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U.S. SARS Cases: An Emerging Picture

Health officials reveal little about the 51 suspected cases in 21 states

FRIDAY, March 28, 2003 (HealthDayNews) -- The deadly respiratory illness spreading in alarming proportion across the globe has significantly increased its presence in the United States in just the past two weeks.

Yet, little is known about the American victims. U.S. and state health officials have held back their identities, conditions and locations, and are just beginning to reveal details on how the cases connect. From those details and from regional media reports, it is clear most cases involve travel to Asia, the area that has been hardest-hit by the illness known as severe acute respiratory syndrome (SARS).

One other thing is clear: There are now 51 suspected cases in 21 states, and experts say the toll is likely to increase before it decreases.

"It's disturbing because it's widespread," says Steven Brooks, director of infection control and clinical microbiology at Kingsbrook Jewish Medical Center in New York City. "You have an incubation period of two to seven days, maybe even out to 10, so we may have people who are already infected who aren't showing symptoms yet."

Also of concern is the fact that the early stages of SARS mimic many other diseases: fever, chills, muscle ache and dry cough.

"People come into an emergency department and they present with this condition, which may be early on and which is relatively mild. And before you know it, you've got health-care workers exposed," Brooks adds.

Although there are no deaths yet in the United States, the SARS worldwide mortality rate of 4 percent is "significant," says Dr. John Sinnott, director of the division of infectious diseases at the University of South Florida in Tampa.

"Physicians who are pausing and reflecting are very concerned about this. This is a virus that has jumped from animals to man. It's a new virus," Sinnott adds.

The first cases of SARS developed between November and February in the Guangdong province in China, and the illness has spread throughout Asia and into Europe and Canada. The global toll rose again Friday, to 1,485 infected and 54 dead in 13 countries.

The first suspected case in the United States was identified by health officials on March 15. The victim, a 53-year-old man who had traveled to Singapore, fell ill on March 10, according to the U.S. Centers for Disease Control and Prevention (CDC).

In all, four clusters of cases have been identified within the country, three involving travelers to Southeast Asia and one involving a family contact, according to CDC records.

Among those clusters is a married couple who stayed at a Hong Kong hotel from March 1 to March 6, where other guests were symptomatic. The husband fell ill on March 13, after returning. His wife became ill several days after her husband. There was also a third person staying at the same hotel who represents a cluster. Another cluster originated with a person who traveled to Guangdong province and to Hong Kong and then apparently infected two health-care workers at a U.S. hospital.

In addition to health-care workers, five people who were family members of travelers have also become ill.

Most of the U.S. cases are not considered severe, and there have been no deaths so far.

"We're seeing milder illness overall than people in Asia are encountering," Dr. James Hughes, director of National Center for Infectious Diseases, told a news conference Thursday. "Of the 51, 14 have had pneumonia and only one has required ventilatory support."

California has the bulk of the cases: 12. Among the victims: a 37-year-old Santa Clara County woman who just returned from Hong Kong, the Los Angeles Times reports. Her traveling companion, a 38-year-old man, was hospitalized with suspicious symptoms. Another Santa Clara County victim, a 28-year-old woman who traveled recently to Asia, is now in isolation at home, says the Bay City News. In Marin County, a 38-year-old person who visited Hong Kong and Guangdong province has a mild illness and is improving, the Marin Independent Journal reports.

New York has six cases, at least four of them in New York City. Early reports had said an older man, who was hospitalized, and a younger woman were among the city cases; both had traveled separately to Asia.

Utah has four cases. One person remains hospitalized; the other three are recovering, according to The Salt Lake Tribune. Two had traveled to Asia.

Texas has three cases. An elderly Harris County woman who had returned from Hong Kong on March 6 fell ill on March 13 and was hospitalized three days later, the Houston Chronicle reports. In Lubbock, according to the Midland Reporter Telegram, a woman who traveled to Singapore took ill but was never hospitalized. The third case is a Collin County man who had traveled to Hong Kong; there are no details on his condition.

Hawaii and Virginia each have three cases. Maine, Michigan, Missouri, North Carolina and Pennsylvania each have two. Alabama, Connecticut, Illinois, Kansas, Massachusetts, Mississippi, New Jersey, New Mexico, Rhode Island and Wisconsin each have one.

In New Mexico, the Albuquerque Tribune says a Presbyterian Hospital patient hospitalized March 16 after returning from Hong Kong has now recovered. In Massachusetts, a Cambridge man recently traveled to Asia, returned with a high fever and respiratory complications but has recovered, the Boston Globe says. And in Connecticut, the Associated Press reports, a University of Connecticut student is hospitalized in fair condition after attending classes for several days after symptoms appeared.

Because the disease remains a mystery, experts are recommending tried-and-true infection control procedures.

"It certainly does reemphasize the concept of washing hands," Dr. Philip Tierno, director of clinical microbiology and immunology at New York University Medical Center in New York City and author of The Secret Life of Germs. "The greatest enemy here has been cavalier contacts that went on through families dealing with sick people. You really should take extra precautions when somebody is sick."

The worst may be yet to come. "I'm not sure we have escaped," Sinnott says ominously.

"It doesn't seem to be out of control yet," Brooks says. "There's a possibility that if we're really aggressive, we still could get a handle on it here. But you have the problem of people coming constantly in from these areas with fresh illnesses."

However, he adds, "we're not seeing cases [in the hospital] yet, but we are all on the alert and we have every expectation that we will eventually have problems."

Meanwhile, an ominous new footnote to all this appeared on Friday. Singapore Airlines officials announced that one of its flight attendants now has SARS symptoms. The attendant had been on a New York-to-Frankfurt flight along with an infected doctor, the AP reports.

While the airline gave no further details, it would appear to be the March 14 night flight. On board was a Singapore surgeon, who had flown to New York City to attend a medical conference at the Crowne Plaza Hotel after treating SARS patients at home. He was confirmed as a SARS case on March 18 in Frankfurt, where he was quarantined when the plane landed.

More information

The U.S. Centers for Disease Control and Prevention and the World Health Organization have updates and information on SARS.

SOURCES: March 28, 2003, Morbidity and Mortality Weekly Report; March 27, 2003, news briefing with James Hughes, M.D., director, National Center for Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta; Steven Brooks, Ph.D., director, infection control and clinical microbiology, Kingsbrook Jewish Medical Center, New York City; Philip Tierno, M.D., Ph.D., director, clinical microbiology and immunology, New York University Medical Center, New York City, and author, The Secret Life of Germs; John Sinnott, M.D., Cullison professor and director, division of infectious diseases, University of South Florida, Tampa; Associated Press; Los Angeles Times; Boston Globe; Houston Chronicle; Albuquerque Tribune; Midland Reporter Telegram; The Salt Lake Tribune; Bay City News; Marin Independent Journal
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