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CDC Telebriefing Transcript
SARS Update

March 29, 2003

MODERATOR: Thank you for standing by. Welcome to the SARS update conference call.

DR. GERBERDING: Thanks for joining us for another update on the Severe Acute Respiratory Syndrome or SARS. What I'm going to do today is just give you a brief recap of where we are in the epidemic and then I will talk about some new guidance that CDC will be issuing today to help prevent the spread of this infection here in the United States.

I'd like to first begin, though, with just a reflection on some sad news that CDC received this morning. Dr. Urbani, who is the WHO physician investigating the outbreak in Hanoi, died of SARS that he acquired during his investigation. He was a very close colleague of ours and someone that we had worked closely with in both Hanoi and Thailand through the past several years, and we are very sad and our condolences certainly go to his family and his colleagues as well as our colleagues in the area who've been working with him over the past few weeks on this investigation.

The global epidemic continues to expand. Today, WHO is reporting 1,491 cases and 54 deaths, plus the 62 cases that we are reporting here in the United States.

As you know, the U.S. cases are constantly undergoing revision and updating as additional information about the patients is determined, so that number may change over time.

We continue to regard the new coronavirus as the leading hypothesis for the etiology of this condition. The evidence is mounting from a number of international laboratories, that this is indeed the case; but we are also exploring other potential viruses as are our collaborators, and we will keep you posted as we go forward on that part of the scientific investigation. A number of things are in progress, including sequencing of the whole virus genome, and we'll have more information on that, potentially next week or the week thereafter.

We are at a situation in time where we recognize that the disease is still primarily limited to travelers, to health care personnel who have taken care of SARS patients, and to close contact with SARS patients.

The affected travelers are those who have been in Hong Kong, in Hanoi, in Singapore, and in mainland China, for the most part.

We believe, based on what the investigations have shown us so far, that the major mode of transmission still is through droplet spread when an infected person coughs or sneezes and droplets are spread to a nearby contact. But we are concerned about the possibility of airborne transmission across broader areas and also the possibility that objects that become contaminated in the environment could serve as modes of spread.

Coronaviruses can survive in the environment for up to two or three hours ,and so it's possible that a contaminated object could serve as a vehicle for transfer to someone else.

In health care settings, we have already initiated guidance to protect against droplets, airborne and contact spread of this virus, and today we're issuing an update on how to protect people in homes of SARS patients.

We know that the individual with SARS can be very infectious during the symptomatic phase of the illness. We don't know how long the period of contagion lasts once they recover from the illness and we don't know whether or not they can spread the virus before they have the full-blown form syndrome.

But most of the information that the epidemiologists have been able to put together suggests that the period of contagion may begin with the onset of the very earliest symptoms of a viral infection, so our guidance is based on this assumption.

If we learn more or we learn something different as we go forward and intensify our investigations, we will of course update or change our guidance.

SARS patients are either being cared for in the home, or who have been released from the hospital or health care settings, and are residing in the home, should limit their activities to the home. They should not go to work. They should not go to school. They should not frequent public places until at least ten days after they are fully asymptomatic.

In addition, if they're coughing or sneezing, they should use common sense precautions such as covering their mouth with a tissue, and ,if possible, and medically appropriate, they should wear a surgical mask to reduce the possibility of droplet transmission from them to others in the household.

In addition, and very importantly, they should use good hand hygiene, and that means washing your hands with soap and water, or using an alcohol-based hand rub frequently, and particularly after any contact with body fluids.

For the people who are living in the household with the SARS patients, and who are otherwise well, there is no reason to limit activities at this point in time. The experience in the United States has not demonstrated spread of SARS from household contacts into the community and so we are not advising any restrictions on the activity of contacts at this point in time.

However, it's very important that contacts with SARS patients be alert to the earliest symptom of a respiratory illness. That may be fatigue, headache or fever, and the beginnings of the usual upper respiratory tract infection, and if they have any symptoms suggestive of an impending illness, they should contact a medical provider, alert them that they are a SARS contact, so that the health care system can advise them where to come and get evaluation, and prepare the delivery system to implement the appropriate infection control precautions so that others are not exposed in the health care setting.

Contacts with SARS patients should also of course use hand hygiene and use the appropriate surgical mask to prevent contact with droplets, if the SARS patient in the home is unable to wear a mask.

We also are updating our guidance to travelers. I think that the travelers at risk for SARS are those who have been in mainland China, in Hong Kong, in Hanoi and in Singapore.

However, we recognize that there are passengers who moved through these areas for brief periods of times and are arriving here in this country indirectly, after being in those countries, so right now we are meeting both direct incoming flights from the affected areas as well as passengers who are arriving from different regions and have passed through those areas en route.

The alerting is being expanded to include arriving passengers from China, from mainland China, and from Singapore at this point in time.

In addition, the alert extends the period of passenger monitoring to ten days. Previously it had been seven days but we are aware of some patients that may have a longer incubation period, and to be on the safe side, we want to make sure that they seek medical attention if they develop any symptoms within ten days of departure from one of the SARS regions of the world.

These travel alerts do not include passengers coming in from Canada. The epidemiology of the SARS in Canada is very different and there is not a risk from incoming travelers at this point in time.

WHO is not issuing any travel restrictions. We are not issuing any travel restrictions either, but WHO has also implemented procedures for screening passengers before they leave the country of SARS origin. They're asking countries to evaluate departing passengers for respiratory illnesses or other signs that could represent SARS. In part, this is because there are some early reports that passengers traveling with a SARS patients on board could be at risk for acquiring this infection, and we don't want to have any cases acquired during flight or during transfer on a ship or other vehicle.

So the travel alerting process that's already been in place, and actually we've issued more than 150,000 alerts, is being expanded and will be involving 23 ports of entry into the United States.

So let me just stop here and take questions and I'll take a caller on the phone first. Can we have the first call.

I don't have a caller on the phone. I'll take someone from the audience.

MODERATOR: Ladies and gentlemen, if you wish to ask a question, please press one at this time.

Okay. Our first question comes from the line of Miriam Falco with CNN. Please go ahead.

QUESTION: Hi. Can you hear me?

DR. GERBERDING: Yes. We can hear you now.

QUESTION: Excellent. I don't know what that was. First of all, thanks, again, for having this.

The Canadian health authorities have issued quite a restrictive quarantine, now expanding to a second hospital.

Why are you not issuing any quarantine? Is it because you can't or because the situation is not so dire?

DR. GERBERDING: Well, first of all, we have been in constant communication with Canadian health authorities and they are not actually issuing a quarantine. They are issuing a voluntary self-isolation policy which is slightly different than a regulated quarantine.

The main reason we are not taking this step right now, in this country, is because the epidemiology of our problem is very different than the outbreak that Canada is experiencing in Toronto.

Although I reported 62 cases under investigation here, two of those cases are in health care workers and there have been no further signs of spread in that particular cluster. Five cases have been in household contact and the rest of the cases have all been in travelers coming in from SARS areas.

So we are not experiencing any sign of community transmission at this point in time, but we are alert to it, we are monitoring potential contacts very carefully, and if we see evidence that our infection control measures are not containing spread within communities, then we will have to reconsider whether additional steps are necessary.

I'll take another question from the floor here.

QUESTION: I notice that you list mainland China but now Taiwan. How significant is the risk in Taiwan?

DR. GERBERDING: Taiwan is a country that is reporting cases and they are included in the travel advisory for incoming passengers.

http://www.cdc.gov/od/oc/media/transcripts/t030329.htm

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Centers for Disease Control and Prevention
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