SARS headlines:

• WHO adds Taiwan to list of "affected" countries. Taiwan reports its first SARS death. The number of SARS cases has increased from 41 to 66 in 4 days.
• Vietnam was removed from the list.
• New Zealand reports its first SARS case.
• India is not making regular reports to WHO. News reports indicate SARS cases in multiple parts of the country, some with local spread in the community.



• Health Canada suspended routine access to ribavirin. Ribavirin will only be allowed in scientific trials, since there is no good evidence that it helps in SARS.

For details about the headline stories only, click "More" below, or
you can read the complete 4/29 SARS Updates, Part 1 and Part 2.

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Taiwan:
April 25: 49 probable SARS cases (increase of 8 cases, or 19.5%, in past 24 hours)
April 26: 55 probable SARS cases (increase of 6 cases or 12.2%, in past 24 hours)
April 27: 55 probable SARS cases, 72 suspected. (inconsistently, an increase of 2 probable cases is reported on the Taiwan CDC Web site, both in English and in Chinese.)
April 28: 66 probable cases, “0” deaths according to WHO.

The first Taiwanese death from SARS occurred on April 27.

At the Center for Disease control of Taiwan, R.O.C., Web site, the banner headline says, "Travel to Taiwan is safe..." , despite the recent death and an increase in the number of SARS cases from 41 to 66, in the past 4 days.

The Australian: "Taipei city authorities have vowed to track down 25 staff who have fled from a city hospital at the centre of a SARS outbreak, as 11 new cases of the disease were confirmed. The workers from the Hoping Municipal Hospital, including doctors, nurses, technicians and administration officers, face fines of up to 300,000 Taiwan dollars ($14,000) if they are caught."

eTaiwan News: Incoming airline passengers from Hong Kong, Macao, Singapore, Vietnam and Toronto must enter quarantine for 10 days. Taiwanese natives, returning from those countries, will enter 10 days of quarantine.


New Zealand:
No cases, reported to WHO yet. .

Sky News:New Zealand's Health Ministry said its first victim was a woman who spent 10 days in isolation in hospital. She travelled from China to New Zealand and has now been discharged, to home, where she will be isolated for 10 days. Further details are available from Dow Jones/Yahoo!.

Stuff.co.nz: Christchurch prepares a strict isolation area for SARS, backed up by duct tape.


India:
1 case reported, as of April 21. No more recent report to WHO.

1 reported case, according to WHO.
Reuters says there are at least 9 cases, and 46 suspected cases (up from 7 and 20, respectively, yesterday). "The first SARS case was detected in India on April 17 in the coastal resort state of Goa. Five SARS patients are being treated in Maharashtra, home state of the financial capital of Bombay, one in New Delhi and two in the eastern state of West Bengal."

As noted previously in SARS Updates, India is inappropriately using SARS blood tests to 'confirm' SARS cases. These tests are not sensitive enough.

We read that India is clearing patients based upon the lab tests. Patients who actually have the SARS virus would be wrongly given their negative test results, leading to a risk -- when they return to the community, they will spread the infection. The non-scientific Indian attitude to SARS lab test is seen in all media reports, such as this one, which talks about "confirmed cases" and "tested positive", as if the lab tests were accurate.

The SARS cases in India include members of a wedding party and a taxi driver who conveyed them. [Evidence of community spread. One would expect that a WHO travel advisory against India is due soon. – docbear]

The Hindu: Job action continues by Air India pilots who want to avoid flying to SARS-infected countries and working with SARS-exposed crews. More from Hinduonnet.

Hindunet also provides evidence of very poor isolation procedures: Quote:
Julia D'Silva, who tested positive in Pune, was allowed to marry because she threatened officials with dire consequences if the wedding was put off. Helpless, they allowed it to be solemnised and then `closed down' the church; those who attended the marriage, including the priest, were later isolated.

Then came the case of Bhaskara Murthy, a Hong Kong-based businessman. He reported to a hospital in Mumbai, was found positive and after being isolated, "he left against medical advice". He stayed with friends before leaving for Delhi where he was pushed back into isolation in a hospital.


Web Mid-Day: "Kolkata: About 30 per cent of doctors and para medical staff at the Infectious Diseases Hospital, did not report to work today for the scare of contracting the deadly corona virus after a patient was declared SARS positive yesterday." [Hat-tip to Phil_B]


Speaking to The Times of India, a former director of the National Institute of Communicable Diseases, Dr K K Datta said, "SARS will spread. We cannot avoid it. As time passes, the mortality will come down...There is nothing like an infected or an affected country anymore. It's just that some have reported and some have not."

[In the absence of official statements, I suspect Datta's attitude is prevalent. India is apparently going to miss the chance to control SARS -- docbear]


From ProMED mailing list, issue #71:
"We have stressed in prior postings the need to maintain consistent clinical and epidemiological criteria for case reporting, pending more information on the sensitivity and specificity of currently available laboratory tests."

The Financial Express: "Has India Got Its Act Together On SARS?"


Health Canada Rescinds Routine Access to Ribavirin:
"Health Canada, through its Special Access Programme, will no longer provide routine access to ribavirin for the treatment of SARS. This decision stems from a recommendation by a working group advising Health Canada, comprised of health experts and clinicians from across Canada and representatives from the Centers for Disease Control and Prevention in the United States. After reviewing the existing anecdotal clinical experience with ribavirin, negative results from in vitro testing with ribavirin against SARS related coronavirus, and knowledge of reports of serious and unexpected adverse drug reactions, the working group reached a consensus that there is no data to support the continued use of ribavirin outside of clinical trials at this time.

On April 27, Health Canada notified physicians that the continued access to the drug is contingent upon the submission and review of data in the possession of physicians with respect to the use, safety and efficacy of ribavirin for the treatment of SARS. Physicians currently treating patients with ribavirin are also strongly advised to critically re-examine the risk/benefit for each patient before continuing treatment."


Read the complete 4/29 SARS Updates, Part 1 and Part 2.


Posted by docbear @ 04/29/2003 07:20 AM | TrackBack