11 April 2003
CDC Heightens Efforts to Contain SARS Spread
(Agency cautions against stigmatization of patients) (7620)
The U.S. Centers for Disease Control and Prevention (CDC) is
heightening its efforts to contain the possible spread of the
respiratory disease called severe acute respiratory syndrome (SARS).
The action comes as U.S. health officials weigh whether to revise
earlier findings that the disease was spreading in the United States
only through individuals who apparently contracted the disease on
recent travel to Asia and then transmitted the virus to family members
or health care workers through close personal contact.
CDC Director Julie Gerberding said in a briefing April 10 that the
agency is working with state and local health officials to develop a
more intent monitoring system to observe individuals who've had some
contact with a SARS patient. "So that we will know not only passively
if a contact develops any illness, but we will proactively be
monitoring them or asking them to participate in a monitoring program
where their symptoms can be recognized at the earliest possible
moment, so that they have very little chance of spreading this
infection to anyone else," she said.
The pattern of transmission has puzzled international researchers who
have been tracking the disease since its emergence in March. The World
Health Organization is reporting 2,890 cases as of April 11, occurring
in 19 countries. The disease has developed a pattern of local
transmission in four of those countries -- Canada, China, Singapore
and Viet Nam. Cases in the rest of the countries are transmitted only
through close contact, as U.S. health officials have observed in the
166 cases of suspected SARS in this country.
Now, U.S. officials are looking at cases where SARS may have spread in
office and classroom settings, and Gerberding said the pattern seen in
other nations indicates that rapid transmission through communities is
possible. "Whether that is because there are modes of transmission,
such as the airborne route, that we haven't identified or documented
well yet or because some people are particularly efficient
transmitters, we need to be prepared here for the possibility that we
will have spread outside of the close family or the health care
workers."
Briefing from CDC headquarters in Atlanta, Georgia, Gerberding also
cautioned against the stigmatization that is emerging in some Asian
communities because of SARS.
"It is not a disease that is in any way related to being Asian or to
the fact that Asia happened to be the place where we first recognized
cases," Gerberding said.
Following is a transcript of the CDC briefing:
(begin transcript)
U.S. Centers for Disease Control and Prevention
CDC Telebriefing Transcript
Update on Severe Acute Respiratory Syndrome (SARS)
April 10, 2003
DR. JULIE GERBERDING, CDC DIRECTOR: I'm going to continue with our
regular updates on the SARS situation. There are folks who are calling
in on the phone so we'll rotate back and forth from the reporters who
are here in the room and the reporters who are on the phone.
For my opening remarks, I'm going to focus on basically the update on
what's happening internationally and domestically as well as the
articles that were published today on the Internet version of the New
England Journal of Medicine that described the virology, progress that
we've made so far.
As of today, the WHO is reporting 2,627 cases of SARS, plus we have
166 cases in the United States from 30 states, that are under
investigation.
Domestically, we have 60 cases that have been hospitalized, ever. We
have four individuals who are currently hospitalized. We have a total
of 33 out of the 166 people who have ever had pneumonia, and we've had
one person who's required ventilation, and to date, no deaths
associated with SARS in the United States.
We have been working really hard to try to keep you up to date on the
information as it emerges and I just want to take a minute to, first
of all, appreciate the interest that the media has had in this issue
but also to acknowledge some of the response that CDC has been making.
We have received over 13,000 inquiries about SARS from around the
country on our hotline. We have conducted an international satellite
video conference for clinicians, globally, that included CDC experts,
WHO experts, as well as clinicians from Asia, and that video
conference has been accessed by more than 40,000 clinicians,
internationally, to help get the word out about SARS.
We've also received numerous consultations from clinicians,
domestically, on our clinician hotline and continue to monitor the
very high number of Web hits that we're getting on our Internet.
So we are still working hard to try to get this information out and,
again, I just appreciate that the interest that the media has shown
and the assistance that you're giving us in getting the story out
straight.
There are some very specific issues that are of concern to CDC right
now. One is that we are hearing reports, internationally, about some
stigmatization that's occurring among people in the Asian community.
It's very important that people appreciate that this is a respiratory
illness caused by a virus, probably a new virus, and is a disease that
is an infection of great medical consequence but it is not a disease
that is in any way related to being Asian or to the fact that Asia
happened to be the place where we first recognized cases.
So we want to ask people's support and help in appreciating how
difficult this is for the affected people and how we really need to
take the high road here and recognize that this is a time when all of
our communities need support and empathy, not stigma or bias or
shunning that has been reported in some international press.
In part to address that, CDC has established a community outreach team
and we are working with various communities, in particular the Asian
community, to understand what are the issues, what are the best ways
of providing information to the community and languages, and formats
that are accessible to the individuals who are concerned or affected
by this problem, and we will be continuing to work aggressively to
provide factual information and hopefully reduce some of the stigma
that could evolve.
We are very concerned today about reports of suspected SARS cases that
may be related to community transmission in Florida. The Florida
health department as well as the local health departments in the
involved communities have been doing an excellent job of assessing
these situations.
One situation, in particular, involved a person who traveled to Asia
and developed an illness consistent with SARS. In the very early
phases of that illness, the individual did go to work, and during the
active monitoring of contacts that the Florida health department is
conducting, an individual in the workplace who has respiratory illness
was identified. So that worker is now on the list of suspected SARS
patients but it's far too early to indicate whether any of these
individuals actually has SARS.
There's certainly no indication of spread beyond that point and the
health department is aggressively taking the appropriate steps to make
sure that they have communicated with all of the exposed people or
potentially exposed people, and are doing the right things to contain
any addition spread, should this indeed turn out to be SARS. But it's
far too early to say that at the moment.
We are also taking steps today to enhance the guidance for contacts of
SARS patients. So later today you will see posted specific information
for schools and for workplaces to ensure that should an individual
with SARS inadvertently go to the school or go to a workplace, that we
have the appropriate steps in place to manage those events, and we
will be working with state health officers today, and consulting with
them on our regular conference calls, to get input about how to
implement a more active monitoring system for contacts of SARS
patients, so that we will know not only passively, if a contact
develops any illness, but we will proactively be monitoring them or
asking them to participate in a monitoring program where their
symptoms can be recognized at the earliest possible moment, so that
they have very little chance of spreading this infection to anyone
else.
In the New England Journal today, the CDC group as well as other
laboratory groups are reporting on the advances made in the
coronavirus assessment and the virology of case patients.
I want to emphasize that this is still an evolving story and while we
are increasingly confident that we are dealing with a new coronavirus,
we cannot yet say that this is the definitive cause of SARS.
We had a consultation with experts in virology and in clinical
medicine to determine what would it take to say yes, this coronavirus
is indeed the cause of SARS, and there are two additional steps that
must be fulfilled before we could make that claim.
First of all, we need to unequivocally demonstrate the coronavirus in
the affected tissue, i.e., in the lung of patients with the disease,
in areas where we would also see inflammation or pneumonia. We've seen
the virus in tissue and we've seen evidence of pneumonia but we need
to see them both together in the same specimen to really show that the
virus is geographically associated with infection.
The second important aspect to prove definitive relationship is that
we must have an animal model where we inoculate the coronavirus into
an animal, the animal gets sick and develops pneumonia, and then we
isolate coronavirus from the affected tissue in that animal model.
CDC has provided our strength of coronavirus to investigators in The
Netherlands. They are actively pursuing this animal model and we
await, with great interest, their results, to see whether or not this
will be a successful introduction and really proof of causality.
When we have that information we of course will be making it available
to you.
I think that will be the last formal remark I'll make at this time,
but I will open this up to questions and I'd like to start with a
question from the telephone, please.
MODERATOR: Ladies and gentlemen, if you do wish to ask a question,
please press the one on your touchtone phone.
DR. GERBERDING: Okay. Then we'll just go ahead and take a question
from the reporters here. You need the microphone.
QUESTION: I read that the World Health Organization is concerned about
the possibility of transmitting SARS through the blood supply.
What can you say about the level of concern of that, and of course the
search to develop a test, if it can be transmitted that way?
DR. GERBERDING: Thank you. We have no evidence, at the moment, that
this is in any way a blood-borne infection, but any time there's a new
viral infection or patients are as sick as these patients, I would
have to be concerned about at least a temporary period of time where
the virus could be in the blood.
So CDC is working with FDA and the blood banking industry to develop
some sensible guidance about deferring donation among people who have
traveled to affected areas and could be in an incubation period, and I
anticipate that those guidances will be out very soon.
Now, can I have a question from the phone, please?
MODERATOR: Yes. We have a question from the line of Laurie Garrett
with Newsday. Please go ahead.
QUESTION: Yes, good afternoon. Quick question. In terms of looking for
an animal model, are any of the labs that are going to be working on
that, the Amsterdam lab or anyplace else, likely to have and be able
to run experiments on Asian species of pigs, and in particular unusual
pigs, like the Vietnamese miniature pig and the Chinese guinea pig,
and so on?
DR. GERBERDING: Thank you, Laurie. I think right now the focus is on
simply fulfilling any animal model criteria for infection. But I think
what you are really getting to is the question of where did the virus
come from and is this a virus that could have jumped species, so being
able to establish infection in an animal model might be a clue to
that. I think we're more likely to get at that answer by looking at
the virus sequences as the genome emerges, and also identifying
animals in Guangdong Province or in other areas where the earliest
cases occurred so that we can see if we can locate related Corona
virus in any animals species in the region.
Question over here?
QUESTION: Hi, Dr. Gerberding. Thanks for doing this. I have two
questions, one relating to Florida. I'm glad you were able to
elaborate a little bit more on this co-worker incident, because the
Florida Health Department yesterday threw that out and said that's yet
another definition of close contact but there was not information.
But given that somebody in the workplace did get sick and that the
child in Florida also was in school while he was having slight
symptoms--he had a slight cough--doesn't that raise the concern that
people are being exposed and don't know it, and what are the guidances
going to be that you're putting on the website later today?
And then the other question I have is, you have an updated case
definition on the website talking about airport transit as the
criteria for being a possible suspected SARS case. Could you elaborate
what that means, too?
DR. GERBERDING: Let me speak to the first issue about the definition
of community exposure or community transmission. We know, and have
known since we first heard about this problem, that most of the
individuals involved in acquiring disease from contacts are either
health care workers or close family members. And that has certainly
been the pattern in the United States, where up until these Florida
cases emerged we had seen three cases in health care workers and five
cases in close household contacts.
We are most concerned from a public health perspective about spread
unlinked to known cases of SARS. And when we see an unexplained case
popping up in a school or an unexplained case of SARS popping up in a
workplace, that's when we become concerned that our containment
efforts have failed and that we are not able to contain this from a
public health perspective. We are not seeing that in Florida or
anywhere else in the United States at this time. The cases that are
under investigation area all linked to a traveler and are within the
confines of what we would consider to be related transmission
outbreaks.
So first of all, we have no proof that any of these patients have SARS
at this point. They haven't been tested and there's a lot of work that
needs to be done. If you read the articles in the New England Journal,
I think you would appreciate that increasingly it looks like we've
done exactly what we wanted to do. We've cast a very broad net around
the SARS patients and we're including on our suspected list many
patients who don't seem to have evidence of SARS. So as we go forward,
we will have a more specific definition that will probably make some
of this investigation a lot faster and relieve a lot of anxiety in the
community right now.
Nevertheless, look at the globe. We see that it is possible for this
virus very quickly to spread under certain circumstances, and whether
that is because there are modes of transmission, such as the airborne
route, that we haven't identified or documented well yet or because
some people are particularly efficient transmitters, we need to be
prepared here for the possibility that we will have spread outside of
the close family or the health care workers. And that's why we are
taking steps today to enhance our monitoring of contacts and to be
more inclusive of who is in the contact compartment and to be more
proactive about, rather than asking the individual people to contact
their clinician if they develop any kind of an illness, that we are
going to work with our health departments so that we contact the
contacts and check in with them at periodic intervals to identify
their health status.
I think this is for us right now in this country a very sensible way
for being more aggressive about containment and still keeping in mind
the epidemiology as it's unfolding here.
QUESTION: What does airport transit mean? When you list it on the
website, what are you talking about? If I'm in the airport with a
planeload of passengers returning from the area, am I an airport
transit?
DR. GERBERDING: We have concerns that in areas of the world where this
disease is being transmitted in the community, that any exposure in a
congregant environment could potentially pose a health hazard. And if
you are a passenger traveling from an unaffected part of the world,
but you go through an airport in a country like, say, Hong Kong, where
disease is being transmitted, it's possible that you would come in
contact with someone who is infectious. And so we are considering that
as a potential exposure as well learn more about how this disease is
being spread.
May I take a question from the telephone, please?
MODERATOR: Yes, we have a question from the line of Jeremy Manier with
the Chicago Tribune. Please go ahead.
QUESTION: Thanks very much for doing this. Another question about the
sequencing which you alluded to a minute ago. How far along is that? I
guess it's fairly far along, if not largely done by now. How soon will
that be made public to researchers? And also, have other Corona
viruses been sequenced entirely so you can compare this to them to
see, you know, what it's most closely related to and where it might
have come from?
DR. GERBERDING: Thank you. In the New England Journal today there
are--the publications include the molecular assessment of the group of
viruses that this Corona virus belongs to, compared to the known
groups of Corona virus. This sequencing is based just on a component
of the polymerase gene. Obviously, we want the whole genome sequence.
The laboratories at CDC as well as other laboratories within the
collaborating network are very far along on this. We at CDC has made
the philosophic decision that when we have the genome and we've
validated that we have it right, we're going to make it available in
the public domain so that other scientists can use it.
We recognize that there is always controversy about publicizing
genetic sequences, and we will of course confer with others to make
sure that this is an appropriate step. But our initial philosophy is
that the more open and transparent we make the science here, the
faster we'll be able to get to a solution.
Yes, over here?
QUESTION: I wanted to go back to Diana's question, if we could, on the
blood supply. Is there any way to trace back people who donated blood
to see if they had traveled to Asia, and are you recommending to the
Red Cross, if that's possible, that they pull that blood off the
shelves? And how far back would you go on that?
DR. GERBERDING: I think we need to step back away from this issue and
recognize that what we're doing right now is an extra precaution. They
have absolutely no evidence in Asia or anywhere that the blood supply
has been a source of transmission of Corona virus, and in general that
is probably unlikely, although we want to be absolutely sure. We have
seen this happen, for example, with West Nile, where we did find
evidence that the blood could be a vector under certain circumstances.
So we are not initiating look-back investigations at this point in
time. There is no indication clinically or epidemiologically that
that's appropriate or necessary. But again, we have an open mind and
we will take the necessary steps if the evidence leads us in that
direction.
I'll take a telephone question, please.
MODERATOR: Yes, we have a question from the line of Stephen Smith with
the Boston Globe. Please go ahead.
QUESTION: Hi, Dr. Gerberding. Good afternoon. I was hoping that you
might elaborate a bit further on the issue of community transmission
and discuss what you think some of the differences are that have
resulted in limited community transmission, or no--as you're defining
it--community transmission in the United States; whereas in other
settings there has been community transmission experienced. Is it a
matter of, essentially, bulk of cases, that there has not been a
sufficient number of cases in the United States to result in that sort
of transmission? Do you think it has something to do with the
variability of the virus? What is your thinking at this point?
DR. GERBERDING: What I'm going to do is speculate, because we don't
know the explanation. And one explanation may just simply be we're
having very good luck here. But we do have the advantage of
recognizing SARS later than many of the other countries where cases
first appeared until our public health system and our clinician
system, or medical system, have been able to very quickly implement
appropriate isolation precautions when we do have suspect cases. I
think that's a sign that our public health system is doing what it
should be doing; that is, detecting and isolating in very short order.
It's also possible that we've been lucky in the sense that we haven't
had here any of the patients who are especially infectious. Again,
this is just hypothesis, but there does seem to be a suggestion,
looking at the Asian experience and perhaps the Canadian experience,
that some patients are particularly efficient at transmitting this
virus, for whatever reason, and we haven't had patients in that
category here.
And finally, as I emphasize over and over again, we have cast a very
broad net here in trying to identify anybody who could possibly have
this illness so that we are over-isolating, over-diagnosing, and
probably overdoing the whole effort to achieve containment because we
would rather make sure that we have everybody who could possibly be a
SARS patient in isolation. And as we get more experience with the
diagnostic tests or the antibody tests that we have available to us, I
think we'll narrow our case list and then we'll have a much better
evidence base for understanding the true tendency for transmission and
the true numerator and denominator of the frequency that this is
occurring.
I should also mention concerns about the potential for transmission
without symptoms. This does not appear to be a major component of
spread so far, but now that we have these diagnostic tests or these
potential tools for epidemiologic purposes, we'll be able to check and
see if people are carrying the virus in the absence of having any
symptoms. And that may also help shed some light on how this is being
spread.
May I take a question from a reporter here?
QUESTION: [Off-microphone, inaudible.]
DR. GERBERDING: Thank you. The sequence is certainly an important
aspect of developing a vaccine if we're going to make a molecularly
based vaccine. But the fastest way to get from where we are now to a
first-generation vaccine is to do the old-fashioned methodology, which
is basically growing the virus in a certified cell line, killing it,
and then inoculating an animal to see if it offers protection against
exposure.
In the best-case scenario, if everything goes well and we have a good
system for growing the virus and we have a good animal model for
demonstrating that it works, we're still at least a year out from any
kind of investigational vaccine.
In terms of antiviral treatment, we're continuing the process in
conjunction with our collaborators in the Department of Defense at the
U.S. Army Disease Research Institute, and we are disappointed that the
early results suggest that Ribavirin is not active in the screening
system that they're using. That was reported in today's MMWR. But
there are other compounds under evaluation there. And pharmaceutical
companies, through the work of Secretary Thompson and the FDA, have
certainly agreed to make anything they have on the shelf or anything
in the pipeline available for screening in these systems. So if
there's something out there that has antiviral activity, I anticipate
we'll be able to find it, and that could lead to a treatment. But it's
a ways off, and I don't think we should hang our hat that that's going
to be the way we contain the problem, at least in the stage we're in
right now.
QUESTION: [Off-microphone] But right now, [inaudible].
DR. GERBERDING: Right now, for individual
patients the treatment remains symptomatic, and in addition, sometimes
broader spectrum antimicrobial therapy in case they have a completely
unrelated illness and could benefit from antibiotics or anti-virals
for an alternative diagnosis.
A telephone question, please.
MODERATOR: Thank you. You have a question from the line of Larry
Altman with New York Times. Please go ahead.
QUESTION: Yes. Two questions, Dr. Gerberding. First, could you clarify
the distinction between your definition of community and the World
Health Organization's definition of community because the World Health
Organization says their definition is anything other than an imported
case is a community case, and the second question is can you highlight
the specifics of what is new in your guidelines from today.
QUESTION: Thank you. Yeah, I think there's a lot of definitional
issues that are causing confusion. It's probably better not to rely on
these jargon terms and instead talk about what exactly it is that
we're trying to accomplish and where we need to focus our attention.
We have defined a linked case of transmission as a person who is a
traveler from an involved area, who is a SARS case, and then either
close household contact, or a health care worker who's taking care of
that individual, as being tightly linked to the case.
When you move outside of that immediate environment and you see
transmission outside of the home or outside of the health care
setting, where we get concerned about transmission in the community
and there, additional public health measures may be required, and so
that is where we are focusing our new guidance.
What we will be recommending is dependent, in part, on the input that
we receive from our state health officers this afternoon.
I was pleased, when I spoke with Dr. Awanabi [ph] from Florida, health
officer for the State of Florida, that they are already utilizing some
proactive monitoring of contacts in that state. So it looks like this
approach may be feasible and as soon as we understand what our health
officers are doing and what seems to be working, we will try to
formalize that and put the best practice out as a means of enhancing
our assessment and early detection of potential symptomatic people.
I'll take a question over here.
QUESTION: Thank you. Doctor, a first question about how the CDC is
handling the numerous calls that it's getting, I understand 1500 a day
or something like that, how are you dealing with that kind of
overload?, and also we've also had a report here that at least one of
the cases here in Atlanta, metro Atlanta, was in fact not a SARS case.
We just got that from the state health department.
Your concern about having, since the symptoms are so common, your
concern about having so many false cases that may arise out of this?
DR. GERBERDING: Well, first, let me say that a false case is a good
thing from our standpoint, cause we would rather err on the side of
overinclusion than underinclusion, and this has happened several times
in the last few weeks and we fully expect this to continue as we use
this broad case definition.
With respect to how we are handling the communication challenges that
we bring, Dr. Vicki Freimuth is here today, and largely her emergency
communications system has been activated. This is a communications
system that we established in response to the lessons we learned in
the anthrax attacks and is a organized, cross-discipline communication
plan here, at CDC, that allows us to have teams of people who are
approaching the needs of individual target audiences.
So we have a group of people who are focusing on the communication
needs of clinicians, a group who are focusing on the Internet, a group
who are focusing on health officers, and so forth, trying to
anticipate and learn from our constituents what their true
communication needs are. So there's a lot of outreach going on.
With respect to how we are handling the volume of public inquires, we
have established a contract with an organization that is available to
provide this kind of information to the public on a not quite
24-hour-a-day basis, but over a long period of time each day, and we
constantly provide them with the latest information in a format that
allows it to be easily transmitted to the public.
But, in addition, we learn from them. We pay attention to the calls
that we are receiving, so that we can identify what are the
communication gaps between what we've got out there and what people
are asking about, and we work really hard to fill them.
I'll take a question from the telephone, please.
MODERATOR: Yes. We have a question from the line of Jennifer Warner
with WebMD. Please go ahead.
QUESTION: Yes. Dr. Gerberding, looking at the New England Journal
articles, could you address some of the mention in there of the
presence of the coronavirus in the stool of the patients during
convalescence, and the possibility that that virus might be
transmitted during that route, and there was also some talk about,
related to roaches in the apartment complex in Hong Kong, and tell us
what that might mean about how the virus is being spread.
DR. GERBERDING: Well, first of all, the epidemiologic evidence, to
date, still continues to support the hypothesis that the primary means
of transmitting this virus is face to face contact.
Finding PCR evidence of virus in the stool may mean that the virus is
in the stool, or it could also mean that the genetic material from the
virus is present there. That's two very different possibilities.
The coronavirus family, in animals, often does cause a diarrheal
illness, and so it's not impossible that the virus is in fact directly
affecting the intestinal tract, and some of our early clinical reports
did describe diarrhea or gastrointestinal symptoms. But I think that
we have a lot of work to do before we can interpret the presence in
stool, and we have no direct or indirect evidence, at this point, that
the fecal, oral route, or any other relationship with fecal material,
either through cockroaches or sanitary conditions is playing a role in
transmission.
That is something that is being investigated in Hong Kong and we look
forward to learning more about where this hypothesis was generated.
I'll take a question here in the front.
QUESTION: Can you talk about the significance of the virus being
active in the viro cells and also if this virus came from animals or
from a recombination of human viruses? Do we know whether it might
mutate more?
DR. GERBERDING: Thank you. When we have an unknown situation like an
unknown illness, and we're looking for a virus, the scientists
inoculate a large number of different kinds of cell lines to try to
see if it will grow in anything. In this case the virus did not grow
in the things that typically show virus growth but it did grow in this
particular viro cell line, which is a cell line derived from monkey
cells.
What's interesting about the viro cell line is that it does not have
interferon. Interferon is a compound that often inhibits virus growth
as part of the natural immune system against viruses, and so that
suggests that maybe cells that lack interferon are permissive to the
growth of coronavirus, and for whatever reason, we are lucky that the
virus did grow in that cell line and that certainly gives us a
headstart on being able to produce it in larger quantities for the
research and the vaccine development work that will need to go on in
the future.
With respect to your second question about either recombination of
human viruses or cross-species transformation of the virus, this is a
single-stranded RNA virus, so it's wobbly, and by that I mean when it
reproduces, it's not necessarily a 100 percent capable of creating an
exact clone.
There are very high likelihoods of small genetic changes each time a
virus like this divides, and so we would be surprised if we didn't see
ongoing evolution in this family of viruses, over time.
Of course of all the different genetic variants that can be created,
many may not be virulent, many may not be efficiently transmitted, so
it's just impossible to predict what the future may hold. But it is
something that obviously will be important to monitor, over time, as
this moves throughout the population and particularly as we move
toward vaccine development or antiviral treatment.
I'll take a question from the phone, please.
MODERATOR: Yes. We have a question from the line of Jennifer Culman
[ph] with KYW TV. Please go ahead.
QUESTION: Hi. Yes; thank you. You had talked, a couple days ago, about
diagnostic tests may be getting out to the state level. What's the
status of that? Are you moving any closer to that?
DR. GERBERDING: It's very important to distinguish between tests that
are licensed diagnostic tests and tests that CDC creates in a public
health emergency for epidemiologic purposes or to enhance our
understanding of an emerging health problem.
Right now, we have three tests that show a high degree of promise for
this particular outbreak and it's possible that any one, or all of
these tests could be developed as licensed diagnostic tests in the
near future.
But what we have right now is a PCR test which is useful in
identifying virus material in the respiratory secretions of patients.
The advantage of this test is that it would be positive early in the
course of illness.
We also have two different antibody tests. The advantage of the
antibody tests is they're generally easier to do, even in developing
countries than a PCR test, but the results in a given patient may not
be positive until several days have passed after the onset of
infection cause the antibody measures the body's response to
infection.
These tests right now are being used epidemiologically at CDC. In
today's MMWR, we report on the distribution of test results to states
that are taking care of a small number of SARS patients, positive test
results were provided there, and I think this will be important in
epidemiologic evaluation as well as hopefully to the individuals.
But we are having to go through several additional steps before the
tests can be widely available in every laboratory or even every
laboratory in the Public Health System.
Those steps include, number one, optimizing the methodology so you get
the same result every time you do the tests, and we are very far along
in that.
Number two, we have to make the reagent. For example, for the PCR test
we have to make the priers, and that takes some time, to get enough of
the primers produced, in a volume that's great enough to allow
widespread distribution.
Thirdly, we have to develop a method that works for every kind of
equipment that laboratories might be using.
For example, there are several different equipments that do PCR
testing and the protocol has to be optimized for all of them, and then
finally, we have to send blind samples out to individuals in the
laboratories so that they don't know what the result is in advance,
and we can test their proficiency and help validate that they're
getting the same results that we are.
We think by the end of next week, we will have all of the protocols
developed and we'll be well on our way to producing the reagents, and
probably by two weeks we'll have distributed this test methodology to
at least many of the laboratories, if not all of the laboratories in
the Public Health System.
Independent of that, the FDA is working with us to make sure that we
are doing all the things we need to do to be able to license this test
and the big issue there is we just have to do it on a lot of control
test specimens, a lot of cases that we know have SARS, and then a lot
of cases in between, and that really takes some time.
So we're doing it very fast and I know it seems like it's taking a
long time, but keep in mind that this is really just 30 days since CDC
activated it's emergency response center and began to receive virus
specimen.
So this is actually an amazing achievement that our laboratories and
other international laboratories are even this far along right now.
I'll take a question over here.
QUESTION: Dr. Gerberding, thank you for doing this. I have two
questions. One is on the New York Times report saying that a doctor in
Beijing, [Chinese name], [inaudible] even in his hospital are 100
patients suspected with SARS cases. I was wondering if WHO team or CDC
experts will do further investigation in Beijing area?
And the second question is WHO's report, it mentioned about possible
case in a rural area of China. Will any effort on that?
DR. GERBERDING: Thank you. The WHO team is still in China and they are
still working very hard. Their efforts, right now ,have been
concentrated in the Guangdong Province.
I think there's great interest in understanding the epidemiology and
the disease patterns in other provinces but I don't have today's
report from China, so I can't really give you any specific
information.
We're all interested, we're all worried, and we hope we'll be able to
get some enlightenment soon.
I'll take a phone question, please.
MODERATOR: Yes. We have a question from the line of Elizabeth Cohen
with CNN. Please go ahead.
QUESTION: Hi, Dr. Gerberding. Last night, at the elementary school
that's attended by the six-year-old boy in Florida who's believed to
have SARS, there was a meeting for parents, and the parents were
asking the same basic question over and over again, which is this
child, the index child, was at the school with symptoms. He's gone,
but what if he infected another child who's now asymptomatic but is
infecting other children?
They were sort of worried about a kind of chain of transmission. What
would you have said to the parents, if you were there last night?
DR. GERBERDING: The first thing I would have said is that I can
understand full well why they are concerned. This is still a very new
and a very frightening situation and it is alarming to feel like a
child in a school system could potentially have exposed your child.
So I would really first try to communicate my empathy, as I try to do
with all the people who are dealing with this, and in terms of the
risk, the objective risk of spread, I would try to acknowledge what we
know so far, and what we know so far is that it is people who are
symptomatic who seem to be the ones who are transmitting the
infection, and we are not seeing spread from people without symptoms
in any of the places, even where we have very good monitoring.
So what we know so far is that asymptomatic people don't seem to be
transmitting it but we have to acknowledge some uncertainty and that's
why the school and the local health department are taking steps to
make sure that there is a monitoring program and that the children in
that school are under close observation.
We will also, as I said, work to address this with some additional
guidance that we hope to be able to promulgate later today, and we'll
be working with the health officers there to make sure that we haven't
left any stones unturned.
I'll take a question from a reporter here in the room.
QUESTION: What have you learned from your CDC colleague in Canada, in
regards specifically to community transmission? They seem to be having
a growing problem there of folks not participating in the voluntary
program, report of a student leaving to take a test and then the
entire class has to stay home because of that.
And then the other question I have--and I'm sorry to keep going back
to the airport transit--from what you described earlier, would that
mean that flight attendants should be a little more concerned, or they
might need a little more protection?
DR. GERBERDING: With the situation in Canada, I would first of all
encourage you to talk with the health officers there because we
respect the hard work that they're doing and they really would have
the detailed answers to your question.
But I would say that as of this morning at least, our information was
that the cases in Canada are still limited to contacts in homes and in
health care settings.
What's happened is as people have become ill with SARS they've gone to
new hospitals and set up some tendency for transmission to health care
workers in the new situation. But they are not seeing unexplained
transmission in schools or out of the two groups that I just mentioned
there.
With respect to the safety of air travel and concerns of flight
attendants, again, we understand how concerning this would be for
travelers and crews on these modes of transportation ,and are working
with the international union that represents flight attendants as well
as other organizations, to make sure that, first of all, we've given
people the information they really need to understand what is a risk
and what isn't a risk, but also that they have the information they
need to protect themselves.
We are also creating a video that will be shown on airlines. It's
about a two-minute video that will be available to international
flights. It's actually been produced and we're in the process of
reviewing it and translating it into the appropriate languages, but
this video will be available on airlines to help remind passengers
about SARS, what they need to be concerned about, what they don't need
to be concerned about.
So we appreciate that there's concern and we're working with WHO and
others to try to address it in a sensible way.
I think I can take one last question from the phone, please.
MODERATOR: Yes. We have a question from the line of John Norman with
Bloomberg News. Please go ahead.
QUESTION: Hi. Thanks for taking my question. Could you talk about how
the state that we're at now with diagnostics, with this test, how does
this change things?
For instance, will this change--the state that we're at, will it
change the count of patients in any way? Will it change treatment,
prevention, in any way? Or are we really, in terms of diagnosis, are
we at the same stage that we were yesterday?
DR. GERBERDING: I think we're a little closer to being able to have
more specificity about the diagnosis of SARS but we're a long way from
being able to do that with the same kind of reliability that we have
with regular licensed diagnostic tests.
Now keep in mind, we still have not proven that this coronavirus is
the cause or that it's the only cause of SARS, so that alone gives us
some room for inaccuracy in what we're doing.
But we also I think have made a great deal of progress and have tested
more and more samples now, so we're beginning to get a sense that in
the people who have the most classic presentation of severe SARS, who
have had the travel history that we're concerned about, these tests
are positive, and so that is bringing us much closer to an
understanding of what the link is.
We also have people on our suspected SARS list who we include because
they technically meet the case definition, but probably in the minds
of most clinicians and most epidemiologists, they're not likely to
actually be SARS, and we're hoping that the tests results in those
people will be negative and that will give us more confidence.
It's an indirect way of saying we've got a lot more to learn but we
remain optimistic, and let me thank you for you attendance today and
for helping us get this information out and as we learn more we'll
tell you more. Thank you.
MODERATOR: Thank you, ladies and gentlemen, that does conclude our
conference for today. Thank you for your participation and for using
A&T Executive Teleconference. You may now disconnect.
(end transcript)
(Distributed by the Office of International Information Programs, U.S.
Department of State. Web site: http://usinfo.state.gov)
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