Familiar mix of virus, travel seen in SARS case

Friday, December 19, 2003

TAIPEI, Taiwan -- The new emergence of SARS this week includes key elements of the global outbreak last winter and spring, but world and U.S. health authorities say they're not alarmed.

Two people who were exposed to a Taiwanese man with SARS later flew to the United States but have shown no symptoms.

In fact, no SARS has been reported in any known contacts of the 44-year-old military scientist diagnosed in Taiwan, said World Health Organization spokeswoman Maria Cheng.

"It doesn't look like the start of a new outbreak," Cheng said Thursday. "We're very much hoping that it's an isolated event."

The U.S. Centers for Disease Control and Prevention said Thursday it does not have any active role in the Taiwanese SARS investigation -- even concerning the two scientists who arrived in the United States.

Health safety precautions conducted during the height of SARS last spring -- such as handing out notices asking passengers to monitor themselves for SARS symptoms for 10 days -- have not been activated, said CDC spokesman Dave Daigle.

The CDC also is working to finalize its prevention plan for severe acute respiratory syndrome.

Taiwan has put 34 people in home quarantine and Singapore has isolated 75 because they had close contact with the researcher, who attended a conference last week in Singapore. There are also four wild cards: three Americans and one Japanese who flew to Taiwan with the researcher Dec. 10 but can't be found by officials who say they should be quarantined.

"We don't know where they are, whether they're in Taiwan or elsewhere," said Shih Wen-yi, a spokesman for Taiwan's Center for Disease Control.

A Singaporean man was also missing, but the city-state's Health Ministry said late Thursday the traveler had been found.

"The Singaporean man had returned to Singapore but had left the country again," the ministry said. "He reported that he is well."

The scientist -- identified only as Lt. Col. Chan -- might have become exposed to the virus Dec. 5 while disinfecting equipment in his military laboratory in suburban Taipei, officials have said. Two days later, he flew to Singapore with five colleagues.

After he and his co-workers returned to Taiwan on Dec. 10, two of his colleagues in the Ministry of Defense flew to the United States, said Shih, who would not specify where the two are staying.

Officials have said the researcher was probably not contagious while traveling because he had no symptoms. He developed a fever only after he got home, and was diagnosed with SARS earlier this week.

In a television interview broadcast Friday, the researcher's father said his son knew he was infected but delayed going to the hospital because he didn't want to bring shame to Taiwan.

"He was thinking of the country," the father, identified only by his surname, Chan, told CTI cable news.

The new case sounds a lot like the one believed to have played a role in triggering the global outbreak that started about a year ago, infecting 8,098 people and killing 774.

One of the suspected "super spreaders" in that outbreak was believed to be a 64-year-old doctor from China who attended a wedding last February in Hong Kong -- a crowded, regional travel hub like Singapore.

While in Hong Kong, the doctor stayed on the ninth floor of the Metropole Hotel before he died of SARS. Other guests on the ninth floor at the same time caught the bug and took it around the world. They included:

--a 26-year-old Singaporean woman who checked into the hospital when she got home.

--a 48-year-old Chinese-American businessmen who carried the virus to Vietnam.

--a 78-year-old Canadian woman who brought the virus to Toronto.

Hong Kong, Singapore, Vietnam and Toronto were all among the biggest SARS hotspots.

Another key element of the outbreak that seems to be repeating this time was medical professionals who dropped their guard against the virus. Taiwan lost control of SARS last April when hospitals failed to properly screen and isolate patients.

The island was eventually ranked No. 3 in the world behind China and Hong Kong for cases and deaths.

Officials revealed Thursday that Taiwan's new SARS patient didn't strictly quarantine himself after he became sick. Shih said the scientist spent the night at his work dormitory on Dec. 10. The next day, his wife drove the researcher -- who wore a surgical mask -- to a medical clinic, he said.

After his checkup, the scientist went home and waited five days before going to a hospital, Shih said. This was a violation of guidelines requiring SARS researchers to seek immediate hospital care, he said.

"Maybe our awareness campaign was not enough," said Shih, who declined to discuss possible disciplinary action against Chan.

Officials have said the scientist might have become exposed to the virus by being careless while disinfecting lab equipment. A WHO official also said the researcher wasn't wearing safety gear, like gloves and a gown.

Defense Minister Tang Yiau-ming defended the researcher, saying he was a careful scientist. But Yiau acknowledged mistakes were made.

"With people, you cannot avoid shortcomings and negligence, this is natural. This we have to improve," he said. "If there was no negligence, this case would not have happened, so here I offer my sincere apologies to my compatriots."

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