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The Well-Behaved Epidemic

On May 28, the L.A. Times ran a two-paragraph brief on Page B4 about 14 suspected SARS cases in L.A. County.

The lack of a single confirmed case suggested that the county had been all but spared by the virus. Was it luck, or the good efforts of health officials that made the numbers so small? Or a little of both? Or, to put it another way, why isn’t L.A. another Toronto?

Severe Acute Respiratory Syndrome first appeared in China, and its spread overseas can be traced to Liu Jianlun, a physician who checked himself into Room 911 of the Metropole Hotel in Hong Kong on February 21. Fourteen hotel guests likely caught the virus from Jianlun and, as luck would have it, traveled to other countries besides the U.S. One was Sui-chi Kwan, a Toronto woman, who stayed on the ninth floor. She tested positive for the virus and died in Toronto after infecting her son, daughter-in-law and grandchild. Twenty-nine Angelenos stayed at the Beijing hotel but none on the ninth floor. The Centers for Disease Control and Prevention (CDC) has monitored the hotel guests but has yet to release its findings.

“We were just lucky,” said David Dassey, deputy medical director of the acute-communicable-disease-control program with the L.A. County Department of Health Services. “That Canadian woman could have just as well have been a Chicagoan or an Angeleno.” Dassey also says that L.A. had the advantage of gaining experience without suffering from the disease. “It was introduced to Toronto before they even realized what it was.”

In L.A., the first case of SARS was identified on March 17 in a man who had just returned from a trip to Asia. He passed on symptoms to his child. Fifteen others, including three reported in the past week, soon followed. All of them shared this in common: They had traveled to Hong Kong, mainland China or Singapore within 10 days of showing symptoms, which include fevers of more than 100 degrees, respiratory conditions and, in more severe cases, pneumonia. Twelve of 17 were males ranging in age from 2 to 78.

When they were first reported, 11 of the 17 were defined as suspected cases, which means they had light-grade fevers (of around 100.4 degrees), minor respiratory issues and had traveled to a country known to have SARS. Six cases were probable, which means that they have fevers as high as 104, severe respiratory issues and evidence of pneumonia. To prevent the spreading of the virus, patients were told to isolate themselves at home for 10 days. L.A. County officials monitored the patients with twice-daily phone calls.

 

Health officials have since reported that six of the 17 cases have tested negative for the human coronavirus, the deadly strain of respiratory virus known to cause SARS. The remaining cases are awaiting tests by the CDC. Both county officials and the CDC admit that the main tests, which can take up to three weeks, are not always accurate.

Three of the people who might have SARS are in the hospital. The others are on the honor system to remain homebound and out of public places.

Still, health officials in L.A. aren’t overly concerned. “There is no SARS in L.A., so we don’t think there is any risk of exposure. If so it would be in health-care facilities where cases are being housed, and our house-care workers know what to do,” said Dassey.

If you show signs of fever, respiratory problems and have been overseas in an area where SARS is prevalent, health officials say you should contact your doctor. Otherwise, take an aspirin and get plenty of bed rest.

“Sure, there is a remote possibility that someone coming from Des Moines who has the flu is carrying the SARS virus, but it is pretty unlikely,” said H. Cooke Sunoo, director of the Asian Pacific Islander Small Business Program and member of the L.A. County SARS task force. “You can’t put masks on everyone in the world. Given the empirical evidence we have in L.A. today, I think the level of precaution we have is appropriate to the amount of evidence we have seen.”

The two most recent cases came under the microscope on May 25, when crew members on Cathay Pacific Airways Flight 882 alerted CDC quarantine at LAX that a woman and her granddaughter had developed a fever en route from Hong Kong to Los Angeles. Upon arrival, the woman and her granddaughter were evaluated by CDC officials and taken to an area hospital where they were treated for SARS-like symptoms. Five days later Cathay Pacific sent out a press release stating that the passengers tested negative for SARS.

Last week the CDC made available the PCR test, a molecular test for the SARS virus’ genetic material. This test along with the ELISA test, which detects antibodies, are the two main tests used to detect the coronavirus. The World Health Organization says both tests have limitations. For example, the ELISA test is reliable from about day 20 after the onset of clinical symptoms, which means that it cannot be used in the early stages. The PCR test produces many false negatives.

As of right now, L.A. County officials say that there are no coronavirus cases here. As a precaution, guidelines have been posted at hospitals and airports setting forth CDC protocols for dealing with any outbreaks.

“If it happens, it won’t be the end of the world,” said Dr. Laurene Mascola, chief of acute-communicable-disease-control program for the county health department. “It is no more dangerous than other things that happen in L.A. or the world. We might be overcautious by making people stay home for 10 days.”

Around the country, there are 298 suspected cases and 67 probable cases of SARS. Only seven, including two in California, have tested positive for the coronavirus. Worldwide, SARS has killed more than 754 people.

For now, L.A. is no Toronto. But is it luck, or because we’re good?