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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

One theory for the rising SARS death rate is that the initial cases involved health care workers who were healthy 20-to-45-year-old adults and who had better access to health care than others. Then, as the infected health workers unintentionally spread the disease to family members and friends, and they, in turn, to others, SARS has infected an increasing number of older people with heart disease, diabetes and other chronic ailments. If the death-rate trend continues, SARS will be unlike the first outbreaks of other newly discovered microbes where the initially high death rate substantially declined as the development of diagnostic tests and further epidemiologic investigation documented the existence of mild, even asymptomatic, cases. (If that happened with SARS, the death rate would be lower.) On Saturday, the Centers for Disease Control and Prevention in Atlanta posted on its Web site (www.cdc.gov) an advisory to doctors caring for SARS patients, saying the cause of the disease was unknown. The update came days after the W.H.O. had announced that the coronavirus was the cause of SARS and created some confusion as to whether the Americans and the W.H.O. disagreed on the matter. Although a C.D.C. spokesman said yesterday that the update was in error and would be corrected, the Saturday version remained on the Web site last night

The current 5.6 percent death rate for SARS is much higher than that for the 1918-1919 influenza pandemic, which was less than 1 percent, 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

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

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

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

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

Unless the numbers fall drastically, SARS would be among the infectious diseases with the highest death rates. Until now, fatality rates reported by the World Health Organization had ranged from 2 percent, when the epidemic was first detected in March, to 7.2 percent. The new findings come from a statistical analysis of 1,425 patients suspected of having severe acute respiratory syndrome who were admitted to Hong Kong hospitals from Feb. 20 to April 15. Overall, their mortality rate was estimated to be as high as 19.9 percent. The principal authors of the study from Imperial College, the University of Hong Kong, the Chinese University of Hong Kong and the Hong Kong health department said their findings underscored that SARS is a serious threat to the public and that health officials and workers must act to contain it. The authors credited Hong Kong's efforts to reduce the time from the onset of symptoms to the isolating of patients in hospitals as an important step in controlling the disease. Reducing the time did not affect the course of the illness in individual patients, they said, but speeding the isolation process reduced the period when they could transmit the virus to others. The study, said Dr. Michael Osterholm, an expert on infectious disease at the University of Minnesota, 'looks solid and provides an important source of information about the evolving epidemic.' Dr. Klaus Stoehr, the scientific director of the SARS investigation for the World Health Organization, said in an interview that the agency was reviewing the new data and the statistical models used to obtain them. 'The case-fatality rate can be calculated in many ways and can depend on various scenarios,' Stoehr said

Mortality rates are bound to change somewhat as an epidemic continues. But unless the numbers fall drastically, SARS would be among infectious diseases with the highest death rates. Until now, fatality rates reported by the World Health Organization had ranged from 2 percent, when the epidemic was first detected in March, to 7.2 percent. The new SARS findings come from a statistical analysis of 1,425 patients suspected of having SARS who were admitted to Hong Kong hospitals from Feb. 20 to April 15. Overall, their mortality rate was estimated to be as high as 19.9 percent. On Tuesday, the WHO said the number of new SARS cases in Hong Kong had steadily declined, which officials said suggested that the outbreak there had reached a peak. So far, Hong Kong has reported 1,646 probable cases and 193 deaths, which would mean that the death rate was 11.7 percent