Travel related SARS Questions and Answers from the WHO

Today the World Health Organisation (WHO) held a teleconference to address the issue of its latest travel advisory, issued today, regarding travel to Beijing, Shanxi Province - China and Toronto, Canada. Dr. David Heymann (DLH), Executive Director, Communicable Diseases and Dr. Dick Thompson (DT), Communications Officer, Communicable Diseases chaired the conference.

Instead of dissecting the conference and giving you only snippets we have decided to publish almost the entire conference including most of the more interesting travel related Questions and Answers.

=======

DLH: If you think back to when we put out the announcement about this new disease, one of our major concerns was that maybe we could stop this disease from becoming endemic. The jury is still out on that. We do not know whether by having put out the alert we can have the countries where the disease is imported stop it from becoming endemic there, and at the same time whether or not China and Hong Kong and other countries can stop the outbreaks there. So that is where we are.

Today, one of the most important means of spreading diseases around the globe is air travel. That is why we have been concentrating on that as a part of it. That is where I would put us today. We still do not know whether or not we can stop this disease from becoming endemic. We are working very hard so that that does not occur, because this is a disease which, as you remember, affects first health workers and is a very serious disease with a death rate now of about 5%.

Having said that, there are a series of issues that we have gone through. In the first alert we recommended that people who are travelling internationally understand what this disease looks like and that if they should get signs and symptoms of this and have had contact with a place where the disease is occcuring that they notify their health workers. The second thing we did was we went to countries where there were cases being exported, where there was a fairly high magnitude of cases and where we felt there was a great risk of local transmission. Those countries were Guangdong Province and Hong Kong; not countries but areas. And  so we have made our second recommendation with the recommendation that people who have possibilities of postponing travel to these areas do so. So we made a voluntary postponement of travel to these areas.

Today, we are making a further recommendation in that we are going to recommend that people who have unnecessary travel to Shangxi, to Beijing, and to Toronto postpone that travel if possible because, as was the case for Hong Kong and Guangdong, we now have these areas which have a high magnitude of disease, a great risk of transmission locally outside of the usual health workers, but still traceable in most instances, and also there is exporting of cases. We know that cases have been  exported to other countries and we have been following those would-be countries. So our recommendations therefore are that travel be postponed, that they continue their exit screening, and that we increase our advice and awareness to all international passengers.

QUESTIONS and ANSWERS

Q. And Guangdong and Hong Kong, that advice still stands? You are not retracting that and swapping it to ....

DLH:  That is correct. And what we are doing is, as we said, daily we are looking to see if the situation changes in any one country as far as exportation or transmission risk. So any day we could make a recommendation that a country has the travel recommendations that we have made. However, the countries which we have put on the list now today will not be reassessed for a period of three weeks. That is because, at least as far as lifting recommendations go, we want to wait for two periods of maximum incubation, which would be 20 days. So we will let those countries go for three weeks now.

Q. And on Shanxi and Beijing, can you tell us what kind of pattern of exportation and how bad that has been to bring you to this decision. Do you know the exact number?

DLH: We follow those numbers, but this is information that countries are keeping between themselves. It is not good to point fingers internationally on who is travelling where. This is information which we keep very secret as our confidential information with countries.

Q. Okay, but they are definitely exporting, which is the one of the reasons why?

DLH: Absolutely. That is one of the criteria. Magnitude, transmission risk locally, and exportation risk.

Q. Has Toronto suddenly taken off? It seems to have been bubbling for a long time without this level of attention. What has happened that has changed?

DLH: Toronto has had last week an exportation which set up a cluster of 5 cases ... and I cannot tell you the country ... but this is what has called it again to our attention. An exportation which set up a cluster of 5 local cases in health workers. And when these things come to our attention, we then evaluate them. This was slowed down a bit because we were working to classify our clear criteria, which now I have given you.

Q. And the two governments have obviously been informed that you are going to make this travel recommendation?

DLH: Yes, they have been informed 24 hours in advance.

Q. Going back to China, have you had any more data coming in from these western, these rural provinces?

DLH: No, and again our team there is very concerned because (i) we do not have the manpower yet to go with the Chinese to those provinces; (ii) the health care in those provinces is of a lower standard than in the rest of China and therefore there is concern that if this gets into fertile health facilities it will continue to spread.

Q. Have you got any other locations kind of on your watchlist for an upgraded travel advisory or not?

DLH: We do. We have all these 22 countries on our list which are being looked at daily and we have one additional country which may have to be put on this list. I cannot tell you any of that until we have been able to clarify with the country some of the information we have. That is going on right now.

Q. Okay, so that might be imminent, in the next couple of days?

DLH: It may be in the next couple of days or on Monday at the latest, yes.

Q. Today we have had reports that a lot of people are actually just fleeing Beijing, where there have been rising cases, where schools have closed and so forth. Are you concerned that this will be a mechanism for them spreading it, if people go to the provinces ahead of this 1 May holiday, etc?

DLH: The Government has actually forbidden travel and they are doing their best to keep people from travelling. We know that. Whether these people are slipping through the net that has been put up we cannot say. But Henk would be able to say in China. Dick, have you heard from Henk today at all?

DT: Not today no. But they have postponed or cancelled their May holidays. We have yesterday's figures.

DT: In Beijing the cumulative total is 482, deaths 25, and there is local transmission. There have been 34 cases since the last update. We have a very good and complete understanding of what's going on in Beijing.

Q: David, the Hong Kong travel advice. As far as checking every day, obviously they've been under this travel margin for more than the WHO incubation period. What about criteria for taking them off? They seem to be optimistic that they're making progress against the disease.

DLH: Yes, we are looking at the three-week limit for Hong Kong. And we don't have that all analysed yet. The three week limit, if the figures have changed in any way, they would come off. The problem with Hong Kong is that they still have this non-clear means of transmission and they still have so many prevalent cases. It would make them hard to come off even if their exportation rates were minimal. But we're looking to see what the exportation pattern has been from Hong Kong over the past three weeks and we'll be able to provide that information. They're up to the three weeks analysis, in other words. As is Guangdong.