Faculty Bibliography

It is the second World Health Organization team since early February to be denied access to Guangdong Province, just north of Hong Kong. The group arrived on Sunday in Beijing, where its members are reviewing epidemiologic information about the illness known as SARS, for severe acute respiratory syndrome, and have met with officials from Guangdong and Beijing. Dr. [David L. Heymann] said the organization was also ''very concerned'' about the rising number of cases in Hong Kong, because ''we have less information and we are less sure that containment activities are being successful'' there than in other countries. Hong Kong has reported 286 SARS cases, including 10 deaths. Hong Kong officials played down the seriousness of SARS earlier this month. Dr. Yeoh Eng-kiong, Hong Kong's secretary of health, welfare and food, who has managed the SARS outbreak with Dr. William Ho, the chief executive of the Hong Kong Hospital Authority, accused the World Health Organization of being too quick to sound an international alarm

Since Sept. 11 the agency has also offered doctors training materials to sharpen their ability to recognize anthrax and other unusual infections. Health experts cited other advances as well, including the computer systems now used in many communities to flag odd patterns of illness or medicine use. In addition, hospitals have retooled their disaster plans. The United States now has enough smallpox vaccine to inoculate the entire population, and, Dr. [Tara O'Toole] said, vaccinating military personnel and health workers has helped doctors learn how to conduct immunization programs. The government has also stockpiled antibiotics, treatments for burn and blast victims, and antidotes to chemical weapons and nerve gases. A federal program called the Strategic National Stockpile, part of the Department of Homeland Security, says it has enough medicine to treat 12 million people exposed to anthrax, 100 million exposed to plague and 50 million exposed to tularemia, a bacterial infection. The program says it can deliver the drugs anywhere in the country in 12 hours or less. The drills that have been conducted may not have been realistic enough. James D. Bentley, senior vice president of the American Hospital Association, said: ''The problem is, we tend to organize these drills in a way I'll call nondisruptive drills, on Saturday morning, with off-shift nurses and firemen. We haven't done many in this country where at 2 o'clock in the afternoon Mayor Bloomberg goes out there and stages something that will really disrupt the Bronx or Brooklyn. If there is a real terrorist incident, we'll have to do that. It's those kind of drills that I think the preparedness community wishes we could do more of.''

''This virus could be, if not the entire cause of SARS, at least contributing to SARS,'' said Dr. Julie L. Gerberding, director of the centers. But she cautioned at a news conference that it is ''very premature to assign a cause.'' The time in the course of a patient's illness when a specimen was collected can be critical to the interpretation of laboratory findings. For example, if a specimen was obtained from an autopsy, a virus that caused an illness may no longer be present because the immune system may have cleared it so that what is left is tissue damaged by the virus. So the inability to identify a virus in an autopsy specimen may be meaningless. For that and other reasons, the network is seeking as many specimens as possible obtained in the early course of a patient's illness. The important message, Dr. Gerberding said, is that scientists at the centers have cultured coronavirus from two of the four patients from whom it has specimens. The scientists also saw the virus in electron microphotographs from one of the patients from whom the coronavirus was detected and have found evidence of the virus in affected tissues like lungs and kidneys

The government has also stockpiled antibiotics, treatments for burn and blast victims, and antidotes to chemical weapons and nerve gases. A federal program called the Strategic National Stockpile, part of the Department of Homeland Security, says it has enough medicine to treat 12 million people exposed to anthrax, 100 million exposed to plague and 50 million exposed to tularemia, a bacterial infection. The program says it can deliver the drugs anywhere in the country in 12 hours or less

Dr. Tara O'Toole, director of the Johns Hopkins Center for Civilian Biodefense Strategies, said: 'We have done some useful things, as a nation and in states and some cities, to prepare for a bioterror attack. But I think people don't appreciate the kind of scale of effort that is needed and has not been achieved. I think there is also an understandable reluctance to talk truthfully about how vulnerable we are, lest we encourage would-be terrorists and undermine our own defense. I don't think we're a lot less vulnerable now than we were in 2001.' Since Sept. 11, the agency has offered doctors training materials to sharpen their ability to recognize anthrax and other unusual infections. Health experts cited other advances as well, including the computer systems now used in many communities to flag odd patterns of illness or medicine use. In addition, many hospitals have retooled their disaster plans. The United States now has enough smallpox vaccine to inoculate the entire population, and, O'Toole said, vaccinating military personnel and health workers has helped doctors learn how to conduct immunization programs. The government has also stockpiled antibiotics, treatments for burn and blast victims, and antidotes to chemical weapons and nerve gases. A federal program called the Strategic National Stockpile, part of the Department of Homeland Security, says it has enough medicine to treat 12 million people exposed to anthrax, 100 million exposed to plague and 50 million exposed to tularemia, a bacterial infection. The program says it can deliver the drugs anywhere in the country in 12 hours or less

Since 9-11 the agency has also offered doctors training materials to help recognize anthrax and other unusual infections. Health experts cited other advances as well, including the computer systems used to flag odd patterns of illness or medicine use. In addition, hospitals have retooled their disaster plans. The United States has enough smallpox vaccine to inoculate the population, and, [Tara O'Toole] said, vaccinating military personnel and health workers has helped doctors learn how to conduct immunization programs

Scientists at the University of Hong Kong, a member of the W.H.O.'s collaborative network, have isolated a virus in recent days that is a prime suspect. Yesterday, the agency reported further progress in identifying the virus and developing a test for it. Hong Kong has reported 222 cases, including seven deaths. Hong Kong officials said 210 patients remained in hospitals, 38 in intensive care. Scientists at the University of Hong Kong isolated infected cells. (Associated Press); A policeman in Hong Kong gave directions yesterday to four people wearing masks to protect themselves from a mysterious respiratory illness that has affected at least 386 people in 14 countries since Feb. 1. (Agence France-Presse)

'Within the first 24 hours we had calls to the state health officers and clinician community,' [Julie L. Gerberding] said. In 2001, the agency was severely criticized for not providing crucial information about anthrax to the public promptly. Gerberding said that since then, the agency had 'taken giant steps in streamlining our capacity to communicate information to the public.'

'What we would call transmission in the general community,' [David Heymann] said, would be evident in the inability to trace contacts of new cases to older ones. With influenza, for example, such transmission occurs when droplets containing the virus are dispersed widely in the air

As evidence, she cited the centers' ability to respond rapidly to severe acute respiratory syndrome, the mysterious illness that has affected hundreds of people in Asia and elsewhere. She said dealing with the SARS outbreak required skills much like those needed to respond to a terrorist attack. Health experts cited other advances as well, including the computer systems now used in many communities to flag odd patterns of illness or medicine use. In addition, hospitals have retooled their disaster plans. The United States now has enough smallpox vaccine to inoculate the entire population, and, [Tara O'Toole] said, vaccinating military personnel and health workers has helped doctors learn how to conduct immunization programs. A federal program called the Strategic National Stockpile, part of the Department of Homeland Security, says it has enough medicine to treat 12 million people exposed to anthrax, 100 million exposed to plague and 50 million exposed to tularemia, a bacterial infection, and can deliver the drugs anywhere in the country in 12 hours or less