken farms in
Netherlands and Belgium has made its first human victim. If this were
to give rise to person-to-person transmission of the disease, a major
epidemic of another type would be on the verge of starting. All this
indicates that we must now be ready to take major measures to control
the spread of contagious epidemics, throughout the world.
- 18 april 2003. The
first three cases of SARS were reported yesterday from Australia,
while the disease appeared to slacken its pace of infection in Hong
Kong (1,327 cumulated cases, showing a steady state of infection at
around 30 cases per day, similar to the figure before march 27th).
India has also reported its first case but the description is not
entirely consistent with SARS. At Amoy Gardens in Hong Kong, the cause
of the outbreak is identified, suggesting that it would be easy to
prevent further incidents of this type. If one takes out this episode,
the epidemic in Hong Kong has features similar to that in Guangdong
province, suggesting that it is starting to recede. However one must
still be extremely cautious because a single patient may start a
sudden outbreak, as repeatedly witnessed in the past month. The team
at the Faculty of Sciences that sequenced the virus is analyzing its
relationships with birds coronaviruses, as well as with similar
viruses in other vertebrates. At this time the cause of the disease is
consistent with the shift of an
enterogastritis virus to a respiratory form, a Human Respiratory
CoronaVirus (HCRV).
- 16 april 2003. In
a remarkable breakthrough involving world-wide collaboration a Dutch
laboratory demonstrates by experiments using monkeys that the new
coronavirus recently identified is the cause of SARS. In Hong Kong,
the sequence of a local isolate is completed, allowing comparison
between three different isolates. While RNA viruses are always highly
variable it will be of fundamental importance to link the severity of
the disease with variations in the genome sequence. The virus being
probably of animal origin it is certainly in a phase of adaptation to
its new hosts, humans, and this may result in particularly virulent
mutants. This also may result in attenuation: it is too early to know
how the disease will evolve, although extrapolating from the situation
in Guangdong should be seen as positive.
- 15 april 2003. The
rise of the number of SARS cases world-wide
is worrying, since it seems on the verge of beginning a pandemic. The
cumulated number of cases in Hong Kong is 1232. Concern comes from the
observation that, among the nine deaths recorded in 24 hours, several
come from persons under 40 years of age, with no other disease. It is
important to monitor the type of treatment used, since antivirals can
be extremely toxic. Identification of the virus is still a challenge:
a PCR test, developed by the CDC in Atlanta, has been shown to be ten
times more sensitive than previous PCR tests for SARS. WHO experts
hope that the test will be ready for distribution by the end of this
week. The sequence of the isolate of the virus at the CDC has been
completed, after a Canadian group sequenced another isolate. The virus
differs significantly from previous isolates. Scientists are
concentrating on the features of the "spikes" porteins, that are
important for penetration into target cells.
- 13 april 2003. The
World Health Organisation has raised several caveats about too early
and misleading enthusiasm about diagnostic tools and remedies for SARS
while a team of Canadian scientists announced that they have completed
the sequence of the viral genome. The virus has unique features that
make its origin still an enigma. It must be remembered however that
the sequence of the AIDS virus is known since 1983 and that we are not
yet rid of the disease, and also that antiviral molecules are very
dangerous and often have severe secondary effects. Collaboration,
without delay, with all relevant partners in the world is essential to
try to contain the disease, and limit its extraordinary economic
consequences already reaching some 40 billion US$. The team in Canada
benefited from an excellent organisation of a team previously working
on cancer and of the information provided through the WHO network. A
second team at the CDC in Atlanta, with the support of scientists at
the Bernhard-Nocht Institute, Hamburg as well as from Rotterdam and
San Francisco, is completing the sequence of a second strain, while
the Hamburg team is providing information to a company for
distribution of free primers meant to help hospitals in the world to
identify the virus. It is difficult to know at present whether the
disease simply spreads in a linear fashion, or begins an exponential
exploration of the available population. Reaching the number of 5,000
patients world-wide by the end of the month would be a sign suggesting
that the disease may have become out of control. The transmission
pattern still remains ununderstood, with some patients infecting a
very large number of persons, while others remain infected while
contaminating no other person. Strict quarantine measures are now
implemented in Hong Kong, and Mainland China has created an efficient
alert system that will be particularly important in the poorest parts
of the country. The cumulated number of patients in Hong Kong reached
1,150. One should also note that, because of the lack of essential
collaboration between scientists throughout the world, the cause of
SARS is still disputed... This is very unfortunate at a time when the
disease is spreading. The observation by groups in different
continents that the same coronavirus is present in patients however
substantiates the idea that it is the cause, rather than an accidental
contaminant.
- 11 april 2003. While
it is likely that persons living at Amoy Gardens Estate left before
the quarantine measures, the number of new cases increases more or
less linearly (1,059 cases at 1 pm) in Hong Kong. Several laboratories
of the WHO task force on SARS concentrate on the hypothesis that a new
coronavirus, never previously identified from animals or humans is the
main cause of the disease. The main problem now is to be able to trace
the routes of propagation, by identifying contacts of patients. Hong
Kong health authorities have announced that all household contacts of
confirmed SARS patients will be required to confine themselves at home
for up to 10 days with immediate effect. A similar measure will be
implemented in the Mainland as soon as a way to identify the disease
(remember that pneumonia are very frequent diseases) can be proposed.
- 9 april 2003. Our
diseases are strongly linked to the way our society behave. This
must be taken into account for analysis of the outbreak in Hong Kong,
which reached 970 persons at 3 pm, with a still significant proportion
of health care workers. Of course, one expects that scientists
involved in the fight against the disease have a very open behaviour,
widely sharing their results to increase the probability of finding
rapidly a solution to the crisis, but is this what we are witnessing?
The future will tell...
- 8 april 2003. At
3 pm, the cumulated number of patients in Hong Kong reached 928.
Many hypotheses try to account for the sudden local outbreaks, in
particular it is known that coronaviruses are not only involved in
respiratory diseases, but also in gut
diseases, suggesting that, in some cases they may survive in the
gut and be propagated by a faecal-oral route. This hypothesis stresses
again the important role of a good hand hygiene. Data are collected to
explore this route. The disease, which appeared to have been contained
in Hanoi might be reappearing elsewhere at other places in Viet Nam.
One of the present difficulties is that diagnostic tests that have
been initially proposed have been found to be somewhat problematic.
The international collaboration set up by the WHO should however be
able soon to provide a reliable test.
- 6 april 2003. The
cause of contamination remains elusive, while 42 new persons are
infected in Hong Kong. In Singapore the disease appears to be dying
out, but there are still new cases, while the quarantine measures are
very strictly enforced. In Mainland China, reported cases come from
the whole of the country. In Guangdong, the total number of new cases
is stable at around 10-15 cases per day. The total number of cases
from Hong Kong is higher, in particular because 268 cases have been
reported from the Amoy Gardens estate. This large number of cases
still remains a puzzle. In the same way, the Singapore government is
investigating the situation posed by 29 cases reported on March 29th,
in the staff from two wards of the same hospital. It seems highly
improbable that a single patient would be the cause of these almost
simultaneous cases, suggesting an environmental parameter (which may
be of similar nature as that at Amoy Gardens).
- 5 april 2003. In
the USA, the cumulated number of patients affected by SARS reached
115, prompting the Federal Government to take action in terms of
compulsory quarantine measures. In Hong Kong, the number of new
patients rose again, to reach 39. Among those 10 are medical staff, 7
are persons who were residents of Amoy Gardens. The 22 remaining
patients correspond to the steady state of the disease that appears to
prevail for the last weeks. Two major observations about SARS puzzle
observers: the disease is considerably biased towards affecting
medical staff, and the outbreak at least at one place, the Amoy
Gardens estate, mimicks what happened in hospitals with very high
geographically concentrated clusters. In contrast the background of
the disease, probably in Hong Kong as in the Guangdong province, stays
more or less constant, neither increasing, nor decreasing. This makes
the course of the disease highly unpredictable and its propagation
route still very enigmatic. Among the many hypotheses that remain to
be fully explored is the idea that two viruses, with somewhat
different contamination properties, are needed to cause the severe
form of the disease. The actual cause of the disease is not yet fully
established. Health authorities are currently investigating other
cofactors such as propagation through sewage pipes (Block E at Amoy
Gardens is a 33 floors high rise building, and a large concentration
of patients is in a vertical cluster) as well as airborne through some
kind of particles coming from a neighbour construction site... The
second patient in France has probably been contaminated while
travelling on the plane from Hanoi to Paris.
- 4 april 2003. While
the outbreak seems to level off in Hong Kong, new cases are discovered
throughout the world. In Hong Kong at 1pm the cumulated number was
761, indicating a constant rate of infection. In the absence of any
easily available test for identification of the disease, it is still
difficult to count the number of real cases. Most definitions come
from epidemiologic investigation and linkage with known cases, as well
as clinical signs. This is the more difficult because clinical signs
appear to vary from place to place. For example, in the USA, for some
reason the clinical signs are milder than at other places. All this
suggests that there may be co-factors to the disease, which is still
not yet understood, and/or that the virus is still evolving extremely
rapidly.
- 3 april 2003. At
1 pm (local time) the cumulated number of cases in HK was 734,
representing a sharp drop in the increase of new cases in Hong Kong.
While the Mainland authorities have opened their hospitals for WHO
investigation and help, many questions arise about the origin of the
disease. It has been repeatedly stressed that SARS was originally
detected in FoShan and HeYuan county, Guangdong Province. A local
newspaper however tells that a medical professor in RenMin hospital of
HeYuan county named Xie JinKui does not agree with that assumption.
Prof. Xie said the first case in HeYuan was detected in 17th of Dec,
last year (2002). The patient is a 35 year old man. He is a cook in
ShenZhen, working in a restaurant where he has close contact with wild
animals, such as snakes (see more about this
story). Although the date does not fit with earlier descriptions
of diseases similar to SARS in Guangdong, this raises interesting
questions about the origin of the virus. In Hong Kong, if one
removes the very special case of the Amoy Gardens Estate, the
outbreak is constant since the beginning of march, not exponential.
This suggests, as initially proposed, that the disease is propagated
by (almost) close contacts only. The situation at Amoy Gardens has to
be investigated in details, since it suggests another mode of
propagation, specific to that particular place. It will be extremely
important to understand what it could be.
- 2 april 2003 (see also the WHO press
conference). Once the cluster of patients at
Amoy Gardens reaches its maximum, the disease seems to be contained
elsewhere in Hong Kong, suggesting that it may begin to become under
control (a total of 708 cumulated cases since the begginning of the
outbreak). The drastic quarantine measures implemented by the local
government seem to have had a significant impact. However the outbreak
has some unique features that suggest that an unknown route of
contagion may be existing. It is too early to be sure that the
situation is stabilising, but the warming
up of the weather acts against viability of the virus combined with
stringent hygiene measures might have contained the disease. One
should not, however, relax a good hygienic behaviour. At this time it
becomes important to start reflection on the political, sociological
and psychological factors involved in the spreading of the disease.
Despite the lack of accurate reports from the Mainland, it appears
that, after a peak around mid-february, the outbreak did not come out
of control suggesting that some factor(s) have played an important
role, whether political, or simply sociological (the structure of
cities, buildings etc. is extremely important). The Mainland being now
a full partner of WHO, accurate knowledge of the situation will soon
be available. Patients at the French Hospital in Hanoi are under
strict control measures: on march 14, a group of 12 staffs
(specialists of intensive care, nurses, virologists) was sent to
Vietnam. Besides taking care of the patients, this staff was involved
in a vision of prevention of infection. In Hanoi, the risks of further
contamination seem to be under control: since march 25, no new case of
chain contamination has been reported. Nine persons from the medical
staff of the French Army arrived to replace the orginal staff on march
25. Identification from new cases substantiate the hypothesis of a
coronavirus as the cause. One must remember however that until
explicit link with the disease has been established one should remain
open to other hypotheses.
- 1 april 2003. While
SARS does not seem to recede in Hong
Kong, a model of the outbreak at Amoy Gardens Estate,
constructed by mathematicians at the University of Hong Kong, suggests
that contamination follows a route similar to that of flu. This is a
matter of great concern, since flu is highly contagious. This also
suggests that the outbreak in Mainland China might not be under
control yet. If this is the case it is almost inevitable that the
disease will spread throughout the world. However it is important to
remember that Amoy Gardens Estate is a high rise building and that
spread of the disease might be due to this specific situation.
- 31 march 2003. Quarantine
measures are implemented in several places in the world while the
epidemic does not seem to level off. Eighty more patients have
been identified in Hong Kong since yesterday. One block (block E) at
Amoy Gardens seems to have been most affected, and investigation is
proceeding to try to identify the nature of high contamination there.
This would certainly be a lesson for containing the disease elsewhere.
The nature of the virus that causes the disease is still under
discussion, since there has not been, as yet, an explicit correlation
with the immune response of patients who have recovered.
- 30 march 2003. The
outbreak might be levelling off in Hong Kong, but at a high level:
sixty new cases have been diagnosed there. A thirteenth patient
passed away while the Italian doctor who discovered the disease in
Hanoi died in Bangkok. A group of French military doctors departed for
Hanoi to help their colleagues. Including the recognized Mainland
cases, one already counts more than 1600 cases and 58 deaths.
- 29 march 2003. Anxiety
rose in Hong Kong while 58 new patients have been affected by SARS.
470 cases have been identified in HK, and 86 in Singapore. The cause
of the sudden increase in the past two days is the outbreak that
affected 34 new persons at the Amoy Gardens Estate. A twelvth patient,
an elderly person, died from the disease in HK. General models
describing the progresses of similar outbreaks would predict that, if
appropriate prophylactic methods are enforced, the disease should
presently level off then go extinct. A favorable circumstance should
be the weather that is warming up, provided air conditioning is not
creating a situation that would mimick the winter time weather. It
must be stressed that identification of the virus, at this point, is
mainly useful as it substantiates the hypotheses about its mode of
transmission. As in most cases of viral diseases, implementation of
drastic preventive measures is the only efficient way to stop the
outbreak. Vaccination would also be efficient, but creation of a
vaccine takes time, and is only rewarding if the disease is supposed
to become recurrent. In fact this particular outbreak should become a
lesson for political authorities as well as medical staff, since an
outbeak of a much more contagious disease like a new form of influenza
would certainly have a much more severe impact. Fast reaction, as well
as drastic control of hygiene is a necessity.
- 28 march 2003. The
number of affected persons in HK jumped with 22 from a single
building adding to the steady daily flow (51 more patients enrolled
on the evening of 27th). The local governement has finally
resorted to measures similar to those implemented in Singapore,
restricting the movement of more than 1,000 people. Consistent reports
throughout the world suggest that the disease is indeed caused by a
coronavirus, making the identification by Pr Peiris an important step
in the fight against the disease. Some think that a paramyxovirus
could be an aggravating factor: ''The coronavirus is the primary cause
of the disease,'' said Pr Peiris, adding that another virus, of the
family that causes mumps or measles, may also be involved and increase
the severity of the disease. Interestingly, the new strain had
characteristics unlike any other he had ever seen. In a parallel
statement Pr Bernhard Fleischer, head of Hamburg's Bernhard Nocht
Institute for Tropical Medicine, said his institute had probably
identified the virus causing Severe Acute Respiratory Syndrome. "I
don't assume that there will be a worldwide epidemic which will spread
among the population," Fleischer told Reuters in an interview. "We are
lucky that this disease is not as contagious and does not spread as
easily as first assumed."
- 27 march 2003. While
about thirty new cases are discovered in HK, all connected to the
initial patients, it appears now clear that the epidemic of SARS
in Guangdong affected almost eight hundred people, with thirty deaths.
Some indications suggest that the disease is now spreading in Beijing
and other parts of China. Clinical symptoms are described at PROMED.
The government of Hong Kong is now considering to take measures
similar to those in Singapore, asking people who have been in contact
with affected patients to stay at home for ten days. The cause of the
disease is not yet clear, but the symptoms and propagation makes a
pattern that suggest that the world-wide outbreak started from the
same origin. At the moment it might be traced back to a patient in
Foshan City (Guangdong) who got sick on 16 Nov 2002. Patients of the
initial outbreak are now systematically recovering and, if the disease
can be contained, this will alleviate some of the extremely tense work
load at hospitals. However, in other parts of the world, such as
Taiwan and Canada, the outbreak is not yet contained. Scientists
world-wide are trying to decide what is the exact cause of the viral
disease with no compelling
conclusive evidence yet. However the coronavirus hypothesis now
seems the most plausible, since tests that had initially been negative
appear now to be positive after new types of assays. Also, as said
earlier, coronaviruses being highly prone to recombination, they have
more potential to create new unknown virulent variants.
- 26 march 2003. 25
new cases were added to the list of HK people affected by SARS. An
incident in a plane carrying HK tourists to Beijing from march 15th
and march 19th examplifies the way the disease is propagated. In the
world the disease continues to spread (see Health Surveillance for
airline passengers). It may be affecting Beijing. The puzzle about the
nature of the virus continues, while the virus
isolated at HKU is better characterized. For journalists
interested in the difficulty of identifying viruses, and in the vivid
ongoing debate, here is a summary provided by scientists at
PROMED.
- 25 march 2003. As
the number of SARS cases resumed growth in Singapore the local
government decided to warn all 700 persons who have been in contact
with patients to remain at home for ten days.
The CDC in Atlanta has identified another type of virus as the
possible cause of the disease. This virus
family, the coronaviruses usually causes gastroenteritis in humans. It
is also the cause of bonchitis in birds as well as many other diseases
in all kinds of animals including humans. It is also the frequent cause
of common cold. The virus that has been
isolated at HKU is also a coronavirus. It is difficult to
reconcile the data from the previous identification of paramyxoviruses
and these new identifications. Several explanations may be proposed,
including sample contamination, multiple infection and different
outbreaks with similar symptoms. In Hong Kong the Chief Executive of
the Hospital authority was found to be affected by the disease and the
number of patients reached 260.
- 24 march 2003. The
number of Severe Acute Respiratory Syndrome cases kept growing
steadily in Hong Kong (about 25 new cases each day, see
dedicated government site, 242 cases in the afternoon of march 23d),
but the spread of the disease seems to be contained elsewhere in the
world. Schools where cases were detected in staff or students are
closed for seven days, until the incubation time for possible new
cases has elapsed. The World Health Organisation cautions that virus
identification is difficult since our respiratory system is commonly
infected by many types of more or less innocuous viruses. The easiest
to be cultivated might not be the cause of the disease. However all
identifications so far concur to the idea that the virus is a
paramyxovirus.
- 22 march 2003. The
virus identified in the SARS outbreak in Canada is a metapneumovirus
(6 identifications out of 8 cases), a virus from the paramyxoviruses
family, which has been discovered in 2001 and is usually the cause of
common cold-like diseases. This virus may be the common source of the
outbreak. In another effort, scientists
of the team of Pr Malik Peiris at the University of Hong Kong have
cultivated the virus that may have started the outbreak in the city
and are testing an efficient diagnostic test that detects the virus
.
This would rapidly tell whether cases of pneumonia, frequent during
this period of the year are indeed SARS and prompt appropriate
precautions. It is not known however whether this is a metapneumovirus
yet. One must also have in mind that pneumonia cases are documented
with at least two
viruses infecting the same patients.
- 21
march 2003. The number of SARS cases
rose to 165 in Hong Kong. The history of the disease in the
city is now fairly well understood. At its origin is a medical doctor
travelling from Guangdong and staying at a Kowloon hotel, where he
infected, either in the elevator or in the elevator lobby several
persons who then transmitted the disease. One of those started the
outbreak at the Prince of Wales hospital. authorities are actively
looking for all the persons who stayed at the time of infection in the
hotel. This outbreak is an illuminating illustration of how our
travelling habits are spreading diseases throughout the world
extremely rapidly. The fact that apparently no staff of the hotel has
been affected provides good hope for the disease to be under control
rapidly if appropriate hygienic behaviour is followed. Remember that
coughing and sneezing, in particular, is an efficient route spreading
the virus.
- 20 march 2003. The
origin of the SARS in Hong Kong has been traced back to a traveller
who stayed in a hotel in Kowloon. Apparently, no personnel at
the hotel has been affected, substantiating the reassuring observation
that close contact is needed for the disease to spread. A
paramyxovirus has further been identified as the cause in Singapore.
As yet, no clear connection is made with the epidemic
of pneumonia that spread in Guangdong province since november
and seems now under control. However, both the symptoms and the spread
are so similar that it seems likely that the cause is the same. It
will be important to identify the source, and political authorities in
the Special Administrative Region of Hong Kong and in Mainland China
have agreed to tighten their collaboration. This will be particularly
important in the future since the risk for an outbreak of a dangerous
influenza epidemic is high.
- 19 march 2003. A
paramyxovirus has been identified as the probable cause of Severe
Acute Respiratory Syndrome (SARS). First indication came from
Frankfurt and Marburg, and explicit identification was performed by a
team from the Prince of Wales Hospital and Chinese University of Hong
Kong. Paramyxoviruses
infect vertebrates, and cause often severe outbreaks in communities of
birds. They cause outbreaks
of encephalitis in South East Asia. The common and highly
contagious measles virus belongs to this family. A
family of these viruses has a strong tendency to infect lungs.
- 18 march 2003. The
origin of the outbreak at the Prince of Wales Hospital has been
identified. This permitted local authorities to screen for
people who have been in contact and bring them under medical care. The
result is that at the present date almost 100 persons are under
surveillance most of whom having acquired the severe flu-like disease.
The WHO maintains its alert until identification of the virulent
pathogenic agent is identified. For ongoing discussion on the subject
see PROMED.
- 17 march 2003. The
WHO maintains its global alert. Forty two persons have
contracted an unknown flu-like disease with frequent pneumonia
symptoms at a Hong Kong hospital. One nurse died of a similar disease
in Hanoi. Several similar cases have been described, possibly related
to South East Asia, in the world. However it must be noted that, until
now, no shared infectious agent has yet been identified. What makes
the situation complicated is that we are at a period of the year where
many flu-like, pneumonia-like diseases prevail. Several important
facts must be borne in mind to prevent spreading of a possible new
virus or bacterium, taking into consideration the unusual fact that
effective contagion seems to occur within hospital premises.
- Strict personnel
hygiene must be enforced: one should never see medical personnel in
their work coats outside (in particular at cantines or such public
places, as often unfortunately seen); spitting on the ground should be
strictly forbidden; after visiting a patient one should wash one's
hands carefully; as much as possible, direct contact with patients
should be avoided (gloves can be used, and one should not forget, of
course, to discard them properly immediately after use).
- Air conditioning should be monitored: temperature
should not be kept too low (most microbes survive much longer at low
temperatures), and ventilation should be efficient but indirect
(remember that the nose and lungs act as air filters): filters should
be cleaned up and as much as possible sterilized.
- Water quality should be controlled: filters should be
cleaned up, and water circuits should be checked as much as possible.
At the present time several possible agents are considered
(but none has been identified as a common cause): the influenza
virus (which often causes pneumonia-like symptoms and is
frequently letal); Legionella
pneumophila (a very dangerous bacterium often transmitted
trough infection by amoeba that thrive in water cooling systems or in
the water circuit); Chlamydia
pneumoniae (a very fragile bacterium, that may be dangerous
in immunocompromized people); Rickettsia
psittaci, the cause of psittacosis. Many other causes may
exist among which viruses are usually the most difficult to identify
readily unless well known previously. Sudden
mutation of a rather innocuous virus such as syncytial
respiratory virus may even be considered. The present observation
that contagion seems highly confined to specific premises suggest either
direct physical contact (this is the case with the Ebola virus) or some
kind of transmission by water or air fluids.
- 12-14 march 2003.
After a concomitant spread of a pneumonia-like flu-like disease in
a private hospital in Hanoi (Viet-Nam) and in the Prince of Wales
hospital in Hong Kong, the World
Health Organization issued a global alert, waiting for
identification of the pathogenic agent involved. A patient diagnosed
in Hanoi died in another hospital in Hong Kong. Recommendations are
similar to those issued during the previous outbreaks, for which no
clear pathogenic agent has been identified. Contagion appears to have
remained restricted to the medical personnel who was in contact with
the patients. The cause of the disease, presumably a virus, is not
known at this date.
- 20
february 2003. It is established that
the father of the child treated for H5N1 flu died of the same
disease. Although it is not yet established that this was
caused by the same avian strain, this is likely. Sporadic cases of
bird's flu in Hong Kong, including in wild birds, demonstrated that
there are foci of disease in the Mainland. This second identified
direct contamination from birds to humans in Fujian province
demonstrates that the disease must be taken extremely seriously.
Fortunately these recent cases do not appear to have been caused by
person-to-person contamination. The World Health Organisation is
tackling the matter, and considering what types of vaccines should be
prepared to be able to react immediately in case of epidemic. It is
also important to remember that such disease outbreaks spread from
places where birds are in large flocks (poultry farms and markets in
particular). The "atypical pneumonia" diagnosed recently in Guangdong
does not appear to be related to bird's flu: coincidence of infection
with pneumonia-like symptoms, perhaps caused by a variety of
pathogens, appears to have triggered the panic after personnel from
medical care institutions died. This type of disease is frequent in
winter, and the number of people dying from such diseases is always
significant.
- 19 february 2003.
A nine year old child is treated in Hong Kong for H5N1 influenza. No
link has been established with the epidemic that created panic in
Guangdong, but it is a matter of extreme concern, since this form of
flu, which affected Hong Kong in 1997 is significantly more dangerous
than the more common forms. Once again, elementary rules of hygiene
should be followed.
- 11
february 2003. An outbreak of "atypical
pneumonia" in Southern China led the
French General consulate in Guangzhou to close the French School in
the city, until more is understood about the disease. The rumor spread
that several tens or even hundreds of people have been contaminated,
with a high death toll. No reliable information is available at the
present time. It seems likely that the cause of the disease is a
virus, perhaps a new flu strain (but perhaps "ordinary" flu). This
fits the time of the year, and the possibility of hospital
contamination. One should also remember that flu is indeed a deadly,
albeit ordinary, disease... Usual rules of hygiene should be carefully
followed (washing hands frequently in particular) and people should
limit contacts with large concentrations of people. One should avoid
travelling, to limit the spread of the disease. Also, remember that
panic is one of the most efficient way to spread diseases.
- 8 february 2003. An
outbreak of Ebola fever is spreading in Congo, at the border
with Gabon at a place close where it was declared one year ago.
- 18 january 2003. Work
at the Institut Pasteur and de Madagascar results in the creation of
a fast test for diagnosing plague. Paper
strips are used to detect the presence of the plague agent, Yersinia
pestis (discovered by Alexandre Yersin in Hong Kong more than
one century ago). The goverment of Madagascar provides a supply to its
local health centers to identify the disease, which is still endemic
in the island.
- 15 december 2002-21 january 2003. The
flu virus H5 reappears in Hong Kong. It is
most likely that it is not confined to Hong Kong itself, but is
present in the region. This time, it was first identified in
waterfowls, before being found in dead chicken at several market
places. Open markets are closed for cleaning on New Year's eve.
- 7 october 2002. The
Nobel Academy has awarded the Nobel Prize to work on Caenorhabditis
elegans. This is an
important lesson for those who still do not understand that discovery
cannot be planned. Work on the nematode worm C.
elegans allowed discovery of programmed cell death (apoptosis).
This "suicide" of cells is universal. It is of major importance for
the construction of animals, and plays a fundamental role in cancer.
This discovery is the result of purely academic research, as are all
the processes at the root of genetic engineering...
- 6 october 2002. A
new serotype (type 2) of Dengue fever is identified in Hong
Kong. Fortunately, the cooling of the atmosphere, associated to dry
conditions will prevent the epidemic to spread.
- 2 october 2002. Dengue
fever is spreading in Hong Kong. Several
cases of Dengue fever type 1 have been diagnosed since july, raising
concern about a possible epidemic.
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