With its focus on health maintenance and disease prevention, demand for greater knowledge and use of Traditional Chinese Medicine (TCM) throughout the world continues to increase.

Top 5 Countries as at June 13, 2003 - China 5327 - Hong Kong 1755 - Taiwan 693 - Canada 229 - Singapore 206 - Worldwide 8454

WHO July 14, 2003: As of today WHO no longer publishes a daily table of the cumulative number of reported probable cases of SARS.

WHO September 2, 2003: The recent global outbreak of SARS has heightened concern about the occurrence of respiratory diseases having symptoms similar to those seen in SARS. Although the global outbreak of SARS has been contained throughout the summer, considerable uncertainty surrounds the question of whether SARS might recur, perhaps according to a seasonal pattern. Several respiratory illnesses occur much less frequently when temperature and humidity are high and then return when the weather turns cooler. Currently, SARS has no vaccine, no effective treatment, and no reliable point-of care diagnostic test.

Hong Kong September 9, 2003: East Asian countries are on full alert after Singapore health authorities confirmed that a local patient had contracted SARS. Hong Kong authorities have stepped up checks at the airport and sent letters to all doctors to be on alert. It has also made an agreement with mainland authorities to exchange information on infectious diseases. Higher surveillance once again. At Hong Kong's international airport, health checks are being tightened, especially on travelers from Singapore.

Today's Analysis of Severe Acute Respiratory Syndrome (SARS) in Hong Kong

This illness can be severe and, due to global travel, has spread to several countries in a relatively short period of time. However, SARS is not highly contagious when sensible protective measures are used, and the percentage of cases that have been fatal is low.

SARS appears to be less infectious than influenza. The incubation period is short, estimated to range from 2-14 days, with 3-5 days being more common. However, the speed of international travel creates a risk that cases can rapidly spread around the world.

Observation of the figures I have been collecting since March 17 indicate that the death rate in Hong Kong of SARS patients has increased from 1.05% to 16.81%. Most of the deaths occurred in individuals who have a history of chronic diseases, or were patients who sought treatment at a relatively late stage of infection.

WHO Update:

The SARS virus is a new coronavirus unlike any other known human or animal virus in the Coronavirus family. Because the virus is new, much about its behavior is poorly understood. Key questions, which are undergoing intense study, include stages in the course of infection when virus shedding may be highest, and the various concentrations of virus in different body fluids. Scientists are also working to determine the amount of time the virus can survive in the environment on both dry surfaces and in suspension, including in faecal matter.

Experience has shown that when SARS cases are promptly detected, isolated, and managed according to strict procedures of infection control, further spread to hospital staff and family members either does not occur at all or results in a very small number of secondary infections.

Information emerging from outbreaks in Hong Kong and Canada is raising some important new questions about SARS. In Hong Kong, a large and sudden cluster of almost simultaneous cases (321) seen in residents of the Amoy Gardens housing estate has raised the possibility of transmission from an environmental source. Around 66% of Amoy Gardens patients present with diarrhoea as a symptom, compared with 2% to 7% of cases in other outbreaks. Some deaths are now occurring in younger, previously healthy persons as well as in the elderly and persons with underlying disease.

Speculation centres on whether these cases represent infection with high virus loads, as might occur following exposure to a concentrated environmental source, or whether the virus may have mutated into a more virulent form. Viruses in the Coronavirus family are known to mutate frequently.

Lancet Study May 6:

The first major study of SARS trends estimates that about 20 percent of the people hospitalized with the disease in Hong Kong are dying from it, and that more than half of those over 60 die. The average age of the SARS patients in the study _ those hospitalized in Hong Kong _ is 50, and disease experts generally agree that the virus is much more deadly in people over 60. The death rate could be as high as 55 percent in people over the age of 60.

Today's Analysis of Severe Acute Respiratory Syndrome (SARS) Worldwide

What are the Symptoms

When in Public Places

• high fever (> 38° Celsius, 100.4° F)
• dry cough
• shortness of breath or breathing difficulties
• changes in chest X-rays indicative of pneumonia also occur
• SARS may be associated with other symptoms, including headache, muscular stiffness, loss of appetite, malaise, confusion, rash and diarrhea

Remember this is a new virus that has not yet been identified in terms of its evolution and behavior, and it is not yet definite how it is transmitted. It is apparent that it is spread through air droplets from infected people, and also from hand-contact or from inanimate objects. Airborne transmission has not yet been completely ruled out.

All viruses are susceptible to natural ingredients, particularly vitamin C which has an inhibiting effect on virus replication. 

Some WHO Definitions

SARS Affected Area: As at May 2 WHO is now issuing daily lists of countries having areas where local transmission has occurred within the past 20 days. This new list replaces the previous list of affected areas. See list below.

SARS Suspect Case:
1.   A person presenting after 1 November 2002 with history of  high fever (>38 °C) AND cough or breathing difficulty
AND one or more of the following exposures during the 10 days prior to onset of symptoms:
-  close contact with a person who is a suspect or probable case of SARS;
-  history of travel, to an area with recent local transmission of SARS

-  residing in an area with recent local transmission of SARS

2.  A person with an unexplained acute respiratory illness resulting in death after 1 November 2002, but on whom no autopsy has been performed AND one or more of the following exposures during to 10 days prior to onset of symptoms:
-  close contact, with a person who is a suspect or probable case of SARS;
-   history of travel, to an area with recent local transmission of SARS

-  residing in an area with recent local transmission of SARS

SARS Probable Case:

1.  A suspect case with radiographic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome (RDS) on chest X-ray (CXR).

2. A suspect case of SARS that is positive for SARS coronavirus by one or more assays. See Use of laboratory methods for SARS diagnosis.
3.  A suspect case with autopsy findings consistent with the pathology of RDS without an identifiable cause.

• maintain good personal hygiene for the protection of yourself and others around you
• cover your nose and mouth when coughing or sneezing
• keep your hands clean and wash them frequently with liquid soap
• develop a habit of NOT touching your face (eyes, nose, mouth, ears) with your hands - if you must touch your face, wash hands first
• in public wear a surgical face mask; don't touch the outside of it (wash hands if you do!); and change it often
• keep a fair distance from people who are ill and are sneezing and coughing openly. The virus is spread through air droplets and you can pick up the virus through inhalation
• maintain good indoor ventilation at home
• keep home environment clean and pay special attention to cleaning the toilets: before flushing, lower the toilet lid to prevent contaminated water from splashing out
• clean all drain outlets at home once a day by pouring a teaspoonful of 1:99 diluted household bleach down each drain outlet - after 5 minutes, rinse with water
• develop a healthy lifestyle - proper diet, regular exercise, adequate rest and do not smoke
• consult your doctor promptly if you have a fever (of 38 degrees Celsius or above) or develop symptoms of a respiratory infection

Extract from WHO compilation of data on resistance of the SARS Coronavirus against environmental factors and disinfectants (May 4).

Virus survival in stool and urine:

- in faeces(and urine) at room temperature for at least 1-2 days

- in stool from diarrhea patients (which has higher pH than normal stool) for up to 4 days

Virus survival in cell-culture:

- on plastic surface in room temperature for at least 2 days

- only minimal reduction in virus concentration after 21 days at 4°C and -80°C

• avoid sharing eating utensils, and use proper serving spoons/chopsticks
• avoid eating at buffets where the food is not covered by a protective cover (many hotel's buffets in Hong Kong have no such protection)
• the virus is likely to be passed on from inanimate objects - such as buttons in lifts and building entrances; door handles; public transport handles; chairs; utensils,; etc. - so if you need to touch them (and we all do!) wash hands after and avoid touching your face
• avoid crowded places where close proximity to others is necessary
• in taxis open your window a little
• PLEASE do not spit - it spreads germs (and you can also be fined HK$5,000), which others step on and then carry indoors on their shoes

Local transmission has occurred when one or more reported probable cases of SARS have most likely acquired their infection locally regardless of the setting in which this may have occurred. If no new locally acquired cases are identified 20 days after the last reported locally acquired probable case died or was appropriately isolated, the area will be removed from this list.

Pattern A
Imported probable SARS case(s) have produced only one generation of local probable cases, all of whom are direct personal contacts of the imported case(s).

Pattern B
More than one generation of local probable SARS cases, but only among persons that have been previously identified and followed-up as known contacts of probable SARS cases.

Pattern C
Local probable cases occurring among persons who have not been previously identified as known contacts of probable SARS cases.

Pattern Uncertain
Insufficient information available to specify areas or extent of local transmission.

* WHO is currently recommending, as a measure of precaution, that people planning to travel to these areas consider postponing all but essential travel.