UPDATE on SARS - April 1, 2003
News release from Dr. Bill Swan, American medical doctor in Hong Kong

The majority of SARS cases have occurred in health workers, contacts of the original hospital patients, contacts in the Metropole Hotel, and the Amoy Housing Estate. If you are not in these categories your risk is very small at the moment. There is some concern recently that the virus might be mutating and becoming airborne, but there is not evidence that is has actually occurred. Normal hand washing precautions are usually adequate.

They are afraid of it becoming airborne, but if that were the case, everybody in HK would be infected already since the MTR moves around 2 million people (HK pop. = 6 mil.) daily crammed into their cars. Those of us living here are not concerned...except the government who is seeing a huge loss in tourism.

UPDATE ON SARS - March 20, 2003
This is an edited version of an announcement from the Hong Kong Hospital Association and the Hong Kong Medical Association.

The publicity associated with SARS has increased significantly in the last 3 days. This has lead to an associated increase in anxiety. This is an attempt to explain the current situation.

What Do We Know About SARS?
This is a viral illness. Scientists from all over the world are working on this problem and information is changing rapidly. Preliminary studies suggested that a Paromyxovirus (related to mumps and measles) was responsible. Now it seems most likely that a new type of Coronavirus (most "colds" are caused by a coronavirus) is the main trigger. It is possible that in some patients it is a combination of both which is causing the severe symptoms.

A test has been developed in Hong Kong which appears to be very effective and reliable. Now that a blood test is available it will be possible to establish a certain diagnosis early. Previously the diagnosis was made on the basis of the story and the examination. Early and certain diagnosis will allow more effective study of the best treatments. It will also allow appropriate treatment to begin earlier. Early intervention with appropriate drugs appears to significantly improve outcome.

Now that we can identify the exact virus it is possible to be more certain about the method of spread and incubation. It is reasonable to infer the following from our observation of this outbreak in addition to an understanding of the normal spread of viral illness:

• The incubation is 2-10 days.
• The average incubation is 4 days
• It is spread by droplets or direct close contact with an infected person.
• Droplets can last outside of the body for up to 3 hours
• The virus is killed by antiseptic washing
  It is less infectious than Influenza (W.H.O)

Our experience of hospital infection indicates the following:

• Masks probably reduce the risk of infection
• The majority of people recover
• All deaths so far in Hong Kong have been in patients who were either elderly, suffering from significant co existing illness or both.
• Some young and fit people became very seriously ill, but did not die.
• Drug treatment is helping

What Is My Risk?
Any individual making an assessment of risk will be balancing two factors. The absolute risk and the perceived severity of the event.

In a normal year on a normal day in Hong Kong we would expect approximately 60 cases of Atypical Pneumonia in a population of over 6 million.

Yesterday there were 51 new cases of SARS in addition to the "background normal expected cases".

This gives a scale of estimating risk. In simple terms an individual is almost twice as likely to have caught Atypical Pneumonia last week as they were last year. (Exposure one week ago causing symptoms yesterday)

The difference this year is that we do not know how many cases of SARS will occur tomorrow or next week. This is the importance of the daily incidence which will give a good indication of increasing risk.

So far the incidence has remained fairly flat until a rise yesterday. There remains a possibility of widespread community infection. If the figures remain flat this will become less likely and will demonstrate that the public health measures are being effective. If the figures rise significantly widespread infection is more likely.

The majority of cases have occurred in health workers and contacts of the original hospital patients. If you are not in this category your risk is very small at the moment. It can be reduced even further by preventing people from coughing on you, possibly wearing a mask when in crowded or poorly ventilated places, and washing you hands with liquid soap after returning from outside..

Is it time to Worry?
This is certainly an important public health problem. It has the potential to be a worldwide epidemic. As doctors we have been very worried about this issue for several weeks. We are generally less worried now than last week for the following reasons:

• The virus has been identified and a test is available.
• The spread is droplet not air borne, this is easier to control and prevent.
• Drug treatment is helping
• Early treatment is helping
• The very ill patients in Prince of Wales are generally getting better
• Our population in Hong Kong is now informed and generally compliant to preventative measures
• We have an excellent public health system

The US Government is now advising US citizens to avoid travel to Hong Kong and China. However, we are not advising VIM teams to cancel their trips since the risk is very low for people passing through Hong Kong. We will continue to provide updates if anything changes in order to allow each individual to make their own decisions.