Faculty Bibliography

In fact, the investigation into part of the Ontario epidemic is now reaching into the United States. On Thursday, the Centers for Disease Control and Prevention in Atlanta sent a team of epidemiologists to Pennsylvania to help investigate a probable SARS case in a hospitalized patient who attended a religious meeting in Toronto on March 28. Canadian health officials have identified 28 other individuals with SARS who attended the Mass, held by members of the Bukas-Loob Sa Diyos Covenant Community, a Roman Catholic group. Health officials are trying to identify the estimated 500 people who attended the meeting and monitor their health. Of the 35 American cases, 33 had traveled to an affected area in Asia. The two other cases involved a health worker who cared for a SARS patient and a household member of a SARS case. Tests, still in the experimental stage, showed that five of the 33 patients were recently infected with the SARS virus, which is a new member of the coronavirus family. So far, infection with the SARS virus has not been documented among other suspect cases

The request is aimed at people who develop any of six symptoms of SARS, or severe acute respiratory syndrome: severe headache, severe fatigue, muscle aches and pains, fever of 100.4 or higher, dry cough and shortness of breath. The request excludes people who have had cough or shortness of breath from pre-existing allergy or lung disease. Canadian health officials said that all the cases in the Toronto area can be traced back to an outbreak at Scarborough Grace Hospital, and they said that SARS is under control, in part because of their isolation policy. The outbreak in Toronto is now in its fourth generation of cases, increasing the complexity of tracing cases. About 7,000 people in the Toronto area had already been asked to stay in isolation since the outbreak began in March, and about 650 remain in isolation. Of the 35 American cases, 33 had traveled to an affected area in Asia. The two other cases involved a health worker who cared for a SARS patient and a household member of a SARS case

Canada, particularly in the Toronto area, is the hardest-hit country outside Asia in the worldwide SARS epidemic, which is believed to have begun last November in southern China. As of Thursday, 27 countries and Hong Kong have reported a total of 3,389 cases. The number of cases in the United States was sharply reduced Thursday to 35, from 208, when federal health officials, as expected, adopted the World Health Organization's stricter definition of probable SARS cases. Worldwide, SARS is blamed for 165 deaths, for a death rate of 4.9 percent, the World Health Organization reported

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

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

It took only a few dry coughs to spread a mysterious respiratory illness to clusters of health workers in Asia and to kill Carlo Urbani, 46, the World Health Organization doctor who first identified it. And it took only a few airplane passengers for the illness to reach 15 countries in Asia, North America and Europe. Now, one person has apparently spread the illness to scores of residents of an apartment complex in Hong Kong, and the government has put the entire complex in isolation and closed all schools. In Toronto, two hospitals have been closed to new patients. The patterns of transmission raise the possibility that the illness, known as SARS, for severe acute respiratory syndrome, can be spread through the air or contaminated objects as well as close face-to- face contact. The events justify the bold alarm that the World Health Organization set off at a time when cases and deaths were few in number, on March 15, when it declared SARS 'a worldwide health threat.' The organization then hastily created a network of 11 infectious-disease laboratories in nine countries to track down the cause of SARS. Officials at the World Health Organization, a UN agency, cannot recall the last time the agency has issued a global alert for an acute outbreak of a disease. The agency has long had networks of laboratories for influenza and other diseases, but such networks have rarely been pressed into emergency service. In less than two weeks, with an alacrity and a degree of cooperation seldom seen in science, the laboratories identified two previously unknown viruses as the leading suspected agents. (They belong to the coronavirus and paramyxoviridae families.) But because of the danger of the illness, the UN agency is restricting research on it to its network. All laboratories in the network operate at the second- highest hazard level, known as P-3, reserved for all but the most deadly pathogens. Far from being the last link in the discovery process, identification of a new virus in a laboratory is only the first of many steps needed to prove that a suspect virus actually causes a disease. It is likely to take weeks more to determine which virus, singly or in combination, actually causes SARS. In that time, the leading suspects may be displaced by other candidates. For now, the leading suspect is a coronavirus, though proof is far from certain. The family takes its name from the crown of spikes that surround the spherical virus. Known coronaviruses cause the common cold and are suspected of causing diarrheal and other intestinal illness in humans. Though pesky, the ailments are rarely fatal. But in animals, coronaviruses can cause devastating illness among cats, dogs, chickens, pigs and cattle

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

The C.D.C. team from Atlanta arrived yesterday as health workers caring for SARS patients in hospitals in the Toronto area were advised to wear two sets of gloves and two gowns as well as full face shields 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. One reason for strengthening 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. Yesterday, Ontario health officials said that new SARS cases had occurred among health workers at two Toronto hospitals -- Sunnybrook Hospital and Mount Sinai Hospital -- last week. Canada and the United States have had an epidemiologist working with each other's SARS investigating teams from early in the epidemic to exchange information rapidly. But Dr. Julie L. Gerberding, the director of C.D.C. in Atlanta, in answer to a question at a news conference yesterday, said that her agency could not send additional experts until a request from Toronto officials had been cleared through the Ontario and federal Canadian governments. The reason is that the C.D.C. can respond to requests only from another nation, not a city or province

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

The current 5.6 per cent death rate for SARS is much higher than that for the 1918-1919 influenza pandemic, which was less than 1 per cent, said Dr. Klaus Stoehr, the scientific director of WHO's SARS investigation. But the influenza pandemic killed from 20 million to 40 million people in the world because it spread so quickly. One theory about the rising SARS death rate is that the initial cases involved health care workers who were healthy adults 20 to 45 years old and who had better access to health care than others. A second theory is that many of the SARS deaths occurred among patients who became ill weeks ago but who died only recently after long hospital stays