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US Reclassifies SARS
Cases, Number Drops

By Maggie Fox
Health and Science Correspondent
4-17-3


WASHINGTON (Reuters) - The United States changed the way it classifies patients with the deadly respiratory virus SARS on Thursday, and said the number of probable cases dropped to 35 from 208.
 
From the time Severe Acute Respiratory Syndrome reached U.S. shores in March the U.S. Centers for Disease Control and Prevention has used a broader definition than other countries in a bid to catch anyone who might spread the disease.
 
But CDC Director Dr. Julie Gerberding said this was confusing people. "I think we did cast a very wide net early on. We know that we have more people in the net than truly have SARS," she told a news briefing.
 
"We have a test available now and that is going to help us sort out the cases truly related to coronavirus," she said. "We do not want to exaggerate the scope of the problem here."
 
The World Health Organization reports more than 3,200 people have been infected with SARS and 159 have died.
 
But there are many more suspect cases and WHO says in China, where the epidemic started last November, there may be five times more cases than have been officially reported.
 
One stumbling block was uncertainty over the cause of SARS, so health officials have been forced to define the illness by its symptoms, which include fever, a dry cough and a certain pattern of pneumonia as seen in an X-ray.
 
The CDC said probable cases would now be defined as patients who had developed pneumonia, while suspect cases would have fever, cough and recent travel to affected parts of Asia or contact with a suspected SARS patient.
 
Now the SARS virus has been identified, tests are being issued to detect the virus in patients and speed diagnosis. The CDC has three such tests, which are being refined so they can be licensed by the U.S. Food and Drug Administration.
 
The virus is a coronavirus, related to one of the many different common cold viruses and also to viruses seen in birds and animals. The WHO named it SARS Virus on Wednesday.
 
MISSED CHANCE TO CONTROL SARS
 
WHO and U.S. officials have said China could have contained the epidemic if it had been more open from the beginning. The virus is believed to have emerged in southern China.
 
But it has spread to 22 countries, with most of the infections in China and its special territory of Hong Kong.
 
"It is important that we remain vigilant because we are watching with great concern the events in other parts of the world, particularly Hong Kong and China and Singapore where the transmission of the virus is at an accelerated pace in some communities," Gerberding said.
 
The United States will continue to monitor anyone who develops a fever and dry cough after travel to affected parts of Asia, or contact with a suspect SARS patient.
 
"We want to cast the widest possible net. We want to provide the best treatment and protection," Gerberding said.
 
She said the CDC handed out 500,000 cards to travelers from affected regions, advising them to contact a doctor if they develop a fever and cough. Even people who do not develop pneumonia are isolated and watched under CDC guidelines.
 
So far 19 people in the United States who were in contact with SARS patients developed respiratory infections -- five health workers caring for patients and 14 household members, including a child.
 
No one has died, in contrast to Hong Kong, where a single patient infected more than 100 others in one case and where 1,297 people have been infected and 65 have died.
 
"It may very well be that our isolation system is contributing to that but it also may be just luck ... that we haven't had people who are highly infectious," Gerberding said.
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