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<JUST FACTS ABOUT SARS

WHAT YOU NEED TO KNOW:
Just the Facts


What you need to know about SARS

By Alice Park


Posted Sunday, April 27, 2003; 2:31 p.m. EST

What It Is
SARS (severe acute respiratory syndrome) is a respiratory illness that primarily affects the lungs but may also involve the digestive tract.

The Symptoms
In the first phase, patients get a fever of 100.4°F or more, with chills, headache and muscle aches. Within a week, most develop a dry cough and difficulty in breathing; about 10% to 20% require a ventilator. Some also get severe diarrhea.

The Cause
Scientists have identified a previously unknown virus in the coronavirus family as the primary cause of SARS. Coronaviruses often infect animals and until now caused only mild illness in people. It may turn out, however, that SARS results from simultaneous infection by several microbes.

How It Spreads
The most common route is direct person-to-person contact. Unlike influenza or tuberculosis, SARS is transmitted not through the air but most likely by droplets spread when an infected person coughs or sneezes. Doctors don't know how long an infected person remains contagious.

Treatments
There is still no cure. Patients are given supportive care for their symptoms, such as ventilators to aid breathing and fluids to prevent dehydration. Some researchers are searching for drugs that would block coronavirus infections; others are trying to develop a vaccine. Scientists have already sequenced the entire genome of the coronavirus, a major step in developing better treatments.

How to Protect Yourself
Doctors and nurses caring for SARS patients should take proper safety precautions and wear masks, gloves and gowns. Washing hands regularly is a good idea. It doesn't hurt to wear a mask in regions where there are large numbers of cases, such as Beijing, Hong Kong, Singapore and Toronto. Coronaviruses can survive for as long as 24 hours on surfaces, so remove and dispose of your mask carefully.

Article printed in Time Magazine.
Most SARS Super-spreaders are Elderly

by Robert J. Saiget, AFP


May 12, 2003 — The make up of extremely infectious patients of the SARS virus, known as "super-spreaders," is becoming clearer, with many appearing to be the elderly or those already suffering medical ailments, a World Health Organization official said Monday.

"Super spreaders" of Severe Acute Respiratory Syndrome are a handful of carriers who have infected 10 or more people, often family members and medical workers treating them. They are seen as a key link in the transmission of the respiratory disease.

"We are getting more and more information on 'super spreaders' and it appears that they are mainly elderly people who have already been immunologically compromised," Mangai Balasegaram, a WHO spokeswoman in Beijing told AFP.

The "viral load," or the concentration of the virus in the carrier, has appeared to be higher in elderly people, especially if they are already afflicted by some other ailment, like diabetes or kidney problems, she said.

"A high viral load has appeared to make these people more infectious ..., it is also more detrimental to the health of these people," she added.

Last week, the WHO raised its estimate of the SARS fatality rate to about 15 percent - and higher in the elderly, where it can be fatal to over 50 percent of those aged 60 or more.

A 72-year-old Beijing man is believed to be the "super spreader" that led to SARS taking hold in northern China, including Beijing, Inner Mongolia and possibly in subsequent epidemics in neighboring Tianjin and Hebei province.

The man got SARS after visiting his niece in a Hong Kong hospital in March and spread it to nine Hong Kong tourists, three Taiwanese businessmen, a Singaporean woman, two Chinese government officials and two stewardesses, on a March 15, CA 112 flight.

He then infected a whole group of Beijing medical workers as he was transferred to three different hospitals before he died on March 20, according to SARS infection tracing data compiled by China's Center for Disease Control and Prevention and given to the WHO.

The two stewardesses eventually came down with SARS, but were only diagnosed after they returned to their homes in Inner Mongolia, where they have been linked to many of the 288 SARS cases there.

An 82-year-old woman has been identified as the main source of infection of more than 50 SARS cases in Beijing's east, the hardest hit area of the capital that has been reeling from the disease with 2,304 cases and 129 deaths.

The women, named Li Jiecui, had spent two months in Hong Kong prior to being hospitalized at the Dongzhimen hospital on March 21, where she died.

The hospital has been quarantined for weeks.

A 64-year old Chinese doctor named Liu Jianlun, Hong Kong's first recorded and most famous SARS case, is believed to have infected 13 guests at Hong Kong's Metropole Hotel in late February and was seen as the "index case" of what eventually became a global epidemic.

Those 13 guests went on to infect people in Vietnam, Singapore, Germany, Canada and Hong Kong, according to the Center for Disease Control in the United States.

Liu was from China's southern Guangdong province where SARS was first discovered in November. He died in a Hong Kong hospital on February 23.

Not all of the super-spreaders have been elderly though.

The man who caused the SARS cluster that spread to over 300 people in the Hong Kong apartment complex, Amoy Gardens, in late March was only 33, but was being given drugs for a kidney disease that had suppressed his immune system, Balasegaram said.

Afflicted with diarrhea, a known SARS symptom, the man apparently transmitted the disease through the sewage system of the apartment complex.

A 26-year-old stewardess infected more than 100 people in Singapore, including her parents who both succumbed to the disease.

And in another Hong Kong cluster, a 26-year-old Chinese man gave the disease to 112 doctors, nurses and medical students in a local hospital.


The threat of SARS: Responsibility, not panic, is the answer By Alexander Ackley, Jr., M.D. , Chairman, Infection Control Committee, The Medical Center at Princeton 05/29/2003

"When a new disease such as SARS emerges and poses a threat to the global population, it is important to learn the facts as they become available, to follow all recommended precautions, and to remain calm."

SARS (Severe Acute Respiratory Syndrome) is a serious, contagious disease that can be deadly. It also has the potential to cause costly disruptions of daily life in any place in which it gains a foothold.
In my opinion, it is not prudent to attempt to minimize or soften the facts. The SARS mortality rate in Toronto is 10 percent despite first-rate medical facilities and care. In Hong Kong, the populace is mostly masked and fearful; schools have been closed; hotel occupancy is 5 percent, and many businesses are threatened with bankruptcy.
Therefore it is incumbent upon all citizens — not just our civic officials, university administrators and business leaders, but all of us — to take attentive personal responsibility and follow all pertinent recommendations from public health authorities to try and assure that this infection does not even enter our communities.
When a new disease such as SARS emerges and poses a threat to the global population, it is important to learn the facts as they become available, to follow all recommended precautions, and to remain calm.
The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) continue to intensively investigate the epidemiology of SARS and have made a number of recommendations to the public. Their recommendations and those from state, local and school district officials have been essential for those living and working in Mercer County, which has several colleges and universities, a seminary and dozens of international companies each with possible international travelers.
The disease, which first surfaced in China in November, has now spread to 27 countries around the world, including countries in Europe and North America. At least 5,000 cases are reported worldwide, with a 6 percent mortality rate.
As of April 26, there have been approximately 50 probable and 220 suspected SARS cases reported in the United States, including five in New Jersey, but there have been no deaths. Mortality is highest among the elderly and those with chronic diseases, but even young, healthy adults have succumbed. Fortunately, children under 15 years old who have contracted SARS have recovered.
At this time, there is no indication that the United States is experiencing any community spread of SARS.
In a collaborative international effort, scientists at the CDC and other laboratories have identified and sequenced the genome of a previously unrecognized coronavirus as the prime suspect cause of SARS. Coronaviruses, of which there are a number of known human and animal species, are best known as a cause of the common cold.
The identification of a new coronavirus as the most likely cause of SARS means that scientists can now concentrate on developing specific diagnostic tests, antiviral treatments and perhaps a preventive vaccine, although historically it has taken years to produce an effective vaccine for any infection.
In most cases, SARS is spread by close person-to-person contact.
The majority of SARS cases have involved people who cared for or lived with someone with SARS, or those who have had direct contact with infectious material, such as respiratory secretions, from a person who has it. If someone who has SARS coughs or sneezes droplets onto themselves, others, or surface areas, this poses a contagious threat. If you touch the skin or other objects that are contaminated with infectious droplets and then touch your eyes, nose or mouth, you run the risk of developing SARS.
It is also possible that in some instances highly "super-infectious" individuals spread SARS more broadly through the air or by other means that are not yet identified.
The symptoms of SARS are very similar to those associated with the flu. SARS begins with a fever greater than 100.4 degrees. In addition, headache, an overall feeling of malaise and body aches are common. Some people also experience mild respiratory and gastrointestinal symptoms. After two to seven days, they may develop a dry cough and have trouble breathing. Some patients advance into a severe and unusually protracted course of pneumonia from which they eventually recover or occasionally die.
If you think you may have SARS, call your doctor before you visit the office or call in advance before going to an emergency room. To help your doctor make the diagnosis, report if you have recently traveled to China, Hong Kong, Singapore or Toronto, or if you have been in contact with someone who has the symptoms (fever accompanied by a cough and/or difficulty breathing), especially if that person has traveled anywhere recently.
To help contain the spread of SARS, those who may be infected must severely limit outside interactions and should not go to work, school or other public areas until told to do so by a doctor or public health authority.
Information currently available indicates that people are most likely to be infectious when they have symptoms, such as fever or cough. However, the length of time before or after symptoms appear that SARS patients might be able to transmit the disease to others is unknown. For the duration of the illness, be vigilant about taking the recommended infection control precautions, which are described below.
If you are a family member living with someone suspected of or possibly exposed to SARS, the CDC recommends that you contact your local health department and take the following infection control procedures:
• Wash your hands frequently with soap and water or use alcohol-based hand rubs, particularly after contact with body fluids (e.g., respiratory secretions, urine, or feces).
• Use disposable gloves when coming into direct contact with the patient or objects that the patient has come in contact with. Immediately after use, dispose of these gloves and wash hands thoroughly.
• Use surgical masks to limit the spread of infectious droplets (this applies both to patients and those coming in contact with patients).
• Avoid sharing eating utensils, towels and bedding.
• Clean possibly contaminated surfaces frequently with a household disinfectant.
At the present time, the CDC advises that people planning any nonessential travel to mainland China and Hong Kong, Singapore, and Hanoi, Vietnam, should postpone their trips until further notice. The CDC also has a separate travel alert with specific recommendations for travel to Toronto and elsewhere in Ontario, Canada. The WHO has advised the public not to go to Toronto; it is on the same list as Hong Kong.
For more SARS information, visit the CDC Web site at www.cdc.gov/ncidod/sars/or call the CDC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Espa?±ol).
The newspapers and TV news stations have also been reporting very up-to-date and accurate information, but you need to check the news almost every day as the situation has been evolving rapidly. Share your knowledge with family and friends.

Dr. Alexander Ackley, Jr., is the hospital epidemiologist and chairman of the Infection Control Committee at The Medical Center at Princeton. This article was prepared in collaboration with Lorraine Seabrook.

©PACKETONLINE News Classifieds Entertainment Business - Princeton and Central New Jersey 2003

THE TRUTH ABOUT SARS Time Magazine article reprinted

It's deadly, infectious and not going away. What we've learned about the virus and how scared we should be

By Michael D. Lemonick and Alice Park


Posted Sunday, April 27, 2003; 2:31 p.m. EST

So far, the U.S. has been lucky. It has been nearly six months since the SARS outbreak emerged and more than six weeks since the illness spread from its birthplace in southern China to put the world on alert. Yet with more than 4,800 cases in at least 26 countries to date, a disease that has rocked Asian markets, ruined the tourist trade of an entire region, nearly bankrupted airlines and spread panic through some of the world's largest countries has largely passed the U.S. by.
Hospitals and schools were shut down last week in Beijing, thousands of people were put under quarantine, and rumors flew through the capital that martial law was about to be imposed. But in the U.S., only about 40 people are believed to have severe acute respiratory syndrome, or SARS. The number of cases doesn't seem to be growing, and¡ªmost reassuring of all¡ªas of last Saturday, not a single victim had died.

But if Americans think that they have dodged the biological bullet, they had better think again. As the truth about SARS comes out¡ªslowly, due in large part to government cover-ups in the land of its birth¡ªit is becoming clear that what is taking place in Asia threatens the entire world. Epidemiologists have long worried about a highly contagious, fatal disease that could spread quickly around the globe, and SARS might end up confirming their worst fears. Microbes can go wherever jet airliners do these days, so it is a very real possibility that the disease has not yet shown its full fury. "We don't know the reason that we've been lucky so far," says Dr. Julie Gerberding, director of the U.S. Centers for Disease Control (CDC), "but we're not taking any chances."

Americans should not count on their sophisticated health-care system to protect them. China may be relatively backward, but Hong Kong, with a modern medical system, has experienced about as many deaths as have been reported in the rest of China put together. And only a few hours' drive from Buffalo, N.Y., or Detroit, just across the Canadian border, a Western city that thought it had done just about everything possible to contain its outbreak keeps losing ground. A few weeks ago, Toronto believed that the epidemic was winding down. Now, with 20 deaths, it's the first place outside Asia to be put on a do-not-visit list issued by the World Health Organization (WHO)¡ªa public humiliation that infuriated Toronto residents. ("I've never been so angry in my whole life," declared Mayor Mel Lastman.) Beijing and Shanxi province also joined the list last week; Hong Kong and Guangdong province, where the outbreak began, have been on it for weeks.

With fewer than 300 known SARS deaths so far, the worldwide toll is tiny compared with, say, the 3 million people who died of AIDS last year. But if SARS continues to spread, its numbers could skyrocket. Its overall death rate of about 6% is far lower than that of AIDS, Ebola or malaria, but if enough people catch the illness, even a low rate could cause a catastrophe. The Spanish flu epidemic of 1918-19 had a death rate of less than 3%, but so many people became infected that it killed more than 20 million people in just 18 months. The financial toll, meanwhile, is already catastrophic. Economists predict that China and South Korea could each suffer some $2 billion in SARS-related losses in tourism, retail sales and productivity. Japan and Hong Kong stand to lose more than $1 billion apiece, and Taiwan and Singapore could lose nearly that much. In Canada, meanwhile, J.P. Morgan Securities Canada estimates that Toronto is losing $30 million a day. All told, says WHO, the global cost of SARS is approaching $30 billion.

And nobody can forecast how much worse it could get. The more victims there are, the greater the chance that SARS will spread¡ªand there may be a lot more cases in China than anyone realizes. It's hard to gather information in such a vast country under the best of circumstances, but the actions of Chinese officials have made the situation worse. In April the government finally grudgingly admitted that SARS is a problem and belatedly allowed in a WHO team to investigate. Soon doctors at Beijing hospitals began leaking word of a massive cover-up. The country's Health Minister and the mayor of Beijing were dismissed last week from their jobs and their Communist Party posts. Chinese officials have revised their numbers, but they are still not telling WHO about patterns of spread. "Right now," says Jeffrey McFarland, a member of the Beijing WHO team,"we're getting exactly the same information as the press."

CURBING THE SPREAD
Beyond that, the physical mechanism by which SARS is spread is still unclear. In mid-March, Hong Kong officials thought they knew how to control the epidemic. Since SARS seemed to require close contact with a victim, anyone suspected of infection was quarantined, and doctors and nurses were careful to wear protective clothing when dealing with patients. Then came Amoy Gardens. Clusters of cases began proliferating in the giant, 33-floor apartment towers in Hong Kong. Ultimately, more than 300 residents of the complex came down with SARS (at least 15 have died), even though many of them seemed to have had no direct contact with one another.

In fact, despite intensive research in labs all over the world, scientists still have more questions than answers about SARS and the coronavirus that causes it. So while teams from WHO are helping health workers on the front lines, other scientists are redoubling their efforts to understand SARS' natural history.

One mystery is where the disease came from. Coronaviruses have long been known to veterinary medicine because they routinely infect livestock, ducks and other domestic animals. In humans they had never caused anything worse than a cold, but this strain is clearly different. Given belated access to Chinese records just three weeks ago, WHO teams are looking carefully at the records of human cases. They also plan to conduct more detailed studies of unusual infections in animal populations. If they can find the animal hosts, they might be able to prevent new animal-to-human transmissions.

Meanwhile, top virologists in the U.S., Canada, Hong Kong, Germany and several other nations have linked up to create a sort of virtual research lab. Their goal: to understand the virus itself. They identified the SARS virus several weeks ago, and now they are trying to come up with diagnostic tests. That's crucial. Early SARS cases present the same fevers, muscle aches and diarrhea as flu victims, and without a way to distinguish between them, the public-health system could be quickly overwhelmed.

The virtual lab and independent biotech companies have already come up with several tests, but they are not yet reliable enough to be widely deployed. Canadian microbiologists reported last week that as many as 40% of their SARS patients did not test positive for coronavirus. That might be because their tests are not sufficiently sensitive or, even more worrisome, because the coronavirus has mutated enough to elude detection.

Yet another open question is precisely how the disease spreads. Doctors first concluded that the agent responsible for SARS is transmitted by droplets expelled by coughs or sneezes. After the burst of cases in Hong Kong's Amoy Gardens complex and the particularly aggressive spread of SARS in Toronto among health-care workers, however, scientists now speculate that there may be other mechanisms as well. In Amoy Gardens, for example, transmission may have occurred via contaminated fecal matter leaking from a broken sewage pipe. That would explain the lack of direct contact, as well as the fact that all these cases, unlike those in mainland China and Toronto, are characterized by severe diarrhea.

RAPID MUTATION

It may also be that the microbe has mutated into several subtly different strains producing different symptoms. This might explain some of the perplexing transmission patterns seen on planes: people sitting next to SARS victims did not always get infected, while those across the aisle sometimes did. Perhaps the latter had used a lavatory immediately after an affected passenger.

Multiple strains would not be surprising. This bug's genetic code is based on RNA, a single-stranded molecule very similar to DNA. Unlike DNA, however, RNA has no built-in proofreading mechanism to fix mistakes in the replication process. Most of these don't amount to anything, but every once in a while an error may make the microbe more infectious. Beyond that, says Dr. Robert Webster, chief of virology at St. Jude Children's Research Hospital in Memphis, Tenn., "when a virus comes across to a new host, what does a virus do? It varies like crazy."

In Toronto health-care officials are especially alarmed by the high number of SARS cases among health-care workers who had taken all the recommended precautions, including wearing gloves, masks and gowns and vigorously washing their hands. The problem there may have been fatigue and complacency in the changing room. CDC scientists reported last week that the virus can survive as long as 24 hours outside the body: doctors and nurses who touch their protective gear while changing into regular clothing may be unwittingly exposing themselves and others to the coronavirus.

Another factor scientists do not understand is the superspreader, a person who appears to pass the disease on with extraordinary efficiency. Part of the explanation may be in the individual's genetics. "We don't know what those genetic factors are yet," says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), "but they're not necessarily related to how sick the person is." Some experts suspect that superspreaders might have a more virulent strain of coronavirus or be co-infected with other microbes. Having multiple infections may, these scientists speculate, increase one's chance of passing on the disease.

The risk of death from SARS, meanwhile, may have less to do with a particular strain of the virus and more to do with the body's reaction to it. "The immunological and inflammatory response of the body," says Fauci, "could be contributing significantly to the damage in the lungs." But nailing that down, along with questions of whether survivors become immune to further infection and whether the disease is permanently with us, like AIDS, will take more research.

So will the search for a vaccine. The biotech company GenVec announced plans last week to collaborate with NIAID to insert portions of the coronavirus genome into a weakened cold virus. If the proteins generated by these snippets are powerful enough to trigger an effective immune response, then the resulting vaccine might be successful. NIAID is also coordinating separate U.S. government efforts to develop vaccine candidates. And the U.S. Army Medical Research Institute for Infectious Disease is screening thousands of compounds to see if any might slow or stop the disease.



With any luck, SARS won't hit the U.S. hard until some of these loose ends are tied up. Airlines have handed out more than 500,000 yellow health-alert cards from the CDC that tell passengers arriving from SARS-prevalent areas what symptoms to be alert for and whom their doctors can call; the CDC has also posted on its website detailed information for health-care workers.

But that may only put off the inevitable. While the U.S. is better equipped than most countries to detect and contain epidemics, it's pure luck that it has not been hit harder. So far, none of the handful of people who have carried the virus to the U.S. from Asia have been superspreaders. And health-care workers in the U.S. have not yet made any of the mistakes that tripped up the Canadians: a patient transferred from an affected hospital to an unaffected one, lax enforcement of isolation orders, hospital workers who may not have been vigilant enough with protective gear.

The more time that passes, the better the U.S. can learn from the experience of other countries. But as long as there are even small pockets of infection lingering anywhere in the world, an outbreak is always a threat. In a world as interconnected as ours, it may just be a matter of time before SARS strikes in the U.S. the way it has elsewhere. "It's too soon to count our chickens," says Fauci. "This is an evolving epidemic, and we need to take it very seriously."

¡ªReported by Steven Frank and Daffyd Roderick/Toronto, Matthew Forney/Guangzhou and Susan Jakes and Huang Yong/Beijing


LA VERDAD ACERCA DE SARS Cronometre art?­culo de Revista reimprimido

Es mortal, contagioso y no ir. Qu?© nosotros hemos aprendido acerca del virus y c?³mo espantado debemos estar Por Michael D. Lemonick y Parque de Alice Anunciaron el
domingo, el 27 de abril de 2003; 2:31 de la tarde. EST



Hasta ahora, los EE.UU. ha tenido suerte. Ha sido casi seis meses desde que el comienzo de SARS surgi?³ y m?¡s de seis semanas desde que la extensi?³n de la enfermedad de su lugar de nacimiento en China meridional para poner el mundo en la alarma. Todav?­a con m?¡s de 4,800 casos en por lo menos 26 pa?­ses para fechar, una enfermedad que ha mecido los mercados asi?¡ticos, arruin?³ el comercio de turista de una regi?³n entera, el p?¡nico casi hecho quebrar de lineas a?©reas y extensi?³n por parte del pa?­ses m?¡s grandes de mundo ha pasado en gran parte los EE.UU. por. Los hospitales y las escuelas fueron cerrados la semana pasada en Pek?­n, miles de gente fueron puestas bajo la cuarentena, y los rumores volaron por la capital que esa ley marcial estaba acerca de ser impuesto. Pero en los EE.UU., s?³lo acerca de 40 personas son cre?­dos tener s?­ndrome, o SARS respiratorio, agudo y severo. El n?ºmero de casos no parece estar creciendo, y¡ªla mayor?­a del alentar de todo¡ªal dura el s?¡bado, no una sola v?­ctima hab?­a muerto.



Pero si Americanos piensan que ellos han eludido la bala biol?³gica, ellos tuvieron piensa mejor otra vez. Cuando la verdad acerca de SARS sale¡ªlentamente, debido en la parte grande al encubrimiento del gobierno en la tierra de su nacimiento¡ªse aclara que lo que sucede en Asia amenaza el mundo entero. Los epidemi?³logos tienen se preocup?³ mucho tiempo por una enfermedad sumamente contagiosa y fatal que podr?­a esparcir r?¡pidamente alrededor del globo, y SARS quiz?¡s acabe por confirmar sus temores peores. Los microbios pueden ir dondequiera puede lanzar en chorro aviones comerciales hacen estos d?­as, as?­ que no es una posibilidad muy verdadera que la enfermedad tiene mas mostrada su furia repleta. "Nosotros no sabemos la raz?³n que hemos tenido suerte hasta ahora," dice Dr. Julie Gerberding, el director de los EE.UU. Los centros para el Control (CDC) de la Enfermedad, "pero nosotros no tomamos cualquiera acaece."



Los americanos no deben contar con su sistema sofisticado de asistencia sanitaria para protegerlos. China puede ser relativamente atrasada, pero Hong-Kong, con un sistema m?©dico moderno, ha experimentado acerca de como muchas muertes como se ha informado en el resto de China puso junto. Y s?³lo unos pocas campa?±a de horas del B?ºfalo, N. Y., o Detroit, apenas a trav?©s de la frontera canadiense, una ciudad Occidental que pens?³ lo hab?­a hecho casi igual todo posible para contener su comienzo mantiene el suelo que pierde. Hace algunos semanas, Toronto crey?³ que la epidemia enrollaba hacia abajo. Ahora, con 20 muertes, es el primer lugar Asia exterior de se ser puesta un hace no visita lista publicado por la Organizaci?³n (WHO)¡ªa de la Salud de Mundo la humillaci?³n p?ºblica que infureci?³ a residentes de Toronto. ("I've nunca estuvo tan enojado en mi vida entera," Alcalde declarado Mel Lastman.) Pek?­n y la provincia de Shanxi unieron tambi?©n la lista la semana pasada; Hong-Kong y la provincia de Guangdong, donde el comienzo comenz?³, han estado en lo por semanas.



Con menos que 300 muertes conocidas de SARS hasta ahora, el peaje mundial es diminuto comparado con, dice, los 3 millones de gente que murieron de AYUDAS el a?±o pasado. Pero si SARS contin?ºa esparcir, sus n?ºmeros pueden el cohete. Su mortalidad general de acerca de 6% es bajar distante que eso de AYUDAS, el ?©bola o la malaria, pero si suficiente persona agarra la enfermedad, a?ºn una tasa baja podr?­a causar una catastrofe. La epidemia espa?±ola de la gripe de 1918-19 tuvo un mortalidad de menos de 3%, pero as?­ que muchas personas llegaron a ser infect?³ que mat?³ m?¡s de 20 millona persona en apenas 18 meses. El peaje financiero, mientras tanto, es ya catastr?³fico. Los economistas predicen que China y Corea del sur pueden cada sufre unos $2 mil millones en p?©rdidas relacionadas de SARS en el turismo, las ventas al por menor y productividad. Jap?³n y el soporte de Hong-Kong para perder m?¡s de $1 mil millones cada uno, y Taiw?¡n y Singapur podr?­an perder casi ese tanto. En Canad?¡, mientras tanto, J. P. Las Seguridades de Morgan Canad?¡ estima ese Toronto pierde $30 mill?³n al d?­a. Todo dicho, dice QUIEN, el costo global de SARS se acerca $30 mil millones.



Y nadie puede pronosticar cu?¡nto peor podr?­a obtener. Las m?¡s v?­ctimas hay, la m?¡s grande la oportunidad que SARS esparcir?¡?¡?ªy puede haber mucho m?¡s embala en China que cualquiera se da cuenta. Deber?¡ reunir duramente informaci?³n en tal pa?­s vasto bajo el mejor de circunstancias, pero de las acciones de oficiales chinos han hecho la situaci?³n peor. En abril que el gobierno finalmente admiti?³ a rega?±adientes que SARS es un problema y atrasadamente permitido en un QUIEN equipo para investigar. Pronto doctores en hospitales de Pek?­n comenzaron palabra que se sale de un encubrimiento masivo. El Ministro de la Salud del pa?­s y el alcalde de Pek?­n fueron despedidos la semana pasada de sus trabajos y sus postes comunistas de Partido. Los oficiales chinos han revisado sus n?ºmeros, pero ellos todav?­a no dicen QUIEN acerca de pautas de la extensi?³n. "En este momento," dice Jeffrey McFarland, un miembro del Pek?­n QUE equipo, "we're que obtiene exactamente la misma informaci?³n como la prensa."



LIMITAR LA EXTENSION
M?¡s all?¡ de eso, el mecanismo f?­sico por cu?¡l SARS se esparce es todav?­a poco claro. En de marzo medio, los oficiales de Hong-Kong pensaron ellos supieron para c?³mo controlar la epidemia. Desde que SARS pareci?³ requerir el contacto cercano con una v?­ctima, cualquiera sospech?³ de la infecci?³n fue puesto en cuarentena, y los doctores y los enfermeros ten?­an cuidado para llevar la ropa protectora cuando tratar con pacientes. Entonces vino los Jardines de Amoy. Los grupos de casos comenzaron a proliferar en el gigante, torres de 33 pisos de apartamento en Hong-Kong. Ultimamente, m?¡s de 300 residentes del complejo se enfermaron de SARS (por lo menos 15 han muerto), aunque muchos de ellos parecieron haber tenido no contacto directo con el uno al otro.



De hecho, a pesar de investigaci?³n intensiva en laboratorios por todo el mundo, los cient?­ficos tienen todav?­a m?¡s preguntas que las respuestas acerca de SARS y el coronavirus que causa. Tan mientras los equipos de QUE ayudan a trabajadores de salud en las l?­neas anteriores, otros cient?­ficos redoblan sus esfuerzos de entender SARS' la historia natural.



Un misterio es donde la enfermedad vino de. Coronaviruses tiene fue mucho tiempo conocido a la medicina veterinaria porque ellos infectan rutinariamente ganado, los patos y otros animales dom?©sticos. En los humanos que ellos nunca hab?­an causado nada peor que un resfriado, pero este esfuerzo son claramente diferente. El acceso atrasado dado a registros chinos apenas hace tres semanas, QUIEN equipos miran detenidamente en los registros de casos humanos. Ellos planean tambi?©n conducir los estudios m?¡s detallados de infecciones excepcionales en poblaciones animales. Si ellos pueden encontrar a los anfitriones animales, ellos quiz?¡s sean capaces de prevenir animal nuevo a transmisiones humanas.



Mientras tanto, vir?³logos primeros en los EE.UU., Canad?¡, Hong-Kong, la Alemania y varias otras naciones han conectado para crear un tipo del laboratorio virtual de investigaci?³n. Su meta: entender el virus ?©l mismo. Ellos identificaron el virus de SARS hace varios semanas, y ahora ellos tratan de proponer las pruebas diagn?³sticas. Eso es crucial. Los casos tempranos de SARS presentan las mismas fiebre, dolores de m?ºsculo y diarrea como v?­ctimas de gripe, y sin una manera de distinguirse entre ellos, el sistema sanitario se podr?­a agobiar r?¡pidamente.



El laboratorio y las compa?±?­as virtual biotecnol?³gicas independientes han propuesto ya varias pruebas, pero ellos no son mas suficiente seguro ser desplegado extensamente. Los microbi?³logos canadienses informaron la semana pasada que tanto como 40% de sus pacientes de SARS no prob?³ positivo para el coronavirus. Eso quiz?¡s sea porque sus pruebas no son suficientemente sensible ni, a?ºn m?¡s inquietante, porque el coronavirus ha mutado suficiente en eludir el descubrimiento.



Mas otra pregunta abierta es precisamente c?³mo las extensiones de la enfermedad. Los doctores concluyeron primero que el agente responsable de SARS es transmitido por gotitas expulsadas por toses o estornudos. Despu?©s que el chorro de casos en el complejo de Jardines de Hong-Kong Amoy y la extensi?³n especialmente agresiva de SARS en el Toronto entre trabajadores de asistencia sanitaria, sin embargo, los cient?­ficos ahora especulan eso puede haber otros mecanismos tambi?©n. En Jardines de Amoy, por ejemplo, la transmisi?³n puede haber ocurrido puede haber contaminado v?­a salir fecal de cuesti?³n de un tubo roto del agua residual. Eso explicar?­a la falta del contacto directo, as?­ como el hecho que todo estos casos, a diferencia de ?©sos en el continente China y Toronto, son caracterizados por diarrea severa.
MUTACION RAPIDA



Puede ser tambi?©n que el microbio ha mutado en varios esfuerzos sutilmente diferentes los s?­ntomas diferentes que producen. Esto quiz?¡s explique parte del transmisi?³n que desconceieta modela visto en aviones: sentar de gente luego a v?­ctimas de SARS no siempre obtuvo infectado, mientras ?©sos a trav?©s del pasillo hicieron a veces. Quiz?¡s el ?ºltimo hab?­a utilizado un retrete inmediatamente despu?©s de un pasajero afectado.



Los esfuerzos del m?ºltiplo no estar?­an sorprendiendo. Este c?³digo gen?©tico del bicho se basa en RNA, un solo desamparar mol?©cula muy semejante al ADN. El ADN desemejante, sin embargo, RNA tiene no mecanismo incorporado que corrige para fijar los errores en el proceso de r?©plica. La mayor parte de estos no asciende a nada, pero de vez en cuando un error puede hacer el microbio m?¡s contagioso. M?¡s all?¡ de eso, dice Dr. Robert Webster, el jefe de virolog?­a en S. ¿El Hospital de Investigaci?³n de Ni?±os de Jude en Memphis, Tenn., "cuando un virus se encuentra con a un anfitri?³n nuevo, qu?© un virus hace? Var?­a como loco."



En oficiales de asistencia sanitaria de Toronto son alarmados especialmente por el n?ºmero alto de casos de SARS entre trabajadores de asistencia sanitaria que hab?­an tomado todas las precauciones recomendadas, inclusive llevar guantes, las m?¡scaras y las batas y vigorosamente lavar las manos. El problema puede haber habido la fatiga y la satisfacci?³n en el espacio cambiante. Los cient?­ficos de CDC informados la semana pasada que el virus puede sobrevivir tan largo como 24 horas fuera del cuerpo: doctores y enfermeros que tocan su engranaje protector mientras cambiante en la ropa regular puede estar exponiendo a s?­ mismo sin querer y los otros al coronavirus.



Otro cient?­ficos del factor no entienden es el superspreader, una persona que aparece de pasar la enfermedad en con la eficiencia extraordinaria. La parte de la explicaci?³n puede estar en la gen?©tica del individuo. "Nosotros no sabemos lo que esos factores gen?©ticos son todav?­a," dice Dr. Anthony Fauci, el director del Instituto Nacional de Alergia y Enfermedades (NIAID) Contagiosas, "pero ellos no son estados necesariamente relacionado con cu?¡n enferma la persona es." Alg?ºn sospechoso de peritos que ese superspreaders quiz?¡s tenga un esfuerzo m?¡s virulento de coronavirus o sea co infectado con otros microbios. Tener m?ºltiples infecciones pueden, estos cient?­ficos especulan, aumentan una oportunidad de pasajero en la enfermedad.



El riesgo de la muerte de SARS, mientras tanto, tendr?¡ que hacer menos con cierto esfuerzo del virus y m?¡s hacer con la reacci?³n del cuerpo a. "La respuesta inmunol?³gica e incitante del cuerpo," dice Fauci, "podr?­a estar contribuyendo apreciablemente al da?±o en los pulmones." Pero clavar eso hacia abajo, junto con preguntas de si sobrevivientes llegan a ser inmunes a la infecci?³n adicional y si la enfermedad es permanentemente con nosotros, como AYUDAS, tomar?¡ m?¡s investigaci?³n.



Tan haga la b?ºsqueda para una vacuna. La compa?±?­a biotecnol?³gica GenVec anunci?³ los planes para colaborar la semana pasada con NIAID para meter las porciones del genoma de coronavirus en un virus fr?­o debilitado. Si las prote?­nas engendradas por estos recortes son suficiente poderosas provocar una respuesta inmune efectiva, entonces la vacuna resultante tiene ?©xito. NIAID coordina tambi?©n los esfuerzos separados del gobierno de EE.UU. para desarrollar vacuna candidatos. Y los EE.UU. El ej?©rcito el Instituto M?©dico de Investigaci?³n para la Enfermedad Contagiosa selecciona miles de recintos para ver si cualquiera quiz?¡s afloje o quiz?¡s pare la enfermedad.







Con cualquier suerte, SARS no golpear?¡ los EE.UU. duramente hasta que algunos de estos detalles ser?¡n atados. Las lineas a?©reas han repartido tarjetas alertas de salud m?¡s de 500,000 amarillas del CDC que dice a pasajeros que llegan de ?¡reas predominantes de SARS lo que s?­ntomas para ser la alarma para y para quien sus doctores pueden llamar; el CDC ha anunciado tambi?©n en su sitio web informaci?³n detallada para trabajadores de asistencia sanitaria.



Pero eso puede s?³lo posterg?³ el inevitable. Mientras los EE.UU. se equipan mejor que la mayor?­a de los pa?­ses para discernir y contener las epidemias, son pura suerte que lo no se ha golpeado m?¡s duro. Hasta ahora, ninguna de la pu?±ado de gente que ha llevado el virus a los EE.UU. de Asia ha sido superspreaders. Y trabajadores de asistencia sanitaria en los EE.UU. tienen no mas hicieron cualquiera de los errores que tropezaron arriba los Canadienses: un paciente transferido de un hospital afectado a un no afectado uno, la aplicaci?³n floja de ?³rdenes de aislamiento, trabajadores de hospital que no pueden haber sido suficiente vigilantes con engranaje protector.



El m?¡s tiempo que pasa, los mejores los EE.UU. pueden aprender de la experiencia de otros pa?­ses. Pero tan largo como hay los bolsillos a?ºn peque?±os de demorar de infecci?³n dondequiera en el mundo, un comienzo es siempre una amenaza. En un mundo tan interconexionado como nuestro, acaba de ser una cuesti?³n de tiempo antes huelgas de SARS en los EE.UU. la manera que lo tiene en otra parte. "Es demasiado pronto contar nuestros pollos," dice Fauci. "Esto es una epidemia que evoluciona, y necesitan tomarlo muy gravemente."



¡ªInformado por Steven Franco y Daffyd Roderick/Toronto, Matthew Forney/Guangzhou y Susan Jakes y Huang Yong/Pek?­n

WARNING From National Gardening Association/
Are YOU Prepared for Accidental Poisonings?
By Barbara Martin - Mid-Atlantic - June 12 to 26, 2003

In 2001, poison centers received more than 90,000 calls regarding exposure to pesticides -- more than half of them involving children under age six. Please keep gardening chemicals in their original labeled containers and under lock and key, safely out of the reach of children and pets. And keep this number posted by your phone: 1-800-222-1222. Go put it there now. This Poison Control Center Web site has good information:

http://www.1-800-222-1222.info/


¿Advertir de la Horticultura Nacional Assciation Es USTED Prepar?³ para Venenos Accidentales? Por Barbara Martin - mezcla de Brit?¡nico y
Norteamericano - junio 12 a 26, 2003



En 2001, el veneno centra recibido m?¡s de 90,000 llamadas con respecto a la exposici?³n a pesticidas -m?¡s que la mitad de ellos menor de edad de ni?±os que implica seis. Mantenga por favor sustancias qu?­micas de horticultura en su original contenedores marcados y cerrado con candado, seguramente fuera del alcance de ni?±os y animales favoritos. Y mantiene este n?ºmero anunciado por su tel?©fono: 1-800-222-1222. Vaya p?³ngalo all?­ ahora. Este Control del Veneno sitio web Central tiene informaci?³n buena:



el http: //www.1-800-222-1222.info/