WHO officials reporting SARS now in decline

BEIJING -- For the first time since March 28 when the SARS virus began to take hold in eastern Asia and Toronto, there were no deaths anywhere in the world from the tenacious disease, world health authorities said Wednesday.

With outbreaks at all the initial hot zones either contained or coming under control, severe acute respiratory syndrome is clearly in decline, the World Health Organization said.

China, the hardest-hit nation, had its first day of no new cases or deaths since April. WHO officials said evidence over the last two weeks indicates the Chinese are succeeding in bringing their epidemic under control, but that the disease is by no means contained there.

"It's coming under control, but look at Toronto. You can be coming under control and the next day you can be out of control again," said Mike Ryan, who heads the global SARS response network for the United Nations health agency.

Canadians had celebrated three weeks ago when the WHO removed Toronto from a list of the world's SARS hot spots, only to see a new cluster of cases pop up again just over a week later. More than 70 new infections have been reported there since May 26 and more than 5,000 people have been told to quarantine themselves at home.

China, which has the world's most severe SARS outbreak, really started to turn the corner in its battle against the bug about two weeks ago, after intensified measures taken in late April and early May by the Chinese government, Ryan said.

"We are beginning to see the benefits of the scaling up of the Chinese response -- the active surveillance, the home quarantine of contacts ... the improvements in the hospital infection control, the tightening up of the whole surveillance system," he said. "I think we began to see the impact about two weeks ago."

Since the flu-like illness emerged in the southern province of Guangdong in November, SARS has killed at least 334 people on the mainland and infected more than 5,000.

But since the beginning of May, the numbers have been steadily decreasing from the epidemic's peak of more than 150 cases a day. In the past week, the daily figures have dropped below 10.

Ryan was cautious about drawing any conclusions from the fact that China detected no new cases or deaths Wednesday.

"We can't say anything based on one day," he said. "We are going back now and talking to the Chinese to try to make sure that their surveillance is very sensitive and they are not missing things ... It is very encouraging, but we have to be sure."

China would be considered to have controlled its outbreak when the virus stops spreading there, Ryan said.

"When you can say that it has been 20 days since your last case was isolated, that would be it," he said.

"The trend is very encouraging across the whole of China," Ryan said, "but all we need is one infectious case to get into one poorly equipped hospital and we're back in the middle of it."

Vietnam has remained SARS-free since April 8. In Singapore, the last probable case acquired in the country was isolated May 11. No new cases have since been detected in either place despite a high level of alert and aggressive investigation of all rumored cases, according to the WHO. Hong Kong is no longer listed as a place travelers should avoid, either by the WHO or, as of Wednesday, the U.S. Centers for Disease Control and Prevention.

The WHO said that success underscores the agency position that SARS can be contained despite the lack of a vaccine, reliable diagnostic tests and specific treatment.

On a global level, the outlook is hopeful, Ryan said.

Worldwide, a total of 8,402 probable SARS cases with 772 deaths have been reported from 29 countries.

Despite the promising prognosis worldwide, the recent discovery that the virus exists in animals appears to be a complication.

"If we were purely dealing with a human disease, with no animal reservoir, then I would really be very confident now that we could eliminate this completely," Ryan said.

Researchers have found the virus in civet cats at a live food market in China, but it is unclear whether the civets are the source of the human outbreak. If they are, or if another animal is, there is a chance the virus could jump to humans again -- just as bird flu did in a few cases this winter in Hong Kong.

"We're in that same situation with Ebola in Africa. Right now there isn't a single human on the planet with Ebola, but we know any day, it could happen," Ryan said.

Outbreaks of Ebola occasionally crop up in Africa and have been linked to chimpanzee bushmeat. However, chimps are not thought to be the original hosts.

"With SARS, we could end up in that situation, or we could end up in the situation where it's gone forever, which would be nice."

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EDITOR'S NOTE: AP Medical Writer Emma Ross in London contributed to this report.