Emergencies preparedness, response

Severe Acute Respiratory Syndrome - Press briefing, Beijing, China

28 March 2003

Opening remarks made by the WHO representative (WR) in China Dr Henk Bekedam and Professor John MacKenzie, Team Leader of WHO experts investigating the outbreak of atypical pneumonia in Guangdong Province, China at a briefing in Beijing 28 March 2003.

Dr Henk Bekedam WR:
Thank you very much for coming, welcome. My name is Henk Bekedam, WHO Representative. On my left is Dr Alan Schnur, my Deputy and also the Team Leader of Communicable Disease Control in China. And this is the expert team, who will share with you today details of their visit so far. Before I give the word to Professor Mackenzie, I really want to share with you that this has been a very successful week. Many things have moved on and I think we have had made big steps forward. This week, China has become, very clearly, part of Global network in dealing with the disease. Concerning the disease I think we still have many problems at the moment. We still don’t know the cause, the treatment and there are many question marks on how best we can prevent it. But we have made some major steps forward. There are definitely some areas that we perhaps feel that we can still improve. But for sure the overall visit of the expert team has been a great success. One thing I would also like to share with you is that the government has made a very clear commitment. This morning, while Vice-Minister Ma has a very busy schedule, he wanted to be at the debriefing to go through the interim report. He was there which is significant, very committed and he gave a very clear direction which way to go. We are all pleased about that. I will now ask John to go over several things which happened during the week.

Professor John Mackenzie:
Thank you very much indeed. Last time we met was on Monday at our last Press Conference and a lot of things have happened since then. On my right are my fellow team members Dr Breiman, Dr Maguire, Dr Evans and on the end is Dr Preiser. We have had the most interesting five days in Beijing, very productive days I am glad to say. We had meetings with China CDC and people from Guangdong Province and they were very cordial, very frank and open. There was a lot of information from these colleagues in China CDC and Guangdong Province. Most of the things we came here to do we have managed to achieve. One of our major tasks was to look at the cases of atypical pneumonia in Guangdong Province with our Chinese colleagues and to put together a case definition that was usable both by WHO and by the Chinese CDC. Until this week we have had a WHO case definition of SARS that has been used elsewhere in the world and one which the Chinese CDC has been using.

We had to make sure they didn’t overlap and that they could be utilized for the same purpose. This we achieved fairly rapidly. By using the Chinese CDC definition, with a very small modification, we are able to be pretty certain that most cases of atypical pneumonia that Chinese authority has recognized from the middle of Nov. until the end of Feb. 2003 were indeed cases of SARS.

We have also been talking to our colleagues about pathology and about what we can do in future to create a better surveillance system. We are now asking the Chinese authorities to nominate people to join the World Health [Organization’s] Network of those Laboratories looking into SARS. In addition, we have been able to get agreement that Chinese authorities will nominate someone to join the epidemiology network to discuss the aspects of epidemiology of SARS and also we have been able to get agreement that they will nominate someone shortly to join the network on clinical aspects of SARS. Basically, after this event, China will become part of SARS global network.

China has also agreed to provide up to date reports of SARS throughout China. These should be done through the Ministry of Health and they need to be true, frank numbers reported on a regular basis. These are major steps forward and I believe that China has fulfilled all the requirements to be fully in the global community when it comes to dealing with SARS.

I would emphasize again that China has agreed to provide updates from all provinces on a regular basis in real time to WHO. This is a very major advance from Chinese authorities. As Dr Bekedam mentioned earlier, we met today with the Vice-Minister Ma and there was no question that he has fully realized the importance of the global situation and China’s role in this global situation. I believe this bodes very well for the future and China will fulfill its commitment to WHO. I think it is also important to remember there are more cases in China than anywhere else in the world. There is much to learn from these cases in China and this week has meant we have been able to start looking in more depth at the transmission, management, and eventually the origin of this new disease.

I believe working together with the Chinese colleagues we will get an enormous amount more information as time goes by. There is much we still need to understand about this disease and I really do believe we have made a good start this week in China. Finally, I believe that an enormous amount of additional information will come out in coming weeks once we are able to analyze these cases from Guangdong Province in more detail.

(Edited Question and Answer session with the media)

Q: We are a litle bit surprised that you are so happy that you will get the promised data, the Guangdong authorities have declined to give a further update before April. When you say regular new figures for WHO web site, will China give daily updates from every province with new numbers of cases?

Professor Mackenzie: That’s certainly what I understand would be the case. It might take a few days to get it underway. [This has to be] done by the central government and the provincial government. You have to understand they promised to provide daily updates from thorough out China.

WR China: Indeed a crucial question. What is needed at the moment are provincial updates on a daily basis. That is [the] message we have been clearly giving and we got very positive feedback. At this time we have only received data so far from Guangdong until the end of Feb. This was given rather quickly ... The commitment we have seen this week is a major step forward and the Vice-Minister is eager to look at this suggestion.

CBC: What kind of virus is the corona virus and can WHO can control it?

Dr Preiser: I cannot yet confirm the exact virus but we are studying several candidate viruses. However, many open question remain regarding corona virus you probably you referred to. Data suggests that corona virus may be responsible for SARS, which leaves many others still to be investigated. Part of our suggestions to the government of China is that this must be done as matter of urgency. One of the next steps might be to actually go to parts of China that have been affected for some time and look at patients who have had SARS to get a confirmation of corona viruses.

UPI: I heard a report that a hospital in western Beijing has [more] as additional cases than have been reported. Have the Chinese come with you the actual number of cases in various areas? Were there any foreigners amongst the cases?

WR China: The authorities have confirmed there were 10 cases and 3 deaths in Beijing. This information has been shared with us officially. As far as I know, there are no foreigners infected. We were not told the nationalities as the breakdown of the 10 cases were not given, except that 2 of them are heath workers so it could indicate that these are local Beijing people.

Q: TVBS from Taiwan: It’s said you got the permission from the Chinese government to go to Guangdong. Is the information accurate?

Professor MacKenzie: We have not asked for permission to go to Guangdong until today. Today we had a meeting at MOH and suggested that it would be a good idea if the expert team visited Guangdong to find out more about the cases and to get first-hand information about the incidence, and the transmission of the disease. The Chinese government is currently considering that.

Q: [Tape is not clear]

WR China: It is very encouraging is that China will join the global network on epidemiology, the global network on the laboratory part and they will also identify someone on the clinical part. For sure, most cases of SARS globally are here in China. From this information we can learn a lot. It’s very promising that China clearly agreed this week to join global forces in finding out the cause, treatment and what can we do about it.

Q: Hong Kong Cable TV [Hong Kong] has this kind of epidemic. Guangdong stressed the disease is contained Guangdong province. Did they give any information which is promising, maybe clue how [Hong Kong] or other areas (to help them) contain the epidemic as well?

Professor Mackenzie: Important question. This part of the reason that we think it could be valuable for the expert team to visit Guangdong. To observe first hand what the practice has been there and also get a better idea of the entire picture. Based on what we have understood, there is not a clear difference in a way patients have been handled there in terms of infection control practices that would enable us to say why it could be different from other locations.

Q: Hong Kong experts have claimed finding cause and treatment of the disease?

Professor MacKenzie: More and more evidence says that corona virus is the agent, first discovered by the University in Hong Kong. Since then confirmative information has come from US CDC, Frankfurt in Germany and also similar viruses in Canada, Hanoi, Singapore. At this stage, [the] most likely . . . agent is corona virus. We do need to look at the cases in Guangdong. This is crucial.

Q: Have you been stopped from going to Guangdong?

Professor Mackenzie: We have not yet been denied of any visit to Guangdong. We were asking this morning. We believe eventually they will say we can. But this needs time. And I don’t have reason to believe it will be denied.

Q. Can you tell us about the latest travel advisory?

WR China: You may have seen on the web site the new travel advisory and you have all been given copies of it, I hope. This is far more strict in that it tries to stop sick people going on an airplane. We are translating in Chinese and will make sure the Chinese authorities get it.

Q: Did China recognize this as a highly infectious disease? Can we be sure that this disease could be handled by China?

WR China: The good news about this disease is that it is not a highly infective disease. It only needs very close contact. At the same time we do share your concern.