SARS Travel Advisory Is Expanded; WHO Cautions Against Visiting Beijing, Toronto

The Washington Post April 24, 2003 | Rob Stein The World Health Organization yesterday warned travelers to avoid China’s capital city of Beijing and Canada’s most important metropolis, Toronto, saying the drastic step is needed to halt the spread of the dangerous new lung infection, SARS.

The warning, the latest indication of rising alarm about the disease, significantly expanded the U.N. agency’s SARS travel alert and marked the first time in its 55-year history WHO has told the public to avoid the Chinese capital or any locale in North America. WHO also added the Chinese province of Shanxi to its list of places to avoid.

“We’re doing this to try to stop this disease from becoming endemic,” said David L. Heymann, executive director of WHO’s communicable diseases program. “We want to stop cases from spreading around the world.” The decision was denounced by officials in Toronto, which has suffered a sharp drop in tourism because of a large SARS outbreak, and was received as another blow in Beijing, where thousands of people yesterday rushed train stations in a frantic attempt to flee the city even before the announcement.

WHO previously warned travelers to avoid unnecessary visits to Hong Kong and the southern Chinese province of Guangdong, marking the first time the agency had advised people to stay away from any places because of a disease. in our site maryland general hospital

WHO officials said the expanded advisory was necessary because the SARS virus was continuing to spread — and was spreading more widely than had been thought — in those areas, and because cases were being exported to other countries. WHO will review the advisory in three weeks.

“There’s evidence of transmission outside the very close community — for example, outside the hospital workers and their family — and there’s evidence of exportation outside the area,” said Denis Aitken, a top WHO official.

WHO officials reported that someone who caught SARS in Canada sparked an outbreak involving at least five hospital workers in another country, which they would not name. But officials elsewhere said a person infected in Toronto had carried the infection to the Philippines.

“This is a reflection of our need to control the disease. If we can keep the pressure on well enough, it may be able to hold the line,” Aitken said.

WHO has been extremely hesitant to issue such advisories because of their potentially devastating economic impact. Tourism has plummeted in Beijing and Toronto as sightseers, students and others postponed trips, and businesses, political organizations and professional groups canceled conferences.

The decision immediately drew strong reactions in Toronto, which is Canada’s financial center. Metropolitan Toronto has a population of almost 5 million.

“I’m shocked,” said Toronto Mayor Mel Lastman at a news conference, his voice trembling in anger. “The medical evidence before us does not support this advisory. . . . It’s safe to visit this city.” Donald Low, an infectious disease expert at Mount Sinai Hospital in Toronto, also disputed the decision. “I don’t understand the rationale. The impact on Toronto is going to be incredible,” he said.

At least 200 SARS cases and 14 deaths have been reported in Toronto, making it the worst SARS hot spot outside Asia. The disease was spread there by an elderly woman who had vacationed in Hong Kong in late February.

The Toronto outbreak had seemed under control until new cases surfaced in the past week among health workers and a cluster broke out among local members of a Philippine-based Roman Catholic group known as Bukas-Loob Sa Dyos (BLD). Low said that outbreak had been contained and aggressive measures had been instituted to protect health workers.

WHO’s announcement came a day after the federal Centers for Disease Control and Prevention in Atlanta announced plans to begin warning everyone traveling by land or air from Toronto to the United States to watch for SARS symptoms. Federal health officials had already taken such measures for travelers on airplanes, boats and cargo ships arriving from Asia.

Pennsylvania and U.S. health officials are monitoring two dozen people in that state who had contact with a man who is believed to have caught SARS at a BLD conference in Toronto.

A 40-year-old doctor from Baltimore, meanwhile, was isolated at Johns Hopkins Hospital yesterday when he developed symptoms of SARS after visiting Toronto, Maryland health officials announced. The news came one day after health officials said that a Hong Kong woman visiting Baltimore had developed some SARS symptoms and was being monitored at Maryland General Hospital. An Anne Arundel woman is also being isolated, officials said.

SARS, which stands for severe acute respiratory syndrome, is caused by a previously unknown virus related to germs that cause the common cold. It first surfaced in the southern Chinese province of Guangdong in November, and air travelers began spreading it around the world in early March.

Senate Majority Leader Bill Frist (R-Tenn.), who recently returned after leading a congressional delegation to China and three other Asian nations, yesterday predicted more cases will show up in the United States, and that the threat of other emerging diseases will continue to grow. go to website maryland general hospital

“With a virus like this, which knows no borders, has no geographic boundaries, the world is at risk, including Americans,” he said.

The SARS virus spreads most commonly in large droplets spewed out when an infected person coughs or sneezes. But there is evidence that it may spread in other, yet unexplained ways and may be able to survive on objects for as long as 24 hours.

Early symptoms resemble the flu — high fever, dry cough, shortness of breath. There is no treatment. Most people recover after about 10 days, but some grow seriously ill.

About 6 percent of patients are estimated to die, but the death rate varies widely from city to city and could easily rise or fall sharply as scientists learn more about the disease and can make more definitive diagnoses.

The number of suspected cases worldwide yesterday rose to at least 4,288 in 26 nations. At least 251 people have died. U.S. health officials are monitoring 239 suspected cases in 36 states, including six in Virginia, although only 37 are considered probable cases.

Until Saturday, China’s government said that there were only 37 cases of severe acute respiratory syndrome in the capital. But after weeks of international pressure to be more forthcoming, the government on Saturday increased the number of reported cases tenfold.

Beijing, a city of at least 10 million, has reported nearly 700 SARS cases and 35 deaths. Shanxi, a province southwest of Beijing, has reported 157 cases and seven deaths, the third-highest number of cases after Beijing and Hong Kong.

Hong Kong has been hit hardest, with at least 1,458 cases and 24 deaths. Another 24 cases were reported yesterday, but officials were optimistic that the outbreak might be slowing down in that city.

Correspondents John Pomfret in Beijing and DeNeen Brown in Toronto, and staff writer Ceci Connolly in Washington contributed to this report.

Rob Stein