Business Editors/Health/Medical/Government/Public Policy Writers

MINNEAPOLIS--(BUSINESS WIRE)--April 11, 2003

The purpose of this briefing is to give you a current overview of SARS and a baseline of information about the disease and some economic implications to build upon. As the First World War came to an end, we entered a period of global travel; and with that travel, began the first global pandemic. By the end of the pandemic, over 20 million people lay dead. Since that time, we have experienced a variety of related diseases. Some are as dangerous, some with the potential to do as much damage: Aids, Hantavirus, avian flu, variants of CJD and CWD, West Nile, Ebola, Indian plague, small pox, Legionaries disease and many other varied bacterial and viral infections. On an average, the world is subjected to a new biological threat from Mother Nature every 6 to 10 years. Man-made biological threats can be developed ad hoc: Anthrax and Small Pox.

Severe Acute Respiratory Syndrome or SARS has not received the attention in the US media that it has in other countries perhaps due to the war. Perhaps because we are all complacent, thinking the ability to manage these diseases is commonplace. SARS has not yet been proven to be a mega disease, but it may be on the verge of becoming one. If SARS were to go unchecked in the world and mimics the problems created in China, Hong Kong or Toronto, we could see a significant impact on our economic marketplace.

What is SARS?

SARS is a respiratory illness of unknown cause. In some cases, it is being referred to as Atypical Pneumonia because of its close resemblance to pneumonia. The criteria for SARS are: temperature of 100.5 degrees or more, one or more clinical findings of respiratory illness (i.e. cough, shortness of breath, difficulty breathing, hypoxia, or radiographic findings of either pneumonia or acute respiratory distress syndrome), travel to an area with documented or suspected community transmission of SARS, and/or close contact within 10 days of onset of symptoms with either a person with a respiratory illness who traveled to a SARS area or a person known to be a suspect SARS case.

What is the origin of SARS?

A small group of scientist believes that SARS may have come from farm animals. Bi Shengli, of the Chinese Center for Disease Control and Prevention in Beijing, stated that the earliest victims in Guangdong were chefs or bird vendors in contact with chickens, ducks, pigeons and owls. The current theory is that SARS is a formerly unknown coronavirus, similar to the virus that causes the common cold and mild to moderate upper-respiratory illness in humans. When viewed under a microscope, they have a halo or crown-like appearance. The strain of coronavirus identified is similar to a virus that is far more serious and found in animals where it is associated with respiratory, gastrointestinal, liver and neurological disease. In several cases of SARS, metapneumovirus has been isolated; the role in the pathogenesis in SARS remains unclear. Other potential viruses may still yet be identified.

SARS is believed to have originated in the Guangdong province of China in November of 2002. From there it spread to a single hotel in Hong Kong, called the Metropole, then certain hospital clusters involving seriously ill patients. Guests on the 9th, 11th, & 14th, floors of the Metropole Hotel were exposed. International travelers from these floors spread the disease to another five countries; the disease is now in 19 countries. In February of 2003 it appeared in North America for the first time.

What is the incubation period for SARS?

Typically it is 2 through 10 days. The illness begins generally with an onset of fever of 100.4 degrees or more. The fever is often associated with chills and/or rigors and might be accompanied by other symptoms including headache, malaise and myalgia. After 3 through 7 days, a lower-respiratory phase begins with the onset of a dry, nonproductive cough or dyspnea. In 10% to 20% of cases the respiratory illness is severe enough to require incubation and mechanical support.

What is the mortality rate?

This is an extremely aggressive disease. In countries where it was originally established, 1 in 20 are dying. The CDC estimates the mortality rate at about 3.5%, which is similar to other respiratory diseases. Other organizations such as Health Canada have placed the death rate at 4%. It is too early to tell the actual mortality rate and it will likely be different in each country.

At the present time (4/10/03), there are 2,781 cases worldwide; there have been 111 deaths. One hundred fifty four suspected cases have been reported in the US in 30 states, with no deaths to date. Cases studies before 4/5/03 indicated 94% of the individuals had traveled within 10 days before the onset of illness to the areas listed in the CDC SARS case areas For more information on case areas please go to www.cdc.gov and access the SARS page.

What is the risk of exposure?

SARS appears to be spread primarily by direct contact with moisture droplets or body fluids expelled by a SARS carrier. The World Health Organization (WHO) believes, however, that other factors may be involved. Several hundred residents of a housing complex in Hong Kong are now quarantined; they may have been infected with SARS even though they did not have direct contact with a SARS carrier.

It is also becoming evident, according to the CDC and other health organizations, that some individuals may be more infectious than others. An April 4th teleconference, by the CDC and WHO, referred to the possibility of super carriers (individuals that are able to spread the disease greater than others).

According to Dr. Gerberding of the CDC, in one hospital in Hanoi, 56% of the health care worker population that came in contact with a SARS patient came down with the disease. In Toronto, where the disease has had a significant impact on hospitals and health care, 180 paramedics have been quarantined in their homes, three were hospitalized with symptoms after potential exposure to SARS infected individuals.

There appears to be a dramatic difference in the mortality of the disease depending on when it is detected. The US has experienced no deaths and a number of recoveries based on aggressive disease management, while China has experienced 1,290 reported cases and 55 deaths as of April 10, 2003. Actual numbers could turn out to be much higher.

Dr Gerberding of the CDC believes this is a significant and serious threat to world health and one that needs immediate and vigilant attention. "We recognize this as an epidemic that's evolving differently." In transcripts from the CDC, Dr. Gerberding and Dr James Hughes, of the National Center for Infectious Diseases, have stated their concern about SARS. "The potential for infecting large numbers of people is very great". The WHO said outbreaks in most parts of the world are currently under control but still spreading in China and Hong Kong. Other health organizations remain highly cautious and suggest this virus could still break away.

At the present time, many individuals that have been exposed to SARS have recovered or are in recovery. Early medical attention is critical. If you believe you have SARS you should contact local health authorities immediately and try to limit contact with other individuals if possible until you have been instructed on the best course of action.

Does the coronavirus live outside of the human body?

The virus appears to live about 3 hours outside the human body. Similar viruses have the capacity to live from 1 hour to 6 days outside the body. There are some very limited concerns that if dried, it may become airborne and still remain potent or maybe hosted by animals or in sewage or related environments. The Hong Kong government is currently looking at rat and mouse droppings as a possible source of the virus.

Are there any tests developed to detect SARS?

SARS identification testing is under development. Currently a PCR test is being evaluated. Dr James Hughes has noted two CDC tests that look promising; one is an indirect fluorescent antibody test and the other is an Allose test. Both tests require the disease to have some time to establish itself in the human body.

Is there any known treatment for SARS?