Posted 11:03 AM by Dr. Kay

SARS: Health dept. issues guidelines

By Our Staff Reporter

THIRUVANANTHAPURAM April 25. The Health Department has issued a set of guidelines as part of stepping up surveillance to prevent cases of Severe Acute Respiratory Syndrome (SARS) viral infections being carried into the State through international air passengers.

So far, two air passengers, one from Singapore and the other from Toronto, have been kept under observation at isolation wards in the Thiruvananthapuram Medical College and the General Hospital, Kochi, after their pneumonia-like symptoms raised suspicions among treating physicians.

The serum samples of the patients, collected at the Public Health Laboratory, have been despatched for sophisticated confirmatory tests to the National Institute of Virology (NIV), Pune.

Meanwhile, the Director of Health Services, V. K. Rajan, has issued directives to District Medical Officers to strengthen surveillance and preventive measures against SARS.

A team of medical experts has been stationed at the international airports in Thiruvananthapuram, Kochi and Kozhikode to augment screening of incoming passengers.

Ambulance facilities have also been made available to reach suspected cases to designated Government hospitals, which have put in place special isolation wards to deal with such cases.

The Additional Director of Health Services, P. K. Sivaraman, who is leading preventive measures, has urged the public against getting panicky as the department was fully equipped to safeguard SARS infections from spreading in the community.

Meanwhile, in its set of guidelines, the Health Department has underscored the need for vigil against the SARS virus, whose mode of spread, is through the respiratory route. Since travellers may carry this virus of a highly contagious nature, it was imperative to identify a suspected case without delay and quarantined to protect the public.

As fever and respiratory symptoms are very common in the community, persons routinely reporting with these clinical signs, should not be suspected to have probability of SARS without adequate reasons.

However, at the same time, it should be known both among clinicians and the lay public that SARS, in its initial phase, could be mistaken for common respiratory ailments.

Any individual who has contact with anyone with SARS, or suspected for SARS, or has been in an aircraft in which a passenger was suspected to have SARS, must disclose the fact within 24 hours of reaching Kerala, to the doctor/clinic/hospital, to which the person would ordinarily go for medical attention or the nearest health care institution.

Any health care worker (doctor or physician of any system of medicines, any medical practitioner) who is approached by any person with fever and respiratory symptoms (cough, sore throat, nasal discharge) must take a detailed history of travel by the person, in the two weeks prior to the consultation.

In case of travel, the following details are to be recorded in order to assess the poteintial risk: Anyone who has visited China, Hong Kong or Singapore within the past two weeks, persons who has travelled to any country outside India in the past fortnight, or anyone who has travelled to Goa or Pune in the past two weeks.

The responsibilities of health care worker/institution are to immediately report to the DMO concerned or Corporation Health Officer. In case of contact being not established with these officers, the Additional Director of Health Services (Public Health) or the Director of Health Services, should be intimated on these numbers 2302160, 2331177, 2302490 ext: 277, or over mobile: 9447204987).

Patients are required to be kept under observation for 24 hours and also keep in contact with the subject for close follow-up on a daily basis until all suspicion is over.

Whether or not any investigations are conducted by any institution, appropriate specimens will have to be collected and forwarded with all infection containment precautions, to either of the two institutions identified for SARS investigations, namely NIV, Pune or the National Institute for Communicable Diseases, New Delhi. The Health Department will collect and despatch the specimens.

Patient unlikely to have infection

By Our Staff Reporter

THIRUVANANTHAPURAM April 25. The 72-year-old patient who has been admitted to the Thiruvananthapuram Medical College on suspicion of carrying an infection of the Severe Acute Respiratory Syndrome (SARS) virus, is highly unlikely to be a victim of the killer-pneumonia virus, clinical experts have said.

The city resident, who holds a Singapore citizenship, had been referred to the medical college after reporting to a private hospital with signs of viral fever within a couple of days of reaching Thiruvananthapuram by flight on April 17.

However, medical college sources said that all available clinical pointers have led them to believe that the patient was least likely to have a SARS virus infection, even though serological confirmation is awaited from the Pune-based National Institute of Virology.

Diagnostic routines such as chest X-ray and other clinical evaluation parameters indicate that it is not even a case of pneumonia. The patient, who is diabetic, has been at present diagnosed with a bronchial infection, sources said.

``The patient should normally have been sent home but for the extraordinary circumstances that warrant his being kept under observation,'' a senior doctor said.

At present, the referral of the patient as a suspected SARS case to the medical college is being pointed out as a case of some doctors over-reacting in the wake of the global alert on the killer-pneumonia.

Meanwhile, the hospital administrators are in a fix over ensuring proper isolation of the patient. Following protests by other patients over accommodating the suspected SARS case in a common isolation ward, they have shifted the patient to one of the pay wards.

Vigilance stepped up at Karipur against SARS

MALAPPURAM: The Airport Authority of India (AAI) has beefed up vigilance against the SARS disease at the Karipur Airport following a directive from the Union Health Ministry.

Airport director M Subba Rao said that all international air passengers arriving at the Airport were being screened for suspected SARS symptoms.

He said that the medical facilities at the airport had been enhanced with a team of six doctors and paramedical staff for overseeing the precautionary measures.

He said that the doctors and the paramedical staff at the Airport had been provided with masks.

SARS spread: Singapore to punish violators

By P. S. Suryanarayana

SINGAPORE April 25. Singapore today led the battle against the Severe Acute Respiratory Syndrome (SARS) in East Asia by adopting a drastic new legislation to punish those who might break the home-quarantine orders or expose the community to the infection by other means of willful action or sheer neglect.

The law, an expansion of the scope of the Infectious Diseases Act, provides for exorbitant fines and/or jail terms. The enactment, carried out at a session of Parliament here today, flows from the concerns of the Singapore authorities over the continued prevalence of this new disease as a potential danger to society at large despite the steps already taken in recent weeks. Given a sense of fear-psychosis among some sections of Singaporeans, the authorities here have repeatedly assured the public that there is nothing amiss about a particular hospital that has been designated for the diagnosis of the SARS symptoms and the treatment.

The anxieties of the people on this score were set off by the indications that the SARS transmissions initially occurred in hospitals themselves in Singapore. Today's legislation was enacted through a fast-track approach by using a Certificate of Urgency under the relevant rules. Elsewhere in the region, Thailand's Prime Minister, Thaksin Shinawatra, who would host a special summit of the Association of South East Asian Nations on the SARS question in Bangkok next week, indicated today that the participant-leaders would not be subjected to any SARS-detection tests.

In China, the authorities `quarantined' three hospitals and reassured the public that "people's lives are more important than economic growth''. Steps were also announced to build a disease control network this year at a cost of over $420 millions.

The total number of SARS cases in China was today put at 2,601. The death toll in mainland China as also the Hong Kong Special Administrative Region was 115 each.

The Indian Defence Minister is now in Shanghai on the final leg of his China tour which, too, has served as a political gesture of goodwill in the SARS context in China.

Govt. announces tough measures to tackle SARS

By Our Special Correspondent

NEW DELHI April 24. With reports of fresh cases of the Severe Acute Respiratory Syndrome coming in from several countries, the Union Health Minister, Sushma Swaraj, today announced a series of measures to further boost the country's preparedness in meeting the threat posed by the killer disease.

The measures include provision of masks to all airport employees, doctors and paramedical staff who ran the risk of contracting the disease through contact with affected persons. The masks — ranging from simple three-layered ones to the high-tech respirators developed by the Defence Research and Development Organisation (DRDO) for use in case of nuclear, chemical or biological attacks — would be given according to the risk potential.

While the staff at airports would be provided with the three-layered masks, costing between Rs. 3 and Rs. 5 a piece, doctors treating confirmed SARS cases would be provided with the DRDO's high-tech respirators, which cost about Rs. 2,200 each.

In the intermediate categories, paramedical staff at airports would be given what are called A-71 masks which cost about Rs. 80 each while doctors stationed at airports would get the nex grade, N-95 masks costing Rs. 230 a piece. The masks would be distributed in the next few days.

At a press conference, Ms. Swaraj said all passengers arriving at the country's international airports would be screened for the disease and those suspected to be carrying the virus would be confined to isolation wards and would be discharged only when blood tests and other examinations proved negative.

In case the tests proved positive, the patients would be kept under observation. If they showed clinical symptoms, they would remain in isolation wards; and if they did not show clinical symptoms they would be kept in the isolation wards for two days and discharged on the condition they would remain in `home isolation' at least for 10 days.

Ms. Swaraj also announced the constitution of a special Centre-State joint action group to keep track of the developments at the global and national level so that immediate mid-course correction of the strategy to fight the disease could be taken as and when necessary.

The panel would be headed by the Union Health Secretary, S. K. Naik, and would include the joint secretaries in the Civil Aviation and Shipping Ministries, the directors of health services of Maharashtra, Kerala, West Bengal, Delhi, Andhra Pradesh and Nagaland, the Director-General of Health Services in the Union Health Ministry and the Director-General, Indian Council of Medical Research. A WHO representative would also be included to ensure.

The new measures were decided upon following two high-level meetings chaired by Ms. Swaraj. The first was with representatives of various Union Ministries such as Home Affairs, Civil Aviation, Shipping and Tourism and also a representative from WHO. The second was with Health Secretaries and directors of health services of various States and Union Territories.

The main idea, Ms. Swaraj said, was to ensure that SARS did not come into India and if it did it should not be allowed to spread.

PTI, UNI report:

Meanwhile, two suspected SARS cases had been reported from Kerala and the patients were kept under observation in hospitals, the State Health Service Director, V. K. Rajan, said in Thiruvanathapuram. The blood samples of the two, who had recently arrived from Singapore and Toronto, had been sent to the National Institute of Virology, Pune, as they had come from SARS-prone countries, Dr. Rajan said.

In Jaipur, a person suspected to be suffering from SARS was found to be "quite normal", but he would be discharged after he was cleared by the National Institute of Communicable Diseases, a doctor attending on him said. A patient admitted to a private hospital in Bangalore with suspected SARS symptoms two days ago, was also discharged today after a blood test reported negative.

In a significant development, the Bangalore-based Manipal Hospital said it had developed a kit for diagnosing SARS. "The test is similar to the one developed by Bernhard-Nocht Institut fur Tropenmedizin, a medical institute in Germany and also an allied laboratory of the World Health Organisation and meets all the specifications of WHO," a press release said.

In Chandigarh, the Punjab Chief Minister, Amarinder Singh, said there was no SARS case reported so far in the State, and directed civil and health authorities to ensure requisite preventive measures to check the outbreak of the disease.

SARS affects growth projections in Asia

By Our Special Correspondent

NEW DELHI APRIL 24. The outbreak of SARS in the South-Asian region has led to widespread lowering of growth projections in the affected countries which otherwise form the fastest growing region of the world and has been described as an area which had basically been keeping the global economy afloat.

Data complied by the Federation of Indian Chambers of Commerce and Industry here has revealed that international financial organisations have estimated that the largest decline in growth projections has been in the case of Singapore where growth rates are expected to fall by 1.5 to 2.5 per cent. Malaysia's growth rate is also expected to fall by 0.9 per cent while Hong Kong is estimated to witness a 0.6 per cent decline in growth rates in 2003. However, China, which has the largest number of SARS cases, the gross domestic product (GDP) is expected to fall about 0.5 per cent and the country's growth rate could be around 6.5 per cent.

The sectoral impacts have been even more severe, according to the report. Already hit by the Iraq war, international airlines have been doubly hit because of the SARS outbreak with business travellers turning to e-mail and videophones rather than making business trips. The Japanese airlines, ANA has reported that passenger traffic between Tokyo and Hong Kong fell by a fifth after the disease was identified and visitor arrivals in Hong Kong and Singapore have reportedly collapsed by around 61 per cent.

Singapore Airlines recently announced that it has effectively grounded 13.5 per cent of all its flights while Hong Kong-based Cathay Pacific has indicated that it may need to ground its whole fleet next month.

Tourism too has been badly hit whereas this sector contributed significantly to the GDP of the South-Asian countries. Singapore, for instance, has a 10 per cent contribution from tourism to its GDP and has decided to implement a $230 million package to provide immediate relief for the most directly and adversely hit tourism and transport-related sectors.

Similarly, Malaysia, which has a seven per cent contribution from tourism which is also its second largest foreign exchange earner, is expected to lose around RM 200 million per month in terms of tourism revenue. The fall in tourism arrivals in the South-Asian countries also has its ripple effect on retail trade and other services.

The Federation report has suggested that collective efforts be undertaken by the affected countries to check the spread of the disease by undertaking joint scientific and laboratory exercises and increase surveillance and threat detection networks.

Posted 10:42 AM by Dr. Kay

Airports scan for SARS victims' flushed faces

NewScientist.com news service

In a bid to stop the alarming global spread of the deadly SARS virus, airports in the Far East have begun using thermal imaging cameras to detect the flushed faces of travellers suffering from a fever.

Other measures already deployed to try to slow the outbreak of Severe Acute Respiratory Syndrome (SARS) include compulsory quarantines, forced medical treatments and national travel bans. By Thursday, the virus had killed 263 people and infected over 4600 people in 25 different countries.

There is no cure or vaccine for SARS as yet. On Wednesday, the World Health Organization extended its unprecedented advisory against travel to infection hotspots, to include Beijing and the Shanxi province in China and Toronto in Canada.

The infra-red thermal imaging scanners are now being used at Singapore's Changi airport and Japan's Narita airport in Tokyo. Hong Kong, the worst hit region after China, is set to introduce the scanners over the coming weekend.

The technology can detect individual passengers with a temperature higher than 38.0°C or 100.4° - a telltale sign of SARS. These passengers' faces show up as a red image on the screen.

Doctor's note

Passengers with a fever stopped at Singapore's Changi airport will be taken aside by nurses for an examination. Those who have a high temperature will have to be certified by doctors as not having SARS before being allowed to fly, says the Civil Aviation Authority of Singapore.

Singapore's minister for transport, Yeo Cheow Tong, pointed out that the screening would not inconvenience healthy passengers: "Not only does the scanner speed up the process tremendously, it is also hassle free."

Thermal imaging will be very good at picking up people with SARS as fever is a key symptom, says Robert Booy, an infectious diseases expert at Queen Mary, University of London. However, such screening will also select out many other people, as there are many causes of a high temperature.

More seriously, the thermal screening will only detect people who contracted SARS some days earlier and have already developed a fever. People incubating the virus will not have developed symptoms and will not be stopped. The incubation period of SARS appears to be between two to 10 days, although there is some suggestion from China that it may be as long as 16 days.

Full screening would require a test to identify asymptomatic people, Booy told New Scientist. Labs around the world are currently racing to develop fast and reliable diagnostic tests for the novel coronavirus that causes SARS.

The spread of SARS can definitely be slowed with measures like thermal screening at airports, says Booy, but his overall assessment is gloomy: "It is unlikely that this outbreak can be contained, whatever steps are taken."

Shaoni Bhattacharya

Burgeoning SARS virus decoded in China

16:50 22 April 03 NewScientist.com news service

Chinese scientists have sequenced the genetic code of at least four samples of the SARS virus from different patients. Comparison of these genomes will determine whether the virus is mutating rapidly, which in turn will determine how difficult it will be to develop tests and vaccines based on the virus's genes.

The outbreak of Severe Acute Respiratory Syndrome (SARS) began in China in November, but was not made public until March. Now, 243 people have died and over 4200 infected in 26 countries around the world. Some experts fear it may already be too late to contain SARS, for which there is currently no cure.

The biggest challenge facing health officials is the lack of information from China. The country, home to about half the SARS cases, has been severely and widely castigated for its secrecy, but the criticism appears finally to be making an impact.

China has admitted that the virus is spreading into more remote provinces and has dispatched emergency SARS teams. On Sunday, the government raised the official number of SARS cases in Beijing from 37 to 358 and fired the health minister and the mayor of Beijing for covering up the crisis. By Tuesday, suspected cases of SARS in the capital had reached 602.

Nose and throat swabs

The latest gene sequences of the SARS virus were obtained by scientist at the Beijing Genomics Institute and the Institute of Microbiology and Epidemiology of the Academy of Military Medical Sciences. They have now released five sequences on the internet.

A short report on four of the coronavirus samples was also published. The samples came from nose and throat swabs, as well as lung, liver and lymph node tissue removed during autopsies. Three samples were from Beijing patients, with the fourth from a patient from Guangdong, the province where SARS originated.

Four other code sequences have been released by scientists in Canada, the US, Hong Kong and Singapore. All differ by up to 15 "letters" in the 30,000 that comprise the virus. The Chinese scientists note the differences and write that "the virus is expected to mutate very fast and easily". Such slight differences could also be explained by errors in the sequencing process.

However, most of the variations seen so far seem to affect one gene in particular, while 12 more genes show no changes between non-Chinese sequences. This suggests the variants may genuine mutations.

Scientists will now be working to determine whether different strains produce different symptoms in patients and are spread in different ways. In Hong Kong, the group of patients from the now infamous Amoy Gardens tower block were much more likely to suffer diarrhoea and the virus's spread there has been linked to the sewer system. Scientists at Hong Kong University are now sequencing key regions of the virus.

"Dark misgivings"

China's increased openness has given a cautious welcome by the World Health Organization. "We're now much closer to what we always thought was the reality in Beijing," says Peter Cordingley, spokesman at the WHO's Western Pacific headquarters in Manila. "But as for the rest of the country, we have dark misgivings."

New data reveals that SARS now ranges from the densely populated Sichuan province in the southwest to Liaoning in the northeast. "We're very worried about the less accessible provinces, where there is poor health care and poor resources," Cordingley says.

But another WHO official says China is still not revealing some key data. "Without the date of onset for patients, you can't say what the trend of the disease is," Jeff McFarland, a WHO virologist, told AFP. "This is the data that we need to have to fully understand the epidemic."

"To be able to contain SARS, we have to know what is happening in China," says microbiologist John MacKenzie at the University of Queensland, Australia, and a SARS investigator for WHO. "Until the Chinese authorities come totally and utterly clean, they will maintain a sink that will carry on affecting us globally," he told New Scientist.

MacKenzie adds that problems with the flow of information between authorities and the WHO have also been a problem in Hong Kong, particularly in relation to the spread of SARS in the Amoy Gardens housing block. "Details of work on transmission, on what animals, if any, might be involved is still to come out," he says.

On a more positive note, MacKenzie says the draconian quarantine measures have had an impact in Hong Kong and Singapore, the worst affected places after China. Most secondary schools re-opened on Tuesday after weeks of being closed.

Damian Carrington, Emma Young and Debora MacKenzie

Posted 9:46 AM by Dr. Kay

Two suspected SARS patients admitted to hospital in Kerala

Thiruvananthapuram: Two suspected Severe Acute Respiratory Syndrome (SARS) patients, who reached Kerala from Canada and Singapore, have been admitted to a hospital for treatment.

Ramakanthan, 73, who arrived from Singapore, was admitted to the Medical College Hospital here, while Varghese, 63, from Toronto in Canada was being treated at a hospital in Kochi, Health Services Director V.K. Rajan said on Thursday.

He said there was only a remote chance of them being infected with the deadly SARS virus, but the authorities wanted to keep them under observation.

The blood samples of the patients were sent to the National Institute of Virology in Pune for investigations. Earlier, a case of suspected SARS was reported in Kochi but it was found to be negative during blood tests.

Dr Rajan said round-the-clock facilities had been set up at the international airports in Kerala to screen suspected SARS cases. Doctors would be appointed at all the three international airports.

Isolation wards would be kept ready in all major centres if a large number of suspected cases landed, he added.

First suspected SARS case in Tvm

THIRUVANANTHAPURAM: A suspected case of Severe Acute Respiratory Syndrome (SARS) has been reported here. This is the second suspected SARS case in the State.

The patient who arrived here from Toronto, Canada, on April 11 is now undergoing treatment at a private hospital. The 73-year-old patient had complained of chest infection and fever three days ago.

An official of the Health Department told this website's newspaper that the patient would undergo various blood tests tomorrow. The blood samples would be sent to the National Institute of Virology, Pune, for investigations.

A case of suspected SARS was reported in Ernakulam district two weeks ago. The blood samples of the patient were sent to the Pune Institute for investigations. The case was found to be negative.

According to the official, a special ward has been set up for SARS cases at the General Hospital here. Round-the-clock ambulance services have been arranged at all the three international airports in the State.

‘‘We are planning to conduct awareness programmes for the public and the medical staff. A special training programme is also being arranged for the doctors to meet the SARS threat,’’ the official added.

The Health Department has finalised a report on the steps initiated by the State Government to tackle the SARS threat. The report will be presented by Health and Family Welfare secretary K.Ramamoorthy at the meeting of Health Ministers and Health Secretaries in Delhi on Thursday.

Singapore deputy PM warns of SARS catastrophe

Singapore, April. 24. SARS could have "catastrophic" consequences for Singapore if not controlled, Deputy Prime Minister Lee Hsien Loong warned today. He pledged that the Government would muster all resources to fight the outbreak.

"The Severe Acute Respiratory Syndrome (SARS) is a grave threat to Singapore. It has taken a heavy toll on our public health, our economy and society," he told Parliament.

"We have to muster all our resolve and resources in order to fight SARS. Then we can bring the SARS outbreak under control, restore confidence, boost morale and get the economy moving."

SARS: Beijing city invokes emergency measures

Beijing, April. 24. (PTI): Even as the World Health Organisation (WHO) issued an unprecedented global travel advisory against Beijing, the Chinese capital today invoked emergency measures to quarantine people exposed to the deadly SARS virus and bar access to buildings where there has been an outbreak of the infection.

The Beijing Municipal Government issued a circular late last night to quarantine people, areas, animals and products infected, or suspected of being infected, by Severe Acute Respiratory Syndrome (SARS), in its latest bid to curb the spread of the virus.

The SARS outbreak seems to get out of control in Beijing which is home to some 13 million people. The Ministry of Health said the city had 693 cases of SARS and 35 deaths.

According to a circular, those having had close contact with people infected or suspected of being infected by SARS will also be isolated for quarantine.

No case of SARS in Punjab: Amarinder

Chandigarh, Apr. 24. (PTI): Claiming that there was no case of Severe Acute Respiratory Syndrome (SARS) reported so far in the State, Punjab Chief Minister Amarinder Singh today directed civil and health authorities to ensure requisite preventive measures to check the outbreak of the disease.

"Detailed instructions have already been sent to all deputy commissioners and civil surgeons to make requisite preventive measures to check the outbreak of SARS," the Chief Minister was quoted as saying in a official communique from Ropar.

He asked Director, Health Services, to ensure adequate supply of medicines and masks in the hospitals to face any eventuality.

Wife of suspected SARS patient admitted to hospital

An earlier report said the wife of a suspected SARS patient in Bathinda was today admitted to the Civil Hospital there.

Forty-five-year-old Saroj, wife of Jagdish Rai, the first suspected Severe Acute Respiratory Syndrome case reported from Punjab yesterday, was admitted to the Civil Hospital, Bathinda, after she complained of "high fever and respiratory complications," Bathinda Chief Medical Officer Dr S K Goyal said over phone.

Goyal said both suspected patients have been kept in an isolation ward and were under observation. "Rai's condition has shown improvement," he said.

SARS toll rises to 209 in China

Beijing, April 24. (PTI): In its latest move to fight the deadly SARS virus, China today sealed off a major hospital in the capital where four more people died of the disease and invoked emergency measures to quarantine the affected individuals and areas.

According to latest SARS statistics announced by China's ministry of health, the Chinese mainland reported a total of 2,422 confirmed cases of SARS while 209 people have died nationwide.

The panic-stricken capital itself has registered 39 deaths.

Hong Kong also announced four more deaths and 30 new cases of SARS taking the territory's toll to 109.

2 with SARS symptoms quarantined

By Our Staff Reporter

BANGALORE April 23. Two persons with suspected severe acute respiratory syndrome (SARS)- like symptoms were reported in Manipal Hospital, the hospital authorities said here on Wednesday.

A 24-year-old man, who arrived here from Montreal in Canada around a week ago, came to the hospital on Tuesday night, complaining of fever and body pain. He is here with his wife on a holiday and has been staying at a resort on the outskirts of the City. As he had travelled from a SARS-affected country and showed SARS-like symptoms, he has been quarantined and is being kept under observation in the isolation ward of the hospital.

The results of his blood and sputum tests to find out whether he is infected by the SARS-causing Corona virus is awaited in a day or two. "We are sure that the results of the test will be negative, as the patient's chest X-ray was clear. But we are just taking the necessary precautions as directed by the Union Government,'' Malathi, Medical Administrator of the hospital, said.

The other case was that of a school-going boy who came to the City from Singapore. He was quarantined in the isolation ward as he had fever and cough. But apparently, he did not have SARS as his test results were negative, hospital authorities informed.

However, there appears to be confusion as the Government health authorities said they were not informed about the case of the boy.

All suspected SARS cases have to be immediately reported to the SARS nodal officer or the health officials. Kumaraswamy, Additional Director (Communicable Diseases), Department of Health and Family Welfare, who is the nodal officer, told The Hindu that he was not aware that such a case was reported. "None of the Government health officials who are dealing with SARS have been informed about this case by the hospital authorities,'' he said.

The hospital claims to have developed a SARS diagnostic kit. The test is said to be based on the reverse transcription polymerase chain reaction (RT-PCR) technique for detecting the presence of the virus in the patient's blood and sputum. "The test is a modified version of a similar one developed at a medical institute in Hamburg, Germany, and meets the specification of the World Health Organisation (WHO)," the hospital authorities said. The Government authorities are not convinced. "As per Union Government specifications, the blood and sputum samples taken from patients have to be sent to the National Institute of Communicable Diseases (NICD), Delhi, or the National Institute of Virology (NIV), Pune, as these are the recognised institutions for testing the SARS virus,'' Dr. Kumaraswamy said.

Another 70 Hong Kong residents were placed under home quarantine as their observation confirmed one in five chance of infection with the mystery virus.

Malaysia ordered quarantine for 203 citizens, mostly low waged earners, who had visited a SARS-infected produce market in Singapore and warned that it would jail those who would break the orders.

Authorities here sealed off the 1200-bed People's Hospital of Peking University because of multiple SARS infection preventing staff and patients from leaving the complex or allowing anybody to enter.

The Beijing municipal government issued a circular late last night to quarantine people, areas, animals and products infected, or suspected of being infected, by SARS virus, in its latest bid to curb the spread of the disease.

Places infected by the virus that require quarantine include hospitals, factories, construction sites, hotels, restaurants, office buildings, residential buildings, villages, schools and other designated places, according to the circular.

"Compulsory measures may be taken if those involved refuse to cooperate with the relevant departments, and those who violate related laws and regulations will be punished accordingly," the circular warned.

Samples of both suspected patients had been taken and sent to the National Institute of Communicable Diseases at New Delhi.

Fatalities soar, China closes schools

By P. S. Suryanarayana

SINGAPORE APRIL 23. As the fatalities caused by the virulent incidence of SARS (Severe Acute Respiratory Syndrome) in China crossed 100, with nine persons succumbing to the disease in the past 24 hours, the Chinese authorities today intensified their efforts to contain the spread of the new disease.

The most striking aspect of the new measures being taken by China was the mass closure of schools for nearly a fortnight. The objective was to protect the health of well over a million students in the context of Beijing's admission of the severity of the outbreak in China.

At one level, China continued to present a picture of business as usual by hosting India's Defence Minister and a ranking U.S. State Department official among others at this time. On a different track, though, it began to take the SARS crisis very seriously. Home quarantine of suspected patients was also being resorted to. The number of confirmed SARS-related deaths on the Chinese mainland was officially put at 106 today, even as the definitive cases were said to have gone up to 2,305.

Economic package

In China's Special Administrative Region of Hong Kong, the authorities today unveiled an economic package worth about $1.5 billions to stimulate the economic activities that had suffered as a result of the SARS epidemic. With six more SARS-related deaths occurring in Hong Kong in the past 24 hours, the overall situation continued to stay grim. In Singapore, the Prime Minister, Goh Chok Tong, indicated, through an `open letter 'to the people, that tough measures would be taken through legislation and other means so that the disease could be controlled.

Centre convenes meet on SARS tomorrow

By Our Special Correspondent

NEW DELHI April 22. Even as three new suspected cases of the Severe Acute Respiratory Syndrome were reported from Delhi, Jaipur and Nasik, the Union Health Minister, Sushma Swaraj, today announced that a meeting of the State health authorities had been convened here on Thursday to discuss and chalk out an action plan to tackle the killer disease.

Responding to members' concern in the Lok Sabha during zero hour, Ms. Swaraj said she would personally meet all the Ministers and the Health Secretaries to discuss steps to prevent the spread of the disease.

Sharing the concerns expressed by members over the detection of four cases of SARS so far in the country, she said the "Government has taken all effective measures to deal with the situation and it will not be found lacking in future also."

Later, senior Health Ministry officials said declaring SARS as a notifiable disease was under consideration. Once so declared, doctors treating patients suffering from it would be legally bound to inform the authorities. Now, only three diseases were notifiable — plague, yellow fever and cholera.

As regards the three fresh suspected cases, the Director-General of Health Services, S.P. Agarwal, and the Director, National Institute of Communicable Diseases, Shiv Lal, said that though on the face of it these patients did not fit the criteria for SARS, they were being treated in isolation wards and their sputum and other samples had been sent for further tests.

In the Delhi case, the patient, a 29-year-old woman from Guangdong, the southern province of China from where the worldwide epidemic of SARS is suspected to have begun, had complained of cough and cold after landing here on Monday. She was initially taken to a private medical practitioner and then to the Infectious Diseases Hospital, where after repeated X-rays, her lungs were found to be clear, indicating that she was not suffering from SARS.

In Jaipur, a 29-year old man who returned from New York on April 15 was admitted to hospital on Monday after he complained of fever and cough. But, preliminary tests indicated that he was not suffering from SARS.

In Nasik, a 23-year old man, who arrived from the U.S. on April 18 with dry cough and temperature, was admitted to hospital and initial investigations revealed that he was free of SARS, the officials said.

Health Ministry sources said the Thursday meeting would also focus on the way the local authorities had handled the first confirmed case in Goa as also the three subsequent confirmed cases in a family in Pune.

In the Goa case, the patient was discharged even as reports of his sputum and other samples were under test and then suddenly readmitted to the hospital when the reports came in, only to be discharged the next day.

In Pune, even after a mother, her son and daughter had tested positive for SARS, the daughter was allowed to go ahead with her marriage in the presence of a group of relatives and friends. The two incidents have raised concerns about the seriousness being attached to the disease.

SARS case: Search on for taxi driver

By Mahesh Vijapurkar

MUMBAI April 22. As three positive cases of Severe Acute Respiratory Syndrome (SARS) have been reported in the State all of a sudden, the Maharashtra Government has asked the Centre to request China, Hong Kong and Singapore where SARS has occurred widely to detect passengers with any telltale symptoms and detain them for treatment in their own countries and not allow them to leave there for India.

According to the State Health Minister, Digvijay Khanvilkar, "the letter went out today" to the Union Health Minister, Sushma Swaraj, "because we think it is easier and more efficient to check passengers as they leave" than check them as they arrive here. Two of the three SARS victims, Stanley D'Silva, and his mother, Vimla, had travelled by the same flight from Hong Kong on which one of the passengers had symptoms indicates from where the D'Silvas may have got the infection; it was passed on to his sister, Julia, before they surfaced with the problem in Pune. The suspect passenger was taken off the aircraft at Singapore.

Another need, conveyed to the Centre and apparently conceded is, for 1,000 speciality masks, so that Maharashtra can "in a day or two" set up isolation units in all its district hospitals. So far, two in Mumbai and another in Pune have come into being for SARS cases. "Setting them up is one thing, but people have to report to the hospitals if they have symptoms," Mr. Khanvilkar told The Hindu. While these precautions are being taken, what is worrying is the manner in which, despite testing positive and despite advice to be quarantined at home, Julia got married on Monday before being moved into the quarantine.

Though initial reports spoke of her having ducked the request to come to the hospital, she actually threatened unspecified "dire consequences" if prevented from tying the knot.

Apparently, top-level officials were aware of her determination, allowed her to get married at a church in Pune in the presence of a "controlled number of guests."

The bridegroom, Sailesh Suryavanshi, the sources said, is one of the several — including even the domestic servants of the D'Silvas — and Julie's uncle have been quarantined to prevent the possible spread of SARS though, as top officials said, "all of them are as of now stable., including all the three D'Silva family members who tested positive.

The search is on for the driver of the taxi who took the D' Silva's from Ambernath, a distant suburb of Mumbai in Thane district to Pune for the wedding.

Worldwide SARS fatalities rise to 217

By P. S. Suryanarayana

SINGAPORE April 22. With both China and its Special Administrative Region of Hong Kong registering nearly 100 deaths each, the upsurge in the international menace of the Severe Acute Respiratory Syndrome (SARS) stayed at an alarming level on Tuesday.

The World Health Organisation (WHO) is reported to have said in Geneva that almost 87 per cent of the global-scale SARS cases, estimated at 3861 as on Monday, had occurred in China and Hong Kong.

The total number of SARS fatalities globally was put at 217 as on Monday. Of these, 83 per cent of the deaths were traced to China and Hong Kong by the time the WHO took its latest count.

Two other places prominently affected by SARS are Singapore and Toronto.

Giving updated figures on Tuesday, the Chinese Ministry of Health said in Beijing that 97 SARS patients had died across the mainland, while the total confirmed cases of infection rose to 2,158.

The suspected SARS cases were 918 on the Chinese mainland. In Beijing alone, the disease accounted for 588 confirmed cases, including 100 health-care workers.

The WHO team, which had visited Beijing, has turned its attention to Shanghai too.

The Chinese Prime Minister, Wen Jiabao, said the anti-SARS campaign was being treated as a national priority and promised the international community that the Central Government in Beijing would take steps to prevent SARS from spreading to the country's rural areas where, in the reckoning of the international institutions, the available medical facilities left much to be desired.

Mr. Wen promised help to Hong Kong and even Taiwan (which Beijing regards as China's province) in the fight against the SARS.

The updated figures in Hong Kong as of Tuesday were 99 deaths (including five in the last 24 hours) and 32 new cases that brought up the total number of afflicted persons to 1,434.

Posted 9:56 AM by Dr. Kay

SARS scare grips Britain

By Hasan Suroor

LONDON APRIL 21. The SARS scare has taken what many believe a bizarre turn in Britain with hundreds of schoolchildren returning from their Easter holidays in South East Asia — mainly Hong Kong and Singapore — facing forced `isolation' before they are allowed to resume their classes. At the weekend, about 150 children from some of the country's most snobbish boarding schools such as Eton were whisked away straight from Heathrow airport and put into quarantine in a remote Victorian mansion in Isle of Wight where they would spend ten days before they can attend their schools.

The children were reported to be `traumatised' and `baffled' at being treated as `outcasts' and a spokesman for the Association of Guardianship Services, which was looking after them, said they were "very confused and upset." Many were forced to cut short their holidays in order to meet the quarantine requirements.

The move, widely criticised as a panic reaction, came even as the Government's health department insisted that quarantine was not necessary.

SARS suspects test negative for virus

By Aarti Dhar

NEW DELHI APRIL 20. The Centre today heaved a sigh of relief with the laboratory reports of two suspected patients of the Severe Acute Respiratory Syndrome (SARS), including a foreigner, testing negativefor the disease-causing new corona virus. There is only one suspected case of SARS in New Delhi whose test reports are awaited now.

Unconfirmed reports said one more person, who arrived at Mumbai from Bangkok last night, was admitted to the Kasturba Gandhi Hospital after he complained of hypertension, showing signs of high blood pressure and slight breathlessness though he had no fever. However, the Director-General of Health Services, S.P. Aggarwal, said he had no information about the case.

The patient had stopped over at Bangkok before taking a flight to Mumbai and had been advised hospitalisation.

Talking to reporters today, Dr. Aggarwal said the foreigner, who had been admitted to the RML Hospital on arrival from Australia on April 16, had tested negative for the new corona virus in the genetic sequencing. Earlier, his urine and sputum had shown the presence of the virus but his blood sample had tested negative in the commonly carried out PCR test.

Admitting that testing of the new corona virus was a totally new experience for the medical professionals the world over, Dr. Aggarwal said that genetic sequencing was carried out to confirm the results if there was any doubt.

The urine and sputum samples of the foreigner could have tested positive for any other kind of virus and hence he was being kept in the hospital for some more time. The PCR and genetic sequencing tests were time-consuming and expensive with each costing about Rs. 8,000.

The test reports of the seven-year-old girl, who has been admitted to the Infectious Diseases Hospital here upon arrival from Beijing where she stayed with her parents, have certified that she has not been affected by the SARS-causing new corona virus.

Now the Health Ministry is awaiting the test reports of the 34-year-old person who was admitted to Safdarjung on Saturday on his arrival from Malaysia.

He has been discharged with advice for home quarantine and doctors believe that he did not fit into the clinical definition of SARS suspects.

Chinese Minister axed

P. S. Suryanarayana reports from Singapore: To win the confidence of the international community, China today wielded the political axe in the battle against the SARS, even as the new disease claimed more lives and threatened to spiral into a regional crisis. The country's Health Minister, Zhang Wenkang, and Beijing's Mayor, Meng Xuenong, were sacked from their positions in the powerful Communist Party of China. While the World Health Organisation welcomed Beijing's new acknowledgement of the severity of the disease, the death roll rose to 79 in mainland China and 88 in Hong Kong.

SARS: Many nations remain on high alert

By P. S. Suryanarayana

AP

SINGAPORE APRIL 20. Even as the Severe Acute Respiratory Syndrome (SARS) continued to claim more lives in Hong Kong and the Chinese mainland, the ruling Communist Party of China (CPC) today removed the country's Health Minister and the Mayor of Beijing from their key positions within the party.

While no reasons were formally cited, it was obvious that they were being held responsible for China's lurch towards the SARS crisis. The death toll in China is now put at 79, while the fatality figure in its Special Administrative Region of Hong Kong has climbed to 88, with seven more persons succumbing to the scourge today. The clean-up drive on the streets of Hong Kong was sustained for yet another day even as the city struggled to come to grips with a major public health disaster.

Singapore, too, remained in a state of high SARS alert, with people being advised to utilise, if need be, a telephone hotline set up for this purpose. The death toll in Singapore on this count is placed at 14 out of 177 cases. The possibility of SARS being the cause of two other fatalities is still under investigation.

For the moment, China's Health Minister, Zhang Wenkang, and the Mayor of Beijing, Meng Xuenong, remain in their respective official positions, but the CPC's action against them for mishandling the crisis is seen in the Asia Pacific diplomatic circles as a political reprimand at the least. The general inference is that the action by the CPC may well be a prelude to the dismissal of these two functionaries from their official positions as well. One of them was the Secretary of the CPC unit within the Health Ministry, while the other was the Deputy Secretary of the party within the Beijing Municipal Committee.

China's political display of firmness and transparency has come in the wake of the World Health Organisation's decision to publicise its displeasure over the manner in which the epidemic was being handled including in the military hospitals. The WHO is now understood to be pleased with the action (as distinct from the inspection tours and exhortations by the President and the Prime Minister).

China's State Council today announced the cancellation of the traditional week-long May Day holidays so that the possible spread could be averted during the period which, in the normal course, would be marked by mass travel by people within the country.

Explaining the reasons for China's apparent failure to have been more definitive so far, the Executive Vice-Minister, Gao Qiang, said at a press conference in Beijing today that the sheer novelty of the disease and the logistical difficulties of collecting information from varied types of hospitals should account for the latest update in SARS-related figures. The number of confirmed cases in mainland China was now put at 1,807 (a jump of several hundreds). In Beijing alone, the number of confirmed cases was estimated to be 339, with another 402 being placed in the category of suspected cases. So far, 18 patients had died in Beijing. The incidence of SARS among the foreigners in Beijing was said to be confined to five confirmed patients and four other suspected cases.

Posted 1:40 AM by Dr. Kay

Suspected SARS case reported in Jaipur

April 22, 2003

PTI

JAIPUR: A patient with suspected symptoms of severe acute respiratory syndrome has been admitted to a hospital here.

The patient, who returned here from New York on April 15, was admitted to SMS hospital yesterday and was immediately shifted to the isolation ward, hospital sources told PTI here today.

While some tests are being conducted at the local laboratory, samples of the patient's blood and cough have been sent to Delhi, they said.

A team of doctors has been constituted to closely monitor the patient who was referred to the hospital by his famly physician after he complained of high fever, fatigue and bodyache, the sources added.

109 more fall victim to SARS

BEIJING APRIL 21. Chinese health authorities on Monday reported two new SARS deaths and 109 new cases in Beijing as the nationwide toll of fatalities rose to 86, the World Health Organisation said.

The new figures raised the death toll in Beijing to 20 and the number of cases of infection to 448. They were included in a daily report by China's Health Ministry to the WHO.

WHO also reported one death in the southern province of Guangdong and another in the northern region of Inner Mongolia. The new national death toll of 86 was an increase of seven over the total of 79 reported on Sunday by the Health Ministry. It wasn't clear where or when the additional three deaths occurred.

The WHO announcement did not give any other details.

Govt. confident

Meanwhile, in Hong Kong, the Government efforts to contain the spread of SARS by quarantining households of victims and tracking down potential contacts were paying off, sources said. Health officials were confident about beating the disease. Hong Kong reported six more deaths on Monday, bringing the toll here to 94. There were 22 new cases, for a total of 1,402, but 436 patients have recovered and been discharged from hospitals. The Chief Executive Tung Chee-hwa said 150 suspected cases were identified through stepped-up measures to find people exposed to the disease. Those people have been able to get early treatment — which Hong Kong doctors fighting the disease say is crucial.

AP

Posted 1:38 AM by Dr. Kay
SARS hits Pune after bride tests positive

PUNE: The Severe Acute Respiratory Syndrome (SARS) scare hit Pune after a woman from Ambarnath in Thane, who tested positive for the virus, refused to let it come in the way of her wedding.

Health officials waited at a city church for the wedding to get over and then took the bride to hospital.

Officials said her brother, who works in Jakarta and flew in to attend the wedding, and mother had also tested positive. The tests were conducted by the National Institute of Virology (NIV).

It's suspected that 29-year-old Stanley D'Silva, brother of the bride Julie, was the carrier and passed on the infection. He was the first to be admitted to the Siddharth hospital.

The D'Silvas, who had come from Ambarnath for the wedding, were staying with a relative in a middle class housing society in Bibwewadi in Pune.

Dr Subhash Salunkhe, Director General of Health Services who was on his way from Mumbai to Pune, said health officials had asked the family to postpone the wedding but that hadn't happened.

Eleven people, staying in the apartment with the D'Silvas, have been quarantined, said Salunkhe. Health officials in Ambarnath have been asked to quarantine all people with whom Stanley had come in contact.

Dressed in bridal finery, Julie was about to enter the Oldham Methodist Church when the groom Shailesh Suryawanshi, tehsildar of Guhagar in Ratnagiri district, was called by health officials and told to postpone the wedding. He was briefed on the preliminary report from the NIV which confirmed Julie as afflicted with SARS.

But the couple decided to go ahead with the wedding.

Shortly after 6 pm, with just 10 to 15 close family members, the wedding was solemnised at the church. "A team of health officials was present at the wedding. Many people had to return without attending the wedding," said a friend.

And at the reception later, the 150-200 guests found it strange that the bride was missing. "She suddenly took ill and is in hospital now. But she should be here in the next 30 minutes," said a guest. Another said, "Wait until 10 pm, she's definitely going to show up."

Finally, when it was announced that dinner had been served, the hall emptied.