SARS makes few inroads in extremely cautious U.S.

Mystery flulike illness has killed 79 worldwide

April 04, 2003|By Julie Bell | Julie Bell,SUN STAFF

A mysterious respiratory illness that has claimed 79 lives and sickened thousands of people around the world has produced more anxiety than confirmed cases in the United States, where airlines, schools and health departments have taken aggressive steps to contain it.

With no deaths reported in the United States and 100 suspected cases, health officials said yesterday they are cautiously optimistic that they're succeeding.

Most of those thought to have severe acute respiratory syndrome (SARS) have traveled in Asia, where the epidemic originated and has caused the most illnesses.

"I think the situation in the United States looks like things are fairly well in hand because there's no evidence of sustained transmission at all," said Dr. David Brandling-Bennett, deputy director of the Pan American Health Organization, the World Health Organization's regional office in Washington.

"It depends on what happens elsewhere in the world. The more it spreads elsewhere, the more the chance of it spreading in the United States."

In its latest weekly report, released yesterday, the federal Centers for Disease Control and Prevention said four of the U.S. victims appeared to have acquired the disease from contact with people in their households. Two others who developed symptoms are health care workers.

Of the 100 suspected cases, 40 required hospitalization and 13 patients remained in the hospital as of Tuesday. Most have recovered.

California led the nation with 24 suspected SARS cases. New York had 16, and no other state had more than 10, according to a tally updated daily on the CDC's Web site (www.cdc.gov). No suspected cases have been reported in Maryland, Delaware or the District of Columbia.

Viriginia has reported two cases. A third reported illness was determined to be unrelated, state Health Department spokeswoman Michelle Stoll said yesterday.

Health officials have yet to definitively identify the cause of SARS, although they think it is a coronavirus, a family that includes the virus that causes the common cold.

Its symptoms include fever greater than 100 degrees, body aches and, eventually, a dry cough. In 10 percent to 20 percent of cases, patients require a respirator to breathe, the CDC said.

Epidemiologists don't know why the suspected U.S. cases appear to be less severe than those overseas, but there are several theories.

Brandling-Bennett suggested that the virus might weaken as it is passed from person to person.

Another possibility is that U.S. travelers might have only incidental or short-term contact with infected people overseas, which results in less severe infections when they get home, said Dr. Kenrad E. Nelson, a Johns Hopkins University epidemiologist.

Yet another explanation is that U.S. officials, airlines and local agencies are being extraordinarly cautious, intervening early in suspected cases and isolating patients.

The tally of suspected cases in the United States might be too high because there's no test for the illness yet, Nelson said.

"It includes anyone who came from overseas where there was an outbreak who has a fever and respiratory symptoms," Nelson said. "It may well be that a fair number of those cases aren't the same thing."

Precautions abound.

Before SARS had been identified, doctors in Loudoun County, Va. isolated a patient who had recently returned from China with a strange respiratory illness that resembled avian flu.

Dr. Suzanne Jenkins, an assistant state epidemiologist, said health officials took no chances, working late into the evening to confer with the CDC and track down people with whom the woman had had contact to ensure that they weren't also sick. Eventually, SARS was diagnosed in the patient.

CDC employees are handing out "health alert" cards explaining the symptoms of SARS to airline passengers returning from China, Singapore, and Vietnam. Airlines are questioning U.S.-bound passengers about their health before they board in Asia, sending those with SARS-like symptoms to local health authorities for clearance.

In some cases, airlines and other institutions are going beyond the CDC's recommendations. United Airlines gives protective masks to passengers who want them in Hong Kong, Taipei, Singapore, Beijing and Shanghai, spokesman Joe Hopkins said.

In Greenwich, Conn., 20 students and two teachers at Greenwich Country Day School who returned from a trip to China on March 26 will stay out of school until Monday, a spokeswoman for Headmaster Doug Lyons said.

"A reasonable person might say, `Doug, you're overreacting,' and I would accept that and say, `You may be right. Forgive me,'" Lyons told the Associated Press.

With the cause of SARS undetermined, health officials have been reluctant to criticize even some extreme precautions.

But Jenkins, the Virginia epidemiologist, said the Bedford County Sheriff's Department overreacted when it tried to quarantine the family of a man who died of an apparent respiratory infection after returning from the Netherlands.

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