SARS: Mystery Malady

SUSAN DENTZER:

Since the first global health alerts about the disease were issued more than three weeks ago, the number of suspected cases of SARS, or Severe Acute Respiratory Syndrome, has risen to more than 2,600 around the world. Just under 100 people have died.

A total of 20 countries have been affected to date by SARS, including India. Today, health authorities there announced the first suspected SARS case, of a U.S. citizen who had become ill after traveling from China to Bombay. That was probably no accident, since far and away the biggest number of SARS cases– 1,268 to date– has been in China.

China has also recorded the largest number of deaths to date from SARS. SARS appears to have originated in China's Guangdong Province, where the first known cases occurred last fall. Epidemiologists suspect it was in this province that the type of corona virus, now believed to be the primary cause of SARS, made its evolutionary leap from infecting animals to infecting humans.

Close behind China is Hong Kong, with nearly 883 cases and 23 deaths to date. The United States is now in third place among countries where SARS has occurred, with 148 suspected cases to date.

But officials here are using a somewhat broader definition of suspected cases than many other countries are using. They say many people described as suspected SARS cases here may ultimately be shown to have more common illnesses that cause similar symptoms. Although SARS appears to kill about four percent of people who have become ill with it around the world, so far no one in the U.S. has died.

JIM LEHRER:

Ray Suarez has more.

RAY SUAREZ:

Earlier today, two top U.S. health officials testified before a Senate committee about the spread of the disease and how the health care system is responding in this country. I'm joined by both now. Dr. Julie Gerberding is the director of the Federal Centers for Disease Control and Dr. Anthony Fauci is the director of the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health. Welcome both of you.

Dr. Gerberding, what were you able to tell the senators today about what you know in the effort to sort of get your hands around this thing?

DR. JULIE GERBERDING:

Well, we had some good news and I think we had some uncertain news. The good news is that we can contain spread of this problem through infection control measures in hospital settings and in homes. The bad news is that we're just not certain how fast this is going to spread. We've already seen cases of extremely efficient transmission and the global pattern is very worrisome.

RAY SUAREZ:

What was your main message, Dr. Fauci?

DR. ANTHONY FAUCI:

Well, the main message was that the research enterprise, namely the development of vaccines, therapeutics and diagnostics is geared up right now to jump all over this. The CDC has been successful, as you've heard, in isolating virus which we think pretty strongly is the cause of SARS.

We now have that virus growing, once have you it growing in a laboratory, then you can do things with it that can speed the process enormously, with regard to vaccine, therapeutics and diagnostics. The message was, we're on target, we have a long way to go, but you combine the public health issues with the research issues and hopefully we'll get control of this.

RAY SUAREZ:

Do we know much about the transmission yet?

DR. ANTHONY FAUCI:

Well, the transmission certainly is from person to person, and as Dr. Gerberding mentioned it's an aerosolized route of transmission. There are some people in whom the transmission requires very close contact, for example, health workers, and that's how we first became aware of the difficulties with this, was in the Vietnam hospital where there was a number of health workers who were infected by an individual as well as family members.

But there's another possibility that there may be a broader, easier way to spread in certain individuals who might be, as we say, very super transmitters in that the virus in them can perhaps spread in a way that might be a little bit more fine aerosolized.

RAY SUAREZ:

What do we know about the severity of the illness? How would we compare it to other things like the flu or tuberculosis or other things that are passed from person to person?

DR. JULIE GERBERDING:

Well we're seeing a very variable clinical picture here. Some people have very mild SARS and don't require hospitalization. But other people have the more severe pneumonia that can very rapidly progress to lung damage, requiring mechanical ventilation and death.

Overall about four percent of the patients die, and the vast majority of them do seem to get better. But we have a lot to learn about who is at risk for the severe form and what is the best way to treat it to prevent those dreadful complications.

RAY SUAREZ:

Well, why don't you think anyone has died in the United States, and why we haven't got really ramping up, rapidly expanding number of cases?

DR. JULIE GERBERDING:

There are a couple of things that are different here. One is we knew about the problem in Asia before we saw the initial cases here. And so we were able to initiate those infection control guidelines very early on. And that may have helped spread, prevent the spread in health care settings. The other thing is that we've established a very broad case definition because we want to know anybody who might be carrying this virus, and do the proper things to isolate them.

So overall our patients just simply aren't as sick because we're more inclusive in our population, and this is a very nonspecific definition. It's an illness among travelers to the parts of the country that are affected who get a fever and respiratory symptoms. Probably quite a few people on our case list will ultimately prove to have something else. So obviously they're not going to develop the severe form of SARS.

RAY SUAREZ:

Well, you've done a lot of contact tracing and work on epidemiology and the spread of disease. It must be almost a nightmare scenario, people getting on a plane, breathing common air, and then heading off to the four winds when they reach a major American city, like San Francisco.

DR. ANTHONY FAUCI:

That is, that is your worst nightmare that if you have a virus or a microbe that can be transmitted easily through an aerosolized route that you could have — given the modern capability of fast travel — that you could have it spread throughout the world. Some of the good news, I wouldn't say good news, but at least some comforting news is that people had gotten on airplanes and had taken trips that were rather substantial in their length and people on the planes — there weren't a lot of people on the planes and maybe a few at most who got infected. That gets back to what we were saying before that there are some circumstances and some individuals with this particular disease that can transmit in a much easier way.

If that person happens to get on a plane, then you'd have a much greater problem than we have right now. If you get one of those easy transmitters, that would be a problem. But when you combine the travel capabilities that we have now in the 21st century with an aerosolized type of a spreading microbe, then you have a problem.

That's the reason why the public health measures that the CDC and that Dr. Gerberding and the WHO have put into effect, luckily at least at this point have dampened it a bit. We don't know where it's going, so I think we need to be clear that we don't know the pattern of exactly how it's going to evolve because we're still in the middle of an evolving epidemic.

RAY SUAREZ:

With these controls you've described, Dr. Gerberding, is it possible to pretty much put a roadblock on the spread of this thing by limiting contact with known cases, eventually developing a screening? Can we stop it in the United States?

DR. JULIE GERBERDING:

Well, we're in a race. One of the things we're doing is alerting arriving passengers on planes from the affected areas that if they develop any suggestion of a viral infection, that they should contact their clinician and then seek medical care. That helps us get the isolation established immediately after the person develops symptoms and could spread to others.

The other thing is that we are working with the clinicians from the other perspective to make sure that they recognize when a patient from, a traveler who has had contact with a SARS patient, that when they come in with nonspecific respiratory illness or pneumonia, that they isolate them and think about SARS in the differential diagnosis.

So if we can alert the patients that they have this syndrome so that they seek care and we alert the clinicians that there is this problem and they need to think about it when they're examining patients in the urgent care situation, we have a real good chance of being able to get people into isolation before it spreads widely. But if we get one of these individuals that's especially efficient at transmitting, the cat could get out of the bag before we have a chance to really contain it.

RAY SUAREZ:

And Dr. Fauci, if you're one of the 99.99 percent of Americans who either has been to East Asia recently or knows anybody who has, what should you be doing on your own behalf anyway just to be safe?

DR. ANTHONY FAUCI:

Right now do nothing any different than you're doing except pay attention. Pay attention to the announcements that come out of the C DC. We know that there has been this alert. Unless you have absolutely essential travel, do not take a trip to those areas in which there's high risk.

But with regard tour day-to-day interactions with yourself, your family, your business, you can keep it exactly the same. Just listen to what's coming out of the CDC, because they'll keep you tracked as to where the epidemic is going.

RAY SUAREZ:

So no heightened worry about air travel in general, for instance?

DR. ANTHONY FAUCI:

I think in general now when you're talking about going to places that are not the specified countries, I don't think there should be any difficulty there right now.

RAY SUAREZ:

And the kind of cooperation you wanted from China, are you getting it now?

DR. JULIE GERBERDING:

We're very optimistic that the doors have opened and we had contact with some members of the WHO team who are from CDC this morning and they indicated that they were getting to look at the situation in the hospitals in Guangdong Province and that they were really getting the kind of epidemiologic information that we so desperately need. So we're cautiously optimistic that we'll be able to understand better what really is going on there.

RAY SUAREZ:

Doctors, thanks a lot.

DR. ANTHONY FAUCI:

Thank you.