People are not responding to antibiotics or antivirals
Didn't stop Roche plugging Tamiflu (which of course might yet turn out to be a treatment if this is in fact a flu strain):
washingtonpost.com Outbreak Originated in China
Illness Peaked a Month Ago, Agency Told; Official Media Silent
By John Pomfret and Peter S. Goodman
Washington Post Foreign Service
Monday, March 17, 2003; Page A01
BEIJING, March 16 -- The deadly pneumonia-like illness that was the subject of a World Health Organization warning on Saturday originated in southern China in November and peaked a month ago, according to a report the Chinese government provided to WHO officials.
The outbreak has sparked months of panic buying of vinegar, herbal remedies and antibiotics in China. Epidemiologists suspect it is the same illness seen over the past two weeks in Hong Kong, Vietnam, Canada, Germany, Thailand, Taiwan, the Philippines, Singapore and Indonesia.
But while news media in other parts of the world reported WHO's warning, China's media were silent on the issue today. None of the major Internet sitesrun by the official New China News Agency, China News Service and Sina.com -- contained news of the warning. Chinese journalists said they had been told not to publish the warning until the end of the annual session of China's legislature.
The illness, which originated in Guangdong province, sickened about 300 people in China, with five dying. In the subsequent wave in other countries, about 200 people have become ill, including 43 new cases reported Saturday in Vietnam. There have been fewer than 10 deaths in the second wave, although many people are still critically ill.
No cases have been identified in the United States, health officials said. But a Singaporean doctor believed to be infected was taken off a New York-to-Singapore flight in Germany on Saturday and quarantined.
The illness has killed two family members in a suburb of Toronto, and four other members of the same family are in hospital isolation today. Two other people are being treated in Toronto, one of whom had "close contact" with the infected family and one who may have contracted the illness while traveling. In British Columbia, two people were confirmed to have been infected.
The cause of the illness is unknown and is the object of an intense international search.
From the start of the outbreak, China's state-run media have veered from silence to in-depth reports to silence, providing a case study in how the government tries to manage information on sensitive topics. Reporting on the issue was banned in the early days of the outbreak, journalists said. It was suddenly permitted for a week in February. Then, apparently, it was banned or severely limited again, Chinese media sources said.
Despite China's report to the World Health Organization, officials have been reluctant to publicly link the outbreak in Guangdong province to illness. In the only recent statement on the disease by a senior Chinese official, Zhu Qingsheng, the deputy health minister, told Wen Wei Po, a pro-Beijing Hong Kong daily, on Friday that "no clue indicates that the virus originated in Guangdong Province."
Guangdong's top official, Zhang Dejiang, called on the local health authorities to set up an emergency task force. In a sign of the prevailing fear and confusion, he ruled out one possible cause of the outbreak suggested by Hong Kong media. "This is not caused by anthrax," he said. "Experts are still investigating the cause."
The report sent to the World Health Organization by the Chinese Health Ministry said the "peak of the disease outbreak was during 3-14 February," and that the number of new cases has since "decreased markedly." However, the Wen Wei Po newspaper reported over the weekend that the number of cases in Guangdong province was increasing.
Throughout the country, witnesses reported panic-buying of vinegar, believed to kill the disease's germs, antibiotics and an herbal cold remedy called Banlangen, which sold out in stores as distant as Xinjiang, 2,500 miles away. Some merchants have profited mightily from the scare, quadrupling prices of popular remedies.
The panic buying soon embroiled Roche Group, the Swiss pharmaceutical giant.
On Feb. 9, Roche representatives held a news conference in Guangzhou at which they discussed the outbreak of the disease and handed out fact sheets about one of their antiviral medicines, Tamiflu, as a possible treatment. In the days that followed, someone posted messages in Chinese-language chat rooms asserting that "the only effective antibiotic" for the virus was Tamiflu.
The medicine soon sold out in Guangzhou, according to reports in the Chinese press, but Roche quickly shipped in more in from its factory in Shanghai.
Guangdong law enforcement authorities launched an investigation and warned that Roche would be "seriously punished if it was found to have spread rumors that Guangdong was in the grips of a pneumonia and bird flu outbreak." Roche has denied any role in the Internet and mobile phone text messages. It said that sales of Tamiflu had been strong in Guangdong even before the media event there.
No bacterial or viral cause of the illness has been found during routine testing. More elaborate studies, capable of identifying exotic pathogens, has just begun.
In the United States, the Centers for Disease Control and Prevention is testing specimens from three cases -- the first victim of the most recent outbreak, a Chinese American man who fell ill in Hanoi on Feb. 26 and died in Hong Kong in early March, another Hanoi patient who is still alive, and a 44-year-old Toronto man who was apparently infected by his mother after she returned from a visit to Hong Kong. (She died also.)
A half-dozen other laboratories in Europe and Asia are also studying material from patients.
Blood will be tested for antibodies to dozens of organisms and will be "probed" for evidence of microbial genes. Researchers will also try to grow organisms, and will examine tissue with an electron microscope to see if any are visible.
"We are keeping a very open mind. As far as I am concerned, nothing has been ruled out completely," said James M. Hughes, director of the National Center for Infectious Diseases at the Centers for Disease Control.
Initial impressions suggest a virus is the cause. Some patients have low white blood cell counts and low platelet counts -- problems more commonly seen in viral than bacterial infections. The fact that victims don't appear to benefit from antibiotics also suggest that a bacterium is not at fault.
Influenza would normally be the leading candidate for the cause of an outbreak like this one.
China has large numbers of people, pigs and ducks living in close quarters, and influenza virus infects all three. In recent decades, China has been the place where new strains of the virus have emerged. However, WHO officials said yesterday that tests for influenza A -- the more virulent of the two forms of the influenza virus -- have all been negative. The Chinese Health Ministry reported the Guangdong patients showed no evidence of the "bird flu" strain of influenza A that killed a few people and many chickens in 1997.
A few patients hospitalized in Hong Kong in the recent wave of cases have antibodies in their blood suggesting recent infection with influenza B, the milder form of the virus. Such a finding is common in winter, however, and the investigators doubt it is the explanation.
There is a long list of other candidates, with a family of microbes called the paramyxoviruses "certainly ranking on the top of most people's thoughts," said Klaus Stohr, a WHO virologist and epidemiologist who is helping to direct the investigation.
A paramyxovirus called Nipah was discovered in 1999 during an eight-month outbreak in Malaysia that killed 105 people out of 265 who became ill. Nearly everyone had occupational exposure to pigs, and the main symptom was brain inflammation -- two characteristics strikingly different from the current outbreak. Another paramyxovirus called Hendra caused three small outbreaks in Australia in the 1990s. Some of those victims had contact with infected horses.
David Heymann, head of communicable diseases for WHO, said that officials in Vietnam reported Saturday that most of the patients there were improving, and some had been moved out of intensive care. Previously, their condition was deteriorating.
"This is a real nasty infection. But it looks like some are able to fight it off," Heymann said. "It is a relief."
Staff writers David Brown and Rob Stein in Washington and correspondent DeNeen L. Brown in Toronto contributed to this report.
© 2003 The Washington Post Company
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