Geodog

SARS: CDC says we may be in the very early stages of what could be a much larger problem

DR. GERBERDING: Well, from the standpoint of CDC, I would say that we are very concerned about the spread of this virus, particularly in Asia. We recognize this as a epidemic that's evolving differently, in different geographies, but nevertheless, it is a respiratory virus, it does appear to be transmitted very efficiently, and what we know about respiratory viruses suggests that the potential for infecting large numbers of people is very great. So we may be in the very early stages of what could be a much larger problem as we go forward in time. On the other hand, this is new, we don't know everything about it, and we have a lot of questions about the overall spread.
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We have no evidence, unfortunately, right now, that any specific anti-viral therapy, or steroid treatment, or other agents that are targeting this virus, are of any benefit to patients. We hope we'll learn more as we go but that is the status of clinical care today.

... if there's any good news in SARS right now, it's that the majority of patients do appear to recover and that the death rate is actually lower than what we see with epidemic influenza, about 3.5 percent of the patients have died from the illness

Tonight I read the transcript of CDC Director Dr. Julie Gerberding's media briefing, which the CDC was nice enough and smart enough to put on the web. The money quote is above -- while Severe Acute Respiratory Syndrome (SARS) isn't spreading rapidly in the US at this time, it could very easily do so. And we have no treatment for it.

In case you haven't noticed from my earlier posts, I'm very nervous that SARS could spread throughout the US and the world, and I'm concerned that the CDC and government are one step behind the disease, and will stay that way until it is too late. I hope not. In the meantime, I intend to follow the progress of the disease daily, and to call up my congress critters to urge them to follow this disease closely.

I have set up a new blog, www.sarswatch.us, where I will be providing useful links and posting information and news that I find on the disease. The name may not propagate for 2-3 days, in the meantime check http://sars.twjb.com/. You may be able to see the weblog there. You can always check out the CDC's SARS page, which has lots of information, updated on a regular basis.

I've excerpted other useful bits from the press conference below.

DR. GERBERDING: We believe, based on what the investigations have shown us so far, that the major mode of transmission still is through droplet spread when an infected person coughs or sneezes and droplets are spread to a nearby contact. But we are concerned about the possibility of airborne transmission across broader areas and also the possibility that objects that become contaminated in the environment could serve as modes of spread.

Coronaviruses can survive in the environment for up to two or three hours ,and so it's possible that a contaminated object could serve as a vehicle for transfer to someone else.
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We know that the individual with SARS can be very infectious during the symptomatic phase of the illness. We don't know how long the period of contagion lasts once they recover from the illness and we don't know whether or not they can spread the virus before they have the full-blown form syndrome.

But most of the information that the epidemiologists have been able to put together suggests that the period of contagion may begin with the onset of the very earliest symptoms of a viral infection, so our guidance is based on this assumption.

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WHO is not issuing any travel restrictions. We are not issuing any travel restrictions either, but WHO has also implemented procedures for screening passengers before they leave the country of SARS origin. They're asking countries to evaluate departing passengers for respiratory illnesses or other signs that could represent SARS. In part, this is because there are some early reports that passengers traveling with a SARS patients on board could be at risk for acquiring this infection, and we don't want to have any cases acquired during flight or during transfer on a ship or other vehicle.

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QUESTION: The Canadian health authorities have issued quite a restrictive quarantine, now expanding to a second hospital.

Why are you not issuing any quarantine? Is it because you can't or because the situation is not so dire?

DR. GERBERDING: Well, first of all, we have been in constant communication with Canadian health authorities and they are not actually issuing a quarantine. They are issuing a voluntary self-isolation policy which is slightly different than a regulated quarantine.

The main reason we are not taking this step right now, in this country, is because the epidemiology of our problem is very different than the outbreak that Canada is experiencing in Toronto.

Although I reported 62 cases under investigation here, two of those cases are in health care workers and there have been no further signs of spread in that particular cluster. Five cases have been in household contact and the rest of the cases have all been in travelers coming in from SARS areas.

So we are not experiencing any sign of community transmission at this point in time, but we are alert to it, we are monitoring potential contacts very carefully, and if we see evidence that our infection control measures are not containing spread within communities, then we will have to reconsider whether additional steps are necessary.

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DR. CITRON: this is a virus that's routinely susceptible to commercially available, normal types of disinfectants that are used in hospitals, and that's basically what you'll see in that guidance. So there's not need for taking extraordinary measures or using extremely caustic or dangerous types of materials, but the routine types of disinfectants are available and the specifics are on the Web site announcement.

QUESTION: Just a follow up. To follow up. What about disinfection in the home? Do you have guidelines for that? Is it just a question of chlorine or--

DR. CITRON: I think it's the same kind of principles that are going to apply, you know, standard household disinfectant agents to clean surfaces and bathroom areas, and things that may have come in a lot of contact with a potentially-infected patient, ought to be adequate.

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DR. GERBERDING: We have no evidence, unfortunately, right now, that any specific anti-viral therapy, or steroid treatment, or other agents that are targeting this virus, are of any benefit to patients. We hope we'll learn more as we go but that is the status of clinical care today.

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QUESTION: Hello, Dr. Gerberding.

Given what's happened in Hong Kong, and southern China, and given what's happened in Toronto, how concerned are you about the possibility of a community outbreak in the United States?

DR. GERBERDING: We are very vigilant about the possibility of spread. We recognize that there are at least some patients with SARS that are extremely efficient transmitters. We don't know to what extent all patients are particularly infectious but there are clearly some who appear to be very highly infectious, and, for example, in Hanoi where there was one patient who was a source for health care worker transmission and approximately 56 percent of the health care who had direct contact with the patient appeared to have acquired SARS.

So given that high degree of contagion and what we know about spread of cold viruses, I think we are very alert to the possibility that this could spread outside of the confined populations that I've mentioned, travelers to the affected areas, close household contacts, and health care workers. But we are not seeing that now and we are looking for it very closely.

So if we begin to appreciate that, we will have to expand our recommendations to be more inclusive of special protective measures for contacts.

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DR. HUGHES: Well, many laboratories here at CDC, as well as around the world, have been hard at work at this for some period of time. A week ago today, there were no antibody tests which could be used to diagnose this infection. It's a result of considerable hard work. We now actually have two antibody tests that look quite promising and seem to be reproducible in different laboratories, and among the things we're doing is working to get ready to transfer diagnostic testing capacity to public health laboratories around the country, so that before too long, I'm hoping that tests will be available much more locally.

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DR. GERBERDING: Well, from the standpoint of CDC, I would say that we are very concerned about the spread of this virus, particularly in Asia. We recognize this as a epidemic that's evolving differently, in different geographies, but nevertheless, it is a respiratory virus, it does appear to be transmitted very efficiently, and what we know about respiratory viruses suggests that the potential for infecting large numbers of people is very great.

So we may be in the very early stages of what could be a much larger problem as we go forward in time. On the other hand, this is new, we don't know everything about it, and we have a lot of questions about the overall spread.

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right now the largest number of patients [12 cases] are in California. That's not surprising since California is one of our largest states. But that's also a point of a lot of travel to Asia and so it makes demographic sense, that that would be an area where there would be perhaps an increased risk.

In fact if there's any good news in SARS right now, it's that the majority of patients do appear to recover and that the death rate is actually lower than what we see with epidemic influenza, about 3.5 percent of the patients have died from the illness.