Outbreak of severe pneumonia

Health officials work to contain outbreak of severe pneumonia

A B.C. man who recently returned from Hong Kong is in critical condition in hospital

Gwendolyn Richards and David Reevely
Vancouver Sun; with files from Ottawa Citizen
Monday, March 17, 2003

Two Canadians have died and several others, including a B.C. man, are in critical condition suffering from a form of severe pneumonia that is baffling health officials around the world.

The B.C. man, who hasn't been identified, is on a respirator in intensive care at Vancouver General Hospital.

"The man returned from Hong Kong in the first week of March," said Clay Adams, a spokesman for the Vancouver Coastal Health Authority. "He came just after that to the hospital."

Health Canada officials admitted Sunday the Canadian outbreak of atypical pneumonia has raised serious concerns, and said they are working with the provinces and airports in hopes of quickly identifying and containing any new cases.

Dr. Theresa Tam, chief of respiratory infections for Health Canada's immunization and respiratory infections division, said the agency has begun dispatching staff to Toronto and Vancouver airports -- the two Canadian cities with incoming flights from Hong Kong and Asia, where the disease is believed to have originated.

"We have contacted both Pearson International and Vancouver International airports, and trained Health Canada staff are being sent to these airports to assist in the management of any infected passengers," she said.

Officials hope to spot potentially infected passengers so they can then quickly identify others who may have been exposed on the plane, and prevent it from spreading outside the airport. "This will continue until we know more about the situation," Tam said about the airport surveillance.

"We have also begun enhanced surveillance in collaboration with all the provinces and territories to look for cases and histories of travel," she added. "The idea is to identify these cases, and be able to isolate and treat them, and trace their contacts."

The affected B.C. man is in an isolation ward, which is "standard procedure for all pneumonia cases because of the patient's compromised immune system," the health authority's Adams said.

Anyone treating the man, as with anyone else suffering from pneumonia, has to wear a mask, gloves and a sterile gown.

The man's wife was also sick, Adams said, but her symptoms weren't close enough to the atypical pneumonia that struck her husband for doctors to be concerned, so she was treated and released.

The two Canadians who died of the illness were among several members of a Toronto family who recently returned from Hong Kong infected with the pneumonia. The doctor who treated the family is also thought to be infected. Another person is in isolation in a Toronto hospital, and feared to have the disease.

Dr. Danuta Skowronski, an epidemiologist with the B.C. Centre for Disease Control, said symptoms of the illness are far more severe than those associated with "regular" pneumonia. They include a high fever that comes on suddenly, followed by headaches, muscle aches and steadily worsening respiratory problems -- a dry cough that evolves into shortness of breath and eventually difficulty breathing at all.

"The latter symptoms have health officials most concerned," Skowronski said. "It's always been true that anybody with those symptoms should seek medical care, but it's now especially true for those returning from zones where this severe acute respiratory syndrome may be present."

For now, doctors can only try to diagnose the disease based on the symptoms -- there are no lab tests yet.

"We can't have lab confirmation because we don't know what the organism causing this is," Skowronski said. "Because we don't know what it is, don't know how it spreads... We're in the middle of detective work trying to crack the code of what it is and look at the available evidence to see how it might move in the population."

But she cautioned people not to panic.

"With billions of people in Asia living in fairly crowded conditions, if this was airborne, if this was easily transmitted, we would be seeing those outbreaks and we're not. That's very reassuring," Skowronski said.

She said the illness might be spread by droplets from infected people's respiratory systems, meaning that to be at serious risk of catching it, you'd have to have face-to-face contact with a sick person, likely within one metre.

Nevertheless, fear of illness is affecting people's plans to travel to east Asia.

George Ho, deputy editor of the Ming Pao Daily, said his mother is in hospital in Hong Kong with a separate respiratory condition. He'd been planning to fly there to be with her on March 21, but is now holding off on the flight.

"I am worrying about my mom's condition, hoping she won't be affected," he said. He's hoping scientists will be able to figure out what the disease is in the next week or 10 days, and from there work out a way to treat it.

"If my mom's condition goes downhill, I'll still go back no matter what," he said.

Through his work as a journalist, he said, he's also heard of flight attendants on runs to and from Asia who don't want to be cooped up in enclosed airplanes with hundreds of passengers for several hours.

The disease has sickened more than 400 people worldwide, and at least nine have died. In the past week alone, the World Health Organization has received reports of more than 150 new cases of the mysterious strain of pneumonia.

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