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The tourist entered the hospital voluntarily because of a fever and flu-like symptoms that met the definition of a case of severe acute respiratory syndrome. But he stayed against his will because he refused to comply with the New York City Department of Health and Mental Hygiene's policy that suspected SARS patients isolate themselves for at least 10 days, depending on the course of their illness, to avoid the possibility of spreading SARS. Because the tourist had nowhere to stay in isolation for 10 days, the health department exercised its power to force him into isolation. Only once before in the last 25 years has the health department invoked this power for a disease other than tuberculosis, said Wilfredo Lopez, the health department's general counsel. The last time was in 1994, when a traveler arrived in New York with suspect pneumonic plague during an outbreak of the disease in India, Lopez said. The tourist went to a hospital because he had a fever, a cough and felt slightly short of breath. He said he had stopped in a SARS- affected area, Hong Kong, en route to New York. Because the man met the Centers for Disease Control and Prevention's definition of a suspected SARS case, the doctors applied the recommended isolation control procedures and reported the case to the health department. All that doctors can rely on is the definition of a SARS case. The Centers for Disease Control in Atlanta has created two definitions. The one for a suspect SARS case does not include pneumonia. But the Centers defines a probable SARS case as including pneumonia to comply with the World Health Organization's definition. The federal agency developed the broader classification because it does not want to miss any possible SARS case in the United States

All that doctors can rely on is the definition of a SARS case. The C.D.C. in Atlanta has created two definitions. The one for a suspected SARS case does not include pneumonia. But the C.D.C. defines a probable SARS case as including pneumonia to comply with the World Health Organization's definition. The federal agency developed the broader classification because it does not want to miss any possible SARS case in this country. As of yesterday, the current list includes 18 suspected cases and 2 probable cases. One patient remains in a hospital. None of the 23 have had serious, life-threatening illness, Dr. [Thomas R. Frieden] said. Also, he said, scientists at the C.D.C. have not found evidence of the coronavirus that is believed to be the cause of SARS in any of the suspect or probable patients in New York City. The experimental tests available at this point of the epidemic, however, are not precise enough. So doctors must consider suspected and probable cases as true SARS cases. All but the tourist have have complied with requests to remain isolated in a hospital or at home. In New York City, the Health Department decided against allowing the man with suspected SARS to move to a hotel because of a number of concerns. One was that he might check out without permission at any time. Another was that even if he cooperated fully and stayed in his room the entire time, the ventilation system might not be designed to prevent the air he exhaled from circulating to other areas of the building to potentially expose many others to the SARS virus. In trying to find a hospitable solution, Dr. Frieden said his department fleetingly considered using Gracie Mansion, which is empty because Mayor Michael R. Bloomberg lives in his own town house

Yesterday, two top officials of the World Health Organization refused to concede defeat and expressed hope that SARS could be contained if all countries maintained vigilance for the disease. SARS has to be viewed as a worldwide disease, not as one of any country, because its threat is so great to health care workers and systems in affected countries, the W.H.O. said. Dr. [David L. Heymann] also said the W.H.O. was deeply concerned about the possibility that SARS could become an added serious health threat in areas of Africa or Asia where AIDS is highly prevalent. The concern is that SARS could become another so-called opportunistic infection among the millions of people with weakened immune systems from the AIDS virus. Vietnam, which was one of the first countries affected by SARS, may soon become the first country to contain SARS despite its rudimentary health care system, the W.H.O. said. Vietnam has reported 63 SARS cases, with 5 deaths

Speaking at a news conference the morning after his return, Dr. [Robert Webster] said he and his colleagues in Hong Kong think there are likely to be many strains of the SARS virus. The World Health Organization says the virus, a previously unknown member of the coronavirus family, is the cause of SARS. C.D.C. scientists have identified the SARS virus in 7 of 39 probable SARS cases in the United States. But that ''is much too small a number to draw conclusions about the virulence'' of different strains of the virus, Dr. [Julie L. Gerberding] said. The molecular structure of the coronavirus class consists of a single strand of RNA that often makes mistakes as the virus replicates, allowing it to mutate and even recombine with other viruses. But Dr. Gerberding said that the C.D.C. did not have any evidence now to say whether the SARS virus was mutating

Also, for unknown reasons, the proportion of recent cases that are testing positive for the SARS virus is declining and a number of people who are not suspected of having SARS are testing positive, said the director, Dr. Frank Plummer. Plummer described his team's findings as 'weird.' He said that they had the potential to weaken the link between SARS in Canada and a previously unknown member of the coronavirus family that the World Health Organization announced last week was the cause of SARS. Plummer said he was surprised to find the virus in 20 per cent of an additional 250 people who were not suspected of having SARS but who were tested because they had returned to Canada from affected areas in Asia or who had mild symptoms not thought to be SARS

Dr. [Frank Plummer] described his team's findings as ''weird.'' He said they had the potential to weaken the link in Canada between the disease, known as SARS, and a previously unknown member of the coronavirus family that the World Health Organization said last week was the cause of SARS. Yesterday, the W.H.O. said that it continued to believe that the new coronavirus is the cause of SARS and that it is following the developments at the National Microbiology Laboratory in Winnipeg, Manitoba, where Dr. Plummer is scientific director. It is one of 13 laboratories in an international network that the W.H.O., a United Nations specialized agency, created to investigate SARS. He said he was surprised to find the virus in about 20 percent of an additional 250 people who were not suspected of having SARS but who were tested because they had come to Canada from affected areas in Asia or who had mild symptoms not thought to be SARS. Although the 250 were not randomly chosen as scientific controls, Dr. Plummer said he was still surprised at the number who tested positive

One reason for beefing up the already strong infection control measures is that SARS is still being spread to health care workers even though they took the proper precautions in caring for SARS patients. On Tuesday, Ontario health officials said that new SARS cases had occurred among health workers at two of the city's hospitals, Sunnybrook Hospital and Mount Sinai Hospital last week. A second reason is that health officials now say that the SARS virus can survive for 24 hours. SARS is a newly discovered member of the coronavirus family. Some coronaviruses are known to be able to survive on objects for up to three hours. Health officials still believe that SARS is spread primarily in large droplets from coughs and sneezes. But the new studies on the length of time that the SARS virus can survive to contaminate an object renews concern about the role of the environment in spreading the disease

The CDC team from Atlanta arrived on Tuesday as health workers caring for SARS patients in Toronto area hospitals were advised to wear two sets of gloves and two gowns as well as full face shields to protect them while caring for patients with SARS, or severe acute respiratory syndrome. Earlier, health workers were advised to wear only one set of gloves and gown and a special mask. The SARS 'virus has the capacity to survive for 24 hours, that's been studied,' said Dr. Dick Zoutman, an infectious disease specialist from Kingston, Ontario, and chairman of the scientific advisory committee on SARS in Toronto

While there are anecdotal case studies of individuals behind some outbreaks, there is little concentrated research in the field. 'There hasn't been enough time, thinking and probing' to hazard more than a guess as to why superspreaders are responsible for so much of the spread of SARS, said Dr. Donald A. Henderson, the epidemiologist who led the global eradication of smallpox. Referring to a well-known study of a cold outbreak at the Eagle Heights Apartments in Madison, Wis., and to an early theory that the outbreak of more than 300 SARS cases in the Amoy Gardens apartment complex in Hong Kong was spread by cockroaches, he said: 'Don't blame the cockroaches. In Wisconsin, it wasn't the cockroaches, it was the kids.' 2 PICS; 1. Long-distance sneezers may be better spreaders of infectious diseases such as SARS. 2. History's most famous disease superspreader was Typhoid Mary, born [Mary Mallon] in Ireland in 1869 and a cook for wealthy New York families.; Credit: 1. New York Times

One reason for increasing the already strong infection-control measures is that SARS is still being spread to health-care workers even though they took the proper precautions in caring for SARS patients. On Tuesday, Ontario health officials said that new SARS cases had occurred among health workers at two of the city's hospitals -- Sunnybrook Hospital and Mount Sinai Hospital -- last week