Researchers say SARS is mutating

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Researchers say SARS is mutating

China agrees to have WHO experts visit Taiwan

Saturday shoppers protect themselves from SARS in Hong Kong, where at least 162 people have died from the virus. Hong Kong researchers say that SARS is mutating into at least two forms.

NBC, MSNBC AND NEWS SERVICES

May 3 — Researchers in Hong Kong said Friday the SARS virus is mutating rapidly into at least two forms, complicating efforts to develop a solid diagnosis and a vaccine. Meanwhile, China agreed Saturday to have World Health Organization experts visit rival Taiwan to study its outbreak, ending a political stalemate that the island said threatened to hurt disease-fighting efforts.

“THIS RAPID EVOLUTION is like that of a murderer who is trying to change his fingerprints or even his appearance to try to escape detection,” said Dr. Dennis Lo, a chemical pathologist at Chinese University of Hong Kong.

Researchers at the university said that they had determined the genetic sequences of virus samples taken from 11 SARS patients and that by late March there were two forms of the virus in Hong Kong.

“We have shown that the SARS coronavirus is undergoing rapid evolution in our population,” Lo said. But he said more work was needed before researchers could say whether the virus had become more infectious and lethal.

Researchers also need to find out whether people who get SARS from one strain can develop immunity to other strains, he said. If not, finding ways to better diagnose it and develop a vaccine could be more difficult.

The WHO says there is no evidence that the mutations have any effect on the disease itself. WHO scientists also say it is not surprising that the SARS bug shows genetic changes, because the coronavirus family is prone to mutations.

Hong Kong scientists are also concerned that the virus may survive in an infected person’s body for at least a month after recovery. Doctors are urging patients to avoid personal contact such as hugging and kissing when they go home.

“The virus still exists in the patients’ urine and stool after they were discharged. It will persist for at least another month or maybe even longer,” said Dr. Joseph Sung, head of the Department of Medicine at the Chinese University of Hong Kong.

Shanghai has cancelled a harsh 14-day quarantine for tourists from SARS-hit areas but remains vigilant to protect China's commercial hub from an outbreak.

PROGRESS IN TAIWAN

Saturday, China took steps to help bring the virus under control in Taiwan, announcing that it had agreed to allow the WHO to send experts to review the SARS situation there.

The announcement, reported in a brief dispatch by the official Xinhua news agency, did not say when the experts might go or give other details. It quoted a Health Ministry spokesman as saying he was concerned about the “health and well-being” of people in Taiwan, which China claims as its territory.

Taiwan, which announced five new SARS deaths Friday, taking the island’s toll to eight, has complained that the WHO has not responded to requests for information and help with SARS. China has blocked its efforts to join the organization.

Taiwanese health authorities have complained that WHO failed to respond to their requests for help with severe acute respiratory syndrome, which has killed eight people there. The island’s Mainland Affairs Council, which handles relations with Beijing, had no immediate reaction to China’s announcement.

BEIJING SAYS WORST IS OVER

Liang Wannian, deputy director general of the Beijing Municipal Health Bureau, said at a Friday news conference that the pneumonia-like disease was peaking in the capital.

In the recent past, health experts criticized China over its belated and secretive response to the outbreak. But the government has changed its policy and begun fighting very aggressively to contain the disease.

Liang said the number of SARS patients in Beijing had remained steady since April 21, based on figures the Health Ministry released Thursday.

“My personal judgment is the present high plateau of the number of cases in Beijing will continue for a period of time. Overall, the situation in Beijing is stable, and the upward trend has been effectively checked,” he said.

Cases of SARS in the capital will likely drop in the next 10 days if the virus does not mutate, he said.

Beijing has imposed restrictions on university students leaving the city, requiring health checks and barring them from going to rural or disease-affected areas, a Communist Party official said Friday.

Only students who are found to be in good health without fevers or other symptoms of SARS will be allowed to leave the capital for their hometowns, said Cai Fuchao, a spokesman for the city’s party committee.

With a carnation in hand, Dr. Li Yahong touches the screen of a videophone to "shake hands" with her husband, Wang Xian, a doctor on the front lines fighting SARS in China.

A CRITICAL PERIOD IN CHINA

“The next few months will prove crucial in the attempt to contain SARS worldwide, which now greatly depends on whether the disease can be controlled in China,” the WHO said in a statement on its Web site.

China said on Saturday nine more people had died from SARS and another 181 were infected, taking the death toll to 190 and the number of cases to almost 4,000.

The Health Ministry said five of the new deaths were in Beijing, currently the hardest hit place in the world, along with 114 of the latest cases by 10 a.m. local time on Saturday. However, more than 1,400 SARS patients have recovered and been discharged from hospitals, a ministry spokesman told reporters.

SARS has killed 190 people in China and infected almost 4,000 since it emerged in the southern province of Guangdong late last year. Worldwide, it has infected more than 6,100 people in 30 countries, killing close to 400 of them.

• Learn more about the disease

President Hu Jintao called Friday for a “People’s War” on the disease during a trip to the industrial city of Tianjing, which experts say is poised to experience an outbreak because of its proximity to Beijing.

Movie theaters and other recreational spots have been closed in Beijing, where about 12,000 people are under quarantine orders in the city of 14 million.

Xiaotangshan Hospital in a village north of Beijing, boasting at least $11 million worth of medical equipment, opened its doors after more than 7,000 builders rushed to erect the temporary facility for SARS cases in eight days.

Some of the 1,200 medical staff due from the military had arrived, and 156 SARS patients from 15 hospitals in urban areas in Beijing were brought to the hospital in ambulances Thursday evening.

Timeline for SARS

1 / 8

Nov. 16, 2002

The first case of severe acute respiratory syndrome, SARS, occurs in China’s southern province of Guangdong.

Mid-February 2003

China’s government reports 305 cases of atypical pneumonia and five deaths in Guangdong province.

Feb. 10

The World Health Organization, WHO, learns that the cases of atypical pneumonia began in November in China.

Feb. 14

Chinese authorities say the disease is under control.

Feb. 21

A professor, who treated patients in Guangdong province, travels to the Metropole Hotel in Hong Kong. He infects 12 other guests who spread the disease by travel to Vietnam, Canada and the United States.

2 / 8

Feb. 26

Doctors in Hong Kong report the first cases of what they called SARS.

Feb. 28

Cases of SARS appear in Vietnam, similar to those in Hong Kong.

March 12

The WHO issues a global health alert stating that a new, unrecognizable, flu-like disease may spread to health-care workers.

March 14

Canada reports its first case of SARS.

March 15

The WHO issues an emergency travel advisory, saying SARS is spreading worldwide. At the time, the agency did not restrict travel to any parts of the world. Instead, it warned travelers to be aware of the illness’ symptoms and to inform airport personnel if someone on their plane had those symptoms.

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March 18

Doctors in Germany say they have found signs of a paramyxovirus in blood samples from one SARS patient. Scientists in Hong Kong confirm the findings in samples of two other patients. Paramyxovirus is a family of viruses that includes a pathogen causing measles. Scientists say the paramyxovirus theory makes sense, since pneumonia can be a complication of measles.

March 20

Hong Kong health officials link the global spread of SARS with the guest in a local hotel. Epidemiologists trace the illness back to the Chinese professor who stayed at Hong Kong's Metropole Hotel.

March 21

The Chinese government asks WHO for help investigating the outbreak in Guangdong province. A team of WHO experts travels to the region.

March 23

Scarborough Grace Hospital in Toronto closes temporarily because of SARS. The chief of Hong Kong's Hospital Authority is admitted to hospital with pneumonia-like symptoms. Doctors are not sure if he caught SARS.

March 24

CDC scientists say they have strong evidence that a type of coronavirus, which also causes the common cold and infects animals, may be responsible for SARS.

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March 26

Ontario declares a public health emergency and orders thousands of people to quarantine themselves in their homes.

March 27

Passengers on international flights sitting near those with SARS come down with the disease, prompting WHO to tell Canada, Hong Kong and Singapore to screen passengers on flights.

March 31

Hong Kong’s health department issues an isolation order, requiring residents of an apartment block to stay inside until April 9 to stop the spread of SARS.

April 3

The CDC warns against all non-essential travel to Hong Kong, China, Singapore and Hanoi. Hong Kong relocates the citizens of an infected apartment block to isolation camps.

April 4

President Bush issues an executive order allowing the quarantine of healthy people suspected of being infected with SARS but who do not yet have symptoms.

5 / 8

April 7

The WHO recommends people consider postponing all non-essential travel to Hong Kong or Guangdong province. The WHO sends a team to Guangdong province to investigate the outbreak’s origins.

April 8

Doctors in China say there are more SARS cases than the government is reporting. Hong Kong reports 40 new cases a day for three days in a row. The CDC reports receiving a record number of phone calls from the U.S. public about SARS.

April 9

The WHO says China may be withholding information about SARS.

April 14

Canadian scientists sequence the DNA of the coronavirus believed to cause SARS

April 16

Scientists in the Netherlands confirm that a new form of coronavirus, other types of which cause the common cold, is the cause of SARS.

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April 17

Hong Kong officials report that SARS spread through a leaky sewage system in an apartment complex where a quarter of the territory's 1,300 cases were identified.

April 18

China responds to criticism about how it is handling the SARS epidemic by being more open about cases.

April 20

China, under fire for not disclosing the extent of its SARS infections, raised its number of cases to 1,807 from 1,512. Soon after, the health minister and mayor of Beijing were dismissed from their posts. Meanwhile, SARS changed the rituals of Easter in Toronto forcing parishioners not to embrace or share the communion cup. Also, Singapore quarantined 2,400 people who worked at a vegetable market because a worker died there of SARS.

April 22

Hong Kong sends 200,000 secondary school students back to class after a three-week hiatus as efforts to contain SARS seem to lower the daily case numbers. Concern about spread from China remains. U.S. Centers for Disease Control and Prevention specialists arrive in Toronto to help with infection control.

April 23

Beijing keeps 1.7 million primary and secondary students from school until May 7. WHO issues a travel advisory against Beijing, China's Shanxi province and Toronto. The alert already existed against Hong Kong and China's Guangdong province.

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April 24

China seals off a major hospital with a staff of 2,300 people in Beijing and issues quarantine orders to contain SARS. Meanwhile, anxious residents of the capital city stormed supermarkets fearing food shortages and others left the city.

April 25

Beijing closes a third hospital and quarantines approximately 4,000 people. Asian officials meet to create strict travel checks at airports and seaports. Meanwhile, Canadian officials say WHO may re-evaluate the travel advisory the agency issued against Toronto.

April 26

Asian health ministers call for strict pre-departure checks on passengers at airports and seaports in an attempt to battle SARS.

April 27

China shuts down all theaters, cinemas and other places of entertainment in Beijing in an effort to curb the spread of SARS.

April 28

The WHO says outbreaks of the deadly flu-like SARS have peaked in Canada, Singapore, Hong Kong and Vietnam, but not in China, where the virus first emerged last year. The WHO also says Vietnam is the first country to contain the disease and lifted a travel advisory against the country. Meanwhile, Canada announces it is increasing SARS airport screening and will hold an international SARS conference this week.

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April 29

The Association of Southeast Asian Nations meets at an emergency SARS summit in Bangkok and China and Taiwan commit funding to fight the disease. Meanwhile, the WHO lifts its travel advisory against Toronto.

April 30

Beijing's new mayor says the SARS crisis is severe and Hong Kong reports some patients deemed recovered from the illness have suffered relapses. Meanwhile, Canada holds the first international SARS conference in Toronto and WHO says the SARS death rate worldwide has nearly doubled, from 6 percent to 10 percent.

May 1

China's May Day celebrations are quiet due to SARS and a hospital to treat victims of the disease opens on the outskirts of Beijing. Gene sequences of the virus that causes SARS are published in a scientific journal.

May 2

China says Beijing cases of SARS may be leveling off.

Sources: Centers for Disease Control and Prevention and World Health Organization

RELAPSES IN HONG KONG

Scientists in Hong Kong, meanwhile, said they feared that 12 people may have relapsed. The new findings raise questions as to how doctors can tell whether a patient has fully recovered, underscoring the difficulty health authorities face in tackling the new disease.

Dr. David Heymann, the WHO’s chief of communicable diseases, said that the relapses were disappointing and that it was not clear what caused them. He said he had not heard of similar reports outside Hong Kong.

“We don’t yet have the data ... as to exactly what has happened, what these people were treated with,” Heymann said. He said one theory was that some relapses might have happened because patients stopped taking steroids too quickly. The steroid therapy is being prescribed in Hong Kong.

Heymann said that in some other infectious diseases, it was not uncommon to find virus in body excretions after a patient’s symptoms were gone.

“So it’s not a new phenomenon that viruses remain, but certainly a relapse is concerning,” he said.

FATALITY RATE WORSENING

World health officials continue to follow new cases of the disease, but they said its fatality rate was worsening as patients who had been lingering in hospitals have now begun to die from the disease.

The WHO said the death rate may have risen to 10 percent from 6 percent, especially in Canada and Singapore.

The WHO said the mortality rate appeared to be higher in places with developed health services, but a WHO official said the reason was a mystery.

A possible explanation for a higher fatality rate among infected medical staff, at least, in wealthier countries is that in those countries doctors and nurses tend to get more involved in treatment and general care, the official said.

“It may be just that there was much more contact — and that this happened before [the seriousness] of the disease was known,” he said.

RELATED DEVELOPMENTS

The Canadian government said Friday that it would set aside $100 million ($70 million U.S.) this year to protect Canadians and visitors. Canada has had 349 probable or suspected cases of SARS and 23 deaths; the Toronto area reported two more cases Friday, both of them in nurses.

In Malaysia, 60 more patients and staff were quarantined at two hospitals feared to be sites of a SARS outbreak.

Singapore reported two new cases and another death Friday, bringing total deaths to 25, the world’s third-highest number. The latest infections were the first new cases in three days, dealing a blow to hopes that the city-state’s tough quarantine and screening measures had mostly contained the illness.

The United States and Britain have been taken off the WHO’s list of “SARS-affected areas,” the organization said Friday. Countries are removed after 20 days, twice the incubation period for the disease, unless there is evidence of transmission to additional people. Four countries — Canada, China (including Hong Kong and Taiwan), Mongolia and Singapore — remain on the list of countries where national authorities have reported a local chain of transmission. There have been 245 suspected SARS cases reported in the United States, but only 41 are probable cases, and there have been no deaths.

Vietnam’s state-owned airline slashed fares by 20 percent to attract travelers after the WHO declared that the country was the first to contain SARS.