Emergencies preparedness, response

Severe Acute Respiratory Syndrome – Teleconference briefing of wire service recognition

23 April 2003

David Heymann, Executive Director, Communicable Diseases
Dick Thompson, Communications Officer, Communicable Diseases

DT. What we are doing today is announcing travel guidance. These are travel recommendations, which affect Beijing and Shanxi Province, and also Toronto, Canada. David, I will let you start.

DLH. Thank you for calling in. If you think back to when we put out the announcement about this new disease, one of our major concerns was that maybe we could stop this disease from becoming endemic. The jury is still out on that. We do not know whether by having put out the alert we can have the countries where the disease is imported stop it from becoming endemic there, and at the same time whether or not China and Hong Kong and other countries can stop the outbreaks there. So that is where we are.

Today, one of the most important means of spreading diseases around the globe is air travel. That is why we have been concentrating on that as a part of it. That is where I would put us today. We still do not know whether or not we can stop this disease from becoming endemic. We are working very hard so that that does not occur, because this is a disease which, as you remember, affects first health workers and is a very serious disease with a death rate now of about 5%.

Having said that, there are a series of issues that we have gone through. In the first alert we recommended that people who are travelling internationally understand what this disease looks like and that if they should get signs and symptoms of this and have had contact with a place where the disease is occcuring that they notify their health workers. The second thing we did was we went to countries where there were cases being exported, where there was a fairly high magnitude of cases and where we felt there was a great risk of local transmission. Those countries were Guangdong Province and Hong Kong; not countries but areas. And so we have made our second recommendation with the recommendation that people who have possibilities of postponing travel to these areas do so. So we made a voluntary postponement of travel to these areas.

Today, we are making a further recommendation in that we are going to recommend that people who have unnecessary travel to Shangxi, to Beijing, and to Toronto postpone that travel if possible because, as was the case for Hong Kong and Guangdong, we now have these areas which have a high magnitude of disease, a great risk of transmission locally outside of the usual health workers, but still traceable in most instances, and also there is exporting of cases. We know that cases have been exported to other countries and we have been following those would-be countries. So our recommendations therefore are that travel be postponed, that they continue their exit screening, and that we increase our advice and awareness to all international passengers.

That is briefly where we stand today. I turn it over to you now for questions.

Q. Can I just ask, frankly I am not great on the Chinese spellings. Is this the one that is Shanxi?

DLH. Yes.

Q. Could you give us the updated numbers on Beijing, Shanxi and Toronto.

DT. That will go up today at 17:00. We do not give numbers through the day because we are dealing with rolling deadlines.

Q. Sure, but your web site ...

DLH. You want yesterday's?

Q. Yes. Because it does not break out. It just gives the countries but not the regions, not the areas.

DLH. Okay, we will get those for you.

Q. Any recommendations for incoming screening or is that up to countries?

DLH. That is countries' decision. We have not made any recommendations on incoming screening, only on exit screening.

Q. And Guangdong and Hong Kong, that advice still stands? You are not retracting that and swapping it to ....

DLH. That is correct. And what we are doing is, as we said, daily we are looking to see if the situation changes in any one country as far as exportation or transmission risk. So any day we could make a recommendation that a country has the travel recommendations that we have made. However, the countries which we have put on the list now today will not be reassessed for a period of three weeks. That is because, at least as far as lifting recommendations go, we want to wait for two periods of maximum incubation, which would be 20 days. So we will let those countries go for three weeks now.

Q. Can you go back to Shanghai because I know the investigative team has been in Shanghai. Do you know the results of their ...

DLH. We are still looking in Shanghai and we do not have anything further on Shanghai yet. But do not mix up Shanghai with Shanxi.

Q. I understand it.

DLH. Our team in China has clearly indicated that they feel there are probably more cases in Shanghai than have been reported.

Q. And on Shanxi and Beijing, can you tell us what kind of pattern of exportation and how bad that has been to bring you to this decision. Do you know the exact number?

DLH. We follow those numbers, but this is information that countries are keeping between themselves. It is not good to point fingers internationally on who is travelling where. This is information which we keep very secret as our confidential information with countries.

Q. Okay, but they are definitely exporting, which is the one of the reasons why?

DLH. Absolutely. That is one of the criteria. Magnitude, transmission risk locally, and exportation risk.

Q. Has Toronto suddenly taken off? It seems to have been bubbling for a long time without this level of attention. What has happened that has changed?

DLH. Toronto has had last week an exportation which set up a cluster of 5 cases ... and I cannot tell you the country ... but this is what has called it again to our attention. An exportation which set up a cluster of 5 local cases in health workers. And when these things come to our attention, we then evaluate them. This was slowed down a bit because we were working to classify our clear criteria, which now I have given you.

Q. And the two governments have obviously been informed that you are going to make this travel recommendation?

DLH. Yes, they have been informed 24 hours in advance.

Q. Going back to China, have you had any more data coming in from these western, these rural provinces?

DLH. No, and again our team there is very concerned because (i) we do not have the manpower yet to go with the Chinese to those provinces; (ii) the health care in those provinces is of a lower standard than in the rest of China and therefore there is concern that if this gets into fertile health facilities it will continue to spread.

Q. Have you got any other locations kind of on your watchlist for an upgraded travel advisory or not?

DLH. We do. We have all these 22 countries on our list which are being looked at daily and we have one additional country which may have to be put on this list. I cannot tell you any of that until we have been able to clarify with the country some of the information we have. That is going on right now.

Q. Okay, so that might be imminent, in the next couple of days?

DLH. It may be in the next couple of days or on Monday at the latest, yes.

Q. Would that be Indonesia?

DLH. I would rather not say.

Q. Today we have had reports that a lot of people are actually just fleeing Beijing, where there have been rising cases, where schools have closed and so forth. Are you concerned that this will be a mechanism for them spreading it, if people go to the provinces ahead of this 1 May holiday, etc?

DLH. The Government has actually forbidden travel and they are doing their best to keep people from travelling. We know that. Whether these people are slipping through the net that has been put up we cannot say. But Henk would be able to say in China. Dick, have you heard from Henk today at all?

DT. Not today no. But they have postponed or cancelled their May holidays. We have yesterday's figures.

DT: In Beijing the cumulative total is 482, deaths 25, and there is local transmission. There have been 34 cases since the last update. We have a very good understanding and complete understanding of what’s going on in Beijing.

Q: But it’ll be a week or more before the true numbers come out?

DT: Yes, but they won’t be much different, there’ll be close to this, they’re just working through a new reporting system.

Q: When you say “since the latest update”, do you mean since … when, since Sunday or when would that be?

DT: Let me see, so April 21st to April 22nd.

Q: Monday? OK.

DT: And Shanxi had 120 cumulative cases, reported 7 deaths and it does have local transmission.

Q: Oh, yes, David, the Hong Kong thingy. As far as checking every day, obviously they’ve been under this travel margin for more than the WHO incubation period. What about criteria for taking them off? They seem to be optimistic that they’re making progress against the disease.

DLH: Yes, we are looking at the three-week limit for Hong Kong. And we don’t have that all analysed yet. The three week limit, if the figures have changed in any way, they would come off. The problem with Hong Kong is that they still have this non-clear means of transmission and they still have so many prevalent cases. It would make them hard to come off even if their exportation rates were minimal. But we’re looking to see what the exportation pattern has been from Hong Kong over the past three weeks and we’ll be able to provide that information. They’re up to the three weeks analysis, in other words. As is Guangdong.

Q: We’ve had a flash from Hong Kong – six more SARS deaths and 24 more cases on Wednesday.

DT: The numbers for Toronto are actually for the province of Ontario, 136 cases. We don’t have a death number here, but there is a local chain of transmission. I think you’ll have to get the death number off of Health Canada web site.

DLH: It’s actually the Toronto site I think, the Ontario site that gives the most up to date, isn’t it Dick?

DT: Yes.

Q: And can you tell us a little bit about this meeting that’s now scheduled for the 17th and 18th in June?

DLH: In June, yes. This meeting will be a meeting where we’ll be looking at what everyone has learned in the area of virology, in the area of epidemiology and in the area of clinical management. At the same time, countries which have had outbreaks will have an opportunity to discuss what their activities have been and we’ll be looking for lessons learned in this as well.

Q: Will this be the venue for the best science on SARS? You know the European microbiology and infectious diseases meeting is coming up in mid-May.

DLH: Yes, we anticipate that there will be satellite meetings at some international meetings and that’s perfectly healthy. What this will be is bringing everybody together for an up date, not only just looking at one aspect, such as virology or epidemiology, but the whole situation, clinical, epidemiology, laboratory. And in addition, control efforts in countries.

Q: Is it going to be an open meeting or not?

DT: Yes, it will be open to the press. We’ve arranged for the meeting to be open. In the main conference hall there’ll be seats for a pool of 20 reporters and then we’ll have a video conference link to another large media hall and there’ll be daily press briefings.

I’m thinking that perhaps we’ve exhausted all the travel-related questions and if that’s right, then we’ll let Dr Heymann resume with his activities in Thailand.

Q: What are you doing in Thailand, what are you up to out there?

DLH: Well, I’m helping them get ready for a meeting. They’re having a heads of state meeting next week of the ASEAN +4, +3 which includes China. And so we understand the head of state of China will come, and Singapore and various others. So it’s a meeting where they are coming, mainly to discuss what we are discussing today, the travel issues.

DT: OK? So, I want to thank you both for this. We appreciate the opportunity.

Yes, thanks, we appreciate too.

DT: Yeah.

Q: What about the four o’clock briefings?

DT: Yeah, Isabelle Nuttall from our travel and health section is doing a video-radio-telebriefing at four.

Q: OK, it’s not a …., I thought you were having …, every day you were going to have a press briefing?

DT: Yeah, but it’s gonna be this kind of virtual press briefing, allowing us to get to more people. It’ll be web cast, so it’ll be archived and we’ll have a transcript of that as well.

Q: OK. And who is on these, is David going to be on these every day?

DT: No. There’ll be a different person, we’ll cover different topics. It’ll be epidemiology, basic science, clinical management; yesterday, we had Henk Bekedam from Beijing in to talk, so it’ll be different aspects of SARS.

DLH: The reason we didn’t do a press conference today is because this now is actually becoming a routine type of announcement, we’ll have to possibly in a couple of days announce again. And it’s nothing extraordinary, it’s just public health at its best, in real action, trying to prevent the spread of the disease and contain it.

DT: OK, everybody, thank you. Bye bye.