SARS updates and Press Conference Questions and Answers Session

Following on from the World Health Organisation's revised travel advisory against travel to Hong Kong we have published below the complete press conference, including the questions and answers session to give you a better understanding of the current situation.

The press conference held today, 2 April, 2003, at the Palais des Nations in Geneva was an abbreviated press briefing attended by, Dr David Heymann, Executive Director (Communicable Diseases), Dr Guenael Rodier (Director Communicable Disease Surveillance and Response), and Mr Dick Thompson, Communications Officer.

See also : WHO advises against travel to Hong Kong and Guandong Province.

The conference starts out  with statements and updates from Dr Heymann and Dr Rodier followed by the Question and Answers Session.

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Statement from Dr David Heymann: We have two different types of information to offer to you this morning. The first is that China is now a full partner with WHO. The teams have been asked to immediately go to Guangdong. Guangdong has reported the number of cases that have occurred during the month of March, which is 361 cases and 9 deaths, which mean that the epidemic is still going on in Guangdong, and they have promised that later today they will provide all of the information that they have obtained from their national disease surveillance system looking for SARS. So we are very pleased to announce that China is now a full partner with other international partners, in fact with the rest of the world, in collaborating on stopping this epidemic and in finding out the various aspects that we need to find out.

The second is that since control measures have begun in Hong Kong, which began on 15 March, just after we made our announcement, and in other parts of the world, control measures have been successful in stopping the disease. For example, in Vietnam the disease has been stopped we believe.  In Singapore and Toronto, activities are going on and they are having good success.

I would like to focus now on Hong Kong, however, where since 15 March there have been 9 people, travellers, tourists or businessmen, from Beijing, from Taiwan, and from Singapore, who have returned home from Hong  Kong infected with SARS. In addition in Hong Kong, they have found that transmission does not seem to be only by close contact from person to person. It appears that there is something in the environment that is  transferring virus, which is serving as a vehicle to transfer the virus from one person to another. We do not believe this is the air. We believe that it is something else in the environment and we have talked about that in past press conferences. It is possibly an object that people are touching and getting infected from, where there has been a SARS patient who has coughed, or possibly a sewage system or a water system or some type of environmental vehicle that takes the virus from a sick person to others. So we see clusters of cases where there is one case, for example, living in an apartment building, where other people in that apartment building have been infected.

So for these two reasons, because of the fact that we do not completely understand the means of transmission in Hong Kong, and because since the 15 March tourists and businessmen have returned from Hong Kong to their countries with infection, we have decided to make a recommendation that people who are planning travel to both Hong Kong and Guangdong, which as you know is adjacent to Hong Kong, consider postponing their  travel until another time. We will be working daily with the Hong Kong authorities, and we have daily conference calls with them and now we will begin also with Guangdong authorities, to determine if there are any reasons that we can stop that recommendation. In other words, the recommendation will be reevaluated every day and we will make a decision every day whether or not that needs to be changed. So now what we have is from all sites where there is a SARS outbreak that is causing chains of transmission, we have requested that tourists or travellers understand about the disease, that  airports screen passengers who are returning to their countries from these sites, and now, in addition, we are telling travellers who are planning to go to Hong Kong and Guangdong that they consider postponing their travel. So what we have is a system in place now which will, we hope, stop the spread from the sites where SARS is occurring internationally and at the same time  help passengers, tourists or businessmen who are planning to go to Hong Kong or Guangdong decide better whether or not they should go. We are recommending that they reconsider their travel plans and postpone if possible their travel to Hong Kong or Guangdong.

Dr Guenael Rodier: Clearly Guangdong and Hong Kong are the two largest foci for infection, two foci where transmission is documented to be ongoing, and two foci where more investigation is required to get the full picture of what is going on in terms of transmission and the exact size of the event. 

Questions and answers

Q. You say that travellers should consider postponing their travel. Do you have a scale of travel advice for this? Is it code red, code B, code C? Is there an absolute prohibition?

A. Dr David Heymann: WHO has a book of International travel and health and we recommend various ways of preventing disease to passengers or travellers internationally when they go to a country. When they go to a country they look in the book and they decide what to do. Most of the diseases that are in the book have either a vaccine or a drug, so we recommend a vaccine or a drug. This is the first time that we have recommended people avoid an area and this is of course because we do not understand the disease completely, because there’s no vaccine and there’s no drug. So this is the first time that we have made this type of a recommendation in recent years to avoid an area because of a disease.

Q. During your consultation with the Hong Kong authorities, what was their reaction to your decision to declare Hong Kong an area of restriction?

A. Dr David Heymann: We have been discussing on a regular basis with Hong Kong authorities and of course no one wants to have a travel recommendation that recommends people not come to their place. But they have accepted this and they are working very hard now to better understand the situation. As they have been right along. We are very confident that Hong Kong will be able to, in a very few days, understand what is going on and then therefore be better able to control the outbreak there.

Q. You explained the two reasons why you are advising travellers to avoid Hong Kong. But for the second reason, about environmental factors, does that also apply to Guangdong?

A. Dr David Heymann: Guangdong, the recommendation has been made because we do not understand yet what is going on in Guangdong. We have put in a maximum level of recommendations, the same as we have for Hong Kong where we know what is going on. As we understand what is going on in Guangdong, we will know that the epidemic is continuing, we know that there were 361 cases in just the past month. So therefore we do not know anything more than that at present, but because we do not know we are making this recommendation.

Q. How likely is it now that it spills over into other countries in the region, for example, Taiwan?

A. Dr David Heymann: Taiwan actually has had 5 businessmen [added: 4 businessmen and 1 businesswoman] return from Hong Kong since the 19th of March [added: 15 March] with what’s been reported as probable cases of SARS, but remember we don’t have a diagnostic test. We have no confirmed cases.

Q. Dr Heymann, can you explain a little bit about the process prior to issuing this advice? While it probably makes sense from the health perspective, it will have economic, social, political impact in the region. I’m wondering if you have consent from authorities in Guangdong, Hong Kong, or China?

A. Dr David Heymann: We’ve spoken first of all with IATA, which is the International Air Transport Association, and they have understood this and they have given their agreement that this is the recommendation which should be made at this point. We’ve discussed with the various different countries in the region, with our regional office and through our regional office, and we find that in those countries there are already much more strict recommendations than this is. For example, in Thailand, the government has announced that all returning passengers from Hong Kong will be quarantined. So we understand that there are very serious measures already being taken in many countries. So we made this decision with countries, with WHO and, more importantly, with our expert group of advisers on travel and health. We’ve spoken with many of our advisers, you know we have various advisers around the world, we have talked with them as well. And through all of these discussions, which went on all day yesterday and the day before, we’ve come to this conclusion.

Q. Historically, can you explain us when was the last time WHO issued such a thing? And on what occasion? And why?

A. Dr David Heymann: I can’t give you that answer right now, if WHO has ever done that, but we will find that out and we’ll let you know. As far as I know, this is the only time that this has ever been done, but I can’t tell you for sure, so I shouldn’t be quoted on that.

Q. For those people who have to be in Hong Kong in the next few days, so what would you recommend?

A. Dr David Heymann: Our recommendation is that if it’s possible to postpone, they should consider it. But we don’t make any rules or regulations, that’s up to countries to make. So we are saying that there is still unknown information in Hong Kong, that tourists and businessmen appear to still be getting infected, the most recent on 25th March. And so we are therefore recommending that travel be postponed if it’s possible. If it’s not possible for business reasons, then that will have to go into consideration. But it’s a personal decision.

Q. For foreigners who are already in Hong Kong travelling, do you have any recommendation?

A. Dr David Heymann: No.

Q. How do you react to the Swiss government decision that Asian people cannot participate in the Basle Watch Fair?

A. Dr David Heymann: Those decisions are made nationally. All we do is give out recommendations to governments. So I can’t comment on the decision of the Swiss government. You’ll have to ask the Swiss authorities why they’ve made that decision.

Q. Do you find it efficient, or wise or too much?

A. Dr David Heymann: I think that’s up to the government to say.

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See : 1 April 2003, and 28 March 2003.

See also : WHO advises against travel to Hong Kong and Guandong Province