WHO - SARS 'stopped dead' but experts remain wary

KUALA LUMPUR, Malaysia -- The chief of the World Health Organization declared Tuesday that SARS has been "stopped dead in its tracks" -- contained less than 100 days since the sounding of a global alert.

But experts said China, whose capital, Beijing, is the only place still under a WHO travel warning, holds the key to whether severe acute respiratory syndrome will resurface.

"We have seen SARS stopped dead in its tracks," the WHO director-general, Gro Harlem Brundtland told more than 1,000 international researchers, officials and health experts meeting in Kuala Lumpur to discuss lessons learned from the outbreak.

Her statement came just hours after WHO lifted a month-old warning against nonessential travel to Taiwan, the third-most hard-hit area after China and Hong Kong. But the U.N. agency recommended continued vigilance in all areas of Taiwan because "a single imported case or lapse in infection control can re-ignite an outbreak."

The disease has killed more than 800 people and sickened more than 8,400 worldwide since being detected in China last fall. China has been hardest hit, with at least 5,327 probable cases and 347 deaths as of Monday. New cases spiked in March and April, but have plunged in recent weeks.

In Canada, the death of a 67-year-old man on Monday has pushed the toll from the deadly SARS virus in Toronto to 34, Ontario's Ministry of Health said Tuesday.

Toronto had 37 active cases on Tuesday, down from 64 a week earlier, health officials said.

The spread of the pneumonia-like disease by air travel has highlighted the dangers of an infectious outbreak in the globalized age, said Brundtland, a medical doctor and Harvard-educated public health specialist.

Nations that fail to make prompt, open disclosures risk their international credibility, she added.

"SARS has changed the perception of infectious disease spread," Brundtland said. "The first and most important lesson concerns the need to report openly and promptly."

Brundtland did not point a finger directly at China, but she was clearly referring to Beijing's initial attempts to play down its outbreak -- which led to a Health Ministry shake-up -- when she praised China's "change in opinion about what was necessary."

Travel advisories have been lifted for several Chinese provinces, but there was no indication when Beijing might be cleared. The capital still has many SARS cases, senior WHO officials said, but they consider the outbreak to be largely contained.

The U.S. Centers for Disease Control and Prevention on Tuesday downgraded its SARS travel advisory to an alert for mainland China, except for Beijing. A CDC travel advisory for Tawain remains in effect.

The top Chinese delegate to the conference, Gao Qiang, the vice minister of health, delivered a national mea culpa in his presentation Tuesday when he said Beijing's initial response was "inadequate."

Now, Gao said, the Chinese government had no higher health priority than to eradicate SARS and prevent its spread into rural areas, where a poor health care system could make it even more devastating.

Dr. David Heymann, the WHO chief on communicable diseases, said whether SARS makes a big reappearance depends largely on China, where it originated.

"China certainly is the key to this outbreak in many respects," Heymann said. "Particularly because China has been able to contain this outbreak."

Brundtland described SARS as a "tough, resilient" disease, an experience borne out by Canada, which suffered a second outbreak in late May.

Dr. Paul Gully, director general of Canada's health department, said Tuesday the heightened surveillance and rapid-response mechanisms established after the first outbreak weren't enough to prevent a second cluster.

"It's really apparent that the ember can continue to smolder and the disease recur," Gully said.

Earlier this month, when WHO first noted the disease was on a downward swing, Heymann suggested it could be a seasonal decline, or the result of "lots of different factors."

Disease experts disagree over whether it's reasonable to think SARS can be not only contained, but eradicated.

Dr. Jeffrey Koplan, former CDC director, has called that notion "very unrealistic." WHO officials have been more optimistic. However, all agree any kind of cure or vaccine preventing it is years away.

Brundtland acknowledged on Tuesday that during Toronto's first outbreak, Canadian politicians wrote her letters urging WHO to drop a warning against nonessential travel to Toronto.

She said she did not consider the correspondence improper, but was unswayed and based her decisions on communications from Canadian health authorities.

Governments feel the travel warnings carry a stigma that could damage their economies and are keen to avoid or get them canceled.