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K E Y P O I N T S

Since the World Health Organisation's (WHO) global outbreak alert about SARS on 15 March, cases have increased, but knowledge has also grown. As of the 7 April http://www.who.int/csr/sarscountry/
2003_04_07/en/, 2601 cases of SARS and 98 deaths have been reported from 18 countries. SARS is only fatal in four per cent of people.

As previously reported, the virus is likely to be either a coronavirus or paramyxovirus. Research is increasingly focusing on coronavirus as this is starting to be seen as the most likely cause.

The incubation period - the time between becoming infected and showing symptoms - is believed to be 2-10 days.

Close contact with an infected person, for example through contact with a sneezing sufferer where droplets are exhaled, is believed to be the main mode of transmission. In Hong Kong and the Guangdong Province of China, where there are clusters of cases, it's also possible that an additional environmental route of transmission is involved.

Screening methods are now in place at airports in SARS-affected areas to prevent people infected with the virus from travelling. In addition, aircrews have been briefed on signs and symptoms.

On the 2 April, the WHO advised that people should avoid all non-essential travel to Hong Kong Special Administrative Region of China and China's Guangdong Province.

The WHO is constantly monitoring the situation, updating advice on a daily basis and keeping the public fully informed. For the latest information from the World Health Organisation, please go to: http://www.who.int/csr/sars/en/

Severe Acute Respiratory Syndrome (SARS) - the continuing disease outbreak

Bupa investigative news - 8 April 2003
written by Rachel Newcombe, reporter for Bupa's Health Information Team

Click here for the latest SARS information

Cases of the virulent Severe Acute Respiratory Syndrome, better known as SARS, are continuing to occur worldwide, particularly in South East Asia, where it first originated. But as the days pass and the cases mount up, how much more is known about it? What is the latest travel advice and how much of a threat is this unknown disease?

What were the headlines?

Newspapers and websites in the UK, as well as worldwide, have continued to follow the mystery illness with interest. Recent reports have gained headlines such as, "Mystery disease spreads", "UK given travel bug warning", "China under fire for virus spread", "Fifth SARS case reported in UK," and "Bug breakthrough expected soon".

What is the bigger picture?

A team of scientists from 10 countries are continuing to study the disease, looking at the nature of the virus, how it's transmitted and how it can be contained, and developments are being made daily.

Although it is known that SARS first began in the Guangdong Province of China in November, it is still not known how people first became infected with it. The good news is that World Health Organisation (WHO) officials have now been granted access to the Guangdong Province and are investigating SARS occurrences in that area. It is hoped that this investigation will uncover the origins of the disease. One theory is that it may have come from "some type of bird or an animal" and was then somehow transferred to humans. But "that's not yet proven and will need to be proven eventually."
http://www.who.int/csr/sars/press2003_04_01/en/

On 2 April, the WHO took the rare step of advising against travel to the worst affected areas. A press release statement said, "The World Health Organisation (WHO) today began recommending that persons travelling to Hong Kong Special Administrative Region of China and Guangdong Province, China consider postponing all but essential travel. This updated travel advice comes as a result of new developments in the multi-country outbreak of severe acute respiratory syndrome (SARS)."
http://www.who.int/csr/don/2003_04_02b/en/

The method of transmission for most cases is still believed to be through close contact and as a result of droplet infection. "The evidence is that person-to-person transmission is, and will remain until we have better data or even additional data, the major mode of transmission," said the WHO's Dr. Klaus Stohr at a press briefing on 2 April.
http://www.who.int/csr/sars/press2003_04_01/en/

However, in Hong Kong - one of the most affected areas - it seems that there may be other means of transmission. This might account for the large number of cases of SARS in that area.

Dr. David Heymann, explained: "In Hong Kong, they have found that transmission does not seem to be only by close contact from person to person. It appears that there is something in the environment that is transferring the virus, which is serving as a vehicle to transfer the virus from one person to another," he said.

"We do not believe this is the air. We believe that it is something else in the environment. It is possibly an object that people are touching and getting infected from, where there has been a SARS patient who has coughed, or possibly a sewage system or a water system or some type of environmental vehicle that takes the virus from a sick person to another. So we see clusters of cases where there is one, for example, living in an apartment building, where other people in that apartment building have been infected."
http://www.who.int/csr/sars/2003_04_02/en/

Currently, this theory only applies to the densely populated Hong Kong, as in other areas, such as the UK, the few cases have been contained without spread.

There isn't yet a specific treatment for SARS, but patients are being given anti-viral drugs and steroids, and in most instances it's proving beneficial. At a press briefing on 1 April, the WHO were able to provide more exact details about the recovery of patients. http://www.who.int/csr/sars/press2003_04_01/en/ "Ninety per cent of people who have gotten this disease, as we understand it today through our group of clinicians ... are feeling better and are on the way to recovery at day seven after disease," said Dr. Heymann.

Of those who are not so fortunate, those who have died from the infection tend to have pre-existing health problems. Dr. Heymann said that, "Four per cent of people do die, but many of these have had a pre-disposing condition, such as diabetes or other diseases, which has made their immune system weak and not able to fight."

“The vast majority of people in the UK are unaffected by SARS at the moment. The issue is of most relevance to healthcare workers, particularly public health doctors and researchers, and also to people considering international travel to SARS-affected areas such as business travellers and also boarding school pupils considering travel home or on holiday at half term. The best advice for people worried about SARS and travelling is to keep up to date with the latest information published on the World Health Organisation (WHO) website and also on the Public Health Laboratory Service (PHLS) [now Health Protection Agency] website if they're based in the UK.”

Dr Annabel Bentley,
assistant medical director
Bupa Group

What does this mean?

There hasn't been a major SARS outbreak in the UK - just a few isolated cases of people who have flown from areas such as Hong Kong, Taiwan and Singapore. The people affected have been treated in isolation in hospital and several have already recovered. A joint statement from the Health Protection Agency and Department of Health on 6 April said, "There is no evidence of any transmission of SARS in the UK from any of these people."

As Dr. Jane Zuckerman, director of the Academic Centre for Travel Medicine and Vaccines and The Royal Free Travel Centre, and director of the WHO Collaborating Centre for Travel Medicine, explained, all cases so far can be traced back to South East Asia. "The risk of infection seems to occur in Hong Kong and the Guangdong province of China," she said. "To date," she added, cases have been "in people travelling who have SARS, who then present themselves in a country unwell."

Although the disease has spread in Canada, all cases can be attributed to close person-to-person contact with someone who caught the disease in the Far East. According to the WHO: "All Canadian cases have occurred in persons who have travelled to Asia or had contact with SARS cases in the household or in a health-care setting."
http://www.who.int/csr/sarsarchive/2003_04_07/en/

Measures are now in place in ports, airports and on planes to help contain the virus and spot potential SARS sufferers. Since 29 March, anyone arriving in Hong Kong and other areas has to complete a health declaration form and, if symptoms of SARS are spotted, they're seen immediately by health workers. Travellers leaving airports are also screened before departure to detect any signs of SARS; if potential signs are spotted, travellers are asked to postpone their travel.
Department of Health travel advice

Aircrews have been given procedures to follow if people develop symptoms mid-flight, such as isolating the passenger, wearing a protective mask and ensuring the person is assigned a specific toilet to use, away from others.

In addition, a number of countries, including Australia, have passed laws to allow people with SARS to be quarantined on arrival.

A C T I O N P O I N T S

Both the World Health Organisation (WHO) and the Foreign and Commonwealth Office (FCO) are advising against non-essential travel to Hong Kong and the Guangdong Province of China.

The FCO is also advising travellers to be vigilant for the signs and symptoms of SARS if they are visiting: Hanoi in Vietnam, Singapore, Toronto in Canada, Beijing and Shanxi and Taiwan.

Remain aware of the main symptoms of SARS - a high fever (over 38°C / 100.4°F), a dry cough, shortness of breath or breathing difficulties

Be vigilant about hygiene and wash your hands frequently.

If you've recently travelled from South East Asia and develop flu-like symptoms within 10 days of returning, seek medical advice from your doctor or NHS Direct (Tel: 0845 46 47) by phone. Remember to say where you've recently travelled and whether you had contact with anyone else with similar symptoms.

If you are travelling to the Far East in the near future, keep an eye on the World Health Organisation, Department of Health travel advice, and Foreign and Commonwealth Office websites for updated information

What does this mean to me?

"Like everything else, one should try and be sensible about this," said Dr. Zuckerman. "The travel advisories that are out from the CDC [US Centers for Disease Control and Prevention], WHO and FCO [UK Foreign and Commonwealth Office] are suggesting that non-essential travel [to Hong Kong and Guangdong] should be postponed, and that is right. It's important to apply commonsense and not subject oneself unnecessarily to a potential risk."

But, for those who are currently travelling, the most important thing to remember is to adhere to basic hygiene rules, said Dr. Zuckerman. "The basic advice is to be fastidious about hygiene. You should use a handkerchief to your nose and mouth [if coughing or sneezing], frequently wash your hands and make sure you dry them properly, and avoid contact with anyone who may have symptoms."

The Health Protection Agency (formerly known as the Public Health Laboratory Service) advise that any travellers going to other areas where SARS has previously been reported (such as Hanoi in Vietnam, Singapore, Toronto in Canada, and Beijing and Shanxi in Taiwan) should be fully aware of:

The current situation - cases of SARS are continuing to increase
The fact that they may be screened prior to air travel
The symptoms of SARS

Department of Health travel advice

If you do return from overseas travel and have any of the symptoms after returning, the Health Protection Agency say you should phone your doctor or NHS Direct immediately and tell them where you've recently travelled.

Summary

Information about SARS is increasing every day, and scientists hope to soon have an even better understanding about it. While the virus is still spreading in Hong Kong and Guangdong, postponing travel to these regions is advisable.