Emergencies preparedness, response

Severe Acute Respiratory Syndrome – Virtual Press Briefing

23 April 2003

Dr Isabelle Nuttall, Medical Officer, International Travel, Communicable Diseases
Dick Thompson, Communications Officer, Communicable Diseases

Mr Dick Thompson: Hello everybody, this is Dick Thompson. I am a Communications Officer from the Communicable Diseases section of the World Health Organization in Geneva.

We have tried several ways to satisfy the media requests and this is another attempt. We plan on holding these virtual press briefings every day at 14:00 GMT. We will have one person, and hopefully it will be on a topic that is of interest for the day. Today, it is Dr Isabelle Nuttall. She is the Medical Officer for international travel in the Communicable Diseases section. You will be able to ask questions by pressing 14 on your telephone. I am going to turn this over now to Dr Nuttall.

Dr Isabelle Nuttall: Thank you Mr Thompson. Good afternoon everybody. Today, WHO is issuing travel recommendations. These travel recommendations concern the following countries: Beijing (China), Shanxi Province (China) and Toronto (Canada). We are recommending that persons consider postponing all but non-essential [garble] travel to these areas. These recommendations are based on the magnitude of the outbreak in these areas, the fact that we have exported cases from these areas, and the extension of the outbreak outside local transmission. I think I will stop here for the time being and be ready to answer your questions.

If anybody wants to ask questions in French, I think that should be possible as well. I can answer to French questions. I think it is not a problem if we have a combination of English and French. Mr Thompson, can you please confirm that it is fine?

Mr Thompson: That is fine, yes.

Dr Nuttall: Thank you.

Mr Thompson: Okay. We can take your questions now if you press 14 on your telephone.

Canadian Press: I am trying to find out if there was a specific case that triggered the addition of Toronto to the list. And when you say that these cases are now being exported from these countries, including Toronto, does this mean that you think that the virus is out of control in these areas, that it is out of control in Toronto specifically and that it is not traceable to the original cases, that the doctors in Toronto are saying that they can still trace it to?

Dr Nuttall: The idea of an exported case is a person who has been travelling in an area and goes back to their country of origin, is sick upon return, and has a potential of further spreading the infection in the country where the person returns to.

Mr Thompson: Does that mean that the virus has broken the local chain of transmission? I think that was the second part of the question.

Dr Nuttall: It does not mean ... the virus in itself is not breaking any chain of transmission. The disease is being transmitted ... mostly what we have seen in most of the places is that it is through a local chain of transmission, when a person who is sick has infected health care workers and close family. When we have an exported case, that means that there is a potential for further spread of the disease, and this is independently of the virus itself. It is the transmission of the disease that we are talking about here.

El Pais: Hello. Are you thinking of stopping the advertisement of travelling to Hong Kong? It has been three weeks from now nearly. Sorry about my English!

Dr Nuttall: This is a very interesting question. Actually, the recommendation on Hong Kong and Guangdong Province in China remain exactly the same. For the time being, we are still recommending to consider postponing all travel but essential travel to Guangdong and Hong Kong.

These measures, once a country or an area is in the list of areas/countries for which WHO is making recommendations, the area/country will remain in this list for at least three weeks. However, all the travel recommendations are being reassessed on a daily basis, which means that other areas/countries might be added to the list. This will be reassessed on a daily basis, but once the country is there it is for at least three weeks. Three weeks is equivalent to twice the duration of the incubation of the SARS disease.

Canadian Press: Hi. Thank you for taking my question. I have been talking this morning to one of the chief microbiologists in Canada, in Toronto, who has been working with the containment team here. He is very upset by this announcement and says that it is unjustified at this point. He refers specifically to the fact that one of the clusters in the community that the virus moved into, a religious congregation, those cases arose on 4 and 5 April, and there has been no further spread. We are outside of the incubation period for that group and there has been no further spread. He says that in actual fact the tide essentially has been turned in term of community spread and that the problem they are having now is back into the hospitals and that they are working on that with the CDC [Centers for Disease Control and Prevention, Atlanta, USA]. Could you address those criticisms.

Dr Nuttall: You know these recommendations have been carefully assessed by a group of experts on the basis of all available information, being the magnitude of the problem, the transmission, the mode of transmission, the local chain of transmission, and the notion of exported cases. That is on the basis of all these criteria that a decision to issue travel recommendations has been made. The government has been informed 24 hours in advance and therefore we are issuing these recommendations.

Canadian Press: Can I ask a follow-up?

Mr Thompson: Sure.

Canadian Press: Great. I may have missed this, I am sorry I had trouble getting on the call at the beginning. I am just wondering if you could explain what made you make this decision at this point. What tipped the balance on this? You talk about the magnitude and the community. In actual fact, we have about 260 cases in a city of about 5 million people. It is not exactly ... I mean it is a serious problem, obviously, but it is not overwhelming numbers, and I am just wondering what tipped the balance. What made WHO say “okay, now we have to make this decision”?

Dr Nuttall: As I said, it is a consideration of all different factors altogether that made us take this decision right now.

Canadian Press: Thank you.

EFE: Yes, I would like to follow up on these questions. What factors are you referring to on your considerations? Second question, I wanted to know if this new advisory travel means that the SARS is no longer under control as you said a few days ago.

Dr Nuttall: I will start with your second question if you allow me. The point of having SARS under control is to be reassessed every day depending on the number of cases that are being reported, depending on the trend in every single country. It is very important that all measures that have to be taken to limit the spread of the disease be taken. As you know, air travel is one of the routes to spread the disease and it is the major route of spreading the disease. This is the rationale for having recommendations on air travel, on travelling to these areas. Which does not mean that the disease is under control or is not under control. We are currently making all efforts to have the disease under control and this is one of the measures that has to be taken, keeping in mind all other measures that are as important as recommendations on travel. I have in mind the exit screening, which is definitely a very important measure, and raising the awareness in the public of what the disease is about and reinforcing hygiene measures, in particular washing hands.

Coming back to your first question, I think I have already said what can be said on these points, being the magnitude, the local chain of transmission, and the notion of exported cases.

Associated Press: Thank you. Can you explain a bit about what the situation is in Beijing. I also missed the beginning of the call. Sorry if this is a repeat question. It seems like we have gone from about 40 cases to 600 cases in four days. Could you give us some insight as to what explains that and are we finished with these huge jumps? Is it going to settle down? Do we have the clear picture now?

Dr Nuttall: In Beijing, as in the rest of China, we have had WHO teams working with the national Chinese authorities to set up a good reporting system. It is not surprising to see an increase in the number of cases in the last days, in the sense that first it gives the idea that we have a good reporting system now in place. The data that we are going to see coming in the next days will tell us more about the level of the disease in terms of stability, the number of new cases. What we believe is very important is to have a good system of reporting all the cases so that appropriate measures can be taken. The same will happen, we hope, in the rest of China, where it is important that a proper reporting system be in place.

Associated Press: Can I follow that up?

Dr Nuttall: Yes.

Associated Press: So is part of the reason why we have gone from 40 to 693, I see today, is that because new reporting measures have caught more cases? Or how much of it is to do with coming clean on previously unreported cases? And how much is to do with a new reporting system that has brought in cases that were previously unrecognized?

Dr Nuttall: It is very difficult to say. We know that the reporting system has changed. We know that different reporting systems were in place before, in particular in military hospitals not reporting to the Ministry of Health, different reporting systems for schools and postal workers and all different types of reporting systems. Now we know that there is a good reporting system. It is very difficult to be able to assess the proportion of cases due to the new reporting system and the proportion that is due to real new numbers of cases.

Associated Press: Okay, thank you.

Operator: At the moment there are no further questions.

El Pais: Any idea …, or why is there different course of the epidemics? Because we have seen that in Hanoi it seems to be under control but not in Toronto apparently and they are working fine in Hong Kong. Do you have an explanation or idea how could this be? Thank you.

Dr Nuttall: As you know, when there …, I think the …, when the disease started it was localized in the French hospital in Hanoi and by chance it has been easier to contain the disease in Hanoi due to the specificity of the fact that the person was in the Hanoi hospital and it didn’t spread further from the Hanoi hospital. In Toronto, we know that when the global alert was issued, a case had already travelled back to Toronto, the person who was sick had had contact with the family and the disease had already started to spread. The latest we tackle a disease, the more difficult it becomes to contain the chain of transmission. So this is one of the reasons.

El Pais: OK, thank you.

Associated Press: Yes, I’m sorry, this is also due to me missing the beginning. Could you tell me who we are speaking with?

Dr Nuttall: I’m Dr Isabelle Nuttall. I’m Medical Officer in charge of international travel in the Communicable Diseases department of WHO.

Associated Press: And is that Neutal?

Dr Nuttall: N-u-t-t-a-l-l.

Associated Press: OK, and Isabelle with two “l”s and an “e”?

Dr Nuttall: Yes.

Associated Press: OK. Thank you very much, sorry about that.

Operator: At the moment there are no further questions.

Mr Thompson: OK, if there are no further questions, then we’ll end today’s press conference and we’ll be back tomorrow at 4 o’clock.

Operator: Excuse me, Dick, please hold, there was somebody called in again. Mrs Assaline? Please ask your question. No, she has gone away now. I’m sorry.

Mr Thompson: OK, thank you all and we’ll be on line again tomorrow at 4 o’clock. Thanks.

Dr Nuttall: Thank you, bye.