Four new suspected cases reported, 7 dismissed

Shanghai has been successful so far in containing the severe acute respiratory syndrome, or SARS, with the city of 16 million reporting only two confirmed cases, a team of World Health Organization experts said yesterday.

However, they cautioned city officials that the city's SARS prevention network hasn't undergone the big test, which is likely to fall upon Shanghai if a larger number of SARS cases move to the city or more suspected cases are reported, said the investigation team at a news conference.

The five-member WHO inspection team arrived in Shanghai on Monday and will leave for Beijing today.

"We have not found the Shanghai government to have flaunted the numbers or covered up the outbreak," said Keiji Fukuda, a member of the United Nations agency's team. "Based on what we have seen, the case numbers reported are in the ballpark."

The team attributed the small number of SARS cases in Shanghai to two factors: luck and the city's deliberate precautions.

"SARS is not a worldwide epidemic yet and the incidence of the disease is quite different in different regions. Moreover, local health authorities have gained much experience and lessons from Guangdong, Hong Kong and Beijing to conduct effective measures such as avoiding hospital infection and establishing a strict monitoring system to identify SARS cases and suspected patients and to conduct separation measures," said Keiji Fukuda.

However, the WHO experts cautioned Shanghai not to lose its vigilance against the deadly virus.

"This is a big city with a huge moving population. The system hasn't been tested if a larger number of SARS cases are introduced to Shanghai or a larger number of suspected cases are detected," said Daniel Chin, another member.

In addition, as the city adopted the amended diagnostic definition of suspected cases by the Ministry of Health on Tuesday, Shanghai is likely to see a substantial jump of suspected patients in the next week or two, since the new definition broadens the criteria for suspected patients, Chin added.

"Though the present system operates well, the network and staff are working extremely long hours at present. The network is stretching the capacity of the health system," Chin said.

"For instance, when a recent suspected case was reported a few days ago, 168 contacts were chased out immediately and put into observation under the district-based disease prevention and control centers. When a larger number of cases are reported in the city, we are not sure if the local system can still cope with that situation," he said.

In addition, Shanghai won't control SARS if other regions can't control SARS. It is urgent to improve the medical standard and health system in the central and western areas of China to jointly cope with the disease, the experts stressed.

During their inspection, the WHO experts talked with top municipal government leaders, officials from Shanghai Health Bureau, Shanghai Disease Prevention and Control Center, three district-based disease prevention and control centers and 10 hospitals and medical facilities. They also interviewed medical staff, government officials and patients and reviewed the documentation of the patients and suspected cases.

The experts said they were given free access to people and facilities they wanted to meet, talk to and investigate.

"We were given a list of all local medical facilities and were allowed to choose any on the list. We changed our mind frequently and gave short notice of five to 30 minutes in order to get real first-hand information and assess the rumors about a larger amount of SARS cases in Shanghai," Chin said.

Yesterday, Shanghai re-ported four new suspected cases while dismissing seven, bringing the total number of suspected cases to 15, including two Hong Kong citizens and one from the US.

Of the two confirmed cases in Shanghai, a 40-year-old woman patient has recovered and the second, her father, is recovering.

At a meeting between the team and Mayor Han Zheng prior to the press conference, team leader Dr James Maguire congratulated Shanghai for its achievement and spoke highly of its openness and frankness.

Han said the municipal government has decided to initially earmark 100 million yuan (US$12 million) to fight against SARS. In addition, district governments will also put aside money to help prevent and cure the disease.

"As a responsible government, we always put the people's interests ahead of others at any time," the mayor said. "It's our sacred responsibility to ensure the health of every person living in this city."

He said the purpose of inviting the WHO team to visit the city was to help find problems and provide useful guidance in its efforts of fighting the deadly disease.