Thoughts, Dreams, and Emotions…

Coronavirus Confirmed as SARS Agent
Laurie Barclay, MD
April 9, 2003 � Within just two months, investigators have found what may be the causative agent of severe acute respiratory syndrome (SARS), according to a report published online April 8 by The Lancet. A coronavirus that has never been described before was isolated from two patients and then confirmed through polymerase chain reaction (PCR) in 45 of 50 patients but in no controls. According to the commentators, the progress is truly “remarkable and unprecedented.” A separate article in The Lancet also provides guidelines for management.
“This report provides evidence that a virus in the coronavirus family is the etiological agent of SARS,” lead author Malik Peiris, from the University of Hong Kong, says in a news release. “However, it remains possible that other viruses act as opportunistic secondary invaders to enhance the disease progression, a hypothesis that needs to be investigated further.”
The Hong Kong University SARS Study Group reviewed records and microbiological findings for 50 patients with SARS, representing more than five separate epidemiologically linked transmission clusters, and ranging in age from 23 to 74 years. Evaluation included chest radiography and double-blinded laboratory testing of nasopharyngeal aspirates and serum samples.
The most frequent symptoms were fever, chills, myalgia, and cough. Fewer than 25% of patients had upper respiratory tract symptoms, but 10% had gastrointestinal symptoms. Respiratory symptoms and auscultatory findings were milder than would be expected from chest x-ray findings.
Predictors of severity were household contact with other infected individuals, older age, lymphopenia, and liver dysfunction. In two patients, a virus belonging to the family Coronaviridae was isolated. Serological and reverse-transcriptase PCR specific for this virus was positive in 45 of 50 patients with SARS, but in no controls. Of 32 patients from whom acute and convalescent sera were available, all had rising antibody titers to this coronavirus.
Because this virus is not one of the two known human coronaviruses, nor is it exactly like any of the known animal coronaviruses, the investigators believe that it may be a new virus which may have originated from animals. Additional genetic analysis may confirm this hypothesis.
“The high incidence of altered liver function, leukopenia, severe lymphopenia, thrombocytopenia, and subsequent evolution into adult respiratory distress syndrome suggests a severe systemic inflammatory damage induced by this human pneumonia-associated coronavirus,” they write. “Thus immunomodulation by steroid treatment may be important to complement the empirical antiviral treatment with ribavirin.”
They describe a “window of opportunity” of around eight days from symptom onset to respiratory failure, and they note that severe complicated cases are associated with underlying disease and delayed use of ribavirin and steroid treatment. The epidemiologic data suggest that spread is by droplets or by direct and indirect contact, although airborne spread and fecal-oral transmission cannot be ruled out.
“These findings significantly strengthen the tentative etiological association reported by other investigators who have also isolated a novel coronavirus from patients with SARS,” Ann Falsey and Edward Walsh, from the University of Rochester in New York, write in an accompanying commentary. “As other pathogens, such as human metapneumovirus and Chlamydia spp, are identified in SARS patients, it will be important to use control groups to determine their role in causality or as cofactors for severe disease.”
They note that nearly 40% of the patients developed respiratory failure requiring assisted ventilation, and that the lack of untreated control patients prevents definite conclusions about the efficacy of treatment.
In a second commentary, William Ho, from the Hospital Authority Building in Kowloon, Hong Kong, reports that the first index case in Hong Kong was admitted on Feb. 22, 2003. As of April 6, 842 cases with 22 deaths were identified in Hong Kong. The Hospital Authority of Hong Kong and the Department of Health have implemented public health measures and hospital policies for diagnosis and management of patients with SARS, which are available online at http://www.ha.org.hk.
Algorithms consider whether a suspected case has had close or social contact with a patient with SARS, whether there are classic symptoms of fever, cough, and shortness of breath, and whether chest x-ray reveals a new pulmonary infiltrate. Management may consist of outpatient monitoring or admission to hospital or designated medical center.
Source: Medscape.com

SARS Not a Disease of Asians
April 08, 2003 4:28 p.m. ET
WASHINGTON (Reuters) – As Chinese-Canadians complained they were being victimized for the spread of the respiratory illness SARS, a top U.S. health official said on Tuesday it is not a disease unique to Asians. Dr. Julie Gerberding, head of the U.S. Centers for Disease Control and Prevention, warned against such discrimination. She also said U.S. authorities were so far controlling any threat of an epidemic here in the United States. But in China, doctors said the government was under-reporting the number of cases and said many hospital wards were full.Hong Kong doctors also published some of the first journal reports on SARS that give clues about why some patients die and others do not.
At least 103 people have died worldwide from SARS and 2,750 have been infected in about 20 countries — nearly half of them in China. Doctors believe the epidemic began in China’s southern Guangdong province in November. The older the patient, the more likely they are to die of SARS, Dr. Joseph Sung and colleagues in the medical team at Hong Kong’s Prince of Wales Hospital reported in a study published by the New England Journal of Medicine. Those who died also had high levels of an enzyme suggesting lung damage called lactate dehydrogenase, the team reported. In addition, patients who died had high levels of immune cells called neutrophils, which the body releases to fight invading bacteria or viruses. Although all five patients who died in Sung’s study had some other illness, such as congestive heart failure, liver cirrhosis or hepatitis, being ill with something besides SARS did not put patients at special risk of dying, they reported.
Canada is one of the countries hardest hit by SARS, with some 226 people infected and 10 reported deaths. The virus was carried to Canada by people flying on airliners from Asia.

WORKERS QUARANTINED
Thousands of Canadians, many of them health care workers, have been quarantined in their homes, while others are wearing masks to work for fear that they might have been exposed to the virus and might infect others. Chinese-Canadians said they were being treated like monsters. Ming Tat Cheung, president of Toronto’s Chinese Cultural Center, said shoppers were staying away from normally bustling Chinatown, and sales were down by up to 70 percent. “We have people calling here saying that Canadians are telling them ‘You dirty Chinese, you eat everything, that’s why you bring diseases’,” Cheung told Reuters. “Chinese Canadians are the victims, not the instigators.” Gerberding said such reactions were illogical. “This is not an illness of Asians,” Gerberding told a U.S. Senate hearing. “This is an illness of people in a particular part of the world where the virus is spreading.” But one Toronto cab driver said he was not picking up passengers from hospitals or from the Chinatown area. “It’s not racism — it’s a precaution. I have to protect my family,” said the cab driver, who refused to give his name.
In China’s Guangdong province, officials said the rate of new infections was down sharply and the outbreak was under control. At least three more people died in Beijing from SARS than officially reported, doctors in the Chinese capital said on Tuesday, as fears spread and hospitals disclosed suspected cases not previously revealed.

HOSPITAL INUNDATED
“It’s impossible there are only 19 SARS cases in Beijing,” said a doctor at the Beijing University No. 1 Hospital. “There are no beds left in our epidemic ward.” Beijing has reported 19 cases and four deaths out of 1,279 infections and 53 deaths nationwide, most of them in Guangdong, where the virus first appeared last November.
More than 40 people in Hong Kong’s Ngau Tau Kok district in Kowloon and Tuen Mun in the New Territories caught the disease in the last 10 days, said a health department spokesman and a district lawmaker in Tuen Mun, raising fears it is far from contained.
Two more deaths and 45 new infections were reported on Tuesday in Hong Kong, where the disease has already killed 25 people.
Deputy Director of Health Leung Pak-yin told a radio program cockroaches might have carried infected waste from sewage pipes into apartments in a huge housing complex, Amoy Gardens, which has had a quarter of the city’s 928 infections.
CDC officials had no immediate comment on such reports. Gerberding told the Senate appropriations committee hearing that the CDC had enough resources to deal with SARS. She said the CDC was meeting with the airline industry to help find ways to prevent SARS from spreading even more.
Source: Reuters

SARS Death Toll Hits 100
April 7, 2003 09:45 p.m. EST
(CBS) China disclosed Monday that a deadly respiratory illness had struck in more of its provinces than previously reported, while experts in the south looked into whether the disease came from animals on farms or in the wild. The worldwide death toll reached 100.
In nearby Hong Kong, officials said they were preparing for a worst-case scenario of 3,000 cases of severe acute respiratory syndrome, or SARS, amid fears its health system could be stretched beyond its limits. There are 700 cases there and officials say its hospitals can currently handle 1,500 cases.
On Monday, Hong Kong health officials announced that a 78-year-old woman had died � the 100th death reported in Asia and North America. More than 2,300 people have been sickened worldwide. China and Canada both reported one new fatality in the last day, and two deaths were reported Monday in Singapore.
Canada’s ninth death occurred April 1 at a Toronto hospital, but was only confirmed as SARS on Sunday. The victim initially was given a different cause of death but officials took another look at the case when a relative was found to be a possible SARS victim, officials said Sunday.
In the interim, reports Chris Mavrides of CBS Radio affiliate CFRB-AM, the victim’s family has contracted the illness and may have spread it to others.
“We’re not yet out of the woods,” Dr. Colin D’Cunha, the Ontario chief medical officer of health, said. Like most of the other Canadian cases, this one has a link to a particular Toronto hospital, said D’Cunha: Scarborough Grace Hospital east of Toronto, which has now been declared the “hot zone” for the disease. Canada has 170 cases of SARS, all in Toronto.
China and Hong have been the hardest hit by SARS, with 53 and 23 deaths respectively in each nation. Symptoms include high fever, aches, dry cough and shortness of breath. No cure has been found.
Also Monday, the Beijing office of the Geneva-based International Labor Organization was sealed, and an employee of the diplomatic office building said it was disinfected after a Finnish official of the agency fell ill with severe acute respiratory syndrome, or SARS, in Beijing. The official died Sunday. Chinese officials had reported 43 SARS deaths in the southern province of Guangdong, where experts suspect the illness originated, with fatalities also coming in Beijing and the Guangxi region.
On Monday, Chinese state television reported that there were also one SARS death each in the provinces of Shanxi in the north, Sichuan in the west and Hunan in central China � the first fatalities in those areas and an indication the disease was more widespread geographically than previously acknowledged. The new disclosures come after mounting criticism at home and abroad that China’s communist government was too slow to release information about SARS.
In New Delhi, World Health Organization director-general Gro Harlem Brundt said Sunday that “it would have been much better if the Chinese government had been more open in the early stages.”
Meanwhile, World Health Organization experts who are searching Guangdong for clues to how SARS spreads and why it kills were looking into whether it might have come from animals. The team hasn’t yet found clear evidence to support that widely discussed possibility, but its members met with local animal-health officials and discussed both farm animals and wildlife, including pigs, ducks, bats, rodents, chickens and other birds, said team leader, Dr. Robert Breiman. Experts have linked SARS to a new form of coronavirus, other forms of which usually are found in animals. That link “may suggest that it originates from animals,” Breiman said. However, he said, “the discussions today were inconclusive, so we really don’t have clues.”
The team, in Guangdong since Thursday, also is meeting with doctors and scientists, visiting hospitals and reviewing medical records.
On Sunday, the Health Ministry reported six additional SARS deaths that raised China’s death toll to 52. That included Pekka Aro, the 53-year-old International Labor Organization official who died Sunday in a Beijing hospital, but the ministry didn’t give any details about the other deaths. The ILO office was closed Monday and smelled of disinfectant. A woman at the front desk of the diplomatic office building said government health workers started cleaning it Friday after the Finnish official was confirmed to have SARS.
The visa office of the New Zealand Embassy, located in the same building, was closed Monday as a precaution, said a New Zealand diplomat, Moana George. She said the embassy was discussing with the building management how to ensure any possible infection wouldn’t spread through the building.
Also Monday, the Straits Times newspaper in Singapore reported that Prime Minister Goh Chok Tong has called off an official trip to Beijing this week on the advice of his doctors. The report said Goh was going ahead with a visit to India that began Monday.
Meanwhile, Vietnamese officials said they were considering barring visitors from countries with the mysterious flu-like disease.
Japan reported six new possible cases and ordered local authorities to draw up emergency plans for coping with the outbreak.
Source: CBSnews.com

More deaths in Asia linked to SARS
April 5, 2003 12:49 p.m. EST
SINGAPORE — Hong Kong and Malaysia reported new deaths from a mystery illness Saturday, bringing the global death toll to at least 89, while China vowed to share more information on the disease that apparently started in one of its southern provinces.
Hong Kong reported three new deaths and said the number of its people infected with severe acute respiratory syndrome, or SARS, had risen to 800 – accounting for more than a third of the world’s more than 2,300 cases. The disease has killed 20 in the territory.
President Bush followed the lead of governments in Asia and Canada by giving American health authorities the power to quarantine anyone infected with the disease. U.S. health authorities are investigating about 100 suspected cases of the disease at home. The U.S. Pacific Command ordered all military personnel not to travel to China and Hong Kong – including Navy ships that regularly dock in Hong Kong – unless it was essential to their missions.
In China, where the government has been criticized for failing to notify the international community when SARS first hit in November, Vice Premier Wu Yi promised to start releasing more information to the public, the official Xinhua News Agency reported.
Malaysia became the 20th place to join the list of SARS-affected areas after confirming that the illness killed a 64-year-old man who died on March 30 in Kuala Lumpur. He developed SARS symptoms during a recent visit to China, said Malaysia’s Health Ministry Director-General Mohamad Taha Arif.
Thailand’s health minister, Sudarat Keyuraphan, said he was considering calling military medics to help screen incoming passengers for the disease. The World Health Organization has reported seven SARS cases and two deaths in Thailand.
Singapore said the number of new infections in the city-state was dropping and people should resume their normal routines. The government said it would begin reopening the country’s schools in the coming week after shutting them last month due to the disease, which has killed six people and infected 103. However, parents will have to sign declarations saying their children are healthy, and students who have traveled outside Singapore will have their temperatures taken by school staff for 10 days after their return. Singapore’s economic losses for the first month of the outbreak could total an estimated $286 million could hit $2.3 billion if the outbreak continues for three months, Standard Chartered Bank economist Joseph Tan was quoted in the Straits Times newspaper.
In China’s southern Guangdong province, a WHO team met at Zhongshan University where experts have collected hundreds of specimens of blood, lung fluid and other materials from people who died of SARS and those who recovered, team leader Dr. Robert Breiman said.
WHO wants to compare the samples to determine whether those who died were killed by a combination of viruses or bacteria or just one strain, he said. The meeting came after the head of the Chinese Center for Disease Control, Li Liming, offered the world an extraordinary apology for failing to release information sooner about the disease – first detected in China in November.
In Hong Kong, hygiene workers in protective suits collected rats and roaches for testing at the Amoy Gardens apartment complex, where at least 250 residents were infected. They hope the pests may hold a clue to how the disease was transmitted. Agricultural officials also rounded up pets, from dogs to turtles, from the building after a cat was found to carry a type of animal virus called a coronavirus. Experts believe SARS might be a new form of the virus, the South China Morning Post reported. Fear of infection kept many Hong Kong residents from crossing over to mainland China to sweep their ancestors’ graves for the ancient Ching Ming festival.
In Australia, staff of the national airline Qantas were trying to contact 310 passengers who were on flight QF094 from Los Angeles to Melbourne with three children suspected of carrying the disease. The children and their parents flew from their home in Toronto for a holiday in Melbourne.
Cleaners, maintenance staff, pilots and flight attendants who had contact with the aircraft are also being alerted to watch out for symptoms which include high fever, aches, a dry cough and shortness of breath.
Source: Nandotimes.com

Child Abuse Cases On The Rise

Cases of child abuse and neglect rose slightly in 2001 for the second straight year, government officials said. The increase was not statistically significant but Prevent Child Abuse America, a private group in Chicago, worried that it could be the start of a new trend.
Officials could not say what accounted for the increase in 2001, the last year for which data are available. But Prevent Child Abuse America said the stress of an economic downturn and unemployment increases the risk of child abuse. About 1,300 children died of abuse or neglect in 2001, 100 more than in the previous year. Overall, 903,000 children were victimized, said Wade Horn, assistant secretary for children and families at the Department of Health and Human Services.
“The good news is that the overall rate has not significantly increased from the previous year,” Horn said. “The bad news is that there were 903,000 children who were victims of abuse and neglect. That’s 903,000 too many.”
Confirmed maltreatment cases peaked in 1993, with 15.3 per 1,000 children. The rate fell for six straight years, hitting 11.8 per thousand in 1999. In 2000, there were 12.2 cases per thousand.
In 2001, there were 12.4 cases per thousand, or a total of about 903,000, the agency said.
Child protective service agencies across the country received 2.6 million referrals in 2001, according to data reported to the federal government. About a third of them were substantiated after investigation; the majority were cases of neglect. Of those that were confirmed, 59 percent suffered neglect, 18 percent were physically abused, 10 percent were sexually abused and 7 percent were psychologically maltreated. Consistent with previous years, 81 percent of perpetrators were parents.
Horn, joined by Sid Johnson, president of Prevent Child Abuse America, presented the results at a news conference in St. Louis, site of a national conference this week on child abuse and neglect. Both Horn and Johnson emphasized the importance of prevention, but they didn’t agree about how that should happen. Horn focused on the Bush administration’s proposed granting of modified block grants to states’ child welfare systems, an attempt to give states more flexibility and fewer rules. Under the plan, states could use some money now designated solely for foster care for abuse prevention. Johnson said he likes the flexibility but has reservations. He said he worries that the financial risk would shift from the federal government to the states “and ultimately children” if a capped five-year block grant was not enough to cover any spiraling of abuse cases.
Democratic legislation introduced Tuesday by U.S. Reps. Benjamin L. Cardin of Maryland and George Miller of California would, among other things, give performance bonuses and grants to states that improve their child welfare systems and improve the quality, training and retention of caseworkers.
Source: CBSnews.com

Website Hoax Fans Virus Panic
02:01 PM Apr. 01, 2003 PT
HONG KONG — A teenager’s website hoax about a killer virus that is sweeping Hong Kong sparked panicked food buying and hit financial markets on Tuesday, forcing the government to deny it would isolate the entire territory. “We have no plan to declare Hong Kong an infected area,” Director of Health Margaret Chan told reporters. “We have adequate supplies to provide (for) the needs of Hong Kong citizens, and there is no need for any panic run on food.”
Severe acute respiratory syndrome, also known as SARS, has now affected almost 1,900 people in at least 12 countries, and 63 are believed to have died. Indonesia, the world’s fourth-most-populous nation, reported its first three suspected cases on Tuesday. One official said one of the patients had died.
In Hong Kong, where 685 people are infected and 16 have died from the virus, authorities announced on Tuesday that they were taking more than 200 housing estate residents to isolation camps.
The fake website scare fueled dismay in the territory adjoining China’s Guangdong province, where the virus is believed to have originated four months ago. The hoaxer had copied the format of the public Internet portal of the Mingpao, one of Hong Kong’s leading newspapers, and posted a message saying the government would declare the city of 7 million “an infected place.” The daily said it had identified the teenager responsible. Police were investigating.
As the rumor spread, the Hong Kong dollar took a slight knock, and stocks fell for another day as investors calculated the loss to businesses in the tourism, airlines, property and retail sectors. As some supermarkets suddenly found frightened consumers pulling canned and preserved foods from their shelves, Hong Kong medical teams hunted for the reason why over 200 people in one apartment complex in urban Kowloon had fallen ill with SARS.
Protected by white surgical coats, caps, masks and gloves, investigators combed through the Amoy Gardens apartments, home to almost a third of all cases in Hong Kong. Residents there were under official quarantine. A woman outside, calling herself Mrs. Lee, spoke of her family inside: “My granddaughter is so young, and I don’t know how my daughter is doing. I visit them so often. I don’t know whether I have the disease, and I don’t want to infect others.” The government said it was evacuating more than 200 residents of Amoy Gardens to special isolation camps. Finding the cause of the Amoy Gardens outbreak is critical to proving whether the virus has mutated into an airborne plague, which could infect many more people much more quickly. Hong Kong found 75 new SARS cases on Tuesday. So far, doctors believe it has only spread by contact with infected patients, through coughing, spitting and sneezing. Authorities are racing to find carriers of the disease. Many Amoy Gardens residents had already fled their homes before the quarantine, and the government is looking for them.
Hong Kong was also looking for passengers on Thai Airways flight TG 606 from Bangkok to Hong Kong on March 29, the latest infected flight, after an 80-year-old passenger was diagnosed with SARS. Controlling the disease could be a major challenge in Indonesia, a sprawling archipelago of some 17,000 islands and 210 million people, many of whom live in poverty in urban slums or villages with few health services. But a spokesman for the World Health Organization said it was encouraging that Indonesia appeared to have detected the disease. “One way to contain the spread is to quickly identify cases. While it is bad news if it has arrived in Indonesia, it would be good news that the Indonesian authorities have identified it quickly,” said Iain Simpson, a WHO spokesman.
With Hong Kong so badly affected by the SARS outbreak, businessmen were trying to assess the possible economic damage. “If more and more housing estates are infected, this will bring Hong Kong to a standstill, and our economy will definitely contract,” said Alex Tang of Core Pacific-Yamaichi International. “We may have to lower our estimates for corporate earnings as well,” he added.
Malaysia has just reported a 3 percent drop in daily passenger arrivals at Kuala Lumpur international airport “seven days before and after” SARS was detected in the region. In and around Hong Kong, airline bookings are down 20 to 30 percent, and flights have been canceled. But the epidemic has meant roaring business for cleaning companies. In Hong Kong offices, teams of workers carrying tanks have been spraying and cleaning with disinfectants.
In Singapore, the Catholic Church drained containers of holy water at church entrances and switched to putting communion wafers in the hands of worshippers, instead of on the tongues. Some medical officials have issued pleas for calm. “I can’t say this often enough, the risk to the general public is extremely low,” said medical officer Sheela Basrur in Toronto. Canada has reported more than 120 cases of infection. The hope held out by doctors is that the virus’s detailed makeup will be pinpointed soon. Some victims have been successfully treated using antibodies in serum from recovered patients, which suggests they developed some immunity. The World Health Organization has now reported confirmed SARS cases in China, Hong Kong, Taiwan, Singapore, Indonesia, Canada, the United States, Germany, Switzerland, Britain, France, Ireland and Italy.
Source: Reuters, Wired News (medtech)

Severe Acute Respiratory Syndrome (SARS) Update: Monday, March 31, 2003
Craig Sterritt, Editor, Medscape Infectious Diseases

Today’s Leading News
On Saturday, Centers for Disease Control and Prevention (CDC) Director Julie L. Gerberding, MD, expressed worry that new developments in the epidemiology of severe acute respiratory syndrome (SARS) pointed to what could become “a much larger” epidemic. After reiterating “that the disease is still primarily limited to travelers…and to [those who have had] close contact with SARS patients,” she said U.S. and international health officials were “concerned about the possibility of airborne transmission across broader areas and also the possibility that objects that become contaminated in the environment could serve as modes of spread. “Coronaviruses can survive in the environment for up to two or three hours,” she added, “and so it’s possible that a contaminated object could serve as a vehicle for transfer to someone else.” Although not confirmed as the single cause of SARS, a coronavirus is the leading suspect agent at this time. Dr. Gerberding’s statements coincided with a Hong Kong report that SARS had been transmitted to scores of people in a single apartment complex after a single resident visited a hospitalized relative with SARS. Hong Kong reported more than 100 new SARS cases over the weekend. On Saturday, the World Health Organization (WHO) announced the death of Dr. Carlo Urbani, who first identified the SARS outbreak. Dr Urbani had acquired the disease in the course of his investigations.
Epidemiology: As of March 29, the WHO cumulative tallies of suspected SARS cases and deaths were 1,550 and 54, respectively. On March 29, the CDC reported a total of 62 suspected U.S. cases in 22 states, up from 51 cases on March 27. The number of cases reported by Health Canada has increased from 37 to 98. The new figure includes both suspected and probable cases, whereas the earlier count included probable cases only.
Etiology: A new coronavirus remains the prime suspect in the search for the cause of SARS. Dr. Gerberding stated last week that viruses detected so far did not appear to be a known coronavirus. “We know from sequencing pieces of the virus DNA that it is not identical to the coronaviruses that we have seen in the past. This may very well be a new or emerging coronavirus infection, but it is very premature to assign a cause.”
Diagnosis, Treatment, Outcomes: Scientists at the University of Hong Kong announced on March 27 that they had developed a diagnostic test to rapidly identify SARS cases. The test is based on polymerase chain reaction (PCR) technology. So far, test results in confirmed SARS cases have been consistently positive, while healthy controls have consistently tested negative. Another test, an immunofluorescence assay, is also in development.
In a “virtual grand rounds” on clinical features and treatment of SARS organized by WHO last week, clinicians managing SARS patients described disease features at presentation, treatment, progression, prognostic indicators, and discharge criteria. There was general consensus that no therapy in particular demonstrated any particular effectiveness. According to a summary of the proceedings, participating clinicians agreed “that a subset of SARS patients, perhaps 10 percent, decline and need mechanical assistance to breathe. These people often have other illnesses that complicate their care. In this group, mortality is high.” According to the summary, however, the majority of patients show improvement in signs and symptoms at day 6 or 7.
Regarding treatment, the summary concluded that: “Numerous antibiotic therapies have been tried to date with little clear effect. Ribavirin with or without use of steroids has been used in an increasing number of patients. But in the absence of clinical indicators, its effectiveness has not been proven. Currently the most appropriate management measures are general supportive therapy, insuring the person is hydrated and treated for subsequent infections.” Check out the latest exipure real reviews.

Summary of Events to Date
On March 15, 2003, WHO issued a global alert of a multicountry outbreak of SARS, an atypical pneumonia of as yet unidentified etiology. According to WHO, the syndrome was first recognized on February 26, 2003, in Hanoi, Vietnam. According to WHO, as of March 29, 2003, SARS cases have been reported in Canada, China, France, Germany, Hong Kong, Indonesia, Italy, Ireland, Romania, Singapore, Switzerland, Taiwan, Thailand, United Kingdom, United States, and Vietnam. A total of 1,550 cases and 54 deaths have been reported to date. SARS appears to be transmitted by close contact only, most probably via airborne droplets; the majority of new cases have been reported in healthcare workers and family members of affected persons. Evidence of community spread of the disease is emerging, however.
On March 24, the CDC announced that a new coronavirus is the prime suspect in the search for the cause of SARS. Confirmation of this is pending.
On March 26, Chinese authorities officially reported a total of 792 SARS cases and 31 deaths that occurred in 7 cities of Guangdong Province between November 16, 2002, and February 28, 2003. As of March 29, WHO is reporting a total of 806 suspected SARS cases and 34 deaths in mainland China.
Health officials in Singapore have quarantined 861 people with flu-like symptoms and have closed all schools until April 6. A total of 89 SARS cases and 2 deaths have been reported there. More than 1,000 people were quarantined and schools were ordered closed in Hong Kong on March 27. This followed the identification of 51new SARS cases and a warning by a top health official that SARS was spreading among the general public.
Scientists at the University of Hong Kong announced on March 27 that they have developed a diagnostic test to rapidly identify cases of SARS. The researchers also announced that they had confirmed a coronavirus as the cause of SARS, and recommended that SARS, a provisional name for the disease, be retermed “coronavirus pneumonia” or CVP.
On March 29, Hong Kong health officials reported that SARS had been transmitted to 78 people in a single apartment complex after a single resident visited a hospitalized relative with SARS.
Source: Medscape Medical News

Mystery Pneumonia Kills Elderly Man in Hong Kong
Hong Kong: An elderly man has died in a Hong Kong hospital from Sars, Severe Acute Respiratory Syndrome. The death of the man in his 70s brings the global death toll to 11. He had also been suffering from a blood disease. As he died, the number of patients in Hong Kong diagnosed with Sars rose by 19 to 222. A Hong Kong university team has isolated the virus from the lung tissue of a patient who developed Sars after contact with a doctor from southern China�s Guangdong Province. The World Health Organisation, which has issued a rare global warning about the disease, says the laboratory has succeeded in culturing an infectious agent that might be the cause of SARS.It describes the culture as: �The first important step towards the development of a diagnostic test.� A team of WHO infectious disease experts is travelling to China to investigate whether an outbreak of atypical pneumonia in China�s Guangdong Province last month was linked to Sars.In Singapore, a hospital has been closed to all but Sars patients and the US State Department has warned Americans to avoid Vietnam because of the disease.
Source: The Southeast Asian Times.

Hong Kong Hospital Chief Falls Ill With Pneumonia
Hong Kong, March 25: Hong Kong Health Authority Chief Executive Dr William Ho is in hospital with symptoms of pneumonia. But it is not known if he has been stricken with Sarc, severe acute respiratory syndrome.Dr Ho had been working on the outbreak that has killed 18 people around the world for the past few weeks, visiting hospitals, briefing senior government officials and meeting the press. Dr Ho’s was hospitalised as two more people died overnight in Hong Kong bringing the death toll in the Territory to 10. His hospitalisation has fueled fears that the killer respiratory virus that has infected hundreds worldwide could be spreading faster than first thought.
Source: Channel News Asia.

If you fall in love with someone, you hope that he/she feels the same way about you too. But how will he/she know if you never tell the one you love. Just like what happened between Rio (Marcellius Siahaan) and Renata (Rachel Maryam).
The love story begins when Rio and Renata are locked up in a broken lift. Right on the 17th floor, the lift stops and only these two people are trapped in the lift. Rio, a cool, handsome and ambitious young producer seems to be very arrogant and he doesn’t want to talk to Renata. But Renata, a cheerful and easygoing writer at a teen magazine, tries to melt the “frozen situation” between them. Finally, still trapped in the lift, Rio finds that Renata is a charming girl and he’s falling for her. But suddenly the lift can move again. Renata and Rio separated before knowing how to contact each other.
Renata falls in love with Rio but her efforts to find Rio never succeeded. Actually, Rio is already engaged to be married. But he can’t get Renata out of his mind. Rio also tries very hard to meet Renata again. He goes to a claip voyant to find her. But he still doesn’t succeed. Meanwhile, Rio’s fianc�e finds that her sweetheart is thinking about another woman. So, what’s going to happen to Rio and his fianc�e? Are they going to split? Will Ria and Renata meet again?
Transinema-Trans TV produces the movie in connection with its first anniversary. Alex Abbad, Priscillia Amelia and Nadia Mulia also starring this movie. The movie’s soundtrack album features Marcell, Andien, Ariyo and some other singers. Andai Ia Tahu is a cool flick, especially for teenagers.