The outbreak of severe acute respiratory syndrome (SARS) seems to have peaked in Canada, Hong Kong, Singapore, and Vietnam, according to the World Health Organization. Worldwide 5242 cases and 321 deaths were reported by 28 April in 28 countries, and concern is growing that the disease will become endemic in some countries if it is not brought under control soon.
However, in 23 countries the disease has been well contained, said Dr Mike Ryan, WHO's coordinator of the global outbreak alert and response network. “In a country like China, with a very large population, there is a possibility that disease can become established and remain in human populations, but we do have an opportunity to break the cycle of transmission in this disease and put it back in the box,” he said.
The numbers in China are expected to continue to climb in the coming weeks. “We think Beijing is a major, major black spot,” said Mr Peter Cordingley, spokesman for WHO's Manila office. By 27 April 1114 cases and 56 deaths had been reported there, and Beijing looks set to overtake Guangdong province—which had had 1382 cases and 51 deaths by the same date—as the worst affected area in mainland China. The national total by 28 April was 2914 cases of the disease and 131 deaths, with cases occurring in 23 provinces and municipalities.
Shanghai had reported only two cases by 27 April, but WHO warned that once new definitions for SARS cases were introduced there the number of cases would rise. The WHO team of experts who spent a week in the city said that they did not believe the authorities there were deliberately hiding cases and that they were given free access to data and facilities. “The team left feeling more assured about reporting accuracy,” said Mr Cordingley.
The Chinese government is implementing a range of measures to try to contain SARS in Beijing. Schools and places of entertainment in the capital have been closed, and about 8000 people have been put under quarantine because they have had close contact with SARS patients. On 24 April the Beijing University People's Hospital, which has 1200 beds and a staff of 2000, was sealed off. A day later the 500 bed Ditan Hospital, one of six in the city designated for SARS patients, was also quarantined. Similar measures were taken at the student dormitories of two universities and a construction site.
In a bid to prevent the spread of the disease to the less developed central and western provinces, migrant workers have been told not to return home from Beijing. When news of the Beijing outbreak broke many migrant workers began to head home to the countryside. “That was quite worrying, so any reduction in those numbers has to be good,” said Mr Cordingley.
The appointment of vice premier Wu Yi as the new health minister is an indication of the seriousness of the situation in China, as is her announcement that 3.5 billion yuan (£266m; $423m; a385m) will be used to establish a nationwide health network to tackle the disease.
In Hong Kong the number of SARS cases continues to climb, though the rate of increase shows signs of slowing. There were 165 new cases in the week to 29 April, compared with 212 the previous week.
So far Hong Kong has had 1557 cases and 138 deaths, including the first health worker, a 38 year old male nurse who cared for SARS patients. More than 22% of cases are among health workers, putting enormous strain on the public hospital system.
In response to revelations that Hong Kong's Hospital Authority was not supplying its frontline staff with adequate protective clothing, a local newspaper, the South China Morning Post, launched a campaign to raise money for disposable barrier suits to donate to hospitals. It raised $HK3.43m (£0.28m; $0.44m; a0.40m) from the public in three days, enough for 17 days' supply of suits.
A major outbreak has occurred in Hong Kong's Tai Po district, where at least 28 staff from the Alice Ho Miu Ling Nethersole Hospital have contracted SARS. Infected staff have taken SARS into the community, and cases have occurred in 25 different buildings in the area. Officials say that there is no evidence of environmental contamination—unlike the outbreak at Amoy Gardens, where 321 people from one building were infected.
Although the Hong Kong government has already published its findings on the outbreak in Amoy Gardens and attributed the outbreak to a faulty sewerage system, a WHO team, including four environmental experts from the Canadian health department, is conducting its own investigation in a bid to establish a definite cause.
Elsewhere in Asia, Singapore had reported 199 cases and 23 deaths by 28 April, but Vietnam has not had a new case since 8 April. Both the Vietnam health ministry and WHO consider the outbreak there contained, with a final total of 68 infections and five deaths. Hospitals in Taiwan and Malaysia have also been sealed off in a bid to contain the spread of the virus.
WHO has advised people to cancel non-essential travel to Hong Kong, Guangdong province, Shanxi province, and Beijing, as well as Toronto, but has lifted its advisory on Vietnam.
Figure.
JEROME FAVRE/AP
A nurse uses a monitor connected to a thermal camera to check on the body temperature of passengers coming into Taoyuan's airport, south west of Taipei