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To: energyplay who wrote (37273)	8/18/2003 5:47:50 AM
From: Henry Niman	Respond to of 74559

>>When SARS returns, I think we will have coordinated and aggresive response to contain it, where ever it pops up. No more hiding information, << Nonsense. See below: Exposure to SARS CoV from Travel to Infected vs Affected Locales The major Surrey, BC outbreak of SARS, or at least SARS CoV, is creating considerable confusion in Canada, at WHO, and ProMed. Therefore, it is worth reviewing the risks from travel to affected and infected areas. Recently the CDC reviewed its clinical database for antibodies to SARS CoV and found that their definitions for probable and suspect cases cast a very wide net. In the US there were 344 suspect cases and 74 probable cases. About 50% of the cases were tested for SARS CoV antibodies and only 8 positives were found and in all instances the positive cases had been designated as probable cases. A similar data set was generated for cases in the Vancouver area when tested by the Canadian National Labs in Winnipeg. In British Columbia there were four probable and 44 suspect cases. Four tested positive for SARS CoV and all four were the probable cases. Thus, it seems that the patients positive for SARS CoV were concentrated in the probable cases and the cases more broadly defined were not infected with detectable levels of SARS CoV or antibodies produced in response to a SARS CoV infection. A review of the US cases that tested positive SARS CoV revealed the importance of visiting an infected area as opposed to an affected area. In the US, at least 6 of the 8 SARS CoV positive had been in close proximity to patients with SARS. Three had been to the Metropole Hotel in Hong Kong, one had been to a hospital in Singapore that was treating SARS patients, one had attended a religious retreat in Toronto which was attended by over 30 people who developed SARS, and one had visited a hospitalized relative in Toronto who share a room with a patient who subsequently developed SARS. Thus, these SARS CoV positive patients had not only traveled to a country and city that was reporting SARS cases, but had also been in relatively close contact with known SARS patients (same building or same event). A review of the British Columbia cases showed the same trend. Three of the four who were positive for SARS CoV had just returned from trips to Hong Kong prior to developing symptoms. One had stayed at the Metropole Hotel, one had visited Amoy Gardens, and one had stayed with relatives, one of whom had been diagnosed with probable SARS. The fourth British Columbia patient positive for SARS CoV was a health care worker who cared for the case that had stayed with relatives in Hong Kong. Thus, the fourth case was the only confirmed case of SARS transmission in British Columbia. The care was given at Surrey Memorial Hospital while the patient was there from April 1 to April 22. Thus, like the US, the number of case that tested positive for SARS CoV was very low, but the vast majority of the positives had been in relatively close contact with SARS CoV patients. None of the 12 positive for SARS CoV died and all have been discharged from the hospital. The linkage of patients testing positive for SARS CoV to probable SARS patients in previously infected areas is important in the analysis of the current outbreak in Surrey, BC. The nursing home is only 5 miles from Surrey Memorial Hospital, the location of the only documented transmission of SARS CoV to a health care worker in British Columbia (and possibly all of North America, excluding the Toronto area). The initial cases at the Surrey nursing home were health care workers. The outbreak is being managed by Fraser Medical, a group closely associated with Surrey Memorial Hospital. The number of nursing home residents or staff testing positive is 10 even though only 19 of the 143 patients with symptoms have been tested by PCR (and 4 of 7 were positive for SARS CoV antibodies). At least one of the patients positive for SARS CoV has died with pneumonia and two other nursing home deaths were associated with pneumonia. At least 19 associated with Surrey Memorial Hospital have been quarantined because at least one of the SARS CoV positive patients from the nursing home was treated there. Thus, the SARS situation in Vancouver has dramatically changed due to the current outbreak. The number of deaths has increased from 0 to 3, with at least one confirmed by laboratory results for SARS CoV. The number positive for SARS CoV has jumped from 4 to 14, with results from the vast majority of patients not yet reported. The transmission rate has been extraordinarily high (97/142 residents and 46/160 staff), yet the outbreak has yet to be designated as a SARS outbreak. The laboratory data from patients in Surrey shows that SARS CoV can go undetected for quite some time, leading to dozens if not hundreds of cases infected with the virus. This outbreak has gone unreported for 6 weeks and there is no flu season to confuse diagnosis. It is clear that the agencies above are VERY unprepared for a re-emergence of SARS, which has been in place for over 6 weeks in British Columbia.