Faculty Bibliography

The apartment complex outbreak has led World Health Organization officials to focus more attention on the possibility that the illness, known as SARS, for severe acute respiratory syndrome, could be spread in a way other than face-to-face contact. The spread would require intimate contact with the SARS agent. Among the possibilities: sewage, contaminated water and objects like doorknobs and elevator buttons. Dr. [Yeoh Eng] said this evening that the government was investigating whether the virus might have been spread by leaking sewage. Laboratories here have confirmed that the virus is present in fecal matter, he added. But Dr. [David L. Heymann], the World Health Organization official, said that scientists do not know whether the virus detected in feces is a form that can transmit SARS. Health workers gathered at the entrances of Block E of Amoy Gardens in Hong Kong yesterday. (Associated Press); Some residents of Amoy Gardens, a Hong Kong housing complex, left yesterday when a 10-day quarantine was imposed on one of the towers in the development and the number of cases of SARS continued to rise. (Reuters)

To prove that a virus identified in the laboratory causes SARS, scientists must develop diagnostic tests to determine how often it was present among patients in the outbreak and at what stage of the illness it appeared. Those steps require collecting and testing specimens from patients in various stages of the disease and from their contacts, and will further strain the taxed network, said Dr. Klaus Stohr, the scientific director of the SARS investigation. A day or two later, two network members, the Centers for Disease Control and Prevention in Atlanta and the Princess Margaret Hospital in Hong Kong, reported that their scientists had seen electron microscopic evidence of a coronavirus. Around March 20, Canadian scientists reported evidence in a few patients hospitalized in Toronto suggesting that the cause was a second member of the paramyxovirus family -- a metapneumovirus that differs from the paramyxovirus detected earlier. But because this is the peak season for metapneumovirus infections, network scientists have debated the significance of the finding and have since dropped that virus to a distant third on the list of SARS suspects. To help classify a virus, scientists need to know its basic structure, or molecular sequence. The first bits of sequence information were distributed to members of the network through the secure Web site. So far, the suspect coronavirus's sequence most closely resembles that of the murine hepatitis virus, which causes a disease similar to multiple sclerosis in mice. Mildly abnormal liver function tests have been reported among SARS patients, although SARS does not seem to cause full-blown liver disease in humans. The full sequence is expected within two weeks, said Dr. Julie L. Gerberding, the C.D.C. director

The apartment complex outbreak has led World Health Organization officials to focus more attention on the possibility that the illness, known as SARS, for severe acute respiratory syndrome, could be spread in a different way from close face-to-face contact. Among the possibilities: sewage, contaminated water and other objects, like doorknobs and elevator buttons. In Hong Kong, fears have been spreading about hospitals' ability to cope with the growing caseload. Hospitals have already halted all nonessential services, and the State Department in Washington warned on Friday that the rising number of SARS cases was beginning to affect the availability of health services here. [Yeoh Eng] said last evening that the government was investigating whether the virus might have been spread by leaking sewage. Labs here have confirmed that the virus is present in fecal matter, he added

Dr. Yeoh Eng-kiong, Hong Kong's secretary of health, welfare and food, said that there were 80 new cases of severe acute respiratory syndrome (SARS), including 64 at an apartment complex where the outbreak spread rapidly in the previous week. Hong Kong has had 630 SARS patients, of whom 79 have been discharged and 64 are in intensive care. Photo: Kin Cheung, Reuters; A boy who lives in an apartment complex where 213 cases of SARS have been recorded wears a mask and gloves in Hong Kong yesterday

The director of the U.S. Centers for Disease Control and Prevention has warned that a mysterious respiratory disease, which has infected hundreds of people worldwide, could be spread very efficiently through close contact, and expressed deep concern that it might also be spread through the air or on contaminated objects. The warning from the agency director, Dr. Julie Gerberding, came Saturday as officials continued to monitor developments in Hong Kong, where the disease, known as SARS, for Severe Acute Respiratory Syndrome, may have sickened 78 people in one apartment complex. 'The potential for infecting large numbers of people is very great,' Gerberding said. 'We may be in the very early stages of a much larger' epidemic of a disease for which there is no specific treatment beyond standard supportive nursing and respiratory care, she said. 'This is new, we don't know a lot about it, and we have a lot of questions about the overall spread' of the disease and 'the possibility of airborne transmission,' she said in a conference call from Atlanta with reporters

Her warning came as the World Health Organization announced in Geneva that the doctor who first identified the fast-spreading disease has himself died of it. The doctor, Carlo Urbani, 46, identified the disease, known as SARS -- for severe acute respiratory syndrome -- in an American businessman admitted to a hospital in Hanoi, Vietnam, where Dr. Urbani was based. Epidemiologic evidence exists that, for unknown reasons, some patients can transmit SARS to other people much more efficiently than other SARS patients can. Dr. [Julie L. Gerberding] cited one patient in Hanoi who spread SARS to 56 percent of the health workers with whom the patient came in contact. That occurred before hospital workers began using measures like gloves, masks, gowns and goggles. The disease apparently first appeared in Guangdong Province, adjacent to Hong Kong, over the winter, and has infected about 800 people there. But it spread to Hong Kong through just one patient, a Chinese medical professor who had been treating patients in Guangdong and who went to the Metropole Hotel in Hong Kong on Feb. 21 and then fell ill

'We are very concerned about the speed' with which SARS has spread in Hong Kong, [Julie L. Gerberding] said. Epidemiologic evidence exists that, for unknown reasons, some patients can transmit SARS to other people much more efficiently than other SARS patients can. Gerberding cited one patient in Hanoi, Vietnam, who spread SARS to 56 percent of the health workers with whom the patient came in contact. That incident occurred before hospital workers began using such barrier infection control measures as gloves, masks, gowns and goggles

The warning from the disease agency director, Dr. Julie L. Gerberding, came as officials continued to monitor developments in Hong Kong where the disease, known as SARS, for severe acute respiratory syndrome, may have sickened 78 people in one apartment complex. 'We are very concerned about the speed' with which SARS has spread in Hong Kong, Gerberding said. Epidemiologic evidence exists that, for unknown reasons, some patients can transmit SARS to other people much more efficiently than other SARS patients can. Gerberding cited one patient in Hanoi, who spread SARS to 56 percent of the health workers with whom the patient came in contact

'This is new. We don't know a lot about it, and we have a lot of questions about the overall spread' of SARS and 'the possibility of airborne transmission,' she said. 'We are very concerned about the speed' with which SARS has spread in Hong Kong. There's epidemiologic evidence that, for unknown reasons, some patients can transmit SARS to other people much more efficiently than other SARS patients can. [Julie Gerberding] cited one patient in Hanoi, Vietnam, who spread SARS to 56 percent of the health workers with whom the patient came in contact

In Canada, health officials asked that the thousands of people in Toronto who have been in the Scarborough Grace Hospital since March 16 isolate themselves at home for 10 days from the time of their visit. Two people at the hospital have died from SARS. Premier Ernie Eves of Ontario declared SARS a provincial emergency yesterday. In Hong Kong, top officials yesterday ordered more than 1,000 family members of SARS patients to stay home except for visits to government clinics to check for the disease. Those who violate the quarantine face fines of up to $640 and up to six months in jail. In addition, the government closed all primary and secondary schools for nine days as the number of suspected cases climbed by 51, to 367. Singapore decided on Monday to close all schools and restrict SARS patients to their homes. Based on the spread and course of the illness, health officials have repeatedly said that it takes close contact to transmit the SARS agent, presumably a virus, from an ill person to other people. Individuals most likely to transmit SARS are those who are quite sick and have a fever and cough. Most cases have involved health-care workers who have cared for patients, their family members and friends