Global Alert and Response (GAR)

Severe Acute Respiratory Syndrome - Press conference, Hanoi, Viet Nam

The World Health Organisation in collaboration with the Ministry of Health Press Conference on Severe Acute Respiratory Syndrome

Hanoi, 26 March 2003

63 Tran Hung Dao Street, Hanoi,
Viet Nam,
Tel: +84 4 943 3734/5/6,
Fax: 84-4-943 3740
Email: who@vtn.wpro.who.int

PRESS CONFERENCE ON SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

26 MARCH 2003

The World Health Organisation in collaboration with the Ministry of Health held a press conference tomorrow on Severe Acute Respiratory Syndrome.
Venue: Thang Long Hall Sofitel Metropole, 56, Ly Thai Tho, Hanoi

Date: 26 March 2003

Time: 15.00 hrs

Mrs. Pascale Brudon World Health Organisation (WHO) Representative in Vietnam
Professor Aileen J. Plant Coordinator, Centre for International Health, Australia
Dr. Trinh Quan Huan Director of Preventative Medicine, Ministry of Health
Dr. Hoang Thuy Long Director of the National Institute of Hygiene and Epidemiology
Dr. Christophe Paquet Head of International Health Department, National Institute for Public Health Surveillance
Dr. Tim M. Uyeki Medical Epidemiologist, Centers for Disease Control and Prevention (CDC)

The World Health Organization in collaboration with the Ministry of Health Press Conference on Severe Acute Respiratory Syndrome

Hanoi, 26 March 2003

P.B: Welcome everyone to today’s Press Conference. I would like to thank all the guests on our panel here today for their intensive cooperation in restricting the SARS outbreak since the beginning of our effort. Mr. Trinh Quan Huan, Director of Preventive Medicine, Ministry of Health will soon present activities of the Ministry of Health & Government of Vietnam in response to the SARS outbreak. Then we will go to questions and answers.

We would like to thank Mr. Pham Duy Trong, our translator from UNICEF who is willing to help us today. Thank you.

First we would like to introduce the members of this team here. We begin from the left. Ms. Le Thi Thu Ha, please.

Ms. Ha: My name is Le Thi Thu Ha. I am the Deputy Director of the Department of International Cooperation. I have been a member of the Task Force of the Ministry of Health since the beginning of this outbreak. I am coordinating the international support from WHO, CDC, Medecins Sans Frontieres and the Japanese Government to help the Ministry of Health & Government of Vietnam to cope with the SARS outbreak. Thank you.

Mr. Long: I am Hoang Thuy Long, Director of the National Institute of Hygiene & Epidemiology, Vice Director of the National Steering Committee for SARS.

Ms. Aileen Plant, I am from the Center for International Health, Australia, and the Team Coordinator with WHO in Hanoi.

Ms. Pascale Brudon: I am Pascale Brudon, WHO representative in Hanoi.

Mr. Huan: I am Trinh Quan Huan, Director of Preventive Medicine, Ministry of Health, Vice Director of the Standing Committee for Disease.

Mr. Tim: I am Doctor Tim Uyeki, from the Centers for Disease Control and Prevention, USA. I am a member of the WHO team investigating SARS & we are working in collaboration and in support of WHO to assist the Ministry of Health in working on the SARS outbreak investigation.

Mr. Christophe: I am Doctor Christophe Paquet from the National Institute for Public Health surveillance in France. I am here also as a member of the WHO team.

Ms. Brudon: Thank you everybody and before I give the microphone to Aileen Plant, our Team Coordinator, I just want you to know that we are only a small part of the team as we have many more people here looking at different aspects and supporting affected ministries. So I think now very briefly Professor Aileen Plant will provide you with the update situation.

Ms. Plant: Thank you. As we now know, SARS is occurring around the world. With more than 400 cases and 17 people dead, the first case we knew of in Vietnam was one month ago. He came from Hong Kong and before the disease was discovered in Hong Kong, it was reported to originate from Southern China. In fact, we now know a whole group of people appear to have been infected from one person in one hotel, by chance, the same name with this hotel, Metropole Hotel, but nothing to do with this Hanoi Metropole Hotel, not even the same chain. Unfortunately, several people got infected & started a chain of infection in different countries, not just in Vietnam, but we know here that the first infected people were associated with the French Hospital. In Vietnam and the rest of the world we now know that nearly all the cases that have been identified are health care workers or associated with health care workers. There has been amazing international response coordinated by the WHO through what is called Global Outbreak Alert and Response Network, in which when an outbreak occurs in countries, the whole network of experts around the world offer their services and come to help investigate outbreaks like this.

So we see a coordinated attempt to identify, to isolate and to contain this outbreak, to find out what is happening to work out and help treat patients in several centers. So our team in collaboration with Ministry of Health, is part of the global network. At the moment in Vietnam we say there have been 58 probable cases, including 4 unfortunate people who have died. On the good side, a few people have been discharged and quite a lot people are nearly ready for discharge. I think this is probably a clear, brief summation for the international response on what is happening in Vietnam. Now you can raise questions on the issue.

Ms. Pascale: Thank you very much Professor Aileen Plant. Before giving the floor to Doctor Huan, I would like to stress the quality of collaboration that exists between the Ministry of Health and WHO in Vietnam. Following the case in the French hospital on February 28th, we looked carefully at what was happening and became quickly aware of this very important issue. We asked for support from outside and began to work very closely with the Government of Vietnam. We held a meeting at the weekend of the outbreak to set up a Government Task Force to collaborate with WHO. A number of experts came at very short notice during the weekend to help. So first I would like to thank the Government for allowing this collaboration. We are now in a position to investigate the situation in Vietnam and other countries in the world with an overall aim to contain the outbreak and identify and treat the disease. Now I invite Mr. Huan to provide the update on what the Government has been doing.

Mr. Huan: Thank you, Madam Pascale. We are happy to see all of you here today at this WHO / MOH press conference. First, may I introduce the three of us from the Ministry of Health. Firstly, Dr Hoang Thuy Long, Director of the National Institute of Hygiene & Epidemiology, Former Vice Director of the Task Force Team, Ministry of Health. He is now Director of the Steering Committee of the Government. Secondly, Mme. Le Thi Thu Ha, Deputy Director of the Department of International Cooperation. She is a member of the Task Force of the Ministry of Health and working on advocacy. I am Dr. Trinh Quan Huan, Director of Preventative Medicines, Ministry of Health, Former Director of the Task Force and now Director of the Control of Preventative Diseases of Government of Vietnam.

We would like to tell you some good news first of all. Since the outbreak of the disease, we have brought the disease under control in 2 places: The Tropical Medicine Institute of the Bach Mai hospital and the French hospital, both in Hanoi. Since the first case in the French hospital on 24 Feb 2003 until now, March 26th, that means more than 1 month, the total no. of SARS cases is 59. I am sorry to say that 4 patients have died. We regret to say that all 4 of the deceased are health workers, 2 of them are doctors. They are health workers who worked closely with the patients.

After discovering the first case in the French hospital, we have worked very hard in collaboration with WHO to develop disease prevention activities. We have been conducting investigations very carefully and thoroughly since the first detected case on 24 February. We examined all cases relating to the 1st patient, their family, and those closely related to health workers. Reports have been compiled by MoH to present to the Government, and the Task Force has been established, headed by Professor Nguyen Van Thuong, Vice Minister from the Ministry of Health. The Task Force conducts regular meetings with experts and Professors of related agencies and has come up with many recommendations. We have received hourly and daily recommendations to cope with the ever- changing situation. During the initial period, from the 1st to 15th March, the situation was somewhat complicated. Since then, we have invited many WHO experts and experts from Japan to help Vietnam to find solutions to the problem. At the same time, we have been conducting examinations at different laboratories: Tokyo, CDC and NIHE to identify the agent causing the disease.

Also during this time, there was (and still is) continued coordination between the Ministry of Health, WHO and relevant agencies such as the Ministry of Foreign Affairs, Ministry of Transportation, Ministry of National Defense and General Organization of Custom to develop mass activities to contain and investigate the disease. Attention has been paid to flights from the places of disease to others and we give out guidance on disease prevention. We also instruct passengers to fill in the travel form so that we can check their health situation and report to the Border Health Center to improve disease control and restrict transmission.

After a period of time, we have seen that the Task Force activities have been improved effectively, and the cooperation among agencies dealing with the global situation of the disease. The Government also established a Steering Committee of Disease Prevention, headed by the Minister of Health. Now the Steering Committee is leading all departments in order to give directions to prevent the disease, and contain the spread of the disease. As we reported earlier, we have controlled the epidemic and from 20th March until now in the French hospital, there are no new cases of SARS.

In the Tropical Medicine Institute of Bach Mai hospital there are some suspected cases that we think are from flights arriving into Vietnam from overseas. We have isolated them fully but after some surveys and examination they have been excluded. We know it is a serious disease and that disease control is very difficult while international tourism is developing everyday, every hour from the place of disease to others by air, by land, by sea from Vietnam to other countries and vice versa. So the threat of the disease is not small at all. We will cooperate with WHO, MoH, international and national experts in Vietnam to find out the cause of the disease and minimize its spread. This is some information I would like to share with you.

Ms. Brudon: Thank you very much Doctor Huan. Now the floor is open for questions.

Q: I am a reporter from Reuters. As you know this afternoon, the Chinese officials confirmed that SARS has killed 31 people in Southern China, in Quang Dong Province. In fact, 792 people just came out this afternoon. What do you say about that, I mean this is quite a traumatic increase from the 5 dead reported people and 305 cases of infection. If the doctor from MoH also has any precautions for travel out of China into Vietnam, this increases caution. Thank you.

A: We have known there have been cases in China and we have not seen any update figures for some time. So it doesn't really surprise us that the outbreak is larger. It is not easy to control the outbreak in all countries because China obviously has so many travellers now. About travel advisory concerns, the WHO teams discuss these issues through global teleconferences every evening. WHO still does not place any restrictions on travel. However these are re-assessed on a daily basis.

Q: Thank you. I am Claire from BBC. This question is for Dr Huan. Could you please specify what efforts have been done in Vietnam to identify the virus? And the 2nd question, what additional support is being provided to the Bach Mai and French hospitals financially to help them cope with the number of patients. And how about business when the French hospital is closed?

A: I will reply scientifically and epidemiologically about activities within Vietnam's laboratories. From the beginning of the 1st case of Mr. Johnny Cheng in the French hospital, the disease was transmitted to others. We had a group of staff who took some specimens for laboratory analysis. We used the technique of PCR to work on viral experiment with all prima we had. The 1st thing we found was virus group B, then some other viruses were found often occurring in the throat, causing respiratory diseases. Recently in Hong Kong, scientists found a link to the virus group Paramyxovirus. Then CDC found another virus link to the Coronavirus group. Normally these viruses may not cause any severe diseases, but there are also some variants and they are thought to cause some severe diseases. Studies are continuing in the laboratories.

Clinically, our doctors are quick to identify the criteria of SARS and especially distinctive diagnoses. We have also worked out a kind of suitable treatment. These are our researches being conducted so far.

Ms. Brudon: For the 2nd question about the 2 places where suspect and probable cases are hospitalized. I will try to answer: For the French hospital, there will be some more support internationally. In addition there is a short, medium and long term plan. The short-term plan is to improve dramatically the conditions in the Bach Mai Tropical Medicine Institute so that all the infection control measures are implemented and these have been done in close collaboration with the Team and the Ministry of Health. The Ministry of Health agrees to get more support to continue to implement infection control effectively. So in the next 2 months, WHO and others will support the Tropical Medicine Institute. As such outbreaks may happen again in the future, the Government and WHO work with the international community for a long- term support and for the development of a very good centre for potential SARs patients. With regards to the French hospital, we believe that the hospital should transfer patients who suffer from SARS to the Institute of Tropical Medicine.

Q: There is an issue of funding, is there any financial support for the French Hospital?

A: The French hospital has received support from the international community, including the Embassy of France and few other countries in order to continue to take care of patients for few more days.

A: The other thing we would like to talk about is, besides the support from the donors overseas, the Vietnamese Government also provides 71 billion VND for all SARS related activities. All patients will be free of charge during their treatment.

Q: I have the 1st question for Professor Paquet, I understand that now there are 11 probable cases of French hospital workers. Does the French Ministry of Health regret allowing hospital workers to fly from Hanoi to France? Secondly, could someone explain the treatment in more detail? We think the threat is not small at all. Why does Singapore feel it must quarantine hundreds of people yet this is not seen as necessary in Vietnam?

A: Thank you for the questions. First of all, I would like to say that I am not speaking on behalf of French Ministry of Health, I am here on behalf of a WHO international team of experts. As far as I know about the French situation there have been 11 suspect cases in the French hospital that are totally different from probable cases.

A: What we see from the development in the international situation is that no country is protected from having cases of SARS. There have been cases in Canada, Germany, in different countries. So I don’t think France’s situation in this regard is different to the rest of the international community.

A: There has been a spread of SARS cases in Singapore while in Vietnam as you have seen it has not spread into the community at large -only among health care workers and people closely associated with them. Every time we hear of another case, we ask the Ministry to investigate and then the problem is brought to the Tropical Medicine Institute. At the moment, we have no evidence of transmission at the community level.

Q: I am from Vietnam News, I would like to verify some figures: 58 or 59 cases of infection? Which one is correct? Another figure is that there are 48 cases in hospitals in Hanoi. What about the other 10? Mr. Huan mentioned VND71 billion- Has this fund already been spent or is it going to be spent?

A: It is always difficult during an outbreak to keep numbers the same. The Press always likes the number to be the same but from a Doctor's Point of View, first we get the cases, we know which kind of disease we’re looking for so we think this a possible case… then perhaps 2 days later, we find a change in the blood, in the body of the patient, then we say “Ah, it is a different cause of pneumonia, it is not SARS”.

So all the time the Ministry and WHO have to revise the figure. The other thing, from Vietnam’s point of view, the regional cases occur here; from WHO point of view, we count the cases whether it is today or where the cases died. So for the original case occurring in Vietnam, we considered him initially a Vietnam case then we took him off, then we added him to Hong Kong's cases, and Hong Kong's deaths. It is crazy in international counting in some ways but everyday if you ask at different hours of the day, or even the same hours of the day, it depends on when the team comes back and tells me what's happening. You can often find a variation. But when we sift through the numbers we can usually agree and we say right let's cut off at this moment we can agree on the cases. It's not a problem, it's just a symbolic figure from your point of view.

Most cases report probable cases now only instead of suspect cases except for the United States. This makes it easier to compare clearly between countries what was happening and now we have been able to catch up with the concrete outbreak statistics. Now we just report the probable cases which as you know, change often. The reason for the difference in the number of 48 and 58 cases is, according to WHO, that there are 48 patients still in hospital, 4 people have died and 6 people have been discharged.

Q: I am from Ho Chi Minh Women’s Newspaper based in Hanoi. I have 2 questions: the 1st one is for Tim Uyeki. Is there any evidence of information regarding the relapse or re-infection of this kind of new virus found in the cases around the world. That is to say, is there the possibility of relapse or re-infection? The 2nd one is to Professor Long, have any results of specimens from Vietnam patients been sent to the Tokyo WHO Collaborating Center?

A: The question about whether or not a patient with probable SARS can have a relapse or in fact even if they recover, can they be re-infected, is this your question? If so, I think this time, worldwide, it's too early to know the answer to this question. Let me make a comment- This is a brand-new disease to the world as far as we know. Physicians and public health officials worldwide all try to learn as much as they can about the illness and the condition. So the answer to your previous question I think will eventually come out, but right now it takes investigations of each case, as it has been done worldwide coordinated by WHO and the Ministry of Health in each affected country.

I would just like to also add that every day scientists, physicians and public health officials are sharing as much information with each other as we can around the world, because we are all learning about this disease together, and we are sharing information. And from the laboratory side, there is an established WHO network of collaborating laboratories. That is, everybody is working extremely hard to try to identify this virus, to try to share as much scientific information so we can to learn as much as we can together.

(Q): I am from AFP and I have two questions. One is for Prof. Plant. I would like to know whether scientists have rational explanations about why the disease would be under control in Vietnam and not in Hong Kong or Singapore. I mean, can the virus be different or was it just that the answer from the health authorities were much better in Vietnam than anywhere else in the world? The other question is for Mr. Huan, I just want to know whether Vietnamese government sent very strict instructions to hospitals in the northern part of the country. Do you think that hospitals in northern Vietnam would be technically able to identify a case if there would be any, and do they have any strong instructions to call you immediately and to tell you if they find any cases? Thank you.

(A) (Prof. Plant): The first thing, I think, it is undoubtedly the same virus.

The second thing is to some extent, we're guessing because as Tim said, we're in a new situation with a new disease. To some extent, what seems to be happening in different countries depends on how many index cases occur.

One thing that does seem to happen is that as you get each generation of infection, it appears to get weaker, but we're not completely sure.

The other thing that may have happened is that the French Hospital is quite an enclosed community with people working closely together and some of them living in the same place.

So maybe, rather than spreading the virus more externally, they actually mostly infected each other.

But in the end, we're guessing, and we won't really know until we see how the outbreak pans out in Hong Kong and Singapore and other countries.

(Mr. Huan) Well, I think, referring to your second question, I'd like to say something about treatment. I would like to tell you that since we have learnt that there are some cases in Guangdong, China, (there are 305 cases, with five deaths) we've informed all the Vietnamese hospitals.

And training courses have been held for health workers at the central level and grassroots levels, investigating all the cases, to cope with any situation.

(Mr. Long) We'd like to say that our system of surveillance is very close... closely knitted.

We know the addresses of the potential patients and the follow-up is done very carefully. And this of course, we have been doing in very close collaboration with Dr. Tim Uyeki.

(Q): Hi, I'm Margie Mason from the Associated Press. I'm wondering if someone there can answer, yesterday we were told that 5 people were ready and waiting to be released from the French Hospital at 7 pm, and at the last minute the Ministry of Health said 'No. That would be another two or three days'. I'm wondering, six patients have obviously been discharged, and seemingly all of those people come from Bach Mai Hospital. So I'm wondering why some patients are allowed to be discharged, and why other patients are being held up or delayed, and once they are discharged, what type of continuing surveillance will also be in effect?

(A): The decision about discharge is difficult. And we at the World Health Organization, have put out some guidelines. And then the Ministry also put out some guidelines on exactly the same day. The Ministry's guidelines were more cautious.

And Madam Ha and I just came from a meeting with the Minister to look at both sets of guidelines and my view is that the Vietnamese guidelines are fine, and I support the Ministry with the guidelines they have. There are only minor differences, and I don't see any problem.

Everyone has the same objective which is to make sure that patients who are still infectious don't spread the disease to other people. The Ministry recommends 5 days without fever and then a week in isolation – this is more cautious than the WHO guidelines but that is not a problem, the only problem would be if they were less cautious. The people from the Ministry already have a facility ready to receive people if necessary. And of course at the French Hospital, there are quite a number of people who've been without temperature and fit the Vietnam proposal of five days before discharge from the initial hospital and then a week afterwards to make sure they are still well.

(Q) (Representative of British Embassy): I am from the British Embassy here in Hanoi and I have three questions. One to Prof. Hoang Thuy Long, regarding the information he provided that by now: Has Vietnam developed a rational regimen for treatment, that means those who suffer from SARS will be cured by this regime?. That is the number one question. And number two regarding whether the French Hospital will re-open in the future – when? And the third one, whether we found cases in the community?

(A): Prof. Long would like to provide you with the answers for two questions. First regarding the re-opening of the French Hospital, we have no comment because it depends on them. It's a private hospital.

So the treatment guideline and regimen for the SARS patients developed by Vietnamese doctors are not much different to those being used in other countries with SARS cases.

But in clinical management, it's not simple, and we have to have some adjustments case by case.

So the main regimen that we are using for SARS patients here in Vietnam is anti-viral drugs, for example, ribavirin and cortico steroid drugs.

Although we do use broad-spectrum antibiotics in order to prevent some bacteria secondary infection.

And also one important thing to cure patients is good management and use of mechanical ventilation when necessary. Also with the administration of IV fluid vitamins and in some cases we use gamaglobulin.

Up to now we haven't found any cases in the community. All cases in the two hospitals now have direct contact with the initial cases or they are all have some epidemiological contact – link.

- As far as treatment is concerned, there is no specific treatment. This is a new disease, and there is nowhere in the world where there's shown that any particular anti-viral drug works with this disease. So Professor Long is completely correct. The treatment is supportive, looking after the vital functions. But there is no anti-viral that is known to work. The countries talk every couple of days to say what they have been trying, but so far nothing.

But of course most patients get better anyway. As indeed, with most viruses virtually all the patients around the world have got better. There is, you know, a small number, around 3 per cent, I think, that have died – 4 per cent, that sort of number. But mostly patients are surviving well.

(Q) Kay Johnson with Time Magazine and DPA News. Doctor Uyeki, you know the United States has issued travel advisories for Vietnam. And also last week, the US Embassy reported that, what they said was a probable case of SARS was not connected to the Hanoi French Hospital. Would you personally, as a medical professional, have issued those travel guidelines? And can you elaborate on what happened with that case and how it has been eliminated as not a communion infection? And also for the WHO, the gentleman from the Health Ministry said that, if I'm correct, in January, they were informed by China that there was a problem in Guangdong Province. And, if I'm correct, the WHO did not know about that until much later. Vietnam then immediately reported the first case to WHO. If China had done that earlier, would the case not have been as bad?

(A: Tim Uyeki ): I would just like to clarify that I'm not speaking on behalf of myself as a physician, nor am I speaking for the Center for Disease Control and Prevention. However, I'm a physician medical epidemiologist employed by CDC. But I can speak on behalf of the WHO Hanoi Team, of which I'm a team member. I also want to make it clear that I do not speak for, nor do I represent the views of the US State Department.

And in addition, I also do not speak for, nor do I represent the US Embassy in Hanoi.

However, I can offer a few comments of what we have observed about the epidemiology of the probable SARS outbreak, probable SARS cases here.

What we have observed here is the initial clustering and peak of cases at the French Hospital that appeared to be primarily affecting hospital workers who were employed at the French Hospital, who had exposure to the index case of what you now are quite familiar.

And these initial clustering cases were followed by further cases reflecting probable transmission from cases, probable SARS cases, in the hospital to others. The initial increase and peak in cases that occurred is thought to be due to exposure to the index case. Most of these early cases were among health care workers.

And today, all of the probable identified SARS cases, as Dr. Huan has stated, are epidemiologically linked to the French Hospital in some way. We've not seen any other types of cases at this time.

(Q): So would you say that you agree or disagree with the statement that was made by the US State Department?

(A: Tim Uyeki) I'm sorry, as I previously mentioned, I don't represent the views of the US government. However, I don't know if other individuals on the team, particularly the WHO, would like to comment.

(Pascale Brudon). As you know, every evening, as we said before, people all over the world are discussing what is happening in the world. These people include also the national authorities. Based on the epidemiology of the disease and what is happening in Vietnam and in other places, WHO continues to say that there's no need to restrict travel; people should be informed, people should know what is SARS, people should understand the disease. But there is not today any restrictions. Now there are a number of governments who fear that there may be a need to be more cautious. WHO is trying to get information from all parts of the world and are continually reviewing the information. But it's up to each government to decide what to do for its own citizens. And I don't think we, the WHO, can enter any judgment about what the governments have decided. And also, as we said earlier, this travel advice is reviewed everyday and you have an update daily on the web, which provides more information. Maybe in two days or more, or in one week, things will change. But we still state today that there are no restrictions on travel.

Now if we take your second question about China...

So for the second question, which is the issue of China. WHO now knows that since November, something was happening in China, which was not really very well known. We were unable to investigate what was happening, but we have been informed by the Chinese authorities that in fact, there were a number of outbreaks in some of the municipalities. Then when the first case, occurred in Hong Kong, it became clear that there could be some link between what was happening in Hong Kong and what had been happening in the South of China, in Guangdong. So then WHO began to request the Chinese authorities to be able to send an international team like in Vietnam, to investigate much more closely what is happening and to look at the records. And as you probably know, a team is now in Beijing, working with the government.

(Q) Vietnam invited WHO to investigate the disease as soon as they found it. Is that the reason for Vietnam to better control the disease?

(A: Professor Plant): Well, I think that we need to go back a step really. I mean, Dr. Long deals with outbreaks everyday of every week. And to most countries, when an outbreak happens, you don’t realize it’s a new disease. And the difficulty is, at what point do you suddenly realize you have a serious outbreak and you are not actually dealing with influenza. Even when I got on the plane, the night before I got onto the plane, I had my influenza shot, because we still didn't know that it was a new disease. And so... I don't think we will go round saying that we should have been there earlier - it would've been nice being invited here earlier, because we always like to investigate outbreaks. But I don't feel strongly that we would have made a difference. The first thing is that we had to realize that this was a new disease, and I think it took time for the Chinese to realize this was a new disease. The Province is very distant from the center, and the population of China is very large. It was really when other countries started reporting links back to people who travelled from the province concerned that people realized. So, you know, it's hard to look backwards, I suppose.

(Q): I'm from the Canadian Embassy. There was an article today in the Youth Newspaper (Tuoi Tre) indicating that there was a probable case or suspected case in Dak Lak Province of a young woman, nineteen years old, who died and seemed to have the same symptoms. Do you know anything more about this particular case?

(A Dr. Huan): So as far as we know, because we are updated many times a day about the SARS situation in all provinces here in Vietnam, besides Hanoi, there is no other SARS case in other places rather than Hanoi.

- And we find it very reassuring to keep getting reports of possible SARS cases because we know we've increased the sensitivity and awareness about SARS. And we should be getting reports through. And as Professor Long and his team keep on investigating and finding out that there are not, I find it very reassuring that there are reports, because as a doctor in the field, or a nurse, or a primary health care worker, you can't just look at the patient and say "This is SARS". SARS looks like lots of other things.

(Q): So, if the answer is already given, according to Vietnamese guidelines, do you know when some patients from the French Hospital will actually be discharged?

(A Dr. Long): As Prof. Plant said earlier that before coming here, three of us were in a meeting, expert meeting, with the Minister responsible for discharge protocol.

So just half an hour ago, the Minister called us, and informed us that the expert meeting has come up with the final discharge protocol. And with the main criteria for discharge as follows:

Five days without fever, and with improvement clinically – clinically well.

And full blood examination, and all return to normal.

Chest X-rays stable and improved.

And with seven following days in convalescence.

And for the patients at the French Hospital, those who meet these criteria will be discharged soon.

So I would like to provide you with some explanations – the reason why yesterday afternoon they were about to be discharged from the hospital, but then there was a decision to hold them back for a while.

I was with the Minister of Health yesterday afternoon – late afternoon. She was worried about the discharge criteria. If we do not have a consensus and, a good one, and then if we discharge the patient maybe too early, they may be a source of infection. And right after that, she asked me to come to the French Hospital. Yesterday I met with the press, and they asked me about the decision to hold back these patients for a while. I said that these patients have been in hospital for more than three weeks, and now if they stay for one or two days more, it wouldn't matter much. They were a bit shocked and sad, because they were thinking about reuniting with their family last night, but then the decision came, and then they were held in the hospital for a couple of days. And actually I should tell you that among those to be discharged soon, there were some very fully recovered, who volunteered to stay and work in the hospital during the previous days. So I think that our decision was right.

Thank you.

One more question.

(Q): Yes, I'm the last person to ask but I do not think that my question is the least important. Mr. Hoang Thuy Long said no cases were found in the community, but some people say to me that some cases are being treated in the community. I'd like Dr. Trinh Quan Huan to confirm. And the second question. I'm sorry because some questions are very important for my newspaper readers. From the handouts that are delivered to me outside, I find that the greatest clinical mode of transmission of the disease is close contact. Please tell me based on what factors did you suggest that. And the last question. How do you know that paramyxovirus has been identified in Germany and Hong Kong? The virus was detected from the nasal of the infected patients and it hasn't yet been identified from any tissue or lung material or specimen that directly implicates it as the cause of the infections. And so what is the relationship between these viruses in the nose and the disease in the patient at hand? That's all, thank you.

(Coordinator) I understand you're short for time. Perhaps you can summarize and maybe answer one or two of these questions, because we have to close in five minutes. I'm sorry.

(A Professor Plant): The Paramyxovirus has been found in two laboratories: in Hong Kong and in Hamburg. Then more recently, CDC has found Coronavirus. –But as I look at the press conference held in Geneva late yesterday, it is clear to me that nobody knows which is the exact virus. So whatever we said to you would only be guessing, and I think, not informed guessing. I mean one thing to make a guess if you have a reasonable idea, but I don't think we can sort out the virus here in Vietnam. I think we'll wait for laboratories around the world to reach a consensus – there's eleven of them collaborating on the specimens, and doing the best to isolate this virus, and to get such good tests. I think we just have to wait for those results.

(Coordinator) I think we should close the conference now. Thank you for coming. Thank you.

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