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Global SARS Toll Tops 500

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Global SARS toll tops 500

By John Ruwitch

BEIJING (Reuters) - The global death toll from SARS has passed 500 after China reported six more

deaths from an illness the government is trying desperately to stop spreading out of control in the

countryside.

The Health Ministry said on Thursday that 146 more people had been infected, taking the number of

cases to 4,698, the bulk of the world's total, while deaths totalled 225.

Shanghai, China's commercial capital, reported its first SARS-related death on Thursday.

With no sign Severe Acute Respiratory Syndrome is being controlled in the world's most populous

nation, the government and World Health Organisation fear the epidemic could spread rapidly through

the vast hinterland, where health services are often poor.

Chinese Premier Wen Jiabao has urged preventive measures be taken in areas where "basic rural

medical facilities are weak".

Reflecting those concerns, four WHO health experts headed to the province of Hebei on Thursday to

assess the ability of healthcare systems there to cope with a SARS outbreak. The WHO said the number

of probable cases has risen sharply.

The province wraps around Beijing, which has the world's highest number of SARS cases and is home

to a floating population of hundreds of thousands of migrant workers, many from Hebei.

The SARS virus surfaced in southern China late last year and has been spread around the world by

air travellers. Worldwide, the death toll is 503 and more than 7,400 have been infected.

HIGHER DEATH RATE

Reinforcing global concern, an international team of scientists said the death rate from SARS was

higher than previously thought and could be as high as 55 percent among people over 60.

They said the rate was about 13 percent in those under that age. There was no evidence the virus

had mutated into a deadlier form, despite earlier mortality estimates of 6-10 percent.

Researchers and health officials in Hong Kong and Britain, who examined data from the first nine

weeks of the outbreak of the virus in Hong Kong, also found the incubation period -- the time from

infection to displaying symptoms -- averaged six days.

Their study was released online by The Lancet medical journal.

China said on Thursday it has punished more than 120 officials in the past month for covering up

the extent of the SARS outbreak or failing to prevent the spread of the flu-like virus, the Web site

of Xinhua news agency said on Thursday.

Officials in 15 provinces and major cities were sacked, suspended, warned or demoted for

deserting their work, delaying reporting or covering up the number of infections and deaths.

ROADBLOCKS

In China's countryside, fear of SARS has led to some villages setting up roadblocks to keep away

people from Beijing and at least four riots against quarantine centres have been reported in recent

days. Thousands have been quarantined in China.

A police official said on Thursday 64 people had been rounded up for rioting in the northern city

of Chengde because they suspected a local clinic would be turned into a SARS hospital.

About 100 rioters overturned an ambulance and smashed medical equipment and windows with bricks

on April 27, the official said. Chengde is 110 miles northeast of Beijing.

Hong Kong, the worst SARS-hit area outside of China proper, reported four more deaths and seven

new cases on Thursday.

"The number of new infections announced today is the lowest since records began," a health

official told a news conference -- but not yet low enough to win the lifting of a WHO advisory

against travel to the city.

While SARS appeared to be under control in most places outside China, it has wreaked havoc on

economies in the region.

Singapore Prime Minister Goh Chok Tong said on Wednesday SARS will slow East Asia's economic

growth by half to one percent this year. A total of 27 people have died of SARS in Singapore.

U.S. brokerage firm Merrill Lynch cut its ratings on Thursday for Hong Kong's Cathay Pacific

airline and Australia's Qantas Airways, saying recent falls in share prices had not yet reflected

SARS' full impact.

Taiwan said on Thursday SARS had probably spread into the community and the next five days would

be crucial.

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China threatens executions for SARS spreaders

Punishment announced for deliberately transmitting virus

MSNBC NEWS SERVICES

May 15 — China threatened to execute anyone who causes death or injury by deliberately spreading SARS, as officials on Thursday promised more doctors, hospitals and money to fight the deadly virus in rural areas. Meanwhile, the number of cases in Taiwan continued to rise after scores of hospital workers and patients fell ill.

THE WARNING by China’s Supreme Court, reported by the official Xinhua News Agency, cited existing laws, many of which include a possible death penalty for even nonviolent offenses.

The Supreme Court warning says people who violate quarantines and spread the virus can be imprisoned for up to seven years, Xinhua said. It said those who cause death or serious injury by “deliberately spreading†the virus can be sentenced to prison terms of 10 years to life or be executed.

Chinese authorities frequently threaten harsh punishments during emergencies, including possible execution.

CONCERN IN RURAL AREAS

The announcement came as Chinese officials were trying to block SARS, or severe acute respiratory syndrome, from spreading to the countryside, which is home to many of China’s 1.3 billion people.

Rural areas account for only 155 of China’s more than 5,100 SARS cases, said officials from the health and finance ministries. But they called for extra efforts to shield rural villages from the illness.

“We haven’t seen a major spread into the countryside, but we can’t tell whether that might change in future,†Qi Xiaoqiu, director of the Heath Ministry’s Department of Disease Control, said at a news conference.

The Health Ministry said four more people had died from SARS on Thursday and another 52 were infected, bringing the nation’s death toll to 271 and the number of cases to 5,163.

A statement distributed by Qi and other officials at the news conference said health care in the countryside is inadequate.

“We must enhance our efforts to put SARS under control in order to contain its spread and eliminate any hidden perils,†the statement said.

Most of China’s 100 million migrant workers have remained at their city jobs, and health officials are monitoring 8 million migrants who have returned to their hometowns, the officials said.

Many rural villages also have set up roadblocks to keep away outsiders.

CRISIS WORSENS IN TAIWAN

Taiwan reported a jump in SARS cases to 264 on Thursday as a new outbreak of hospital infections fueled fears the worst had yet to come.

The Department of Health said there were 26 new probable cases of SARS and three more deaths, taking the death toll on the island to 34, the world’s third highest.

“The main priority in the past two days has been to prevent hospital infections. This is beyond our expectations. When our team was first set up, we thought our priority was to prevent communal infection,†said Lee Ming-liang, head of the cabinet’s SARS committee, at a news conference.

Nearly 400 medical workers at two major hospitals were quarantined on Wednesday after scores of nurses and patients fell ill. These people have yet to be confirmed as probable cases, health officials said.

The virus has hammered the economy and forced people to avoid public places.

In hard-hit Taipei, traffic has disappeared from once bustling streets, department stores stand mostly empty and restaurants are eerily quiet.

CANADA CLEARED

On Wednesday, the World Health Organization said SARS is no longer spreading in Canada. The announcement means the virus is under control and not jumping from person to person — a finding that should benefit the hard-hit economy of Toronto, where 24 people have died of the illness.

Canadian officials cheered Toronto’s removal from the WHO’s list of SARS hot spots, saying it was “another vote of confidence†and proof that it was safe to travel there.

Ontario Health Minister Tony Clement said the decision was “an absolute vindication of our public health officials, our nurses, doctors, other emergency workers, everyone who fought long and hard.â€

The WHO announced it no longer considers Toronto an area affected by SARS because at least 20 days had passed since the last domestically acquired case of the virus was isolated or had died. The WHO said the last such case was April 20.

The agency had earlier withdrawn its Toronto travel advisory on April 29 after SARS cases dropped significantly and Canadian officials promised to improve screening at airports to block possible transmission outside the country. But, at the time, the WHO said lifting the travel warning did not “change the reality that Toronto has a status as an affected area.â€

Wednesday’s announcement effectively cleared Canada of its SARS-affected status.

SARS has claimed 24 lives in Canada since it was detected in March. All of the deaths and most of the more than 140 probable cases were in Toronto, the epicenter of the largest outbreak outside Asia, where the illness originated.

MORE CASES IN SINGAPORE

Meanwhile, Singapore - which hoped to deem itself SARS-free as early as this week - may have suffered a setback amid reports of a possible outbreak at its largest mental health facility, officials said.

The Institute of Mental Health was sealed off and all 1,800 patients and 1,600 workers quarantined after 37 people there began showing symptoms Friday. Officials hoped to be able to confirm Wednesday whether the new patients had SARS, but the results were “inconclusive,†said Esther Wong, a health ministry spokeswoman.

A WHO team investigating the outbreak said it was possible some of the patients may be suffering from other illnesses.

“The WHO team in Singapore reported today some signs that patients in the cluster, many of whom are elderly, may be ill from causes other than SARS,†the agency announced.

The city-state, where 28 have died, last reported a confirmed new case on April 27 - and it was closing in on reaching the 20-day period with no new infections needed for the World Health Organization to declare its outbreak under control.

ECONOMIC DAMAGE

As nations continued to grapple with the illness, the United Nations’ labor agency gave a sense of some of the likely economic damage from the outbreak.

The International Labor Organization predicted that a drop in international travel caused by SARS fears, combined with the economic downturn, could lead to 5 million job losses in the global tourism sector this year.

Hong Kong, Singapore, Taiwan and Vietnam, all sites of SARS outbreaks, are likely to lose more than 30 percent of their travel and tourism jobs, the ILO reported. The predicted losses would bring to 11.5 million the number of tourism jobs cut around the world since the Sept. 11, 2001, attacks sent the industry into a downward spiral.

“That means a loss of one of every seven jobs in travel and tourism since 2001, with no end in sight,†the ILO said.

OTHER DEVELOPMENTS:

On Tuesday, researchers in Germany said they had found a weakness in the virus and a drug being tested against the common cold could be modified to battle SARS. Such a drug could be designed in months, they said.

Greece said on Wednesday new tests on the country’s first SARS suspect showed a South African airline stewardess probably did not have the flu-like virus.

Nigeria was screening visitors for signs of the disease after a Taiwanese businessman died of suspected SARS. With a population of more than 126 million, Nigeria is Africa’s most populous country. Health experts fear the world’s poorest continent — which has minimal health care and millions already weakened by AIDS — would face devastating consequences from a SARS outbreak.

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WHO Says SARS Outbreak Almost Over

Sat May 17, 4:37 PM ET

By EMMA ROSS, AP Medical Writer

LONDON - The majority of the SARS outbreaks around the world are coming to an end, the World Health Organization said Saturday as officials expressed "great hope" that measures to control the spread of the disease were working.

Difficult struggles remain in mainland China, but the epidemic there, although large, is no more complex than it is in other countries and the government is making great strides, said Mike Ryan, WHO's coordinator of the global effort to stop the severe acute respiratory syndrome virus.

Scientists from 16 SARS-struck locations concluded a one-and-a-half day conference Saturday at the WHO's Geneva headquarters, where they discussed the key factors that allow the virus to spread, the effectiveness of control measures and what remaining questions need to be answered.

"The message coming out of this meeting is certainly one of great hope. It's one of celebration that the measures are working, but also a call to action because we've got a lot more to do yet before we end this problem," Ryan said in a conference call with reporters.

"The experience across the range of countries involved has been that the control measures that we designed at the beginning of the epidemic have worked. In country after country, we have managed to break the cycle of transmission through the simple implementation of good case finding, contact tracing and isolation practices in hospitals," Ryan said.

"We have seen the number of secondary cases per case dropping systematically in all of the countries to a point now where we believe, in the majority of cases, we are now seeing the epidemics coming to an end," he said.

SARS has infected more than 7,800 people around the world and killed 625.

Taiwan on Saturday announced its biggest one-day jump in those infected, raising the total number of SARS cases on the island to 308. Singapore said fears of a SARS outbreak at a mental hospital were unfounded, leaving it on track to be declared free of the disease.

The main lesson of SARS, Ryan said, is to be prepared and organized.

"Managing an outbreak as serious as SARS requires very good collaboration between all services. The lesson for any future epidemics is really how we organize ourselves. We probably need to do that better in future," Ryan said. "It's about having in place good preparedness measures, good communication systems between the different sectors of government, early decision-making and systematic implementation of what's been decided."

Dr. Margaret Chan, director of Hong Kong's Department of Health, said epidemiologists at the meeting concluded that the pattern of the SARS outbreaks is similar in different places.

The belief that SARS is spread almost exclusively by droplets from coughing and sneezing emerged clearly from the discussions, Chan said.

It is possible that the virus could be contracted through feces if it becomes so fine that it can be inhaled, the scientists concluded, but there is scant evidence that it can be spread by feces-contaminated hands touching mouths.

Questions remaining include whether people have caught the virus but did not get sick enough to be noticed and whether people can spread the bug before they develop symptoms.

Ryan said some evidence indicates that there are mild cases but no sign that those sufferers have spread the virus.

The same is true for those who have been quarantined and later developed SARS.

"We are reiterating that there is no sign of infection coming from people before they start developing symptoms," said Angus Nicoll, from Britain's Health Protection Agency. "There are one or two circumstances that need further investigation, but nobody was reporting that as a phenomenon."

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Toronto Hospitals Brace for SARS Outbreak

By TOM COHEN, Associated Press Writer

TORONTO - Hospital workers in Toronto once again strapped on stuffy masks and gowns Saturday to confront a new possible SARS outbreak that officials said involved 33 suspected cases, weeks after Canada proclaimed itself free of the deadly virus.

The new cluster of possible cases of severe acute respiratory syndrome prompted U.S. health officials to issue a new travel alert for Canada's largest city.

The World Health Organization confirmed one new positive case but said more confirmation of an outbreak was needed before considering such a travel warning.

In Toronto, health officials ordered restricted access and use of protective masks and gowns for all area hospital emergency rooms, repeating steps taken earlier this year against the largest SARS outbreak outside of Asia.

At least 500 people possibly exposed were told to quarantine themselves at home for 10 days as a precaution, they said.

Dr. Colin D'Cunha, the Ontario commissioner of public health, said 33 people with respiratory illness were being tested for SARS. All were believed to have contracted the illness in hospitals over the past month, he said.

Two of the suspected cases involved elderly patients who died in recent weeks. If confirmed, they would raise the SARS death toll in the Toronto area to 26.

A formal definition of a probable SARS case requires a link to a known SARS case, and that has yet to be established, D'Cunha said. But the officials were proceeding as if all the possible new cases were SARS.

"Clinically, we think they have it," said Dr. Donald Low, a microbiologist at the forefront of Toronto's anti-SARS efforts.

Despite the inability to trace the new suspected cases to known cases, officials said there was no danger of an uncontrolled outbreak.

"This is not a disease out there in the general community," D'Cunha said.

A WHO spokesman in Geneva said one new case in Toronto tested positive, and results on other cases were expected shortly. Dick Thompson said Canadian officials reported 31 cases of respiratory illness they were checking for possible SARS. The figure he was given excluded the two dead patients.

In Asia, the Taiwan government said Sunday another 12 Taiwanese have died of SARS, but that the number of new infections continued to fall to only three.

It was the first time in three days that new SARS deaths were reported in Taiwan, pushing the toll there to 72, the Center for Disease Control said.

In Hong Kong, however, for the first time since late March, no new cases were reported on Saturday. Taiwan has the world's third-highest SARS toll after China and Hong Kong.

Canada received the latest bad news in a dismal week after the discovery of mad cow disease in the cattle heartland of Alberta prompted the United States and other countries to ban imports of Canadian beef products. Health officials also recently warned that Canada can expect an increase of West Nile virus in the summer mosquito season.

On Saturday, investigators placed three more Alberta farms under quarantine in search of North America's first case of mad cow disease in a decade.

Alberta Agriculture Minister Shirley McClellan said 16 farms were now under quarantine — 11 in Alberta, where the recent case of bovine spongiform encephalopathy, or BSE, was found; two in Saskatchewan to the east; and three in British Columbia to the west.

An editorial cartoon in Saturday's National Post newspaper showed a family walking outdoors exclaiming, "Aaah ... the weekend," all dressed in protective suits and helmets — even the dog.

SARS has spread to more than 8,000 people around the globe and killed 708, the vast majority of them in Asia. Canada earlier saw about 150 cases and 24 deaths.

Ontario and Toronto health officials said Friday an apparently undiagnosed SARS case at North York General Hospital may have infected health care workers, other patients and their family members in one ward in late April.

A patient transferred from the ward to St. John's Rehabilitation Hospital was considered the likely source of four more cases under investigation, they said. It was not known where the new cases may have come from.

A third hospital, St. Michael's, closed its neurosurgery units until June 2 after learning a potential new SARS patient was treated there recently without respiratory precautions, D'Cunha confirmed Saturday. More than 50 staff members were put into 10-day quarantine.

Toronto was removed from the WHO list of locations with SARS earlier this month when more than 20 days — the length of two SARS incubation periods — had passed since the last known case on April 19.

WHO also had issued a travel advisory for Toronto on April 23, but lifted it a week later. Canada agreed to WHO demands to increase airport screening of international travelers and said it started using fever-detecting scanners at airports in Toronto and Vancouver, British Columbia.

The SARS outbreak that first appeared in March hit Toronto's vital tourism and convention industry hard as travelers canceled plans to visit the city. Ontario and city officials launched aggressive marketing campaigns to lure back business and visitors.

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